ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE AND IMPORTANCESmall, irregular aneurysms of the internal carotid artery (ICA) that are not related to arterial divisions are rare and have characteristics similar to pseudoaneurysms: they do not appear to have well-formed sacs, they are surrounded by clot, and they avulse readily. We report two patients whose treatment demonstrates the surgical technique and important points concerning the management of distal ICA pseudoaneurysms.CLINICAL PRESENTATIONBoth patients presented with diffuse subarachnoid hemorrhage. The initial angiographic results were unremarkable in each case. A week after presentation, however, a growing outpouching in the distal ICA was seen.INTERVENTIONAt surgery, the aneurysms were found to be on the medial wall of the ICA and were not related to arterial divisions. Quantitative blood flow measurements of the efferent vessels at risk (ICA, M1 and A1 segments) were obtained using a perivascular microflowprobe before and after clipping. In each patient, the aneurysm avulsed entirely during clip application, despite careful placement of the clip parallel to the parent vessel. An encircling clip was then used. Pathological sectioning of the aneurysms revealed loose connective tissue and/or clot with no defined aneurysmal sac.CONCLUSIONAneurysms of the distal ICA that are not related to arterial divisions are difficult to visualize on angiograms immediately after subarachnoid hemorrhage. They are frail, avulse easily, and may be pseudoaneurysms, necessitating the use of encircling clips. The base of the aneurysm or clot must be trimmed to prevent it from buckling inside the clip sleeve and compromising the ICA lumen. Measuring distal blood flow quantitatively provides valuable information about the patency of the ICA inside the metallic sleeve, since this segment cannot be demonstrated with angiography.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE AND IMPORTANCEAlthough conventional superselective chemical thrombolysis is frequently successful for the treatment of severe acute dural sinus thrombosis, the technique has limitations and risks. This prompted us to develop a supplemental technique for achieving more rapid recanalization, using coronary microballoon percutaneous transluminal angioplasty catheters. We describe a successful application of this technique and technology that has not been previously reported.CLINICAL PRESENTATIONAfter several days of severe headaches, photophobia, and vomiting, a 29-year-old woman presented with rapidly progressive neurological deficits secondary to complete occlusion of the superior sagittal sinus (SSS) and right transverse/sigmoid sinus complex. Owing to her rapid neurological decline, she was referred for emergency endovascular intervention.TECHNIQUEInitially, superselective chemical thrombolysis of the SSS was performed using urokinase. However, because of the extensive nature of the thrombus and lack of initial therapeutic response, we elected to attempt mechanical thrombolysis with various coronary percutaneous transluminal angioplasty microballoon catheters. This was accomplished by initial coaxial positioning of the device into an occluded segment, followed by gentle inflation and retraction of the device along the course of the right transverse sinus and/or SSS. These maneuvers were repeated with balloons of increasingly large diameter. Near-complete restoration of venous outflow was obtained within the SSS with preferential runoff into the left transverse sinus. The right transverse sinus was only partially recanalized. Despite the patient’s rapid neurological decline on presentation, she experienced a dramatic clinical recovery with near-complete reversal of neurological deficits within 24 hours of intervention.CONCLUSIONThis report shows the feasibility of performing safe and effective mechanical thrombolysis with percutaneous transluminal angioplasty coronary balloon microcatheters within the major dural sinuses. This technique can probably accelerate clot disruption and thrombolysis, possibly resulting in a more rapid restoration of venous flow.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE AND IMPORTANCEThis case report illustrates an uncommon complication from the retroperitoneal exposure of the lumbar spine. The diagnosis and management of a retroperitoneal lymphocele is presented. The lymphocele was treated with intralesional povidone iodine (Betadine; Purdue-Frederick, Norwalk, CT), which eradicated the lesion and provided symptomatic relief to the patient.CLINICAL PRESENTATIONA young woman developed an iatrogenic, rapidly progressive spondylolisthesis after having undergone three previous lumbar surgeries for radiculopathy at the L5–S1 level.INTERVENTIONA back-front-back approach was used for operative reduction and fusion of the spondylolisthesis. The patient’s postoperative course was complicated by a retroperitoneal lymphocele. She presented with symptoms of urinary urgency and incontinence. The lymphocele was successfully treated with repeated drainage and sclerosis with povidone iodine. The patient ultimately developed a solid fusion, and her pain resolved.CONCLUSIONA retroperitoneal lymphocele is an uncommon complication caused by the surgical exposure of the lumbar spine when a ventral approach is used. In this case, it was diagnosed and treated without further surgical intervention.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID