RESUMEN
OBJECTIVES: Coblation to create a cavity in the affected vertebral body was performed for complex fractures and/or when there was a posterior wall defect. This permitted a low-pressure injection and potentially reduces the risk of extravasation of cement into the spinal canal. METHODS: Prospective audit for outcome measures and complications allowed retrospective review of cases treated by coblation. A commercial wand inserted via a wide-bore vertebroplasty needle created a cavity before inserting cement. A visual analogue scale assessed pain and Roland Morris scoring assessed mobility. RESULTS: Thirty-two coblation procedures were performed. Primary diagnoses were myeloma, metastases, osteoporosis and trauma. Outcome measures were recorded with a 56 % success rate, 6 % no change and 32 % with mixed but mainly positive results; 6 % died before follow-up. No complications were observed; in particular no patient suffered neurological damage and none have developed subsequent fractures at the treated levels. CONCLUSIONS: This technique makes possible cementation of patients who would otherwise be unsuitable for vertebroplasty. The modest pain and disability improvement is partly due to our stringent criteria as well as fracture complexity. Further work will assess the efficacy of the method compared with conservative measures. KEY POINTS: ⢠Treatment of vertebral compression fractures with possible posterior wall defects is controversial. ⢠Coblation before vertebroplasty allows a low-pressure injection into fractured vertebrae. ⢠This technique reduces risk of extravasation of cement. ⢠No serious complication of our coblation procedures was observed.
Asunto(s)
Fracturas por Compresión/cirugía , Fracturas por Estrés/cirugía , Fracturas de la Columna Vertebral/cirugía , Vertebroplastia/métodos , Cementos para Huesos , Humanos , Imagen por Resonancia Magnética , Mieloma Múltiple/complicaciones , Agujas , Metástasis de la Neoplasia , Osteoporosis/complicaciones , Dimensión del Dolor/métodos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Heridas y Lesiones/complicacionesRESUMEN
OBJECTIVES: Recent publications compared treatment of vertebral fractures reporting improvement in the majority but with no significant difference between the local anaesthetic and vertebroplasty groups. Potential explanations include placebo response or therapeutic response to the "control procedure". We investigated whether preliminary facet joint injection can identify those patients whose pain arises from paravertebral structures rather than the vertebral insufficiency fracture itself. METHODS: Patients referred for treatment by vertebroplasty were first offered local anaesthetic and steroid facet joint injection (FJI) at the most painful level. Those who failed to respond were offered a vertebroplasty. RESULTS: Ninety one patients referred, 16 went straight to vertebroplasty. Sixty one of 75 were initially offered FJI. Twenty one were successful; two relapsed, had further FJIs with good results; three declined treatment; 5 had temporary benefit; 1 died from unrelated causes. Of 29 who failed to respond to FJIs, 24 underwent vertebroplasty and 23 had a successful outcome. CONCLUSIONS: A third of patients technically suitable for vertebroplasty responded beneficially to FJI. In this group the pain mediator maybe one of instability and overload on the facet joints produced by adjacent wedge fracture. This protocol allows more selective and more successful vertebroplasty.
Asunto(s)
Anestésicos Locales/administración & dosificación , Inyecciones Espinales/métodos , Fracturas de la Columna Vertebral/tratamiento farmacológico , Articulación Cigapofisaria , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Dimensión del Dolor , Fracturas de la Columna Vertebral/cirugía , Resultado del Tratamiento , VertebroplastiaRESUMEN
INTRODUCTION: Thrombotic events are a common and severe complication of endovascular aneurysm treatment with significant impact on patients' outcome. This study evaluates risk factors for thrombus formation and assesses the efficacy and safety of abciximab for clot dissolution. MATERIALS AND METHODS: All patients treated with abciximab during (41 patients) or shortly after (22 patients) intracranial aneurysm coil embolisation were retrieved from the institutional database (2000 to 2007, 1,250 patients). Sixty-three patients (mean age, 55.3 years, +/- 12.8) had received either intra-arterial or intravenous abciximab. Risk factors for clot formation were assessed and the angiographic and clinical outcome evaluated. RESULTS: No aneurysm rupture occurred during or after abciximab application. The intra-procedural rate of total recanalisation was 68.3%. Thromboembolic complications were frequently found in aneurysms of the Acom complex and of the basilar artery, whilst internal carotid artery aneurysms were underrepresented. Two patients died of treatment-related intracranial haemorrhages into preexisting cerebral infarcts. Two patients developed a symptomatic groin haematoma. CONCLUSIONS: Abciximab is efficacious and safe for thrombolysis during and after endovascular intracranial aneurysm treatment in the absence of preexisting ischaemic stroke.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Anticoagulantes/uso terapéutico , Embolización Terapéutica/efectos adversos , Fragmentos Fab de Inmunoglobulinas/uso terapéutico , Aneurisma Intracraneal/terapia , Trombosis Intracraneal/prevención & control , Terapia Trombolítica , Abciximab , Adulto , Anciano , Aneurisma Roto/complicaciones , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/terapia , Estudios de Cohortes , Femenino , Humanos , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/diagnóstico por imagen , Trombosis Intracraneal/diagnóstico por imagen , Trombosis Intracraneal/etiología , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECT: The aim of this study was to analyze the endovascular treatment results of using the Onyx liquid embolic system for spinal intramedullary arteriovenous malformations (AVMs). METHODS: The clinical and radiological records of 17 patients with symptomatic spinal intramedullary AVMs treated exclusively by embolization with Onyx between 1999 and 2003 were retrospectively reviewed. There were 12 females and five males in the patient series (mean age 29 years). Four of these AVMs were located in the cervical spine, eight in the thoracic spine, and five in the lumbar spine. The clinical presentation of these AVMs included upper motor neuron signs and symptoms, and hemorrhage was the initial presentation in 12 patients. Neurological and functional evaluation was performed before and after treatment with Onyx in all patients. RESULTS: Thirteen patients underwent a single endovascular treatment and four patients underwent two endovascular treatments (average 1.23 sessions per patient). Intraprocedural complications occurred on two occasions without neurological consequences. The mean follow-up duration was 24.3 months. Angiographic outcomes included total AVM obliteration in six patients (37.5%), subtotal obliteration in five patients (31.25%), and partial obliteration in five patients (31.25%). Improvement in neurological and/or functional status was noted in 14 patients, resulting in an 82% rate of overall good clinical outcome. CONCLUSIONS: Embolization using the Onyx system is a promising treatment method for spinal vascular malformations, even for challenging intramedullary AVMs. Larger studies with longer follow-up durations will further enhance our knowledge on the safety and efficacy of this relatively new liquid embolic agent.
Asunto(s)
Malformaciones Arteriovenosas/terapia , Malformaciones Vasculares del Sistema Nervioso Central/terapia , Dimetilsulfóxido/uso terapéutico , Embolización Terapéutica , Polivinilos/uso terapéutico , Médula Espinal/irrigación sanguínea , Adolescente , Adulto , Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
We present a case report of a 56-year-old woman with a ruptured fusiform aneurysm of a fenestrated A(1) segment of the anterior cerebral artery (ACA). Fenestrated A(1) segments are rare and only a few case reports have been published of a saccular type aneurysm formation. To the best of our knowledge, there have been no documented cases of fusiform aneurysms in these segments.