RESUMEN
OBJECTIVES: In indirect carotid-cavernous sinus fistulas (CCF), abnormal connections exist between tiny dural branches of the external and/or internal carotid system and the cavernous sinus. Usually this kind of fistula occurs spontaneously and is characterized by a low shunt volume. Alternative vascular approaches for embolization are required when standard interventional neuroradiological access via arterial or transfemoral venous routes is not feasible. PATIENTS AND METHODS: Two symptomatic patients with indirect CCFs are described. Transarterial and transfemoral venous approach was unsuccessful or resulted in incomplete occlusion of the CCF. Therefore, the superior ophthalmic vein (SOV) was surgically exposed and retrograde catheterized to allow the delivery of platinum coils to the fistula point via a microcatheter. RESULTS: Complete fistula obliteration was accompanied by recovery of the clinical symptoms. CONCLUSION: The surgical SOV approach might be sufficient when standard neuroradiological procedures do not succeed. The technique is safe and effective when performed by an interdisciplinary team.
Asunto(s)
Fístula del Seno Cavernoso de la Carótida/cirugía , Seno Cavernoso/cirugía , Embolización Terapéutica/métodos , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Venas/cirugía , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/patología , Arteria Carótida Interna/cirugía , Fístula del Seno Cavernoso de la Carótida/diagnóstico por imagen , Fístula del Seno Cavernoso de la Carótida/patología , Cateterismo/normas , Seno Cavernoso/diagnóstico por imagen , Seno Cavernoso/patología , Angiografía Cerebral , Diplopía/etiología , Diplopía/fisiopatología , Diplopía/cirugía , Embolización Terapéutica/instrumentación , Femenino , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/instrumentación , Órbita/anatomía & histología , Órbita/cirugía , Grupo de Atención al Paciente , Platino (Metal) , Prótesis e Implantes/normas , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/instrumentación , Venas/anatomía & histologíaRESUMEN
A 37-year old male with newly diagnosed, untreated Wegener's granulomatosis including glomerulonephritis, sinusitis, conjunctivitis, arthralgias, and positive cANCA, developed a pulsating tumor in the left submandibular region and a reversible ischemic neurologic deficit. Ultrasonography revealed both a hyperechoic wall thickening of the left proximal internal carotid artery as is known in Takayasu's arteritis and a surrounding hypoechoic region typical for perivasculitis. The wall thickening and the perivascular infiltrate could be less clearly seen by MRI. Ultrasonography, angiography, and MRI demonstrated a 3 cm long, 30%, stenosis. Angiography and MRI additionally found a more distally located kinking of the internal carotid artery that was missed by ultrasonography. Carotid artery vasculitis is a rare complication of Wegener's granulomatosis. In this case ultrasonography was superior to angiography and MRI to visualize the artery wall and the surrounding tissue, but it failed to evaluate the whole distance of the vessel.
Asunto(s)
Enfermedades de las Arterias Carótidas/diagnóstico , Arteria Carótida Interna/patología , Granulomatosis con Poliangitis/diagnóstico , Vasculitis/diagnóstico , Adulto , Angiografía , Enfermedades de las Arterias Carótidas/etiología , Arteria Carótida Interna/diagnóstico por imagen , Granulomatosis con Poliangitis/complicaciones , Humanos , Imagen por Resonancia Magnética , Masculino , Ultrasonografía , Vasculitis/etiologíaRESUMEN
A retrospective analysis of 58 patients with spontaneous SAH was conducted. 33 patients suffered on severe SAH, clinical grading IV and V (Hunt, Hess). 11 died without treatment due to decerebrate rigidity. 22 patients were treated, 16 underwent a clipping procedure and 6 were selected for endovascular coilembolization. A total of 14 SAH were associated with intracerebral, intraventricular or subdural hemorrhages. In fact of these in 10 patients first an evacuation of the haematoma or a ventricular drainage was necessary, two times combined with a decompressive craniectomy. In 4 patients the removal of haematoma was combined with clipping of aneurysm in one operation. After occlusion of aneurysm decompressive craniectomy was required in 3 patients, an evacuation of an intracerebral bleeding in 1 patient. 6 patients needed a permanent shunting system. The outcome according the Glasgow Outcome Score was: 4 died (GOS1), 12 were severely disabled (GOS3) and 6 were moderately disabled (GOS4).
Asunto(s)
Aneurisma Roto/terapia , Hemorragia Cerebral/terapia , Aneurisma Intracraneal/terapia , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma Roto/clasificación , Aneurisma Roto/mortalidad , Hemorragia Cerebral/mortalidad , Embolización Terapéutica , Femenino , Estudios de Seguimiento , Escala de Consecuencias de Glasgow , Humanos , Aneurisma Intracraneal/clasificación , Aneurisma Intracraneal/mortalidad , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Reoperación , Estudios Retrospectivos , Instrumentos Quirúrgicos , Tasa de Supervivencia , Procedimientos Quirúrgicos VascularesRESUMEN
SUMMARY: Dural arteriovenous fistulas (DAVF's) of the cavernous sinus are curable by endovascular means in the vast majority of cases. Both transarterial and transvenous approaches by femoral route can be used for closure. In rare cases with unsuitable anatomy or angioarchitecture, an endovascular approach is proposed by open surgical exposure of a major venous outflow, e.g. the superior ophthalmic vein. We report on a case of unsuccessful attempts at transarterial and transvenous catheter navigation through traditional endovascular routes, where surgical exposure of the major cortical venous drainage was necessary. A direct puncture of the sylvian vein allowed placement of a microcatheter in the cavernous sinus and occlusion of the fistula by coils.
RESUMEN
Interventional treatment by neuroradiological embolisation of cerebral arteriovenous angiomas has become an alternative to surgical exstirpation especially in problematic localisations and large-size malformations. Clinical results showing a marked reduction in attacks and recurrent haemorrhages, evident from a three-year report on 17 patients, confirm the value of the method even in case of only subtotal occlusion of the malformation.
Asunto(s)
Neoplasias Encefálicas/terapia , Cateterismo/instrumentación , Embolización Terapéutica/instrumentación , Hemangioma/terapia , Malformaciones Arteriovenosas Intracraneales/terapia , Neoplasias Encefálicas/diagnóstico por imagen , Angiografía Cerebral , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/terapia , Estudios de Seguimiento , Hemangioma/diagnóstico por imagen , Humanos , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Examen Neurológico , RecurrenciaRESUMEN
A CT-guided pain therapy can be an additional tool in cases with vertebrally caused problems and lesions. The axial CT scan in the altered vertebral segment allows a controlled puncture of the radicular or articular regions and a helpful pain therapy with different injections. The procedure is performed in outpatients.
Asunto(s)
Analgesia Epidural , Desplazamiento del Disco Intervertebral/terapia , Síndromes de Compresión Nerviosa/terapia , Cuidados Paliativos , Radiculopatía/terapia , Raíces Nerviosas Espinales/efectos de los fármacos , Tomografía Computarizada por Rayos X , Anestésicos Locales/administración & dosificación , Cortisona/administración & dosificación , Desnervación , Estudios de Seguimiento , Humanos , Sustitutos del Plasma/administración & dosificación , Raíces Nerviosas Espinales/diagnóstico por imagenRESUMEN
From 1987-1991 we performed 20 balloon occlusions in 15 patients with intracranial aneurysms. In 9 patients procedures were technically successful however long term complications included three deaths. In spite of the advancements in the balloon catheter technology fatalities occur restricting the use of percutaneous balloon occlusion to patients with unclippable aneurysms.
Asunto(s)
Cateterismo/instrumentación , Embolización Terapéutica/instrumentación , Embolia y Trombosis Intracraneal/terapia , Adulto , Anciano , Angiografía Cerebral , Femenino , Humanos , Embolia y Trombosis Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Recurrencia , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/terapia , Tomografía Computarizada por Rayos XRESUMEN
Interventional embolisation is an accepted treatment for intracranial or spinal arteriovenous malformations. Since multiple embolizations are often required, noninvasive repeatable follow-up studies are desirable. The aim of this study is to demonstrate the usefulness of T2-weighted images, MR angiography, and gadolinium-DTPA first-pass studies for post-embolisation follow-up studies. Five patients with arteriovenous malformations, four cerebral and one spinal, were studied prospectively before and repeatedly after single or multiple embolizations. A total of 26 MRI studies (1.5 T Magnetom, Siemens AG) were performed. The combination of T2-weighted images, MR angiography, and gadolinium-DTPA first-pass studies nicely demonstrated the arteriovenous malformations and the effect of embolisation which ranged from negligible to almost complete. While contrast-enhanced T1-weighted images and contrast-enhanced MR-angiography seemed to be of little more value than unenhanced studies, gadolinium-DTPA first-pass studies appeared to be more sensitive than T2-weighted images or MR-angiography because of their high intrinsic sensitivity to regional blood flow and volume. In the spine, T2-weighted images and MR-angiography were too insensitive to detect arteriovenous malformations, whereas gadolinium-DTPA first-pass studies sensitively detected the malformation and the changes after embolizations.
Asunto(s)
Embolización Terapéutica , Malformaciones Arteriovenosas Intracraneales/diagnóstico , Imagen por Resonancia Magnética , Adulto , Medios de Contraste , Embolización Terapéutica/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Gadolinio , Gadolinio DTPA , Humanos , Malformaciones Arteriovenosas Intracraneales/epidemiología , Malformaciones Arteriovenosas Intracraneales/terapia , Imagen por Resonancia Magnética/instrumentación , Imagen por Resonancia Magnética/métodos , Imagen por Resonancia Magnética/estadística & datos numéricos , Compuestos Organometálicos , Ácido Pentético , Estudios Prospectivos , Factores de TiempoRESUMEN
Intraoperative angiography allows for control procedures for exstirpation of arteriovenous malformations and clipping of problematic aneurysms during the entire operation. During intraoperative embolizations, it is especially helpful to see whether the occlusion of the nidus of an arteriovenous malformation is complete. The method is easy to perform; there were no complications in 19 cases.
Asunto(s)
Angiografía Cerebral/instrumentación , Embolización Terapéutica/instrumentación , Aneurisma Intracraneal/terapia , Malformaciones Arteriovenosas Intracraneales/terapia , Complicaciones Intraoperatorias/terapia , Cateterismo/instrumentación , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Complicaciones Intraoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagenRESUMEN
Cystic space occupying processes are well imaged by CT because of their low density. For localization and identification of the surrounding brain structures additional coronary or secondary cuts can be used. Measurements of distances and angles from the intended point of puncture allow, with an appropriate technique, a free-hand puncture of the cyst. Needle position must be recorded with CT-images. No complications occurred in 22 patients. Punctures of cysts have only a symptomatic and transient effect. The immediate pressure reduction and the improvement of the clinical condition of the patient, however, can be valuable as an intermediate measure before surgery.
Asunto(s)
Biopsia con Aguja/métodos , Encefalopatías/patología , Quistes/patología , Enfermedades de la Columna Vertebral/patología , Tomografía Computarizada por Rayos X , HumanosRESUMEN
A report is given on our experience gained in the introduction of the method of detachable microballoon catheters in the sense of the intervention neuroradiological operative technique. Twenty patients with arteriovenous angiomas, bag-like aneurysms, a carotid Sinus vernosus fistula and intracranial tumours rich in blood vessels were treated according to this method. Adjoining procedures such as embolisation are discussed.
Asunto(s)
Neoplasias Encefálicas/terapia , Cateterismo/instrumentación , Trastornos Cerebrovasculares/terapia , Embolización Terapéutica/instrumentación , Fístula Arteriovenosa/terapia , Enfermedades de las Arterias Carótidas/terapia , Seno Cavernoso/lesiones , Angiografía Cerebral , Trastornos Cerebrovasculares/diagnóstico por imagen , Hemangioma/terapia , Humanos , Aneurisma Intracraneal/terapiaRESUMEN
On the basis of the example of two observations symptomatology and therapy of the ventral sacral meningocele are discussed. Besides the clinical diagnosis, the combination of myelography and computer tomography show the greatest informative value. The therapy should be a surgical one with the aim of the extirpation or elimination of the cellular bag.
Asunto(s)
Meningocele/cirugía , Sacro/anomalías , Adulto , Femenino , Humanos , Persona de Mediana Edad , Mielografía , Sacro/cirugía , Tomografía Computarizada por Rayos XRESUMEN
In the presence of Spondylosis hyperostotica an isolated spondylophytary ventral ossification leads to the stiffening of the vertebral column with a considerable loss of elasticity. Patients with a rarely occurring participation of the cervical vertebral column are particularly endangered by traumata. Even a trivial trauma may lead to the fracture or a spinal canal diameter in the lower normal range lead to neurological symptoms. The degree of the instability and the neurological symptoms determine the therapeutical approach. The strategy of the treatment is discussed on the basis of the example of six patients from two neurosurgical clinics.
Asunto(s)
Vértebras Cervicales/patología , Hiperostosis Esquelética Difusa Idiopática/complicaciones , Osteofitosis Vertebral/complicaciones , Anciano , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Humanos , Hiperostosis Esquelética Difusa Idiopática/diagnóstico por imagen , Hiperostosis Esquelética Difusa Idiopática/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Radiografía , Fusión VertebralAsunto(s)
Enfermedades de la Columna Vertebral/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Vértebras Cervicales/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Mielografía , Traumatismos Vertebrales/diagnóstico por imagen , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Osteofitosis Vertebral/diagnóstico por imagen , Espondilitis/diagnóstico por imagen , Espondilitis Anquilosante/diagnóstico por imagen , Vértebras Torácicas/diagnóstico por imagenRESUMEN
A report is given on three patients in whom after interventions in the region of the vertebral column and the spinal cord haemorrhages in the area of the posterior cranial fossa had occurred. An excart diagnosis is only possible by exact neurological findings and computer tomography. The causes of these complications are discussed, therapeutically there is only the restoration of the cerebrospinal fluid passages through the efferent systems.
Asunto(s)
Enfermedades Cerebelosas/etiología , Complicaciones Posoperatorias/etiología , Enfermedades de la Columna Vertebral/cirugía , Adulto , Hemorragia Cerebral/etiología , Derivaciones del Líquido Cefalorraquídeo , Humanos , Hidrocefalia/etiología , Laminectomía , Masculino , Persona de Mediana Edad , Neurilemoma/cirugía , Neoplasias de la Columna Vertebral/cirugía , Raíces Nerviosas Espinales/cirugía , Estenosis Espinal/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Lateral puncture of the dorsal CSF space, which is usually dilated, at the height of C1/2--called the cisterna atlantoaxialis--is a low risk approach that represents an optimum for cervical myelography, the liquor containing space is sufficiently large for damage to the spinal cord to be avoided.
Asunto(s)
Mielografía/métodos , Punción Espinal/métodos , Articulación Atlantoaxoidea , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , MetrizamidaRESUMEN
A report is given on 5 patients with diastematomyelia, in one case the fissure formation of the marrow being without a provable septum. In the frequently very complex pathological-anatomical conditions of the spinal dysraphic malformation, CT can be a considerable help. In combination with metrizamide myelography, details of the marrow parts and their envelopes can be demonstrated. The preoperative planning of the marrow separation becomes more exact. Other causes of a deep spinal marrow level (tethered cord) such as teratomas can also be recognized by CT.
Asunto(s)
Defectos del Tubo Neural/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Mielografía , Defectos del Tubo Neural/cirugía , Compresión de la Médula Espinal/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Detailed pictures obtained by functional myelography show that anteflexion causes substantial ventral movement of the myelon in the lower neck region. This lack of lateral stability can, in cases of degenerative kyphosis accompanied by dorsal osteophytic swelling across the intervertebral space, lead to constant irritation of the myelon sheath outside of the region concerned although the spinal canal is not constricted. If surgical treatment is necessary preference should therefore be given to Cloward's ventral fusion rather than to laminectomy.