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Biomedical subjects

A Berenstein

Publications and source records attributed to A Berenstein.

At least 19 recordsLinked to original sources
PubMed2000

Visual loss from arterial steal in patients with maxillofacial arteriovenous malformation.

OBJECTIVE: To determine whether an arterial "steal" from the ophthalmic artery accounts for the ocular manifestations associated with maxillofacial arteriovenous malformation (AVM) outside the orbit. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Seven patients with maxillofacial AVM who had been previously treated, unsuccessfully, with proximal ligation of the supplying external carotid artery branches were evaluated clinically and by superselective cerebral angiography. No cases had intraorbital arteriovenous shunting or abnormal venous drainage to the orbit. INTERVENTION: Endovascular embolization. MAIN OUTCOME MEASURES: Signs and symptoms of ocular ischemia were correlated with findings on cerebral/orbital angiography. RESULTS: Four of seven patients had signs of ocular ischemia. By selective angiography, these four patients were found to have a significant ophthalmic artery supply to the AVM. In contrast, the three patients without signs of ocular ischemia had minimal or no ophthalmic artery supply to the AVM. CONCLUSIONS: When the ophthalmic arterial blood supply is recruited, ophthalmic artery "steal" phenomenon occurs in patients with maxillofacial AVMs that do not directly involve the orbit. This mechanism appears to be the cause of ocular ischemia. It is possible that this "steal" is precipitated or worsened by previous surgical proximal ligation of external carotid arterial branches that are potential collaterals with the ophthalmic artery but fail to occlude the arteriovenous (AV) shunts.

Adolescent↗
PubMed2000

Orbital arteriovenous malformation mimicking cavernous sinus dural arteriovenous malformation.

AIMS: Orbital arteriovenous malformations (OAVM) are rare, mostly described with high flow characteristics. Two cases are reported with an OAVM of distinct haemodynamic abnormality. The clinical, angiographic features, and the management considerations are discussed. METHODS: Case review of two patients with dural AVM (DAVM) who presented to referral neuro-ophthalmology and endovascular services because of clinical symptoms and signs consistent with a cavernous sinus dural AVM. RESULTS: In each patient, superselective angiography revealed a small slow flow intraorbital shunt supplied by the ophthalmic artery. The transarterial and transvenous endovascular approaches to treat the malformation were partially successful. Although, the abnormal flow was reduced, complete closure of the DAVM could not be accomplished without significant risk of iatrogenic injury. Neither patient's vision improved after intervention. CONCLUSION: A DAVM in the orbit can cause similar clinical symptoms and signs to those associated with a cavernous sinus DAVM. Even with high resolution magnetic resonance imaging, only superselective angiography can identify this small intraorbital slow flow shunt. The location in the orbital apex and the small size precludes a surgical option for treatment. The transarterial and transvenous embolisation options are limited.

Aged↗
PubMed1999

Visual symptoms with dural arteriovenous malformations draining into occipital veins.

OBJECTIVE: To determine the cause of the visual dysfunction and effect of treatment on dural arteriovenous malformations (DAVMs) that secondarily involve the occipital lobe. BACKGROUND: DAVMs are an infrequent cause of visual dysfunction that should be amenable to treatment if diagnosed before permanent visual field loss. METHODS: The records of seven patients with cerebral visual disturbances associated with DAVMs were analyzed with attention to visual symptoms, visual field testing, and vascular anatomy. RESULTS: Sudden visual loss occurred in five patients, two with a hemorrhage and one with a venous infarct in the occipital lobe. Fortification images occurred in three patients, two of whom had palinopsia (one with de novo formed visual hallucinations). Homonymous quadrantic or hemianoptic field defects, some fluctuating, were found in six patients. Angiography revealed each DAVM was supplied solely by dural arteries and drained into occipital pial veins due to retrograde blood flow through the sites near or in the wall or lumen of the dural venous channels that normally drain the occipital lobe. Unlike DAVMs in other locations, only two patients had occlusion of an adjacent venous sinus. These patients, particularly the two with posterior fossa DAVMs remote to the occipital lobe, clearly demonstrate the visual and neurologic dysfunction resulting from venous hypertension. In six patients, intra-arterial embolization of the arterial feeders and nidus (one patient required additional surgery) resulted in resumption of normal occipital venous emptying. No further visual episodes occurred in five of these six patients. The visual fields normalized in three patients and improved in one with venous infarct but were unchanged in both patients with a hemorrhage. CONCLUSIONS: DAVMs that drain into occipital veins cause field loss and other visual disturbances because of venous hypertension in the occipital lobe, which can be reversed by occluding the DAVM nidus. If a venous infarct or hemorrhage has not caused irreversible damage, visual recovery should be complete.

Adult↗
PubMed1999

Spinal dural arteriovenous fistulae draining to the anterior spinal vein: angiographic diagnosis.

OBJECTIVE: To describe and present atypical spinal dural arteriovenous fistulae (SDAVFs) that drain into the anterior spinal vein (ASV) and thus cause some degree of difficulty in differentiating the anterior spinal artery from the ASV. METHODS: A retrospective review of 80 selective spinal angiography procedures (with or without endovascular treatment) performed on SDAVFs since 1980 identified three cases in which the venous drainage was into a dilated ASV via a radicular vein. The patients included two men and one woman, ranging in age from 55 to 82 years (mean age, 71 yr), all of whom presented with mild to severe progressive paraparesis and sensory disturbance. RESULTS: The appearance of the venous drainage mimicked that of the usual hairpin configuration of the radiculomedullary artery and therefore caused diagnostic difficulty. There are no characteristic clinical features that differentiate this form of SDAVF from the usual type of SDAVF. The angiographic criteria for identification of the ASV draining an SDAVF include the demonstration of the branching of the ASV and its drainage into the epidural vein, opacification of other medullary veins connected with the ASV, recognition of distortion of the hairpin shape, and the identification of the anterior spinal artery at the segment where the ASV is opacified. Two patients were treated with embolization and one with surgery. All patients improved after the treatment. CONCLUSION: Before performing endovascular treatment, thorough spinal angiography with an appropriate field of view must be performed to identify this unusual type of SDAVF.

Aged↗
PubMed1999

Embolization of a spinal arteriovenous malformation: correlation between motor evoked potentials and angiographic findings: technical case report.

OBJECTIVE AND IMPORTANCE: Endovascular procedures for the treatment of spinal arteriovenous malformations place the spinal cord at risk of ischemia. This report illustrates the usefulness of motor evoked potentials (MEPs) in detecting functional changes within the spinal cord motor pathways during embolization of a spinal arteriovenous malformation under general anesthesia. CLINICAL PRESENTATION: A 28-year-old man presented with a history of progressive lower extremity numbness and weakness followed by bladder dysfunction. Magnetic resonance imaging and angiography disclosed a T11-T12 spinal arteriovenous malformation. INTERVENTION: During the endovascular procedure, before injection of particles, the disappearance of MEPs from the tibialis anterior muscle led to prompt angiographic reevaluation, which disclosed the arrest of spinal blood flow secondary to radiculomedullary artery occlusion by the catheter. Embolization and catheter withdrawal were followed by temporary recovery of spinal blood flow and MEPs. A second arrest of spinal cord blood flow, caused by severe vasospasm of the feeding radiculomedullary artery, was documented by a control angiogram, and its functional relevance was revealed by a second disappearance of MEPs. The therapeutic effect of papaverine infusion and induced moderate hypertension was confirmed angiographically by complete reopacification of the anterior spinal artery and confirmed neurophysiologically by the complete recovery of MEPs. At the end of the procedure, no additional neurological deficits were noted. CONCLUSION: During spinal cord embolization, MEPs may play a critical role in early detection of spinal cord dysfunction by aiding in the prevention of damage to the spinal cord as well as by predicting the clinical outcome.

Adult↗
PubMed1999

Large arteriovenous malformations of the face: aesthetic results with recurrence control.

Large facial arteriovenous malformations are problematic for patients because of grotesque disfigurement, risk of rapid enlargement, and life-threatening rupture. Successful treatment of these relentless complex lesions is one of the most difficult challenges facing plastic surgeons. From a series of 300 large facial arteriovenous malformations, 85 patients were treated with embolization and excision; six of these cases (representing six separate anatomic regions: labial, auricular, eyelid, cheek, chin, and occipitoparietal) were selected for review. The purpose of this article was to look critically at the management of these six facial arteriovenous malformations, including patient presentation, angiographic procedures, surgical planning and technique, and postoperative long-term follow-up care. Lessons learned from the six representative cases provide clues for the management of large facial arteriovenous malformations and demonstrate the possibilities of recurrence and their occasionally relentless behavior. The cases show that long-term control of these lesions with acceptable aesthetic results can be achieved. The mainstay of treatment includes the following: (1) selective intra-arterial embolization with fine catheters and direct lesional embolization; (2) judicious resection and reconstruction with local or expanded tissue flaps; and (3) careful follow-up with serial examinations, duplex, and arteriography.

Adolescent↗
PubMed1999

Venous anomalies and associated lesions.

Developmental venous anomalies (DVAs) of the central nervous system are an exaggeration of the normal venous collector system, not a vascular lesion. They may be associated with many vascular and nonvascular processes with the nervous system including tumors, demyelinating lesions, arteriovenous malformations (AVMs), dural AVMs, cavernous malformations, and vascular lesions of the head, face, and eye. The instigating factors involved are not completely understood. The primary clinical significance of DVAs is that planned or inadvertent occlusion during treatment of associated lesions frequently leads to venous infarction of the surrounding normal brain.

Central Nervous System Diseases↗
PubMed1999

Endovascular treatment of spinal vascular malformations.

Endovascular treatment is considered as the first choice of treatment for most cases of spinal vascular malformations. Clinical presentation, natural history, and origin of symptoms are briefly described on spinal cord arteriovenous malformations, spinal dural arteriovenous fistulas, epidural fistulas, and paraspinal fistulas. Pretherapeutic evaluation, materials and technique for embolization, post-therapeutic management, results, and follow-up are discussed for each disease.

Arteriovenous Malformations↗
PubMed1998

Temperament profiles of children with vein of Galen malformations.

Unlike many brain injured children who are often rather difficult, toddlers and school-aged children with congenital vein of Galen malformations (n = 20; age range, 4 months to 12 years with a mean of 4 years) evidence a relatively positive temperament profile (based on the Temperament Scales of Carey, McDevitt, Fullard, Hegvik, Medoff-Cooper). They do not, however, differ from normal children with regard to the frequency of easy, difficult, slow to warm up, and intermediate temperament clusters. The temperament profile of children with vein of Galen malformations appears unaffected by additional neurologic abnormalities (hydrocephalus, abnormal developmental quotient, seizure disorder, focal cortical lesions) or other factors including age at testing, sex, or socioeconomic status. Contrary to the findings in adults of right hemisphere dominance for attention, presence of additional right-sided focal cortical pathology was not associated with greater activity level, distractibility, or impersistence. In contrast to the findings in adults and children of right hemisphere dominance for emotions in general, children with vein of Galen malformations and additional right hemisphere cortical damage are not more difficult than those with additional left cortical pathology or no additional focal cortical pathology. The fact that the pathology in vein of Galen malformations is subcortical may explain their relatively easier temperament and the absence of lateralization effects.

Analysis of Variance↗
PubMed1998

Future endovascular management of cerebral aneurysms.

The endovascular management of cerebral aneurysms is undergoing revolutionary growth. Recent advances in endovascular surgery including balloon remodeling, revascularization techniques, functional cerebral rearrangement, intracranial stents, treatment for vasospasm and coil design are discussed, as are their future considerations.

Embolization, Therapeutic↗
PubMed1998

Evaluation and treatment of head and neck venous vascular malformations.

Congenital venous vascular malformations of the head and neck are low-flow, nonproliferative lesions that should be distinguished from hemangiomas. The characteristic history and clinical findings can establish the diagnosis. Direct percutaneous puncture and contrast injection at the time of treatment delineate the lesion and its drainage pattern. Treatment must be individualized according to lesion extent, patient tolerance and physician experience. Sclerotherapy with ethanol has proved to be a successful treatment modality for these lesions, as demonstrated in this study of 57 patients. Surgery is used for treatment of clinically significant residual disease. A multidisciplinary approach to evaluation and treatment is key to successful management.

Adolescent↗
PubMed1997

Embolization of spinal dural arteriovenous fistulae: results and follow-up.

OBJECTIVE: To evaluate the efficacy of embolization for spinal dural arteriovenous fistulae (SDAVF). METHODS: We reviewed 49 cases of SDAVF treated by embolization. An acrylic material was used in all except two cases. Variable stiffness microcatheters were used in 38 cases. RESULTS: "Adequate" initial treatment was performed in 39 cases (80%). After the introduction of variable stiffness microcatheters, the initial success rate of embolization increased to 87% (33 of 38 cases). Eight patients underwent subsequent embolization for recurrence after "adequate" embolization. Causes of recurrence were collateralization in five cases, development of new fistulae in one, and unknown in two. Two additional patients developed subsequent aggravation of the symptoms, probably caused by progressive venous thrombosis, that responded to heparinization. Ten cases were initially "inadequately" embolized. Five of the 10 cases were treated before the introduction of variable stiffness microcatheters. Each of three of the remaining five cases had a common trunk from which the feeder and a spinal cord artery arose. CONCLUSION: Embolization with an acrylic material should be the first choice of treatment for SDAVF, unless a spinal cord artery shares the same pedicle as the feeder of SDAVF. Subsequent aggravation of the symptoms after embolization can occur by various mechanisms. Therefore, periodic and long-term follow-up examinations are important.

Aged↗
PubMed1997

Transumbilical catheterization of cerebral arteries.

OBJECTIVE AND IMPORTANCE: For neonates requiring cerebral endovascular procedures, an alternative route of arterial access, the umbilical artery, is described. Transfemoral catheterization, with its attendant risks, can thus be avoided. CLINICAL PRESENTATION: Six neonates with severe cardiac failure secondary to aneurysmal malformations of the vein of Galen underwent transarterial embolization in an effort to reduce flow through the intracranial arteriovenous malformations and therefore improve control of the high output cardiac failure. TECHNIQUE: The transumbilical route was used in each case, with successful devascularization of some of the malformations in all patients. The femoral arteries were preserved for future staged embolizations. No complications related to the umbilical artery catheterization were encountered. CONCLUSION: Femoral artery cannulation in neonates is technically challenging and may result in stenosis or thrombosis of the vessel. The umbilical artery provides an alternative route of vascular access for cerebral artery catheterization and embolization in these patients, preserving the femoral arteries for future interventions.

Angiography, Digital Subtraction↗
PubMed1996

High-dose administration of nonionic contrast media: a retrospective review.

PURPOSE: To assess the safety of high-dose nonionic contrast media (CM) during a single radiologic procedure. MATERIALS AND METHODS: From November 1991 to August 1995, 255 high-dose angiographic procedures were performed in 228 patients with normal serum creatinine (SCr) levels (< or = 1.6 mg/dL [141 mumol/L]). All patients received 250-800 mL low-osmolarity CM (300 mg iodine per milliliter). Pre- and postprocedure SCr levels were assessed. Urine output was measured daily in the 75 patients who received more than 400 mL CM. With linear regression analysis, a dose-related elevation in SCr levels was calculated. RESULTS: No patient developed abnormal SCr levels (> 1.6 mg/dL [141 mumol/L]) as a result of the CM. Among the patients who received more than 400 mL, none developed oliguria over the first 36 hours. With follow-up up to 3 years, no patient experienced delayed clinical renal failure. In 11 (4.3%) patients, the SCr levels increased more than 25%, but all increases were within expected limits (chi 2 analysis). Linear regression analysis revealed a 0.015 mg/dL (1 mumol/L) increase in SCr levels per 100 mL CM. CONCLUSION: Intravenous administration of high-dose low-osmolarity iodinated CM appears safe in patients without renal dysfunction or other underlying risk factors, in doses as large as 800 mL (300 mg iodine per milliliter).

Adolescent↗