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Biomedical subjects

A Berenstein

Publications and source records attributed to A Berenstein.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1996

Occipital arteriovenous malformations: visual disturbances and presentation.

BACKGROUND: Occipital arteriovenous malformations (AVMs) cause a variety of visual disturbances and headaches. Early diagnosis may lead to treatment that reduces the risk of hemorrhages, visual field loss and other neurologic deficits, and death. METHODS: We reviewed the records of the 70 patients with occipital AVMs referred to New York University Medical Center to investigate the mode of presentation and the outcome of treatment. RESULTS: Sixty-eight patients presented with one or more symptoms, including homonymous visual disturbances in 39, headache in 39, seizures in 20, and hemorrhage in twenty-six. Visual field loss was more common (p = 0.0007) and more severe (p = 0.0002) in patients who bled than in those with unruptured AVMs (16/44). The frequency of visual field loss was not associated with calcarine artery supply to the AVM. Prior to treatment, the fields improved in five patients with visual loss associated with a hemorrhage. Forty-six patients were treated with embolization, surgery, radiosurgery, or a combination of therapies. The AVM was eliminated in 19 of 20 patients (nine with preoperative partial embolization) treated with surgery versus in 4 of 27 patients treated only with embolization. There were two AVM-associated deaths, two subarachnoid hemorrhages, and four new neurologic deficits after treatment. Visual fields were worse in 15 patients, unchanged in 22, and improved in eight. CONCLUSIONS: Whereas some features of headache and visual symptoms are similar for occipital AVMs and migraine, the two disorders are usually distinguishable. Visual field improvement can spontaneously occur in patients who have had loss secondary to an intracerebral bleed. Treatment with embolization or surgery, particularly with surgical excision of the AVM, can result in new or worse visual field loss.

Adolescent↗
PubMed1996

Vertebrospinal angiography in the evaluation of vertebral and spinal cord disease.

Spinal angiography is an infrequently performed radiologic procedure requiring much skill and knowledge for its proper application. Most commonly, spinal angiography is used in the diagnosis of spinal arteriovenous malformations and in the delineation of vascular tumors of the spinal cord. Less usual indications may include preoperative evaluation of the spinal cord vasculature prior to surgeries involving the descending thoracic aorta or ventrolateral approaches to the spine, particularly in patients undergoing repeat operations. Spinal angiography should address three crucial considerations for the surgeon or neurointerventionalist: (1) the exact location and anatomic configuration of the lesion, (2) the vascularity of a lesion and identification of all feeding and draining vessels, and (3) depiction of the regional vascular anatomy of the spinal cord in relation to the lesion. Considering the relatively longer length of the procedure, larger contrast volumes, and increased complexity (as measured by catheter exchanges required) of spinal angiography, however, certain angiographic techniques (e.g., digital subtraction angiography, the use of general anesthesia, or placement of a groin sheath to facilitate catheter exchanges) and the use of low osmolality contrast agents should be considered to improve the quality of the examination while reducing risk.

Angiography↗
PubMed1996

Angiography of cerebral aneurysms.

Magnetic resonance and computed tomographic angiography have been increasingly applied to the study of disease affecting the cerebral vasculature. Despite these advances, however, conventional cerebral angiography clearly remains the diagnostic gold standard and essential guide to any microneurosurgical or endovascular therapeutic decision concerning cerebral aneurysms. Detailed cerebral angiography is a dynamic study and is influenced by prior axial imaging. It should be tailored to the specific circumstance to obtain information required for selection of the most beneficial treatment.

Aneurysm, Ruptured↗
PubMed1996

Venous obstruction as the cause of retinal/choroidal dysfunction associated with arteriovenous shunts in the cavernous sinus.

OBJECTIVE: To determine the hemodynamic abnormalities that result in visual acuity loss because of retinal or choroidal dysfunction associated with arteriovenous shunts (AVS) that involve the cavernous sinus. METHODS: Retrospective study of the records of 250 patients with either a carotid cavernous fistula or dural arteriovenous malformation revealed a total of 10 patients with vision loss secondary to retinopathy (group I) or choroidal effusion (group II). The cerebral angiograms of these 10 patients and 10 additional patients with visual dysfunction due to elevated intraocular pressure (group III) were evaluated to determine whether the three groups could be distinguished by a specific vasculopathic pattern. Particular attention was given to the extent of thrombosis in the ophthalmic venous system and cavernous sinus. RESULTS: There were angiographic signs of severe thrombosis in the ophthalmic vein in nine patients and in the cavernous sinus in seven patients ipsilateral to the retinal or choroidal lesion. In contrast, in group III, severe thrombosis in the ipsilateral ophthalmic vein and in the cavernous sinus occurred in one and two patients, respectively. Closure of the AVS improved the visual acuity in 1 of 4 patients in group I and in 4 of 5 patients in group II, and normalized the intraocular pressure in all patients. CONCLUSIONS: Ophthalmic vein thrombosis, rather than arterialization of the venous system or an arterial "steal, " is the principal cause of retinal or choroidal dysfunction associated with AVS to the cavernous sinus. Following AVS closure, visual recovery is more frequent with choroidal effusion or detachment rather than with retinopathy.

Adult↗
PubMed1995

Deep central arteriovenous malformations of the brain: the role of endovascular treatment.

Cerebral deep central arteriovenous malformations (AVMs) are uncommon lesions associated with considerable difficulty in treatment. The authors report a series of 14 deep central AVMs treated by endovascular methods and examine the present role of endovascular treatment. This treatment used alone resulted in complete obliteration of AVMs in approximately 15% of case and reduction in 50% to a size permitting treatment by means of radiosurgery. Reversal of previous neurological signs and symptoms occurred in 35.7% of embolized patients. Overall, nearly 80% of patients had either complete obliteration of the lesion, reduction to a size allowing radiosurgical treatment, or reversal of previous neurological deficits. There were treatment complications in 14.3% of the cases. Endovascular treatment methods may make a significant contribution to the therapy of AVMs that have a particularly poor course and are difficult to treat by other means.

Adult↗
PubMed1994

Management of traumatic facial nerve paralysis with carotid artery cavernous sinus fistula.

Massive skull base injuries require detailed preoperative neurological and neurovascular assessment prior to undertaking surgical repair of isolated cranial nerve deficits. We present the management of a patient with traumatic facial paralysis, cerebrospinal fluid leak, and carotid artery cavernous sinus fistula as the result of a gunshot wound to the skull base. The carotid artery cavernous sinus fistula was ultimately controlled with super-selective embolization via the vertebral artery. The facial nerve injury was then safely treated with mobilization of the labyrinthine and vertical segments to allow a primary anastomosis.

Adult↗
PubMed1994

Endovascular treatment of giant aneurysms which cause visual loss.

BACKGROUND: Progressive visual loss that results when a giant cerebral aneurysm compresses the anterior visual pathway requires treatment. When surgical clipping is not safely feasible, percutaneous methods of embolization of the aneurysm can be visual or life saving. METHODS: Endovascular techniques were used to treat 19 of 26 consecutive inoperable giant aneurysms in patients with visual loss, which included optic neuropathy (monocular in 13 patients and bilateral in 8) and optic tract dysfunction in five patients. Embolization of the aneurysm was performed with detachable balloons in 12 patients and with Guglielmi detachable electrocoils in 7. RESULTS: After treatment, vision improved in 7 patients, was unchanged in 11, and worsened in 1. Neurologic complications with balloons were temporary in four patients and severe and permanent in three. In contrast, only one temporary complication occurred with Guglielmi detachable electrocoils. The treatment results are contrasted with the outcome in the seven patients who refused intervention: three hemorrhaged (1 death); monocular blindness with dementia developed in two; a complete homonymous hemianopia and dementia developed in one; and one became bilaterally blind. CONCLUSION: Inoperable symptomatic giant aneurysms can be successfully treated with endovascular treatment.

Adolescent↗
PubMed1994

Optic tract atrophy with cerebral arteriovenous malformations: direct and transsynaptic degeneration.

Three patients with postgeniculate cerebral arteriovenous malformations (AVM) had band atrophy of the contralateral optic nerve. One patient had homonymous hemioptic hypoplasia. These cases might have been construed as demonstrating transsynaptic degeneration across the lateral geniculate nucleus to the anterior visual pathway. However, neuroimaging studies revealed abnormal deep venous drainage remote from the AVM nidus that directly involved the lateral geniculate nucleus and posterior optic tract.

Adult↗