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Biomedical subjects

A Berenstein

Publications and source records attributed to A Berenstein.

At least 73 records · Page 4Linked to original sources
PubMed1988

Dural arteriovenous malformations and papilledema.

We examined and managed two patients with posterior fossa dural arteriovenous malformations (DAVMs) and papilledema. Both DAVMs had venous drainage into the transverse, straight, and sigmoid dural venous sinuses. The mechanism of papilledema in the first case was presumed venous hypertension resulting in impaired cerebrospinal fluid absorption, as the malformation drained into the single transverse sinus. This was cured by selective arterial embolization of the causative DAVM. The second patient had venous sinus thrombosis that impaired venous drainage despite embolization. A lumboperitoneal shunt was necessary to treat the elevated intracranial pressure.

Cerebrospinal Fluid Shunts↗
PubMed1988

Surgical neuroangiography of the spine and spinal cord.

The SCAVMs are high-flow lesions that present at a younger age, during the second or third decades of life. The most common presenting symptoms are subarachnoid hemorrhage and hematomyelia. Endovascular treatment of these lesions has become an important adjunct to surgical management. Complete occlusion is possible by superselective catheterizations and injection of a liquid embolic material. The SDAVFs are slow-flow AV shunting at the dura, which causes progressive neurologic deficit in older age--the fifth or sixth decades of life. Embolization is now the primary mode of treatment. Preoperative embolization of the hypervascular tumors of the spine and spinal cord has become a necessity to reduce bleeding during surgery, and it even reduces the size of the tumor and relieves spinal block. Thorough knowledge of vascular anatomy and better understanding of hemodynamics of these lesions are essential to perform proper and safe embolization.

Angiography↗
PubMed1988

Surgical neuroangiography of intracranial lesions.

Surgical neuroangiography of intracranial vascular lesions is one of the advances in modern neuroradiology. Improved microcatheters permit safer catheterization of very distal intracranial and intracerebral vessels. With proper embolic materials various cerebrovascular problems can be effectively treated by endovascular embolization.

Arteriovenous Fistula↗
PubMed1987

Intracavernous branches of the internal carotid artery (ICA). Comprehensive review of their variations.

Since we started to work in the lateral sellar region (in 1973), a large volume of angiographic material has provided us with exceptional variations that added to the anatomic facts obtained from our dissections. At present, these anatomic facts remain, but the way we look at them and the way we use them for endovascular treatments, has created a need for a different type of approach and understanding. In this report, we present a flexible anatomical view of the intracavernous branches of the internal carotid artery and a scheme to understand and predict the anatomical variations of these collaterals. Four embryonic vessels play an important role in the variations of the arterial supply to the lateral cavernous region: the dorsal ophthalmic artery, the stapedial artery, the trigeminal artery and the primitive maxillary artery. In general each of them partially regresses leaving behind a remnant. However there is a spectrum from their persistence to incomplete regression, resulting in variations of the supply to their distal territories. The term "meningohypophyseal" should be abandoned because it is misleading and improperly used. Complete agenesis is known for a long time; in case of segmental agenesis of the ICA each of the embryonic vessels presented above may represent an alternate route to bypass the agenesis. The ICA is not a direct feeding artery but a succession of independant segments which can be the site of various anomalies. An embryonic transdural circle can be individualized; it is constituted by the trigeminal arteries posteriorly, the ICA siphon anteriorly, the transsellar anastomosis and internal maxillary artery connections. Although regressions usually occur in this embryonic transdural circle, its derivatives congenital and acquired arterial pathologies. It also constitutes the key system in determining the arterial variations of the perisellar region.

Carotid Artery, Internal↗
PubMed1986

Neuroophthalmologic abnormalities and intravascular therapy of traumatic carotid cavernous fistulas.

Traumatic fistulas were successfully embolized using various transvascular approaches in 33 of 34 lesions. Complete superselective angiographic demonstration of the exact site of the shunt and possible collaterals was necessary to choose the appropriate embolization techniques. Improvement in the signs of orbital congestion was seen in all cases. Embolization, which directly occludes the fistula, precludes recurrences via collateralization and restores the normal arteriovenous gradient to the eye and optic nerve.

Adult↗
PubMed1986

Supraophthalmic intracarotid infusion of BCNU for malignant glioma.

We treated five patients with 11 supraophthalmic infusions of BCNU at 200 mg/m2 every 2 months. All three patients with residual tumors showed marked CT response after one infusion. Two patients with bilateral tumors had no response on the contralateral side. All four evaluable cases showed evidence of BCNU neurotoxicity. CT findings superficially resembled tumor recurrence, but white matter changes, nonspecific gyral enhancement, and delayed calcification were more indicative of neurotoxicity. There were no procedure-related complications. One autopsy suggested that direct parenchymal damage might be responsible for delayed neurotoxicity. Supraophthalmic BCNU infusion, at this dosage, is too toxic for cerebral tissue.

Adult↗
PubMed1984

Combined treatment of head and neck vascular masses with preoperative embolization.

Recent advances with aggressive vascular radiologic techniques have altered the methods of treatment of head and neck vascular malformations. High resolution CT scanning and superselective angiography with subtraction technique is now capable of defining the extent of these lesions and demonstrating blood flow dynamics. Careful joint evaluation by the vascular radiologist and the head and neck surgeon is necessary for the proper treatment of these patients. Preoperative embolization of these lesions effectively reduces intraoperative blood loss and provides for better exposure in those patients ultimately undergoing resection of these masses. Careful selection of those cases that are amenable to total or subtotal excision, with adherence to specific criteria and goals, usually produces gratifying results. We present five patients who have undergone combined treatment of their head and neck vascular lesions. Our treatment protocol is reviewed and emphasis is placed on the integral part that the vascular radiologist assumes in the treatment of these patients.

Adult↗
PubMed1984

Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries. Functional investigation and embolization.

Functional angiographic investigation and percutaneous embolization using detachable balloons in nine carotid cavernous aneurysms, three petrous aneurysms, one vertebral artery aneurysm, and one posterior inferior cerebellar aneurysm are reported. A double-lumen balloon catheter is used to evaluate acute tolerance to occlusion of the carotid or vertebral arteries. Occlusion is tested under systemic heparinization. Local perfusion of heparinized saline, proximal as well as distal, to the balloon occlusion is used. The procedure was successful in all but one cavernous aneurysm. The arterial lumen was sacrificed in all cases. Clinical improvement occurred in all successful cases. Retro-orbital pain was relieved in all. Ocular cranial nerve palsies improved or resolved in most. One delayed ophthalmic episode that improved represents the only complication. No such embolic problems occurred in any case in which the cavernous carotid artery was occluded by balloon trapping. The delayed embolic complications after carotid artery occlusion are related to the collateral vessels to the C-4 and C-5 segments of the artery. Balloon trapping decreases the length of the thrombosed segment and prevents retrograde filing of the aneurysm.

Adult↗
PubMed1984

Blood supply of the upper craniofacial skeleton: the search for composite calvarial bone flaps.

This study investigated the blood supply of the upper craniofacial skeleton by injection studies. The major supply to the calvaria is provided by the middle meningeal artery and its branches. This vessel is difficult for the plastic surgeon to exploit in composite bone-flap design. The majority of the outer surface of the craniofacial skeleton is supplied by tiny perforators from the overlying periosteum. The vascular interconnections within the periosteum are poorly developed. For this reason, the galea and the overlying vascular network (derived from the superficial temporal, occipital, supraorbital, and supratrochlear vessels) should be left broadly attached to the bone when transferring a vascularized calvarial bone flap. Dissection of the scalp away from this vascular network should be carried out just below the hair follicles. By observing these principles, vascularized calvarial bone can be transferred on the superficial temporal, deep temporal, supraorbital, supratrochlear, or occipital vessels. Details of the use of each are discussed.

Adult↗
PubMed1984

Iopamidol and Conray 60: comparison in superselective angiography.

Iopamidol (280 mgI/ml) was compared with Conray 60 (iothalmate meglumine, 282 mgI/ml) during selective and superselective cerebral arteriography. Twelve patients were examined, and a total of 51 selective injections were compared. Iopamidol produced significantly less pain and burning than Conray 60 and caused no patient motion.

Adult↗
PubMed1984

Percutaneous transvascular treatment of giant carotid aneurysms: neuro-ophthalmologic findings.

Twelve of 17 patients with cavernous carotid aneurysms had balloon embolization directed through a percutaneous double lumen catheter for progressive pain, ophthalmoplegia, or visual loss. Functional angiography was carried out with systemic heparinization and double-lumen balloon catheters to test tolerance to carotid occlusion. Eleven were successfully treated, though two patients with initial preservation of the ipsilateral carotid artery had unplanned deflation of the balloon, necessitating re-embolization. No serious permanent neurologic complications occurred. All patients had complete resolution of pain, and nine had improvement in the extraocular eye muscle and lid function. Balloon trapping of the cavernous carotid artery, rather than placing the balloon directly into the aneurysm, resulted in involution of the aneurysm and decompression of the involved cranial nerves.

Adult↗
PubMed1984

Somatosensory evoked potentials during spinal angiography and therapeutic transvascular embolization.

Somatosensory evoked potentials (SEP's) were monitored during 42 angiographic examinations and 33 therapeutic embolization procedures in 41 patients. The SEP amplitude decreased in 36 of the 42 angiographic techniques, but recovered to baseline within 2 to 4 minutes in all but one case. Angiographic opacification of the anterior spinal artery reduced SEP amplitude in all but two patients, who had lost their proprioceptive sense and had no recognizable SEP prior to the procedure. No neurological complications resulted from any of the angiography procedures. Of the 33 embolizations, 15 were performed in 12 patients with arteriovenous malformations (AVM's) and 18 in 17 patients with spinal canal tumors. There was only one complication associated with embolization: that occurred in a patient with an intramedullary spinal cord AVM. Monitoring SEP amplitude in this series of patients provided a means of rapidly and reliably identifying the anterior spinal artery, served to assess the potential risk of contemplated steps in embolization, and aided in the execution of the angiographic procedures.

Angiography↗
PubMed1984

Neurologic applications of interventional radiology.

The development of radiographically controlled interventional procedures directed at neurologic disease can be attributed to improved fluoroscopic and catheterization equipment, new angiographic techniques, continued refinement of embolic materials, and the drive and determination of individual physicians over the past 25 years. In this article, the authors present a comprehensive review of the use of interventional radiology in neurology.

Angioplasty, Balloon↗
PubMed1983

Brachiocephalic vessel: selective and superselective catheterization.

The development of a catheter for easy and reproducible selective and superselective catheterization of the distal branches of the brachiocephalic arteries is reported. The catheter consists of a proximal 6- or 7-F braided wire shaft and a distal, nonbraided 10 cm made of thin-walled polyurethane with a 4- or 5-F diameter. The most distal 1 cm has a 105-degree curve and is not tapered at the tip. In this series, 209 patients were embolized in 277 separate procedures. Catheterization of the desired vessel was achieved in more than 95% of cases.

Carotid Artery, External↗