In a series of 54 caroticocavernous fistulae and eight vertebrovertebral fistulae, clinical cures were obtained in 46 of the caroticocavernous fistulae and in all of the vertebrovertebral fistulae using the Debrun coaxial catheter detachable balloon technique. Most low vertebrovertebral and about half of the posteriorly opening caroticocavernous fistulae were successfully treated by the safe transvenous approach. Technical difficulties were not infrequent but were overcome in most cases. In nine cases the artery was occluded with the fistula and in two others minimal residual shunt persisted, progressing in one to a symptomatic aneurysm. Five caroticocavernous fistulae in which the balloon could not be satisfactorily sited were not closed, and another caroticocavernous fistula closed spontaneously after a failed transvenous approach. Displacement of balloons during detachment reopened two caroticocavernous fistulae. One of these had to be closed by transcranial surgery; the other balloon embolized the middle cerebral artery, was surgically removed, and a mild hemiparesis persisted. Premature balloon detachment in a grossly atheromatous artery caused the only other major complication and contributed to the death of an 87-year-old patient. The most frequent complications were transient ophthalmoplegias. Minor modifications to the catheter system should reduce the incidence of such catastrophes and complications.

Adolescent↗

PubMedDate not supplied

Cord shape and measurements in cervical spondylotic myelopathy and radiculopathy.

A combined clinical myelographic and computed myelographic study was performed in 30 patients with cervical spondylotic myelopathy; computed myelography was also performed in 16 control patients. Good correlation was found between degree of deformity of cross-sectional shapes of the cord and the outcome of surgery, and measurements of anteroposterior diameter and area of the cord seemed helpful in this preliminary study. There was also reasonably good correlation between the clinical features when grouped according to specific tract involvement, and the pattern of deformity shown by the abnormal cross-sectional cord shapes.

Adult↗

PubMedDate not supplied

Delayed diagnosis of spinal vascular malformations presenting as intermittent myelopathy.

We report our recent experience of three male patients, whose clinical diagnosis and subsequent surgery was delayed for 9.25 and 15 months respectively. Initially, they all presented with vague, either sensory or motor lower limb disturbances and intermittency of symptoms was followed by bladder dysfunction or impotence. Extensive laboratory work-up was unrevealing and the non-specific diagnosis of myelopathy further delayed the recognition of the underlying vascular lesion. Finally spinal magnetic resonance imaging (MRI), supine myelography and selective spinal arteriography indicated the presence of a tumor in the first patient and vascular malformation in the other two. Neurosurgery and histology confirmed one cavernous angioma and two arteriovenous malformations, all thoracic and dural. We believe that both the cryptic nature of these lesions and our technical limitations (spinal arteriography and MRI not readily available), accounted for the delayed diagnosis in our three patients, who nevertheless, when treated by surgery showed a satisfactory outcome in the first case, while further deterioration was prevented in the other two.

Adult↗