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Biomedical subjects

B Richling

Publications and source records attributed to B Richling.

At least 37 records · Page 2Linked to original sources
PubMed1997

Diagnostic and therapeutic approaches to carotid body tumors. Review of 24 patients.

OBJECTIVE: To determine the clinical characteristics of carotid body tumors to define better a standardized proceeding in the management of carotid body tumors. DESIGN: Retrospective survey. Duration of postoperative follow-up was 4 months to 16 years (median, 57 months). SETTING: Institutional, tertiary care medical center. PATIENTS: Consecutive sample of 24 patients (10 men and 14 women) with 28 carotid body tumors treated in the University of Vienna (Austria) General Hospital in 35 years. INTERVENTIONS: Surgical resection, preoperative embolization. MAIN OUTCOME MEASURES: Initial signs, duration of symptoms, extension of the tumors, methods of investigations, and treatment modality, with special respect to the operative technique. RESULTS: Doppler color flow imaging and angiography provided essential mainstays for definite diagnosis. Computed tomography and magnetic resonance imaging contributed additional information about tumor extension. Nineteen patients (79%) underwent surgical resection of 22 tumors, 8 (42%) after preoperative embolization. There were no perioperative deaths. Hemiplegia occurred in 1 patient, and cranial nerve palsy occurred in 5 patients. Tumor recurrence was observed in 3 patients. Five patients refused surgery or tumors were unresectable. CONCLUSIONS: Our standard diagnostic procedure consists of establishing diagnosis by Doppler color flow sonography, angiography for detailing the vascularization of the tumor, and selective embolization to enable safer surgery with less bleeding. Early surgery is recommended to minimize major risks.

Adult↗
PubMed1997

False aneurysms of the intracavernous carotid artery--report of 7 cases.

We present 7 cases of false intracavernous carotid artery aneurysms. Four occurred after trauma and three were caused iatrogenically. Two of the latter occurred in patients with pituitary adenomas, one after transsphenoidal microsurgery and the other after yttrium [YI90] seed implantation into the sella. The third iatrogenic aneurysm was seen shortly after transcavernous tumour surgery. In five of our seven patients massive, delayed, life-threatening epistaxis was the leading symptom. All traumatic cases were associated with immediate unilateral blindness or blurred vision and with skull base fractures. One of these had a concomitant carotid cavernous fistula. Treatment of choice of our 5 recent cases was permanent balloon occlusion of the intracavernous carotid artery at the level of the lesion. Collateral circulation was evaluated prior to definitive carotid occlusion using a balloon test occlusion. During the balloon test adequate collateral circulation was defined as symmetric angiographic filling of both hemispheres. Awake patients were neurologically examined continuously. In unconscious patients transcranial Doppler sonography, electroencephalographic and somatosensory evoked potential monitoring was used in addition. Intra-operative heparin administration was not reversed with protamin. A postoperative continuous heparin infusion was not found necessary. In our two early cases this technique was not available: In the first case we accomplished aneurysm occlusion by a surgically introduced Fogarty balloon catheter. Our second patient needed surgical trapping of the involved carotid after early unsuccessful attempts of selective aneurysm occlusion. After treatment no further epistaxis occurred. Follow-up angiography showed persistent aneurysm occlusion. The results were excellent in 5 cases and good in 1 case. One patient with bilateral lesions suffered a stroke after occlusion of the second, remaining carotid artery, despite functioning bilateral extra-intracranial bypasses. Four years later there is a mild dysphasia still present in this patient. The mean follow-up time was 75.6 months.

Adult↗
PubMed1997

Treatment of post-traumatic carotico-cavernous fistulae using electrolytically detachable coils: technical aspects and preliminary experience.

We treated six patients with post-traumatic cavernous carotid fistulae by electrothrombosis using Guglielmi's new electrolytically detachable coils. The transarterial endovascular route was chosen in five and the transvenous in one case. Exophthalmos, chemosis and/or an audible bruit disappeared immediately after therapy or in the following month in all patients suffering from these symptoms. Third and sixth cranial nerve palsies resolved in three of four patients. Clinical results were excellent in three, good in two and fair in one. In this last patient massive thrombosis of an enormously dilatated superior ophthalmic vein occurred after treatment of a giant longstanding fistula, leading to unilateral visual impairment and increased sixth nerve palsy. In our first patient the intracavernous carotid artery was occluded by balloons after coil embolisation because of improper coil position and the fear of possible thromboembolic events. Angiographic cure was demonstrated in all cases by angiograms 1-6 months after therapy. The characteristics of these new coils are easy use, manoeuvreability and retrievability. They conform ideally to the shape of the vessel lumen to be obliterated and produce practically no trauma to the vessel walls. Furthermore, they can be positioned in the sinus close to the orifice of the fistula. In the last two cases partial occlusion of the fistula was sufficient to initiate the process of complete thrombosis, and delayed, complete occlusion was observed after 1 month. In our opinion this new device is not only a major contribution to treatment of intracranial aneurysms, but may also improve the results of treatment of carotico-cavernous fistulae.

Adult↗
PubMed1997

Extensive facial vascular malformations and haemangiomas: a review of the literature and case reports.

We present 6 selected cases of extensive facial vascular anomalies extending to the skull base or actually involving it. These patients are compared with other cases in the literature. The spontaneous course of these vascular lesions is different and so variable treatment modalities are suggested depending on the age of the patient and the type of lesion. In young children, haemangiomas are common and spontaneous involution is characteristic. Conservative treatment in the sense of a wait-and-see approach is thereby favoured if there is no urgent indication such as involvement of essential structures, e.g. blockage of an orifice as demonstrated in one case or complications such as excessive bleeding. Vascular malformations most commonly appear in adults, there is no tendency to spontaneous involution and resection is usually necessary, especially in arteriovenous malformations. Nowadays, preoperative superselective embolization is recommended to minimize intraoperative blood loss. Superselective embolization is the treatment of choice in cases of a-v fistulae. Proximal ligation of the supplying arteries should be avoided because this may make embolization more difficult, and may be responsible for the common occurrence of rapid revascularization.

Adolescent↗
PubMed1997

In vitro training model for endovascular embolization of cerebral aneurysms.

We present a new in vitro model for the training of endovascular embolizations of cerebral aneurysms. The technique and laboratory set-up described allow the embolization of thin-walled, transparent silicone aneurysm models under "semi-physiologic" conditions, i.e., in a closed circulation with pulsatile flow and pressure, simulating the hemodynamic conditions encountered in biologic systems.

Embolization, Therapeutic↗
PubMed1997

Recurrent aneurysmal subarachnoid haemorrhage: bleeding pattern and incidence of posthaemorrhagic ischaemic infarction.

This report is based on a consecutive series of 162 patients with aneurysmal subarachnoid haemorrhage (SAH), including 22 patients (14%) with recurrent SAH, who were treated within 72 h after the most recent bleed. Of the 22 patients with recurrent haemorrhage: 68% were in poor clinical condition (Hunt & Hess grade 4-5); 73% presented with intracerebral haemorrhage (ICH); 41% developed delayed ischaemic infarctions from chronic arterial spasm; 14% made a good recovery, while 41% died. Of the 140 patients with a single bleed: 34% were in poor clinical condition (Hunt & Hess grade 4-5); 33% presented with ICH; 22% developed delayed ischaemic infarctions; 53% made a good recovery, while 19% died. Our results suggest that a high incidence of intracerebral haemorrhage in conjunction with a more severe course of chronic arterial spasm substantially contributes to the high morbidity and mortality associated with recurrent SAH. In poor grade patients not suitable for acute open surgery, endovascular treatment should receive consideration for the prevention of early rebleeding.

Adolescent↗
PubMed1996

Evolution of different therapeutic strategies in the treatment of cranial dural arteriovenous fistulas--report of 30 cases.

30 cases of cranial dural arteriovenous fistuals, treated between 1983 and 1992, are reported. Twelve presented with an aggressive clinical course including intracranial haemorrhage, progredient neurological deficit, medically intractable seizures, and cerebellar symptoms. The other 18 patients had a more benign clinical presentation with audible bruit, exophthalmus, chemosis, and cranial nerve dysfunction. One of the latter had symptoms of pseudotumour cerebri due to sinus occlusion with contralateral sinus stenosis. The most common location was at the transverse sinus, followed by the cavemous sinus, the tentorial ring, and the orbita. Four vessel angiography verified the diagnosis and demonstrated all fistulas, mainly supplied by branches of the external carotid artery. 16 of 18 benign lesions were treated by endovascular therapy alone. Two recent patients received adjuvant stereotactic radiosurgery. Among these 18 patients 2 remained untreated, one because of spontaneous fistula thrombosis prior to therapy and one because of poor medical condition. 12 of 16 treated benign dural fistulas were partially occluded. In 6 of them spontaneous fistula thrombosis occurred during the following months. Total endovascular obliteration was achieved in the remaining 4 patients. 7 of 12 aggressive fistulas were embolized only, one of them having additional radiosurgery. Two of them were totally obliterated and five partially. Surgery was performed in the remaining 5 aggressive fistulas. Complete microsurgical excision was achieved in 2 and partial in further two, who presented initially with a life-threatening intracerebral clot. In one early case ligation of the external carotid artery was done, which is now obsolete. Over all 20 of 28 treated patients became asymptomatic or improved clinically. 3 of the remaining 8 patients were unchanged, two deteriorated despite therapy, and 3 worsened after therapy. All of the latter complications occurred early in our series due to thromboembolic events during the procedure. One surgical patient suffered from a new facial nerve palsy postoperatively. Follow up time in all treated patients was between 1 and 139 months with a mean of 48,3 months.

Adolescent↗
PubMed1996

Repermeation of partially embolized cerebral arteriovenous malformations: a clinical, radiologic, and histologic study.

PURPOSE: To describe the pattern and time course of embolization-related tissue lesions and repermeation of the intranidal cast after endovascular embolization of cerebral arteriovenous malformations (AVMs) with N-butyl cyanoacrylate (NBCA). METHODS: We retrospectively reviewed the records of 26 patients who were treated by endovascular embolization with NBCA and subsequent surgical extirpation to look for embolization-related tissue lesions and repermeation of the cast. A residual flow through the malformation was identified on preoperative angiograms in every case. RESULTS: Pattern and time course of embolization-related tissue lesions were typical. Until 3 months after embolization, repermeation of embolized structures did not occur. In contrast, repermeation was found in every patient who had surgery later than 3 months after the first embolization (n = 13; 50%). In these cases, histologic examination of the resected nidus disclosed capillary structures inside the lumen of embolized vessels. Capillaries were traced immunohistochemically with antibodies against membrane-bound factor VIII. No parameter other than the interval between the first embolization and surgery was found to relate to the repermeation of the cast. CONCLUSION: Intranidal recapillarization can occur later than 3 months after the first embolization with NBCA if total and solid casting of the nidus was not accomplished.

Adolescent↗
PubMed1995

Radiosurgery in the treatment of cerebral AVMs.

Radiosurgery of AVM's is gaining in popularity and is advocated by many for the treatment of lesions less than 3 cm in diameter. During a 17 month period 33 patients with cerebral AVM's were treated with radiosurgery. All regions of the brain were represented in the series including brain stem. A mean follow-up of 10.8 months revealed a 6% rebleed rate and a 9% total complication rate. Multimodality therapy including embolization and surgery is recommended for the treatment of AVM's and radiosurgery is seen as an important adjunctive treatment option.

Adolescent↗
PubMed1995

GDC-system embolization for brain aneurysms - location and follow-up.

GDC (Guglielmi detachable coil)-embolization for the treatment of brain aneurysms was first published by Guglielmi in 1991 and has become an integral part of the treatment strategy for cerebral aneurysms in many places around the world. Low morbidity and mortality rates are set against the limited possibilities of aneurysm neck occlusion, especially in large necked aneurysms. Depending on the architecture and on the kind of coil distribution, recanalization of the neck is more or less frequent. Nevertheless, rebleeding rates are low. In our series of 211 brain aneurysms from March 1992 to June 1994, 74 (35%) patients underwent GDC-embolization. 4 patients received combined treatment (GDC-embolization and subsequent surgery). Follow-up angiography was performed on 41 patients (55%) at periods of 6, 12, and 24 months (mean follow-up 8 months). To demonstrate the results in a graphic display, the aneurysms were grouped according to location and size. The analysis of the follow-up results shows the highest occlusion stability in aneurysms of the basilar tip, followed by aneurysms of the PICA origin, the basilar trunk and the PCA. Less stability was obtained in aneurysms of the PCom followed by MCA, Acom and aneurysms of the internal carotid (C1, ophthalmic). Aneurysms of the posterior circulation show generally better results than those located in the anterior circulation. This makes (in combination with the increased surgical difficulties of aneurysms in the posterior fossa) the GDC-treatment especially useful for posterior circulation aneurysms.

Cerebral Angiography↗
PubMed1995

Endosaccular occlusion of basilar artery bifurcation aneurysms using electrically detachable coils.

Thirteen patients with basilar artery bifurcation aneurysms, treated by electrothrombosis using electrically detachable coils, are presented. Nine of them presented after hemorrhage, two with mass effect, and two were found coincidentally with other ruptured aneurysms. Selection for endovascular therapy was based on the following criteria: 1) poor clinical condition (Hunt and Hess III-V); 2) high surgical risk; 3) age and poor medical condition; 4) morphological features (small necked aneurysms). With endovascular Guglielmi detachable coils aneurysm occlusion ranging from 70-100% was achieved in all cases. All five small necked and two large broad necked aneurysms were totally occluded. Two large aneurysms had a 95% occlusion and two other large aneurysms were 90% occluded. In another patient with a large broad based aneurysm only an 80% occlusion was achieved, because of tortuosity of the vertebrobasilar system. Our last patient, who presented as grade V clinically, was partially treated with a 70% aneurysmal occlusion. The clinical results were excellent in 10 and good in 2. The only poor outcome was seen in the grade V patient. There was no morbidity or mortality related to therapy. The only complication was an asymptomatic dissecting aneurysm at the origin of the vertebral artery. Angiographic follow up time ranged from 6 to 20 months with a mean of 9 months. Four patients were treated too recently to have their angiographic follow up at 6 months. Two patients were lost to follow up. Clinical follow up ranged from 1 to 17 months with a mean of 8.9 months. The analysis of our cases clearly shows that aneurysms, which were densely packed with coils, especially if small necked, were less likely to be reperfused and showed a longlasting stable result. Large broad based aneurysms were more likely to be reopened by blood flow after the first procedure, especially if loosely filled with coils, and needed up to 3 interventions to achieve a satisfying result, whereas later in the series a high percentage rate of occlusion was seen after the first procedure. We consider now also a less than 100% occlusion acceptable, because most of the aneurysms will rupture at the dome, which was occluded in all our cases. We conclude, that this new endovascular method is a viable alternative in the treatment of posterior circulation aneurysms with a high surgical risk, in old patients and those in poor clinical and medical condition.

Adult↗
PubMed1993

Haemorrhage in intracerebral arteriovenous malformations: detection with MRI and comparison with clinical history.

Fifty-one patients with 59 angiographically proven cerebral arteriovenous malformations (AVMs) were examined by high-field MRI to detect blood breakdown products. Results were correlated with the history of intracranial bleeding. Evidence of previous episodes of haemorrhage was seen in 10 of 12 patients (83.3%) with verified bleeding, in 4 of 9 patients (44.4%) with symptoms which could suggest bleeding and in 6 of 30 patients (20%) with negative histories. Because of the known rebleeding rate and the increased risk of associated complications, identification of the subgroup who had had haemorrhage and should therefore be considered for surgery may be beneficial. MRI can make a contribution to management by demonstrating prior haemorrhage in patients with an inadequate clinical history.

Adolescent↗
PubMed1992

Marking of the stereotactic target point by a radiopaque silicone sphere. Technical note.

We present a simple but efficient technique for marking the site of a stereotactic biopsy. This is done by a radiopaque Barium impregnated silicone sphere, which is introduced through the stereotactic cannula and placed at the target point. This allows a postoperative check of the target point by computer tomography or Magnetic Resonance Imaging and offers a landmark for further stereotactic intervention as well as for planning of high precision radiotherapy. Moreover it gives information about the growing direction of a tumour. The silicone spheres are well tolerated; no complications have occurred so far.

Biopsy↗
PubMed1992

Comparative analysis between epidural (Gaeltec) and subdural (Camino) intracranial pressure probes.

The new fiberoptic Camino system has recently been introduced for clinical intracranial pressure (ICP) monitoring. We compared the subdural Camino system with the well-established epidural Gaeltec system in both in vitro and clinical conditions. In the in vitro experiments the intracranial vault was simulated by a tightly closed, fluid-filled box (0.9% sodium chloride) with the two probes inside. We simulated pulsating waveforms with a jet ventilator. No difference between the simulated curve patterns and values could be detected. In the clinical studies, both probes were implanted in 10 patients who had either head injuries, subarachnoid hemorrhage, or intracerebral hemorrhage. The in vivo comparison revealed no significant difference between the two systems in the recorded pressures in group 1 (ICP less than 20 mm Hg). The subdurally placed Camino probe showed insignificantly lower ICP values than did the extradural Gaeltec probe. Although group 2 (ICP greater than 20 mm Hg) waveforms were nearly identical, significant differences (p less than 0.01) in pressure measurements (systolic, diastolic, and mean) occurred (Camino, 18 +/- 3 mm Hg; Gaeltec, 27 +/- 3 mm Hg). Correlation coefficients for mean ICP values were 0.82 in group 1 and 0.49 in group 2. Problems with the Camino probe were usually mechanical and occurred in 2 patients. The problems were either easy to recognize or manifested as an ostensibly pathologic curve. No infection occurred with either system during or following implantation. The dissimilar characteristics of the two probes can be ascribed to their different extradural and subdural implantation sites. The Gaeltec probe was more durable over the period of implantation, which averaged 98 hours and ranged from 44 to 298 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Arterio-venous malformations of the basal ganglia. Surgical versus endovascular treatment.

Technique, indications and results of endovascular occlusion by superselective embolization of basal ganglia arterio-venous malformations (AVM's) are discussed, based on personal experiences with 21 cases and 41 embolizations. Follow-up was available in 17 cases. Total occlusion could be achieved in 4 cases, partial occlusion in 12, and one was extirpated microsurgically. Further haemorrhages after partial occlusion occurred in two cases. Neurological symptoms improved in 6 cases and remained unchanged in 11.

Adolescent↗
PubMed1991

Effect of sufentanil on intracranial pressure in neurosurgical patients.

The effects of sufentanil on intracranial pressure, mean arterial pressure, cerebral perfusion pressure and heart rate were studied in 20 neurosurgical intensive care unit patients. Epidural intracranial pressure probes were implanted in patients who suffered head injury, intracerebral haemorrhage or underwent tumour resection. Sufentanil was given intravenously in sequential doses of 0.5, 1.0 and 2.0 micrograms/kg. Fifteen minutes elapsed after each dose. The patients were allocated to either group 1 (baseline intracranial pressure less than 20 mmHg) or group 2 (baseline intracranial pressure greater than 20 mmHg). Intracranial pressure did not change significantly in either group. Therefore the falls in mean arterial pressure with the highest dose in both groups and with 1.0 micrograms/kg in group 2, closely reflect corresponding reductions in cerebral perfusion pressure. As sufentanil in itself exerts no effects on intracranial pressure, concomitant haemodynamic changes are the critical factor for an adequate cerebral perfusion pressure.

Adult↗
PubMed1987

[Current status of treatment of the cerebral edema].

The treatment of cerebral edema has changed during recent years. On the one hand, knowledge of the pathophysiology of brain swelling has expanded; on the other, the analysis of biodata such as intracranial pressure, cerebral blood flow, and blood volume has become routine. The methods of measuring intracranial pressure (nowadays without risk due to the use of microtipepidural probes, e.g. Gaeltec) in particular, make it possible to monitor the effects of therapy and enable us to evaluate the different therapeutic measures individually for each patient. Regarding drug treatment, osmotherapy deserves first mention, especially the polyvalent alcohols mannitol and sorbitol, but in spite of possible side effects, glycerin as well. Knowledge of the mechanism of osmotic therapy leads to the proper concept of treatment with bolus administration under control of serum osmolarity and intracranial pressure. Corticosteroids only effectively influence the cerebral edema caused by tumor. The treatment of posttraumatic (and postoperative) cerebral edema is described controversally in the literature. As the side-effects of cortisone therapy are under control, corticosteroids may also be included in the treatment of therapy-resistant cerebral edema. Acting together with sedative drugs, procaine derivatives help to reduce intracranial pressure peaks during intensive care measures. Barbiturates are used as sedatives or in a loading dose until burst suppression is seen in the EEG. The risk of hemodynamic side effects such as reduced cardiac output and cerebral perfusion pressure is decreased by measuring pulmonary arterial pressure and the use of catecholamines. The acidotic impairment of cerebral autoregulation can be regulated using THAM (thrometamine) and the response of the vascular system to hypocapnia can be improved.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗