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Biomedical subjects

C G Drake

Publications and source records attributed to C G Drake.

At least 55 records · Page 3Linked to original sources
PubMed1986

Posterior fossa arteriovenous malformations.

The authors report their treatment of 66 infratentorial arteriovenous malformations (AVM's) in patients aged 5 to 69 years. Sixty-one of them presented with hemorrhage, three with headache, and two with focal neurological deficits. Five patients underwent surgical exploration only, one was treated with ventriculostomy, three had ligation of the AVM feeding arteries, four underwent intraoperative embolization, and two had pontine hematomas removed; complete excision was attempted in 51 patients and accomplished in 47. Twelve of the patients also had aneurysms (nine of which had ruptured). Of this series, 71% had a good result, 14% a poor result, and 15% died. Most of the operative morbidity was due to massive postoperative hemorrhage, probably related to inadequate hemostasis.

Adolescent↗
PubMed1986

Unusual clinical manifestations of dural arteriovenous malformations.

Fourteen patients had classical angiographic findings of intracranial dural arteriovenous malformations (AVM's). They presented with unusual central neurological signs and symptoms, including visual disturbances, hemiparesis, speech disturbances, gait ataxia, diffuse increased intracranial pressure, and intracranial hemorrhage. In 12 of the 14 patients there was a direct correlation between the clinical presentation and the venous drainage characteristics of the AVM's. The symptoms were probably related to a regional steal phenomenon in two patients. Six patients had direct surgical excision of the dural AVM. Five patients underwent endovascular embolization of the malformation and, in one case, the AVM was removed surgically after embolization. In one patient, the external carotid artery in the neck was ligated. Ten of the 14 patients had substantial clinical improvement or cure. A complete anatomical obliteration of the malformation was obtained in seven cases. None of the patients deteriorated clinically after therapy.

Adult↗
PubMed1986

Diagnosis and endovascular therapy of vascular lesions in the cavernous sinus.

One hundred and twenty-eight lesions of the cavernous sinus were diagnosed and treated by endovascular embolization alone or combined with postembolization surgery. All patients presented with acute or subacute cavernous sinus syndrome. A complete angiographic evaluation included bilateral internal and external carotid and vertebral angiography. A total of 88 carotid-cavernous (c-c) fistulae (68 traumatic and 20 spontaneous) and 40 giant aneurysms were demonstrated. A complete anatomic cure or satisfactory clinical improvement was seen in 67 of 68 traumatic fistulae, in 14 of 20 spontaneous c-c fistulae and in 38 of 40 giant intracavernous aneurysms. An overall 15 per cent immediate and 2.7 per cent long-term morbidity with one death was observed. The technical and clinical complications involving endovascular therapy of each specific intracavernous vascular lesion are analyzed.

Adult↗
PubMed1984

Clinico-radiological spectrum of giant supraclinoid internal carotid artery aneurysms. Observations in 93 cases.

A review of a series of 312 giant intracranial aneurysms treated at University Hospital in London, Ontario, showed that 93 of those aneurysms were located between the intracavernous portion and the bifurcation of the internal carotid artery. Sixty-five of those aneurysms were carotid ophthalmic, 12 were located in the internal carotid-posterior communicating-anterior choroidal artery regions and 16 involved the internal carotid artery bifurcation. For the majority, clinical presentation was related to the mass of the aneurysms and compression of surrounding structures such as visual pathways, ocular motor cranial nerves, the fifth nerve, and hypothalamic-pituitary axis. Fourteen patients presented with subarachnoid hemorrhage. Cerebral angiography, computed tomography and xenon inhalation studies of cerebral blood flow were the tools used to study the morphology of the aneurysm and dynamics of the circle of Willis.

Brain↗
PubMed1984

Subarachnoid hemorrhage from intracranial dissecting aneurysm.

Rupture of an intracranial dissecting aneurysm is a rare but dangerous event. The authors' experience with 14 cases of these lesions on the vertebrobasilar circulation suggests that these aneurysms have typical angiographic silhouettes and that, at least in the vertebral artery, they are treatable by proximal arterial occlusion.

Adult↗
PubMed1984

Vertebrobasilar occlusion therapy of giant aneurysms. Significance of angiographic morphology of the posterior communicating arteries.

The clinical and angiographic records were reviewed for 71 patients with giant aneurysms of the posterior circulation, who underwent therapeutic occlusion of the basilar artery or both vertebral arteries. This treatment is used when the aneurysm neck cannot be surgically clipped, and occlusion of the parent artery is performed to initiate thrombosis within the lumen. In these cases, collateral blood flow to the brain stem is supplied mainly by the posterior communicating arteries. Consequently, their angiographic morphology (patency, size, and number) is demonstrated as a preoperative indicator of whether the patient will be able to tolerate vertebrobasilar occlusion. Vertebral angiograms with carotid artery compression (the Allcock test) will often be needed to provide this information. The data relating posterior communicating artery morphology to clinical outcome in 71 cases of attempted vertebrobasilar occlusion are presented. The use and accuracy of carotid artery compression studies are also discussed. It is essential for the radiologist to supply the neurosurgeon with this valuable information in every case of giant posterior circulation aneurysm.

Basilar Artery↗
PubMed1984

Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations. Experience with 20 cases.

Sixty-five carotid-cavernous fistulas were studied at University Hospital, London, Canada, from 1978 to 1982, 20 of which fulfilled the clinical and angiographic criteria of a spontaneous carotid-cavernous fistula. Of these 20 fistulas, 17 were unilateral, and three were bilateral. In 18 cases the angiographic findings were typical of an arteriovenous malformation (AVM), and in two a ruptured giant intracavernous aneurysm was found. These patients were treated according to whether they had a nonresolving or progressive cavernous sinus syndrome or deterioration of vision. The cavernous dural AVM's were treated with polyvinyl-alcohol and/or isobutyl-2-cyanoacrylate (IBCA) embolization of the external carotid artery blood supply. Two patients underwent postembolization surgical procedures. The detachable balloon technique was used to occlude the fistulas associated with the two giant ruptured intracavernous aneurysms and a small dural intracavernous AVM. Eight patients received no therapy; in two, spontaneous obliteration of the fistula occurred. Of the nine cavernous AVM's embolized with particles and/or IBCA, successful transvascular embolization was achieved in seven cases, and partial embolization followed by surgery in two cases. Successful balloon obliteration of the giant intracavernous ruptured aneurysm was obtained in two cases. In one patient, right hemiplegia with aphasia resulted from reflux of IBCA emboli through the artery of the foramen rotundum into the left middle cerebral artery.

Adolescent↗
PubMed1984

Failed aneurysm surgery. Reoperation in 115 cases.

Failure to obliterate intracranial aneurysms completely during initial surgery still occurs in spite of recent technical advances. Of the 115 reoperations reported in this series, 89% of the aneurysms were obliterated, and 84% of the patients had a satisfactory outcome. Twelve patients had poor results, three (2.6%) of whom were in poor condition before reoperation.

Cerebral Angiography↗
PubMed1984

Gordon Murray lecture. Evolution of intracranial aneurysm surgery.

In the late 19th and first half of the 20th centuries, intracranial aneurysms were seldom treated and when they were, Hunterian occlusion of the carotid artery was almost always performed. Although a few pioneer intracranial procedures were done in the 1930s, it was not until after World War II that a major effort was made to obliterate aneurysms during craniotomy. Rebleeding before operation and ischemia with vasospasm were the chief causes of the high morbidity associated with early surgical attempts and even now they remain a problem. However, since the operating microscope was introduced and with modern neuro-anesthesia, intracranial surgery has become routine and reasonably safe, especially since simple modification of the ischemic syndrome by volume expansion and hypertension has proved effective. A return to early operation is now under evaluation. Treatment of aneurysms on the basilar circulation came later and experience in dealing with giant aneurysms on both the carotid and basilar systems is now accumulating.

Basilar Artery↗
PubMed1983

'Foreign' particles in encephalic vascular malformations.

Among 84 surgically resected arteriovenous malformations (AVMs), four were found to have refractile foreign particles lined by endothelium in the vessel walls. In three cases, this was associated with granuloma formation. The particles were probably introduced during cerebral angiography. They represent a not unusual pathologic finding, are relatively more common in AVMs than in other neurosurgically excised lesions, and may have clinical significance, especially if abundant.

Adult↗
PubMed1983

Intraoperative embolization of cerebral arteriovenous malformations in the awake patient.

Fourteen cases of relatively large AVMs within important functional cortical areas, the majority in the dominant hemisphere, are discussed; these AVMs have undergone varying degrees of obliteration by intravascular embolization with IBC in the operating room, under neuroleptanalgesia and local anesthesia. Our belief is that while there have been complications these can hopefully be avoided in the future and that with the evolution of the present technology there will be further refinements in the technique which will eventually allow predictable and definitive treatment of such AVMs.

Adolescent↗
PubMed1983

Peripheral aneurysms of the cerebellar arteries. Review of 16 cases.

True congenital peripheral aneurysms of the cerebral arteries are rare and may constitute a special group. The authors report on 16 cases of peripheral aneurysms of the cerebellar arteries; six of them arising from vessels feeding arteriovenous malformations (AVM's). The possible causative role of increased blood flow versus developmental factors in the frequent occurrence in cases of AVM of this otherwise rare type of aneurysm is discussed. In five of the six cases with AVM's (one dural and five parenchymal), the aneurysm rather than the AVM proved to be the source of the hemorrhage. The occurrence of spasm was in inverse proportion to the distance of the aneurysm from the main arteries. The surgical result was good in 11 cases. One patient with associated AVM died, and four patients had residual symptoms.

Adult↗
PubMed1983

Balloon occlusion of a spontaneous fistula of the posterior inferior cerebellar artery. Case report.

A case is reported of a large spontaneous right posterior inferior cerebellar artery fistula in which the patient presented with a right cerebellopontine (CP) angle and right cerebellar syndrome. The patient was successfully treated by balloon occlusion at the fistula site. The location of the arteriovenous fistula, the mass effect of its enlarged draining veins on the cerebellum and CP angle structures, and the simple therapeutic endovascular occlusion with a detachable balloon make this case unique.

Adult↗