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Biomedical subjects

C M Putman

Publications and source records attributed to C M Putman.

33 records · Page 2Linked to original sources
PubMed1997

Pituitary gland enlargement secondary to dural arteriovenous fistula in the cavernous sinus: appearance at MR imaging.

PURPOSE: To evaluate pituitary gland size in cases of dural arteriovenous (AV) fistula in the cavernous sinus and to correlate the size with the degree of AV fistula. MATERIALS AND METHODS: Magnetic resonance images in 21 patients with angiographically proved dural AV fistula of the cavernous sinus were retrospectively reviewed. In four patients, findings obtained before and after embolization therapy were compared. RESULTS: The 21 patients were divided into group 1 (severe AV fistula) and group 2 (moderate or mild AV fistula). The superior contour of the pituitary gland was convex or flat in group 1 and flat or concave in group 2. The mean height of the pituitary gland was 9.4 mm +/- 1.5 (standard deviation) in group 1 and 6.7 mm +/- 1.2 in group 2 (P = .0002). After embolization therapy, pituitary gland height decreased and signal intensity voids improved in the four patients and no AV fistula was observed in three. CONCLUSION: In cases of severe dural AV fistula in the cavernous sinus, the pituitary gland is enlarged, which should not be misdiagnosed as pathologic.

Adult↗
PubMed1997

Postoperative changes in the brain: MR imaging findings in patients without neoplasms.

PURPOSE: To determine the time course of postoperative changes in the brain by using magnetic resonance (MR) imaging. MATERIALS AND METHODS: Contrast material-enhanced MR images (32 preoperative, 161 postoperative) in 95 patients who underwent temporal lobectomy for treatment of nonneoplastic epilepsy were evaluated for enhancement pattern at the surgical margin and for the presence of dural enhancement, fluid, and air. Images were obtained 9 hours to 5.6 years after surgery. RESULTS: Surgical margin contrast enhancement was present and increased from 20 hours to 29 days after surgery. The predominant early (days 0-5) pattern was thin linear enhancement (16 of 18 [89%] images). The later (days 6-29) pattern was thick linear or nodular (tumorlike appearance) (11 of 18 [61%] images). Surgical margin enhancement was absent after day 30, although few data were collected 1-5 months after surgery. Dural enhancement was seen on 96 of 97 (99%) postoperative MR images. Extraaxial fluid was seen on all 46 images obtained during the first 30 days and was absent by day 51. Intracranial air was present on 31 of 35 (89%) images obtained during the first 4 days but was absent after day 5. CONCLUSION: Knowledge of the evolution of contrast enhancement patterns on postoperative MR images of the brain can help in differentiating benign from neoplastic changes.

Adolescent↗
PubMed1996

Use of large-caliber coronary guiding catheters for neurointerventional applications.

The use of certain large-caliber (ie, 7F to 9F) coronary guiding catheters for selected neuroendovascular procedures is described in the context of surveying recently developed neurovascular guiding catheters. These large-caliber guiding catheters have proved useful in situations requiring proximal access to tortuous brachiocephalic arteries, permitting coaxial delivery of relatively large neurointerventional devices, such as most detachable balloons and 5F percutaneous transluminal angioplasty catheters. These large-caliber coronary guiding catheters have some important advantages over both old and new neurovascular guiding catheters, including favorably preshaped configurations and superior torque control. These features permit relatively easy direct selective catheterization of unfavorable vascular anatomy resulting from dolichoectasia of the aortic arch and great vessels.

Angioplasty, Balloon↗
PubMed1996

Endovascular therapy for the carotid blowout syndrome in head and neck surgical patients: diagnostic and managerial considerations.

PURPOSE: To review our institution's recent experience with patients with carotid blowout syndrome who were referred for emergency diagnostic angiography and endovascular therapy. METHODS: Eighteen consecutive patients who had had surgery for cancer of the head and neck and in whom carotid blowout syndrome had occurred were referred to our service in accordance with a standardized protocol. RESULTS: Twenty-three angiographic pathoetiologic conditions were diagnosed in the 18 patients; the majority of these were pseudoaneurysms involving various segments of the carotid system. Multiple lesions were detected in five patients. Most patients were treated by means of permanent balloon occlusion; in 8 patients with either multiple lesions or impending rupture requiring flap reconstruction, a composite permanent balloon occlusion of the affected carotid system was performed. Hyperacute hemorrhages were arrested in all cases. Hemorrhages reoccurred in 2 cases, and in 2 patients who had permanent balloon occlusion of the internal carotid artery, transient ischemic attacks occurred, which appeared to be related to temporary collateral reserve failure. No permanent neurologic complications ensued. CONCLUSION: Our recent experience with carotid blowout syndrome suggests that this clinical diagnosis represents a heterogeneous group of angiographic pathoetiologies that the physician should evaluate carefully before proceeding with endovascular therapy. Specific endovascular approaches depend on the pathoetiologic mechanism of active or impending hemorrhage and the urgency with which intervention is required.

Adult↗
PubMed1996

Endovascular therapeutic approach to peripheral aneurysms of the superior cerebellar artery.

Peripheral aneurysms of the superior cerebellar artery may be difficult to treat surgically owing to their inaccessibility and to the frequent inability to preserve the involved parent artery. In fact, for most cases, surgical treatment consists of proximal parent artery occlusion and/or trapping with surgical clips. An equivalent endovascular therapeutic approach to these lesions may be an attractive alternative method of management. We describe two cases of peripheral superior cerebellar artery aneurysms that were treated successfully with endovascular embolization.

Adult↗
PubMed1996

Exceptional multiplicity of cerebral arteriovenous malformations associated with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome).

PURPOSE: To describe the clinical and imaging features of seven patients with hereditary hemorrhagic telangiectasia and an exceptional number of cerebral arteriovenous malformations (AVMs). METHODS: One hundred thirty-six patients from a dedicated hereditary hemorrhagic telangiectasia clinic were screened systematically for cerebral AVMs by means of MR imaging. Thirty-one were found to have abnormalities suggestive of a vascular malformation. Eighteen of these 31 patients subsequently underwent diagnostic cerebral angiography. RESULTS: Of the 18 patients who had cerebral angiography, all were found to have at least one AVM and seven were found to have three or more AVMs. The number of cerebral AVMs detected ranged from three to nine. At angiography, the AVMs varied in size from 3 to 25 mm in maximal dimension and consisted of a poorly defined plexiform nidus that typically had a single arterial feeding pedicle and a single draining vein. The two largest AVMs (20- and 25-mm nidus, respectively) contained intranidal aneurysms. Treatment included embolization, surgical excision, or follow-up management. CONCLUSIONS: Multiple cerebral AVMs are associated with hereditary hemorrhagic telangiectasia and further highlight the uniqueness of central nervous system involvement by this systemic angiodysplasia. MR imaging can underestimate the number and size of cerebral AVMs; therefore, catheter angiography is necessary to establish the extent of central nervous system involvement in this disorder.

Adult↗
PubMed1996

Sentinel transoral hemorrhage from a pseudoaneurysm of the internal maxillary artery: a complication of CT-guided biopsy of the masticator space.

A patient presented with transoral hemorrhage 3 months after CT-guided percutaneous biopsy of the masticator space, prompting concern about sentinel hemorrhage from impending carotid artery rupture related to prior radical head and neck surgery and radiation therapy. Angiographic evaluation showed the internal carotid artery to be normal but demonstrated a pseudoaneurysm of the buccal branch of the internal maxillary artery exactly corresponding to the site of prior fine-needle biopsy.

Aneurysm, False↗
PubMed1995

Endovascular therapy for surgical diseases of the cranial base.

Endovascular therapy for surgical diseases of the cranial base is in many ways a survey of the field of interventional neuroradiology (or endovascular neurosurgery). As the multidisciplinary focus to the treatment of various cranial base diseases has become increasingly complex, the role of endovascular therapy as both a primary and secondary treatment modality has expanded. A comprehensive review of this role is presented.

Arteriovenous Fistula↗
PubMedDate not supplied

CT angiography in the rapid triage of patients with hyperacute stroke to intraarterial thrombolysis: accuracy in the detection of large vessel thrombus.

PURPOSE: The purpose of this work was to evaluate the accuracy of CT angiography (CTA) for the detection of large vessel intracranial thrombus in clinically suspected hyperacute (<6 h) stroke patients. METHOD: Forty-four consecutive intraarterial thrombolysis candidates underwent noncontrast CT followed immediately by CTA. Axial source and two-dimensional collapsed maximum intensity projection reformatted CTA images were rated for the presence or absence of large vessel occlusion. Five hundred seventy-two circle-of-Willis vessels were reviewed; arteriographic correlation was available for 224 of these. RESULTS: Sensitivity and specificity for the detection of large vessel occlusion were 98.4 and 98.1%; accuracy, calculated using receiver operating characteristic analysis, was 99%. Mean time for acquisition, reconstruction, and analysis of CTA images was approximately 15 min. CONCLUSION: CTA is highly accurate for the detection and exclusion of large vessel intracranial occlusion and may therefore be valuable in the rapid triage of hyperacute stroke patients to intraarterial thrombolytic treatment.

Adult↗
PubMedDate not supplied

Recurrent carotid blowout syndrome: diagnostic and therapeutic challenges in a newly recognized subgroup of patients.

BACKGROUND AND PURPOSE: To our knowledge, recurrent carotid blowout syndrome (rCBS) has not been well described. Our purpose was to review our institution's recent experience with patients who presented with multiple episodes of carotid blowout syndrome (CBS), and who were referred for emergent diagnostic angiography and endovascular therapy. METHODS: We retrospectively reviewed the last 46 consecutive patients who had a clinical diagnosis of CBS. All patients were examined and treated prospectively according to a standardized protocol. Most patients (43 of 46) had undergone extensive primary and salvage radical surgery with intraoperative brachytherapy or external beam radiation or both. The remaining three patients had either traumatic or iatrogenic CBS. RESULTS: Twelve patients (26%) in our series had more than one episode of CBS in which a total of 32 (20 recurrent) events were observed (average 2.7, range 2-4). Intervals of rCBS ranged from 1 day to 6 years. Thirteen (65%) of 20 recurrent events were attributed to progressive disease (PD), and seven (35%) of 20 to treatment failures (TFs). In the PD group, seven (54%) of 13 had recurrent ipsilateral disease, and six (46%) of 13 had recurrent contralateral disease. Etiologies of rCBS were as follows: seven exposed carotids; seven carotid pseudoaneurysms; eight small-branch pseudoaneurysms; five tumor hemorrhages; three hyperemic/ulcerated wounds; and one aortic arch rupture. Twenty-seven of 32 events were treated with endovascular therapy, which included the following: nine carotid occlusions; 11 small-branch embolizations; three transarterial tumor embolizations; one carotid stent; and two direct-puncture embolizations. Four of six TFs were retreated successfully with endovascular therapy; the remaining two TFs were managed successfully by surgery. In the PD group, hemorrhagic complications of rCBS were managed successfully in all but one patient, who died. No permanent neurologic or ophthalmologic complications occurred. CONCLUSION: Recurrent CBS is a frequently encountered problem in which most cases are caused by PD resulting from both multifocal iatrogenic arteriopathy and occasional wound complications that are characteristic of aggressively managed head and neck surgical patients. Initial TFs are encountered often as well. Despite the diagnostic and therapeutic challenges of rCBS, most cases can be retreated effectively.

Adolescent↗
PubMedDate not supplied

Patient-specific computational fluid dynamics modeling of anterior communicating artery aneurysms: a study of the sensitivity of intra-aneurysmal flow patterns to flow conditions in the carotid arteries.

BACKGROUND AND PURPOSE: The purpose of this study was to investigate the effects of unequal physiologic flow conditions in the internal carotid arteries (ICAs) on the hemodynamics of anterior communicating artery aneurysms. METHODS: Patient-specific computational fluid dynamics models of 2 cerebral aneurysms were constructed from bilateral 3D rotational angiograms. The flow dynamics of the aneurysm sac were analyzed under the effect of unequal mean flows, phase shifts, and waveforms between the ICAs. A total of 9 simulations were performed for each patient; cine flow velocity simulations and unsteady wall shear stress (WSS) maps were created for each flow condition. Time-dependent curves of average WSS magnitude over selected regions on the aneurysms were constructed. RESULTS: Mean flow unbalances in the feeding vessels tended to shift the regions of elevated WSS towards the dominating inflow jet and to change the magnitude of the WSS peaks. The overall qualitative appearance of the WSS distribution and velocity simulations was not substantially affected. Phase and waveform asymmetry increased the temporal complexity of the hemodynamic patterns and tended to destabilize the flow pattern. CONCLUSIONS: Differences in the relative phase and waveform shape in ICAs can significantly affect the complexity and stability of the hemodynamic force distributions. The magnitude of these effects is related to the geometry of the aneurysm and the feeding vessels. Conditions affecting the flow characteristics in the parent arteries of cerebral aneurysms with more than 1 avenue of inflow should be incorporated into flow models.

Angiography↗
PubMedDate not supplied

True malignant mixed tumor (carcinosarcoma) of tonsillar minor salivary gland origin: diagnostic imaging and endovascular therapeutic embolization.

We report a case of carcinosarcoma of the minor salivary glands of the left palatine tonsil, an especially rare location. Imaging characteristics assessed at CT, MR imaging, and angiography are presented. In addition, we describe our experience with preoperative therapeutic endovascular embolization of this hypervascular tumor.

Arteries↗