Biomedical subjects
Publications and source records attributed to D Reizine.
MRI appears to be a very valuable examination to study pathology of the vertebral artery. The examination must include T1 and T2 sequences and scans in three planes. The use of oblique scans allows the planes of section to be adjusted to the course of the artery. MRI can therefore demonstrate abnormalities of flow caused by intrinsic or compressive pathology.
58 patients with a juvenile nasopharyngeal angiofibroma have been treated by a combined neuroradiological-surgical method. In the cases with smaller tumor extension, fed only by the external carotid arteries or with only slight participation of the internal carotid arteries, the external carotid arteries alone have been embolized using particles. In the cases with marked participation of the internal carotid arteries these vessels were also embolized. In the first group there have been no complications and no recurrences. In the latter (31 cases) there have been three temporary minor complications and 11 recurrences.
Direct arteriovenous fistulas originating from the terminal branches of the external carotid artery constitute a rare form of facial vascular disorders. They are usually well tolerated and do not grow. Surgical removal or ligation of the fistula may be hazardous to the facial nerve or lead to aesthetic insult. Based on our experience in five cases treated successfully with detachable balloons, we propose this technique as an alternative to surgery.
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Thirty-four patients with angiographically proved arteriovenous malformations of the spinal cord were studied between May 1986 and July 1987. Examinations were performed on a CGR 5000 Magniscan 0.5-T scanner with a surface coil in all cases, and multislices in both T1- and T2-weighted sequences were obtained in sagittal and axial planes. The results showed that MR can accurately diagnose all cases of intramedullary arteriovenous malformations, since transverse images were able to precisely locate the nidus within the spinal cord. Other types of spinal cord arteriovenous malformations were also studied (perimedullary fistulae and dural arteriovenous fistula), and the findings confirmed the value of MR in the characterization of these lesions as well.
We report two cases of multiple aneurysm complicating bacterial endocarditis and involving the hepatic, renal and superior mesenteric arteries. The aneurysms were treated by the superselective embolization technique hitherto restricted to cerebral arteries. The first patient had been operated upon for mitral valve endocarditis. Because of a persistent anicteric cholestasis, repeat ultrasonography and computerized tomographic scan were performed which revealed two intrahepatic aneurysms associated, at arteriography, with an aneurysm of the superior mesenteric artery. The patient underwent superselective embolization of one of the intrahepatic aneurysms, then of the superior mesenteric artery aneurysm. Angiographic cure was obtained and persists after a 17-month follow-up. In the second patient, persistent clinical and biochemical hepatic abnormalities after mitral and aortic valve replacements for endocarditis prompted us to perform an ultrasonography which showed a large hepatic aneurysm, and an abdominal arteriography which disclosed the presence of several aneurysms. Because of its size and suspected fissuration, the hepatic aneurysm was treated by superselective embolization, and this was followed by embolization of a renal artery. The immediate post-treatment period was uneventful, and complete angiographic cure was confirmed after 6 months. Superselective embolization seems to give good results at mid-term and should therefore be considered for fragile patients with multiple abdominal aneurysms.
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Forty-three patients with arterio-venous fistulae of the dura of the transverse sinus with a complaint of tinnitus are reviewed, with a follow-up of 12 months to 11 years. 34 patients were embolized, 2 treated surgically, and 7 were untreated. Embolization appears to have been beneficial. The frequently benign nature of this abnormality must be emphasized, and serious psychological study of the patient must be made before deciding on therapy.
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Explore the source record for details and available documents.
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Technological progress has resulted in embolization being adapted as treatment of choice for arteriovenous malformations in the region of Galen's ampulla. To ensure recovery it is essential to conduct treatment at an early stage, to adapt it to the morphologic type of malformation and to investigate possible associated thrombosis requiring anticoagulant therapy. A shunt operation may be necessary if hydrocephalus fails to regress.
The construction of a propulsion chamber system is simplified by separating the different elements of its functions. For injections of the propulsive fluid the coiling chamber is bypassed, leaving its contents untouched. The diameter of the coaxial system is reduced by minimizing the space between the two catheters. Consequently the puncture site becomes small (a balloon-catheter may be introduced through a 16 G catheter needle) allowing punctures proximal to lesions (e.g. puncture of the axillary a. or the carotid a.) and thus shortening the length of the coaxial catheter system. The risk of thrombus formation diminishes and renders heparinization dispensable. Control angiographies are separated from the coaxial system.
The vertebral artery and vein are mostly involved, but other sites exist, especially between the inferior thyroid artery and the internal jugular vein. Five cases were treated in our department. All the fistulas were closed by percutaneous transarterial occlusion with a detachable balloon. The mechanisms of fistula formation are discussed. The different therapeutic methods (surgical ligature and endovascular occlusion) are discussed. It would appear the endovascular method gives the best results.
Twenty-two cases of vertebral arteriovenous fistulas treated by embolization are reported. Although such fistulas are usually asymptomatic they may be occasionally responsible for tinnitus. Neurologic complications are exceptional. Spontaneous fistulas have been found predominantly in the C1-C2 region (9 of 13 cases), while post-traumatic fistulas were located in the C5-C6 region and were often iatrogenic in origin (7 of 9 cases). In 17 cases embolization caused definitive closure of the fistula, while the vertebral artery remained patent. In three patients it was also necessary to close the vertebral artery in order to occlude the fistula. In two instances, endovascular management failed to obliterate the fistula. At present, endovascular treatment is the simplest and one of the least aggressive therapeutic approaches to vertebral arteriovenous fistulas.
Radiologic studies of 57 solitary vertebral hemangiomas (VHs) were reviewed to find radiographic and computed tomographic (CT) criteria by which to distinguish asymptomatic lesions from those compressing the spinal cord. Six features were seen significantly more often in those compressing the cord: location between T-3 and T-9, involvement of the entire vertebral body, extension to the neural arch, an expanded cortex with indistinct margins, an irregular honeycomb pattern, and soft-tissue mass. Contrast material-enhanced CT scans and selective spinal angiograms demonstrated extension into the spinal canal. In patients with a VH and back pain of uncertain origin, the presence of three or more of these signs may indicate a potentially symptomatic VH. In such patients, spinal angiography and, in some cases, embolization, are indicated.