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Biomedical subjects

Kieran J Murphy

Publications and source records attributed to Kieran J Murphy.

26 records · Page 2Linked to original sources
PubMed2002

Routine intraoperative angiography during aneurysm surgery.

OBJECT: The routine use of intraoperative angiography as an aid in the surgical treatment of aneurysms is uncommon. The advantages of the ability to visualize residual aneurysm or unintended occlusion of parent vessels intraoperatively must be weighed against the complications associated with repeated angiography and prolonged vascular access. The authors reviewed the results of their routine use of intraoperative angiography to determine its safety and efficacy. METHODS: Prospectively gathered data from all aneurysm cases treated surgically between January 1996 and June 2000 were reviewed. A total of 303 operations were performed in 284 patients with aneurysms; 24 patients also underwent postoperative angiography. Findings on intraoperative angiographic studies prompted reexploration and clip readjustment in 37 (11%) of the 337 aneurysms clipped. Angiography revealed parent vessel occlusion in 10 cases (3%), residual aneurysm in 22 cases (6.5%), and both residual lesion and parent vessel occlusion in five cases (1.5%). When compared with subsequent postoperative imaging, false-negative results were found on two intraoperative angiograms (8.3%) and a false-positive result was found on one (4.2%). Postoperative angiograms obtained in both false-negative cases revealed residual anterior communicating artery aneurysms. Both of these aneurysms also subsequently rebled, requiring reoperation. In the group that underwent intraoperative angiography, in 303 operations eight patients (2.6%) suffered complications, of which only one was neurological. CONCLUSIONS: In the surgical treatment of intracranial aneurysms, the use of routine intraoperative angiography is safe and helpful in a significant number of cases, although it does not replace careful intraoperative inspection of the surgical field.

Adolescent↗
PubMed2002

CT findings in the infantile form of citrullinemia.

Citrullinemia is a rare autosomal recessive inborn error of the urea cycle due to a deficiency in argininosuccinic acid synthetase. We present two cases of the infantile form of citrullinemia in which CT revealed bilateral and symmetric corticosubcortical hypoattenuating areas, ulegyric changes, and atrophy in the frontal lobes, as well as atrophy in the gyrus cinguli, insulae, and temporal lobes.

Atrophy↗
PubMed2002

Tailored cognitive testing with provocative amobarbital injection preceding AVM embolization.

BACKGROUND AND PURPOSE: Transarterial embolization of cerebral arteriovenous malformations (AVMs) has been associated with postprocedural neurologic complications in 7-39% of patients. We sought to determine whether a method of targeted neurologic and cognitive testing during AVM embolization reduces the incidence of focal cognitive and other neurologic deficits associated with the procedure. METHODS: A cognitive neurologist extensively examined 12 patients prior to AVM embolization. In each patient, a battery of tests tailored to their specific abilities was developed by using stimuli selected from standard and experimental cognitive tests to probe specific brain regions related to the location of the AVM. In each feeder vessel to be embolized, a 50-mg bolus of sodium amobarbital was superselectively administered through a microcatheter; this was followed immediately by neurologic and cognitive testing with the tailored battery. After testing, the position of the microcatheter tip was checked with fluoroscopy. If the provocative test results were negative, the evaluated feeder was embolized with N-butyl cyanoacrylate glue. RESULTS: Although results with 27 of 29 provocative amobarbital injections were negative, results with two injections in two different individuals revealed cognitive deficits during tailored provocative testing. In both, the evoked deficits resolved with dissipation of the amobarbital effect; the feeder vessels were not embolized. Neurologic and cognitive evaluation after each of 27 embolizations revealed no major or minor deficits. CONCLUSION: In our experience, provocative amobarbital testing prior to AVM embolization was helpful in identifying vascular territories where embolization may lead to neurologic and cognitive deficits.

Adult↗
PubMed2002

Angiographic and embryologic considerations in five cases of middle cerebral artery fenestration.

Five cases of unilateral middle cerebral artery fenestration were observed during the prospective evaluation of 1466 consecutive cerebral angiograms (0.43% of 1170 patients) between January 1999 and July 2001. In each case, an early branching temporopolar artery was seen to arise from the inferior limb of the fenestrated segment. This finding suggests that early branching temporopolar arteries may participate in the formation of middle cerebral artery fenestration by interfering with the normal fetal development of the middle cerebral artery.

Adult↗
PubMedDate not supplied

Is percutaneous vertebroplasty without pretreatment venography safe? Evaluation of 205 consecutives procedures.

BACKGROUND AND PURPOSE: Vertebral venography has been advocated before bone cement injection when performing percutaneous vertebroplasty (PV) for benign or malignant lesions of the spine. Although venography can document sites of potential leakage during subsequent cement application, stagnant contrast agent renders the cement injection more difficult to monitor, and an allergic reaction to contrast agent remains a potential risk. We evaluated our experience with PV without prior venographic evaluation. METHODS: Two hundred five consecutive PV procedures performed in 137 patients without pretreatment venography were evaluated for complications linked to bone cement injection. Treated lesions were 172 benign compression fractures, 27 metastases, two hemangiomas, and four multiple myelomas. PV was performed with a single-pedicle technique in 146 cases and a two-pedicle technique in 59 cases. RESULTS: No major complication occurred in our series. Three minor complications (1.5%) were documented: One patient had a transient episode of arterial hypotension during cement injection, without cement leak; one patient had a spontaneously resolving patch of cutaneous hypoesthesia at the puncture site; and one patient had a radiculopathy four levels above the treated level, not caused by cement deposition, and successfully treated with a nerve block. None of these three minor complications were related to cement leakage. CONCLUSION: PV can, in our experience, be performed safely without prior angiographic evaluation of the vertebral venous system.

Adult↗
PubMedDate not supplied

Acute vasogenic edema induced by thrombosis of a giant intracranial aneurysm: a cause of pseudostroke after therapeutic occlusion of the parent vessel.

A 16-year-old male adolescent presenting with acute retro-orbital pain underwent emergent internal carotid occlusion for a giant cavernous aneurysm. Three weeks later, the patient complained of headache and right hemiparesis, which suggested an acute stroke. CT and MR imaging revealed vasogenic brain edema without infarct. The symptoms rapidly resolved with steroid therapy. Follow-up CT showed resolution of the edema. The imaging characteristics, clinical implications, and etiology of vasogenic edema occurring after thrombosis of a giant intracranial aneurysm are discussed.

Acute Disease↗