Search PubMed⌕ Search

Biomedical subjects

M E Linskey

Publications and source records attributed to M E Linskey.

36 records · Page 2Linked to original sources
PubMed1992

Emergency embolectomy for embolic occlusion of the middle cerebral artery after internal carotid artery balloon test occlusion. Case report.

Balloon test occlusion of the internal carotid artery (ICA) is useful in preoperatively assessing the risk of temporary occlusion or permanent sacrifice of the carotid artery. The incidence of symptomatic complications from this procedure is 1.7%. The case is reported of a 57-year-old woman in whom a balloon test occlusion of the left ICA was attempted. She developed a left ICA dissection/occlusion with subsequent embolization to the left middle cerebral artery, leading to right-sided hemiplegia and expressive aphasia. She was successfully treated by an emergency embolectomy followed by surgical repair of the left ICA, with an excellent outcome. This case represents the most serious complication encountered by the authors in more than 300 balloon test occlusions. Means of avoiding this complication during balloon test occlusion as well as the important factors in managing this problem are emphasized.

Carotid Artery, Internal↗
PubMed1992

Stereotactic radiosurgery in the treatment of patients with acoustic tumors.

Stereotactic radiosurgery is performed under local anesthesia, and most patients can be discharged from the hospital within 24 hours of treatment. All patients in our series returned to their preoperative level of employment or function within 5 to 7 days of treatment, and this functional level was maintained over the period of follow-up. "Tumor control" was achieved in 96% of patients during an average follow-up of 1.7 years. Tumor shrinkage occurred in 45% of patients who had at least 1.5 years of follow-up. Useful hearing preservation rates were 50% at 6 months and 30% 1 year after treatment. New delayed facial or trigeminal neuropathy occurred in 34% and 32% of patients, respectively, with a median onset of 5 to 6 months after treatment. The vast majority of cranial neuropathies were partial at onset and tended to improve over time. Other complications included tumor growth (4%), communicating hydrocephalus (4%), and transient adjacent brain parenchymal changes best seen on T2-weighted MRI (9%). Stereotactic radiosurgery is an important alternative treatment for carefully selected patients with acoustic tumors. Indications for treatment include sufficient medical problems to pose excessive surgical risk, advanced age, the presence of bilateral acoustic tumors or contralateral deafness, recurrent tumor despite surgical resection, or refusal to undergo microsurgery. Radiosurgery is contraindicated in patients with symptomatic brain stem or cerebellar compression from a large acoustic tumor. Previous posterior fossa radiotherapy is a relative contraindication that must be considered on a patient to patient basis. Stereotactic radiosurgery should be viewed as an additional weapon in our arsenal for combating acoustic tumors rather than feared as a potential replacement for surgical excision. The strategic role of stereotactic radiosurgery in the overall treatment of patients with acoustic tumors will continue to be refined as longer-term, carefully assessed results become available.

Adolescent↗
PubMed1992

Stereotactic radiosurgery for acoustic tumors.

Stereotactic radiosurgery is an important alternative treatment for carefully selected patients with acoustic tumors. We perform radiosurgery under local anesthesia, and 91% of our patients have been discharged from the hospital within 24 hours after treatment. All returned to their preoperative level of function or employment within 5 to 7 days after treatment. Our current tumor control rate is 97%, but reduction in tumor size, judged by strict, objective criteria, was achieved in only 23%. Our actuarial rate of useful hearing preservation after radiosurgery is 38% at 1 year. Three tumors increased in size after treatment. Only one of the three demonstrated increased mass effect on surrounding brain structures by neuroimaging criteria. No increase has led to worsened clinical symptoms or has required surgical excision at this point in follow-up. The 1-year rates for developing new facial or trigeminal neuropathies after radiosurgery were 30% and 33%, respectively. Cranial neuropathies had a delayed onset, with the median onset occurring after 5 to 6 months. The vast majority were partial at onset, and most improved over time. Communicating hydrocephalus requiring ventriculoperitoneal shunts developed after radiosurgery in four patients. Eight patients developed increased signal within adjacent brain parenchyma on T2-weighted MR imaging, consistent with edema or blood-brain barrier breakdown. It is unlikely that stereotactic radiosurgery using the gamma knife will obviate the need for microsurgical removal performed by skilled and experienced microsurgeons. However, radiosurgery is a safe and effective treatment for patients whose medical problems make surgery unacceptably dangerous, those with bilateral tumors or a tumor in their only hearing ear, those who have recurrent tumor despite surgical resection, or patients who refuse microsurgical excision.

Adolescent↗
PubMed1991

Radiosurgery of acoustic neurinomas.

Eighty-five patients with acoustic neurinomas underwent stereotactic radiosurgery with the gamma unit at the University of Pittsburgh (Pittsburgh, PA) during its first 30 months of operation. Neuroimaging studies performed in 40 patients with more than 1 year follow-up showed that tumors were smaller in 22 (55%), unchanged in 17 (43%), and larger in one (2%). The 2-year actuarial rates for preservation of useful hearing and any hearing were 46% and 62%, respectively. Previously undetected neuropathies of the trigeminal (n = 12) and facial nerves (n = 14) occurred 1 week to 1 year after radiosurgery (median, 7 and 6 months, respectively), and improved at median intervals of 13 and 8 months, respectively, after onset. Hearing loss was significantly associated with increasing average tumor diameter (P = 0.04). No deterioration of any cranial nerve function has yet developed in seven patients with average tumor diameters less than 10 mm. Radiosurgery is an important treatment alternative for selected acoustic neurinoma patients.

Adolescent↗
PubMed1991

Chondromyxoid fibromas of the neurocranium.

We report a case of a chondromyxoid fibroma involving the upper clivus in a 73-year-old man. Chondromyxoid fibromas are uncommon benign bone tumors that rarely involve the skull. Chondromyxoid fibromas arising in the membranous neurocranium resemble their extracranial counterparts, appearing as radiolucent lesions with sclerotic margins and presenting most often as a painless focal swelling. Chondromyxoid fibromas arising in the chondrocranium differ from their extracranial counterparts and from those arising in the membranous neurocranium. They appear as locally destructive, often calcified, and exophytic lesions without sclerotic margins and present with cranial nerve dysfunction and symptoms caused by central nervous system compression.

Journal Article↗
PubMed1991

A vascular malformation mimicking an intracanalicular acoustic neurilemoma. Case report.

A patient with an enhancing, completely intracanalicular mass on magnetic resonance imaging was operated on for a presumed acoustic neurilemoma, but was found at surgery to have an intracanalicular vascular malformation. This rare lesion should be distinguished from angiomatous change within an acoustic neurilemoma and in the past has been termed "vascular tumor," "hemangioma," or "fibro-angioma." The clinical distinctions between intracanalicular acoustic neurilemomas and intracanalicular vascular malformations and the ability of magnetic resonance imaging to distinguish between the two are discussed.

Adult↗
PubMed1991

Fatal rupture of the intracranial carotid artery during transluminal angioplasty for vasospasm induced by subarachnoid hemorrhage. Case report.

The authors report the clinical course, radiographic findings, and gross and microscopic pathology of a patient with fatal rupture of the supraclinoid segment of the left internal carotid artery during transluminal angioplasty for subarachnoid hemorrhage-induced vasospasm. The rupture most likely resulted from a small portion of aneurysm neck which remained unclipped, thereby leaving an area of structural weakness in the arterial wall at the site of clipping. The area of structural weakness predisposed the artery to rupture upon the addition of transmural pressure induced by balloon inflation during transluminal angioplasty. Caution is advised when performing transluminal angioplasty in the region of aneurysm clipping since the vessel lumen "recreated" during the clipping procedure may contain some residual and structurally incomplete aneurysm neck in the vessel wall.

Angioplasty, Balloon↗
PubMed1991

Aneurysms of the intracavernous carotid artery: a multidisciplinary approach to treatment.

Of 43 cavernous sinus aneurysms diagnosed over 6 1/2 years, 23 fulfilled indications for treatment; of these 19 were treated, eight surgically and 11 with interventional radiological techniques. Six small and two giant aneurysms were treated surgically: four were clipped, two were repaired primarily, and two were trapped with placement of a saphenous-vein bypass graft. Seven large and four giant aneurysms were treated with interventional radiological techniques: in five cases the proximal internal carotid artery (ICA) was sacrificed; one aneurysm was trapped with detachable balloons; and five were embolized with preservation of the ICA lumen. The mean follow-up period was 25 months. At follow-up examination, three patients in the surgical group were asymptomatic, two had improved, and three had worsened. Three of these patients had asymptomatic infarctions apparent on computerized tomography (CT) scans. At follow-up examination, four radiologically treated patients were asymptomatic, five had improved, two were unchanged, and none had worsened. One patient had asymptomatic and one minimally symptomatic infarction apparent on CT scans; both lesions were embolic foci after aneurysm embolization with preservation of the ICA. It is concluded that treatment risk depends more on the adequacy of collateral circulation than on the size of the aneurysm. A multidisciplinary treatment protocol for these aneurysms is described, dividing patients into high-, moderate-, and low-risk groups based on pretreatment evaluation of the risk of temporary or permanent ICA occlusion using a clinical balloon test occlusion coupled with an ICA-occluded stable xenon/CT cerebral blood flow study. Radiological techniques are suggested for most low-risk patients, while direct surgical techniques are proposed for most moderate- and high-risk patients.

Adolescent↗
PubMed1990

Median nerve injury from local steroid injection in carpal tunnel syndrome.

Local steroid injections for symptomatic relief of carpal tunnel syndrome have become common in the evaluation and treatment of this disorder; yet reports of median nerve injection injury from this practice are rare. We present a case of nerve injury from a steroid injection in a 24-year-old man with carpal tunnel syndrome that was successfully treated by division of the transverse carpal ligament and neurolysis. The histopathological characteristics of the lesion are presented, and the pathogenesis and treatment of this injury are discussed. Means of avoiding this complication include careful attention to anatomic landmarks as well as to the patient's subjective response during injection and avoidance of the use of local anesthetics.

Adult↗
PubMed1990

Radiosurgery for acoustic neurinomas: early experience.

We reviewed our early experience with the first 26 patients with acoustic neurinomas (21 unilateral, 5 bilateral) treated by stereotactic radiosurgery using the first North American 201-source cobalt-60 gamma knife. Follow-up ranged from 6 to 19 months (median, 13 months). Serial postoperative imaging showed either a decrease in tumor size (11 patients) or growth arrest (15 patients). Loss of central contrast enhancement was a characteristic change (18 patients). Seven patients had good or serviceable hearing preoperatively. In all 7 the preoperative hearing status was retained immediately after radiosurgery. At follow-up, 3 had preserved hearing, 1 had reduced hearing, and 3 had lost all hearing in the treated ear. Hearing in 1 patient that was nonserviceable preoperatively later improved to a serviceable hearing level. Delayed facial paresis developed in 6 patients, and delayed trigeminal sensory loss developed in 7 patients, none of whom had significant deficits before radiosurgery. Both facial and trigeminal deficits tended to improve within 3 to 6 months of onset with excellent recovery anticipated. Lower cranial nerve dysfunction was not observed. All 26 patients remain at their preoperative employment or functional status. At present, stereotactic radiosurgery is an alternative treatment for acoustic neurinomas in patients who are elderly, have significant concomitant medical problems, have a tumor in their only hearing ear, have bilateral acoustic neurinomas, refuse microsurgical excision, or have recurrent tumor despite surgical resection. Although longer and more extensive follow-up is required, the control of tumor growth and the acceptable rate of complications in this early experience testifies to the future expanding role of this technique in the management of selected acoustic neurinomas.

Adolescent↗
PubMed1990

Aneurysms of the intracavernous carotid artery: clinical presentation, radiographic features, and pathogenesis.

Thirty-seven patients with 44 intracavernous carotid artery aneurysms (ICCAAns) were seen at one institution from 1976 through 1988. Fifteen patients had multiple intracranial aneurysms and 7 had bilateral ICCAAns. Age at diagnosis ranged from 15 to 80 (median 61). Thirty patients were women. Sixteen had a history of hypertension. In 34% of patients the ICCAAns were asymptomatic at diagnosis, 36% were associated with headache, and 57% had associated signs or symptoms of mass effect including sixth nerve paresis (43%), trigeminal pain or sensory loss (32%), third nerve paresis (20%), decreased vision or visual field cut (18%), fourth nerve paresis (16%), and Horner's syndrome (7%). In 4 patients the ICCAAns ruptured, leading to subarachnoid hemorrhage in 3 and epistaxis in 1. Two patients with ICCAAns were seen with spontaneous thrombosis of the ipsilateral internal carotid artery leading to distal ischemic symptoms in 1. More than 90% of the ICCAAns were saccular. Thirty-four percent were small (less than 1 cm), 48% were large (1 to 2.5 cm), and 16% were giant (greater than 2.5 cm). The majority arose from the anterior genu of the intracavernous internal carotid artery, followed in frequency by the horizontal segment, and then the posterior genu. Magnetic resonance imaging is superior to computed tomography for diagnosing ICCAAns and is the screening procedure of choice. Angiography remains the "gold standard" for diagnosis and determining specific anatomic details necessary to plan therapy. Analyzing the radiographic anatomy of 44 ICCAAns. we conclude that theories attributing the origin of aneurysms to arterial bifurcations may be inadequate to explain the point of origin and direction of take off of up to one-fourth of ICCAAns.

Adolescent↗
PubMed1990

Aneurysms of the intracavernous carotid artery: natural history and indications for treatment.

Of 37 patients with 44 intracavernous carotid artery aneurysms (ICCAAns) diagnosed between 1976 and 1988, patients with 20 aneurysms were followed without treatment for 5 months to 13 years (median, 2.4 years). Ten of the 20 ICCAAns were asymptomatic at diagnosis, and 10 were symptomatic. Three of the asymptomatic ICCAAns were symptomatic at follow-up. One of these required clipping because of a progressing cavernous sinus syndrome; the other 2 were minimally symptomatic and have not required treatment. Of the 10 initially symptomatic ICCAAns, 2 had not changed, 4 became more symptomatic, and 4 had symptomatically improved by follow-up. One patient with an ICCAAn that had not changed clinically was lost to follow-up 6 months after diagnosis. Of the 4 ICCAAns that became more symptomatic, 2 continue to be monitored, and 2 required intervention: one with detachable balloon occlusion of the aneurysm with preservation of the internal carotid artery lumen, and the other with gradual cervical internal carotid artery occlusion. The clinical course of this selected group of patients with ICCAAns suggests that the natural history of ICCAAns can be quite variable. Although clinical progression does occur, symptomatic ICCAAns also can improve spontaneously. Therapeutic intervention for asymptomatic ICCAAns should be reserved for patients with aneurysms arising at the anterior genu of the carotid siphon and/or extending into the subarachnoid space, where subarachnoid hemorrhage is most likely. Intervention for symptomatic ICCAAns should be reserved for patients with subarachnoid hemorrhage, epistaxis, severe facial or orbital pain, evidence of radiographic enlargement, progressive ophthalmoplegia, or progressive visual loss.

Aged↗
PubMedDate not supplied

Neuroimaging of acoustic nerve sheath tumors after stereotaxic radiosurgery.

Using a strict method for measuring tumor size, we evaluated tumor response to radiosurgery in 88 patients with 89 acoustic tumors treated over 3 years with a 201-source cobalt-60 gamma unit. Overall, tumor size was unchanged in 73% of patients and increased in 4%. In 22% of patients, tumor diameter decreased an average of 4.9 mm 3-33 months after treatment. Tumor shrinkage occurred in 36% of 50 patients who were followed for at least 1 year after treatment. Loss of tumor contrast enhancement was seen in 79% of patients 1-18 months after treatment. Delayed communicating hydrocephalus developed in four patients. In eight patients, increased signal on T2-weighted MR images developed in the adjacent cerebellar peduncle (n = 5) or the peduncle and dorsolateral pons (n = 3) 5-15 months after treatment. T1-weighted MR imaging and CT were insensitive to these adjacent brain changes. Stereotaxic radiosurgery is an important alternative treatment for selected patients with acoustic tumors. There is no mortality or major perioperative morbidity, hospitalization time and costs are smaller than for microsurgery, patient employment or functional level is maintained, and hearing preservation and facial neuropathy rates are comparable to those in published microsurgical series. Although the rate of occurrence of trigeminal neuropathy is greater than those reported in published microsurgical series, the majority of cases are mild, transient, and nondebilitating. MR imaging before and after radiosurgery is the most sensitive imaging tool to evaluate tumor response, the presence of adjacent parenchymal signal changes, and ventricular size. With a mean follow-up time of 14.6 months, the rate of complications detected by neuroimaging is low and the tumor control rate is 96%.

Adolescent↗