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At least 505 records · Page 28Linked to original sources
PubMed2006

Preoperative embolization of hypervascular spinal metastases using percutaneous direct injection with n-butyl cyanoacrylate: technical case report.

OBJECTIVE: Intraoperative blood loss constitutes a major cause of perioperative morbidity in surgical decompression and reconstruction of highly vascular spinal metastatic tumors. We propose a technique for embolization of highly vascular vertebral metastases using percutaneous direct injection using n-butyl cyanoacrylate (NBCA) instead of polymethylmethacrylate to complement preoperative transarterial embolization and to minimize operative blood loss. METHODS: Five patients with renal cell carcinoma metastases to the spine (one cervical, one thoracic, and three lumbar) underwent embolization by percutaneous direct injection of the affected vertebrae with a mixture of NBCA and iodized oil to supplement transarterial embolization with polyvinyl alcohol particles and fibered platinum coils. This was achieved via a transpedicular approach in four cases and by direct vertebral body puncture in one case. RESULTS: The percutaneous NBCA direct injection procedure was technically successful in all cases and was not associated with neurological or medical complications. All patients underwent subsequent vertebrectomy and spinal instrumentation. Surgical resection was performed with lower than expected blood loss and with a subjective improvement in tumor tissue handling and dissection. CONCLUSION: The extent of tumor devascularization can be improved by supplementing transarterial embolization with NBCA direct injection to decrease operative blood loss and increase the safety of surgical resection and stabilization of highly vascular spinal metastases.

Administration, Cutaneous↗
PubMed1991

Percutaneous retroperitoneal stimulation of the sacral plexus. Initial report and technical note.

A new percutaneous approach to stimulate the sacral plexus for the treatment of pain is described. The percutaneous electrode is inserted under fluoroscopy through the chosen dorsal and ventral sacral foramen and is advanced into the retroperitoneal layer where the plexus lies. The electrode, can be advanced several centimeters and lies in close proximity to the branches of the sacral plexus. Both motor and sensory responses can be elicited with electrical stimulation. Our initial experience with 4 implanted patients is presented and discussed. Several areas of the nervous system have been target for implantation of stimulating and recording electrodes for management of pain, as well as other indications. This includes parts of the cerebrum, brainstem, spinal cord and peripheral nerves. We report our initial experience with a new approach to stimulation of the peripheral nervous structures. That is stimulation of the sacral plexus through electrodes implanted percutaneously along the plexus in the retroperitoneal area. This initial report is not meant to give clinical results of this methodology, but simply to point to another route to apply electrical stimulation safely to various parts of the nervous system.

Analgesia↗
PubMed1998

Distal posterior cerebral artery revascularization in multimodality management of complex peripheral posterior cerebral artery aneurysms: technical case report.

UNLABELLED: OBJECTIVES AND IMPORTANCE: Although controversial, revascularization of the distal posterior cerebral artery (PCA) may become necessary in treating complex PCA aneurysms before proximal parent vessel sacrifice. The revascularization of the distal PCA territories of two patients with peripheral PCA aneurysms is presented. CLINICAL PRESENTATIONS: One patient had an aneurysm of the P2-P3 segment and failed a selective P2 balloon occlusion test by developing homonymous hemianopia before planned parent vessel sacrifice. The other patient with a giant P2 segment aneurysm presented with visual field deficits. TECHNIQUE: The distal segment of PCA was revascularized before the aneurysms were trapped by surgical clipping or coil occlusion of the distal P2 segment, proximal to the aneurysms. In both cases, the occipital artery was used as the "donor" vessel. Temporary occlusion times were 22 and 20 minutes, respectively. Both grafts were patent on postoperative angiography, and both patients had full visual fields at the time of their follow-up examinations. CONCLUSION: De novo distal P2 sacrifice, advocated for treating peripheral PCA aneurysms, leads to visual field deficits in some patients. Revascularization of the distal segment of the PCA, less technically demanding than bypass to other PCA segments, preserves blood flow, thus sparing vision in this subset of patients.

Adult↗
PubMed1976

Embolization of a traumatic arteriovenous fistula of the scalp with radiopaque Gelfoam pledgets. Case report and technical note.

A large traumatic arteriovenous malformation of the scalp was embolized with Pantopaque-saturated Gelfoam pledgets, which made fluoroscopic monitoring of the radiopaque emboli possible. Postembolization angiography demonstrated complete occlusion of the malformation. There is still no clinical or physical evidence of recurrence after an 8-month follow-up period.

Arteriovenous Fistula↗
PubMed1989

Transoral stereotactic biopsy of the second cervical vertebral body: case report with technical note.

Although the transoral approach to the atlantoaxial region is generally an open surgical procedure, in patients in whom only tissue diagnosis is required, a needle biopsy can be done. In this paper a patient with a metastatic lesion in the second cervical vertebral body is presented, and the technique for needle biopsy of the second cervical body using stereotactic methods is described.

Adenocarcinoma↗
PubMed2005

Pure laparoscopic radical heminephrectomy and partial isthmusectomy for renal cell carcinoma in a horseshoe kidney: case report and technical considerations.

Laparoscopic surgery of the horseshoe kidney has been limited to benign conditions, hand assistance, and retroperitoneal approaches for small tumors. In this case, we describe a pure transperitoneal approach to heminephrectomy for a large renal cell carcinoma. The operative considerations include identification of all arterial branches and careful isthmus dissection. Preoperative angiography may aid surgical planning. A pure transperitoneal approach to cancer surgery of the horseshoe kidney is effective.

Carcinoma, Renal Cell↗
PubMed1989

Split 24-F Amplatz dilator for percutaneous extraction of an intravascular bullet: case report and technical note.

An intravascular bullet was retrieved percutaneously in a 17-year-old boy with the use of a modified 24-F Amplatz dilator. The dilator was modified by means of a longitudinal incision with removal of a wedge at the distal tip of the tapered portion of the dilator. The bullet, which was located in the left pulmonary artery, was removed via the right femoral vein. No complications occurred.

Adolescent↗
PubMed2001

The tandem bypass: subclavian artery-to-middle cerebral artery bypass with dacron and saphenous vein grafts. Technical case report.

BACKGROUND: Fusiform or dolichoectatic intracranial aneurysms often cannot be managed with conventional surgical or endovascular techniques, and instead require trapping and revascularization techniques. On rare occasions in elderly patients, extracranial sites used for anastomosing the bypass have been previously repaired with synthetic vascular prostheses. This circumstance in an elderly subarachnoid hemorrhage patient led to a novel bypass procedure, the tandem bypass: a long extracranial-to-intracranial bypass with two grafts of different materials assembled in series. CASE DESCRIPTION: A 71-year-old man with carotid artery atherosclerotic disease and a previous vascular reconstruction (subclavian artery-to-internal carotid artery Dacron interposition graft) presented with a subarachnoid hemorrhage from a dolichoectatic supraclinoid ICA aneurysm. The aneurysm was treated with trapping and distal revascularization. The final construct was a subclavian artery-to-middle cerebral artery bypass, with the graft being the previous Dacron prosthesis and a long saphenous vein. The vein graft was anastomosed end-to-side to the Dacron graft proximally, and end-to side to the middle cerebral artery distally. Subsequently, inflow to the aneurysm was occluded with clips on the Dacron graft beyond the proximal anastomosis of the vein graft, and outflow from the aneurysm was occluded with clips on the supraclinoid ICA. CONCLUSIONS: The tandem bypass, which uses prosthetic graft material and saphenous vein in succession, is a technically straightforward technique in patients who need extracranial-to-intracranial bypasses and who also have pre-existing carotid reconstructions or lack sufficient saphenous vein to complete a long bypass.

Aged↗
PubMed2002

Extracranial-intracranial vein graft bypass for giant intracranial aneurysm surgery for pediatric patients: two technical case reports.

OBJECTIVE AND IMPORTANCE: Herein we describe two cases of extracranial-intracranial vein graft bypasses for the treatment of giant intracranial aneurysms in prepubertal pediatric patients. One patient is, we think, the youngest patient reported in the literature to have been successfully treated in such a manner, with a good long-term outcome. Such grafts seem to enlarge longitudinally during the growth spurt, making such techniques reasonable long-term therapeutic options for the management of complex intracranial aneurysms in pediatric patients. CLINICAL PRESENTATION: Patient 1, a 13-year-old boy, presented with headaches and rapidly progressive right cavernous sinus syndrome. Computed tomography and cerebral angiography revealed a giant, fusiform, right intracavernous internal carotid artery aneurysm. Patient 2, a 23-month-old girl, was discovered to harbor an asymptomatic, recurrent, giant, fusiform, left M1 middle cerebral artery aneurysm 1 year after presenting with seizures related to subarachnoid hemorrhage from the aneurysm, for which she had been treated with clipping and an M2-M2 anastomosis. INTERVENTION: Both patients underwent craniotomies, with sacrifice of the proximal parent vessel (the distal cervical internal carotid artery and the proximal middle cerebral artery, respectively), combined with cerebral revascularization through extracranial-intracranial saphenous vein bypass grafts. Both patients experienced excellent long-term clinical outcomes, have undergone significant growth, and exhibit excellent long-term graft patency and aneurysm obliteration. CONCLUSION: These two cases highlight the safety and efficacy of extracranial-intracranial vein graft bypasses among prepubertal pediatric patients. The indications for bypass procedures to treat giant intracranial aneurysms are discussed, and the technical aspects of maximizing vein bypass graft patency are reviewed.

Adolescent↗
PubMed1985

Limitations of brain stem auditory evoked potentials for intraoperative monitoring during a posterior fossa operation: case report and technical note.

We have encountered an example of the insensitivity of brain stem auditory evoked potentials (BAEPs) for monitoring the brain stem during a posterior fossa operation. The addition of somatosensory evoked potential recording to conventional BAEP protocols is readily accomplished and is likely to improve the sensitivity of intraoperative electrophysiological assessment of brain stem function.

Brain Stem↗
PubMed1996

Microsurgical removal of an intraventricular meningioma with ultrasound guidance, and balloon dilation of operative corridors: case report and technical note.

The case of a 26-year-old woman with an intraventricular meningioma presenting with visual symptoms is discussed. Preoperative imaging included magnetic resonance angiography, with a high correlation with conventional angiography. The patient underwent microsurgical removal of the lesion by combined transtemporal and transparietal approaches, with intraoperative ultrasound and balloon dilation of operative corridors. There was postoperative improvement of the visual fields. The operative technique will be discussed and compared with the other methods published.

Adult↗
PubMed1976

Termination of pregnancy in the midtrimester using a new technic. Preliminary report.

This report is a preliminary one because the number of cases is small (30+) and follow-up is not adequate, either as to detail or time. However, the initial results and observations are so favorable that unless untoward complications arise, we predict that this procedure will supplant the other usual methods of midtrimester abortion. We have looked for but have not found any infections, hemorrhage, perforations, failure of the uterus to empty within a reasonable length of time or prolonged postoperative bleeding. The method herein proposed offers greater safety by creating fewer risks to the patient; her exposure to hazards is therefore diminished. Future pregnancies are safer because the birth canal has not been attenuated by rupture, near rupture, perforation or surgical scarring. It is our hope that others will try this technic to prove or disprove its efficacy.

Abortion, Induced↗
PubMed2003

Arthroscopically assisted retrograde fixation of patellar osteochondritis dissecans using fluoroscopic guidance: a case report and technical note.

Osteochondritis dissecans of the patella is a relatively rare condition. Treatment recommendations vary significantly from nonoperative treatment to surgical intervention. Surgical management varies from excision of the lesion to a variety of methods of stabilization. We present a case of patellar osteochondritis dissecans successfully treated with arthroscopically assisted retrograde fixation using fluoroscopic guidance. This surgical technique, which we describe in detail, avoids articular cartilage penetration and the need for an arthrotomy and allows for compression of the lesion with the hardware oriented perpendicular to the defect. It uses both fluoroscopic and arthroscopic imaging techniques for reduction and fixation.

Adolescent↗
PubMed1999

Improved cerebral perfusion after stenting of a petrous carotid stenosis: technical case report.

OBJECTIVE AND IMPORTANCE: Atherosclerotic occlusive disease of the intracranial vasculature is associated with increased risk of systemic vascular occlusive disease and stroke. Therapeutic options have included anticoagulation therapy, antiplatelet therapy, or, in a limited number of patients, extracranial-intracranial vascular bypass procedures. We report a patient who had improved cerebral perfusion with silent watershed zone infarctions after endovascular stenting of a severe petrous segment carotid stenosis. CLINICAL PRESENTATION: A 73-year-old man with severe coronary artery disease and unstable angina was referred for treatment of a 90% right petrous carotid artery stenosis before coronary artery bypass grafting. A brain single-photon emission computed tomographic scan using 99mTc-bicisate revealed diminished perfusion throughout the right internal carotid artery territory, particularly in posterior watershed zones. TECHNIQUE: The patient underwent transfemoral placement of a 7-French introducer sheath, followed by a 7-French guide catheter. Urokinase (225,000 U) was infused through a microcatheter placed proximal to the lesion. No changes were noted in lesion morphology after this infusion. A microguidewire was navigated across the lesion. Subsequent balloon angioplasty with a coronary artery balloon was performed twice, followed by placement of a 4- x 12-mm coronary stent. CONCLUSION: Selective internal carotid artery angiography after stenting revealed markedly improved flow. A brain 99mTc-bicisate single-photon emission computed tomographic scan performed within 24 hours of stent placement, revealed significantly improved perfusion within the right internal carotid artery territory. Two perfusion voids suggestive of embolic stroke were noted; both were clinically silent. The patient had uncomplicated coronary artery bypass grafting 72 hours later. Five months postoperatively, he remains at home, living independently and with intact neurological function. Intracranial stenting for severe atherosclerotic stenosis is technically possible. However, its ultimate clinical role remains to be determined.

Aged↗
PubMed1998

Saphenous vein graft reconstruction of an unclippable giant basilar artery aneurysm performed with the patient under deep hypothermic circulatory arrest: technical case report.

OBJECTIVE AND IMPORTANCE: Effective treatment for unclippable giant vertebrobasilar aneurysms remains unclear. We present the first reported case of a giant vertebrobasilar aneurysm being successfully treated with trapping of the aneurysm and internal carotid artery to basilar artery bypass with a saphenous vein graft that was performed with the patient under hypothermic circulatory arrest. CLINICAL PRESENTATION: A 15-year-old female patient with a history of probable subarachnoid hemorrhage and chronic headaches presented with a relatively acute exacerbation of her headache, nausea, vomiting, and weakness. Imaging studies revealed a 4 x 4 x 3-cm vertebrobasilar aneurysm, supplied by an angiographically dominant right vertebral artery and causing significant brain stem compression. INTERVENTION: Initially, a petrosal approach with a hearing-preserving partial labyrinthectomy was used to perform a right external carotid artery to posterior cerebral artery bypass with saphenous vein. Delayed occlusion of the right vertebral artery with an intraluminal balloon was planned; however, intraoperative angiography revealed poor graft flow, presumably because of the small size of the posterior cerebral artery. Postoperative graft occlusion was anticipated. During this same time interval, the patient deteriorated neurologically. Brain imaging failed to reveal evidence of cerebral infarction. The patient underwent subsequent surgery. After a total petrosectomy, the aneurysm was trapped, an aneurysmectomy was performed, and, with the patient under deep hypothermic circulatory arrest, a new interposition saphenous vein graft was inserted between the internal carotid and basilar arteries. Excellent flow was observed angiographically. At her 4-month follow-up examination, the patient had improved to near baseline. CONCLUSION: We present a technically challenging but safe and definitive treatment option for an unclippable giant vertebrobasilar aneurysm. Using cranial base approaches and hypothermic circulatory arrest techniques, aneurysmal trapping and successful bypass grafting directly into the basilar artery was performed.

Adolescent↗
PubMed1998

Rapid insulin sensitivity test (RIST).

A rapid insulin sensitivity test (RIST) was recently introduced to assess insulin action in vivo (H. Xie, L. Zhu, Y.L. Zhang, D.J. Legare, and W.W. Lautt. J. Pharmacol. Toxicol. Methods, 35: 77-82. 1996). This technical report describes the current recommended standard operating procedure for the use of the RIST in rats based upon additional experience with approximately 100 tests. We describe the manufacture and use of an arterial-venous shunt that allows rapid multiple arterial samples and intravenous administration of drugs. The RIST procedure involves determination of a stable arterial glucose baseline to define the ideal euglycemic level to be maintained following a 5-min infusion of insulin, with the RIST index being the amount of glucose required to be infused to maintain euglycemia over the test period. Insulin administration by a 5-min infusion is preferable to a 30-s bolus administration. No significant difference was determined between the use of Toronto pork-beef or human insulin. Four consecutive RISTs were carried out in the same animal over 4-5 h with no tendency for change with time. The RIST index is sufficiently sensitive and reproducible to permit establishment of insulin dose-response curves and interference of insulin action by elimination of hepatic parasympathetic nerves, using atropine. This technical report provides the current recommended standard operating procedure for the RIST.

Animals↗