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At least 559 records · Page 31Linked to original sources
PubMed1996

Intra-aortic balloon pump counterpulsation in the management of concomitant cerebral vasospasm and cardiac failure after subarachnoid hemorrhage: technical case report.

We report two patients who had symptomatic cerebral vasospasm and cardiac failure after aneurysmal subarachnoid hemorrhage and who were treated successfully with intra-aortic balloon pump counterpulsation therapy. Both patients developed congestive heart failure and pulmonary edema while receiving postoperative hypertensive, hypervolemic, hemodilutional (Triple-H) therapy for symptomatic cerebral vasospasm. Both cases of cardiac failure were refractory to maximum pressor and inotropic infusions. Intra-aortic balloon pump counterpulsation was used to optimize cardiac performance to allow continuation of Triple-H therapy and to maintain adequate cerebral perfusion in an attempt to decrease the risk of cerebral ischemic complications. Both patients have had good long-term outcomes. These two cases illustrate the potential usefulness of the intra-aortic balloon pump as an adjunct to Triple-H therapy in patients with symptomatic cerebral vasospasm and cardiac failure. To our knowledge, this report documents the first clinical application of this adjunctive therapy for vasospasm after aneurysmal subarachnoid hemorrhage.

Aged↗
PubMed1996

Successful percutaneous transluminal angioplasty for basilar artery stenosis: technical case report.

OBJECTIVE: We report our experience with low-pressure submaximal percutaneous transluminal angioplasty (PTA) for basilar artery stenosis of > 90%. This treatment resulted in a favorable clinical course and satisfactory improvement of posterior cerebral circulation. CLINICAL PRESENTATION: This technique was applied to two patients with repeated basilar arterial ischemic symptoms that were resistant to medical treatment. INTERVENTION: Low-pressure submaximal PTA was performed with use of a smaller balloon (2.0-mm diameter) and lower inflation pressure (< or = 303,975 Pa) than previously reported. RESULTS: Despite basilar arteries with 50 and 60% residual stenosis, the clinical symptoms and hemodynamics in the basilar arterial territory as assessed using single photon emission tomography were markedly improved after PTA. Follow-up angiographic evaluation demonstrated the absence of restenosis, and improved cerebral blood flow was maintained. Neither patient has developed any new neurological deficits 10 and 13 months after the PTA, respectively. CONCLUSION: Submaximal PTA may have reduced the high risk associated with this procedure, and cerebral blood flow measurement may be a useful tool to assess whether this technique will produce adequate results.

Aged↗
PubMed1996

A pitfall in the surgery of a recurrent aneurysm after coil embolization and its histological observation: technical case report.

OBJECTIVE AND IMPORTANCE: This case report details the unexpected surgical difficulty encountered in treating a recurrent aneurysm after coil embolization and presents the histological findings of the resected aneurysm. This is only the second reported case of histological description of an aneurysm after coil embolization in a human. CLINICAL PRESENTATION: A 60-year-old woman experienced a 3-month history of chronic headache. Neuroimaging studies demonstrated a 2-cm anterior communicating artery aneurysm. The aneurysm was treated with a two-stage endovascular coil embolization, resulting in almost complete occlusion of the aneurysm. A cerebral angiogram at 6-month follow-up demonstrated slight refilling of the aneurysm, and angiography at 18 months showed a marked increase in the size of the small remnant. Therefore, the patient was referred for direct surgical repair of the aneurysm. INTERVENTION: The distal aneurysm dome, which had been packed with the coils and thrombus, was resected under temporary arterial trapping. An intra-aneurysmal endarterectomy was required, because the aneurysm wall developed intimal dissection that extended to the orifices of afferent and efferent arteries. The aneurysm was then obliterated with multiple clips, reconstructing the patent vessel lumen. However, the patient awoke from surgery with left hemiparesis. A postoperative angiogram disclosed occlusion of the right anterior cerebral artery. An histological study of the thrombosed aneurysm showed that the luminal surface of thrombus was not lined by endothelium. CONCLUSION: This case demonstrated not only the limited efficacy of coil embolization treatment for wide-necked aneurysms but also the potential difficulty in the direct surgical repair for such recurrent aneurysms.

Aortic Dissection↗
PubMed1996

Long-term access to cystic brain stem lesions using the Ommaya reservoir: technical case report.

OBJECTIVE AND IMPORTANCE: Unresectable cystic brain stem lesions are often responsible for neurological dysfunction. Stereotactic aspiration of such lesions can lead to clinical improvement, but cyst recurrence is common and multiple aspirations may be necessary. CLINICAL PRESENTATION: Three children with unresectable cystic brain stem lesions were treated at the University of Florida. Two patients initially underwent stereotactic biopsy and cystic aspiration, both improving after cystic decompression. Both patients returned 3 months later with symptomatic cyst recurrences requiring further intervention. Six years after surgical resection of a posterior fossa medulloblastoma, the third patient presented with a dorsal midbrain cyst. INTERVENTION: All three patients had catheters placed into the cyst cavities under stereotactic guidance. A subcutaneous Ommaya reservoir was attached to the existing catheter. In the event of symptomatic cyst recurrence, the Ommaya reservoir can be tapped in an outpatient setting. CONCLUSION: Cystic decompression resulted in clinical improvement in all three children. Multiple aspirations were necessary in two patients for symptomatic cyst recurrences. The Ommaya reservoir allows for cyst aspiration in an outpatient setting and avoids multiple stereotactic manipulations. This system may also be used to instill radioisotopes or it may be converted to a cyst-peritoneal shunt if multiple aspirations fail to achieve cystic control.

Astrocytoma↗
PubMed1996

Cervical-to-petrous internal carotid artery saphenous vein in situ bypass for the treatment of a high cervical dissecting aneurysm: technical case report.

OBJECTIVE AND IMPORTANCE: We describe a novel cervical-to-petrous internal carotid artery (ICA) saphenous vein in situ bypass for the treatment of a high cervical dissecting aneurysm. The cervical ICA has no major collateral branches and can be used as a tunnel for the vein graft. CLINICAL PRESENTATIONS: A 25-year-old man was involved in a car accident. A cerebral angiogram revealed a right ICA dissection with aneurysm formation at the C1-C2 level. The patient recovered fully and was anticoagulated. Six months after the initial angiogram, a second angiogram disclosed ICA stenosis (80%) and persistence of the traumatic dissecting aneurysm. Definitive surgical bypass was considered the most appropriate course of action. TECHNIQUE: The horizontal portion of the petrous ICA was exposed by an extradural subtemporal approach. The cervical arteries were exposed by a separate surgical incision. After dividing the petrous ICA and the cervical ICA, the cervical ICA was dilated using a Fogarty balloon embolectomy catheter. A saphenous vein graft was inserted inside the lumen of the cervical ICA and was anastomosed to the ICA end-to-end both proximally and distally (cervical-to-petrous ICA in situ bypass). The graft was patent on the follow-up angiogram. CONCLUSION: We describe a new technique that could be considered an alternative to the classical extra-anatomic cervical-to-petrous ICA bypass procedures.

Adult↗
PubMed1996

Middle cerebral artery occlusion after pterional approach to basilar bifurcation aneurysm: technical case report.

OBJECTIVE AND IMPORTANCE: The authors present a case of a subacute middle cerebral artery occlusion that was sustained subsequent to a basilar apex aneurysm clipping via the pterional approach. A middle cerebral artery stroke is a rare complication of basilar bifurcation aneurysm clipping, and, to our knowledge, this complication has not been previously described in otherwise healthy patients with unruptured basilar aneurysms. CLINICAL PRESENTATION: A 36-year-old woman was found to have an unruptured 1.6 x 1.0-cm basilar tip aneurysm, as revealed by computed tomography. She elected to undergo surgical repair. TECHNIQUE: Transsylvian dissection, exposure, and uneventful clipping of the basilar bifurcation aneurysm were performed. CONCLUSIONS: A middle cerebral artery stroke occurring after the repair of an intact basilar aneurysm has several possible causes, including retraction injury and direct surgical injury. Awareness of this complication is important for the early recognition and management of the occlusion before infarction is established.

Adult↗
PubMed1996

Radiotherapy in the treatment of symptomatic vertebral hemangiomas: technical case report.

OBJECTIVE AND IMPORTANCE: In contrast to the frequent finding of vertebral hemangiomas at autopsy and during radiographical examinations, symptomatic lesions are rare. In the literature, a variety of therapies and combinations of therapies have been reported. There is, however, significant inconsistency regarding which therapy is considered appropriate. CLINICAL PRESENTATION: We report a young man with multiple vertebral hemangiomas, epidural extension, and secondary spastic paraparesis. INTERVENTION: Rapid neurological deterioration and the clinical suspicion of malignant disease led to an initial decompressive laminectomy and biopsy of the intraspinal soft tissue lesion. Postoperative radiotherapy produced, however, substantial effects, with complete regression of the epidural hemangioma. CONCLUSION: Based on the literature, we focus on diagnostic problems and choice of therapy for vertebral hemangiomas. Further, we discuss in particular the beneficial role of radiotherapy in the treatment of these nonmalignant lesions.

Adult↗
PubMed1997

Aneurysm of the intradural artery of Adamkiewicz treated with muslin wrapping: technical case report.

OBJECTIVE AND IMPORTANCE: An exceedingly rare, isolated spinal arterial aneurysm and its management are presented. CLINICAL PRESENTATION: A 30-year-old man who presented with severe lower back pain and headache underwent a computed tomographic study of his head that disclosed nothing abnormal and a lumbar puncture that revealed bloody, xanthochromic cerebrospinal fluid. The findings from cerebral angiography were normal, and the results from spinal angiography were consistent with a diagnosis of an aneurysm of the artery of Adamkiewicz. INTERVENTION: A transthoracic approach with a partial T11 vertebrectomy gained exposure to this anteriorly located lesion. A fusiform aneurysm of the intradural portion of the artery of Adamkiewicz was discovered. Excision of the aneurysm with a vascular bypass was deemed impossible. The lesion was treated with muslin wrapping. One year after surgery, the patient remains at his baseline neurological condition. CONCLUSION: A review of the literature revealed only one other reported case of a ruptured aneurysm of the artery of Adamkiewicz, which was discovered postmortem. Therefore, this case represents the first report of a diagnosed and treated artery of Adamkiewicz aneurysm.

Adult↗
PubMed1997

Second-look surgery for incompletely resected fourth ventricle ependymomas: technical case report.

OBJECTIVE AND IMPORTANCE: The prognosis for patients with ependymomas is related to the adequacy of surgical clearance. It is, however, often not possible to obtain a macroscopically complete resection of tumors arising in the posterior fossa. This may be because of the involvement of structures, the sacrifice of which would result in unacceptable morbidity, or because of metastatic lesions at diagnosis. For those patients in whom initial surgery was incomplete, elective second-look surgery may allow more complete clearance of tumor. INTERVENTION: We have performed second-look surgery for fourth ventricle ependymomas in five patients: two women, aged 26 and 27 years, and three male patients, aged 4 months, 19 months, and 18 years. The 19-month-old male patient underwent early second-look surgery without receiving any interim chemotherapy. Second-look surgery on the other four patients was performed after they had received chemotherapy. No additional major morbidity was associated with the subsequent surgery, which achieved macroscopically complete clearances in four of the five patients. Three of four patients who underwent macroscopically complete resections were well, without clinical or radiological evidence of recurrent tumor, at 23, 25, and 34 months after their second operations. The 10-month-old patient who underwent early second-look complete resection relapsed locally at 33 months after surgery. Complete resection was not possible in one patient who had progressive tumor 8 months after second-look surgery. CONCLUSION: For patients in whom complete excision of fourth ventricle ependymomas is not possible at initial surgery, second-look procedures may enable macroscopic clearance to be achieved with little morbidity. A larger study is needed to evaluate this approach to treatment.

Adolescent↗
PubMed1997

Lumbar cerebrospinal fluid drainage for symptomatic sacral nerve root cysts: an adjuvant diagnostic procedure and/or alternative treatment? Technical case report.

OBJECTIVE AND IMPORTANCE: The treatment of symptomatic sacral nerve root cysts is difficult and challenging. A major role has been ascribed to the hydrostatic and pulsatile forces of cerebrospinal fluid (CSF) for the symptomatology of sacral nerve root cysts. Theoretically, lowering those pressures should have a beneficial effect on the symptoms. Lowering the hydrostatic and pulsatile pressures may be achieved by lumbar CSF drainage. The effect of lumbar CSF drainage on the symptomatology of sacral nerve root cysts is described. CLINICAL PRESENTATION: Three patients suffered from leg and/or low back pain as a result of sacral nerve root cysts. INTERVENTION: First, CSF was drained through an external lumbar drain that was connected to a CSF bag. Mobilization was not restricted. All patients became free of symptoms. Eventually, a lumboperitoneal shunt was inserted in two patients. Those two patients remained free of complaints for 11 and 9 months, respectively. CONCLUSION: To our knowledge, this is the first report that clearly establishes the role of CSF forces in the symptomatology of sacral nerve root cysts. Lumbar external CSF drainage is a diagnostic tool to investigate the clinical significance of sacral nerve root cyst(s). Lumboperitoneal CSF shunting is a promising alternative in the treatment of symptomatic sacral nerve root cysts.

Back Pain↗
PubMed1997

Interlocking-clipping technique for giant aneurysms of the internal carotid artery: technical case report.

OBJECTIVE AND IMPORTANCE: Direct clipping of giant intracranial aneurysms is sometimes difficult. A unique technique using multiple fenestrated clips for closing a giant aneurysm is described. CLINICAL PRESENTATION: A 65-year-old woman presented with a 10-month history of headache and gait disturbance. Cerebral angiography disclosed an unruptured giant aneurysm of the right internal carotid artery. INTERVENTION: Surgical exposure confirmed the presence of a giant aneurysm with the splaying and incorporation of the parent artery and a number of perforating arteries originating from the dome. Four angled and three straight fenestrated clips were applied in tandem to the aneurysm to reconstruct the parent artery and preserve the perforating vessels. Through their blades and heads, the closely arranged clips were successfully interlocked. CONCLUSION: This "interlocking-clipping" technique is a modification of the tandem clipping technique. The aim of this approach is to enhance closing pressure and allow a more stable "seating" of the clips in giant cerebral aneurysms.

Aged↗
PubMed1997

Functional magnetic resonance imaging: a potential tool for the evaluation of spinal cord stimulation: technical case report.

OBJECTIVE AND IMPORTANCE: The management of chronic pain of spinal origin continues to represent a challenge for neurosurgeons. Spinal cord stimulation for chronic intractable pain is an effective therapy in approximately 50% of patients. The present study uses a novel imaging approach, functional magnetic resonance imaging (fMRI), to examine the central effects of spinal cord stimulation. CLINICAL PRESENTATION: Three patients, each with a chronic history of intractable pain, were treated at the Toronto Hospital with a trial of dorsal column stimulation (DCS). For all patients, significant improvement in pain symptoms was achieved with DCS. INTERVENTION: fMRI on a 1.5-T conventional magnetic resonance system was used to study the effects of DCS in these patients. Images were collected while the stimulator was activated and deactivated. CONCLUSION: This report is the first to describe the cerebral effects of exogenous spinal cord stimulation with fMRI. fMRI allows for the objective examination of the effects of DCS and may provide an objective means of evaluating the efficacy of DCS as a therapy for intractable pain of spinal origin.

Adult↗
PubMed1997

Intraoperative dislocation of the distal lens of a neuroendoscope: a very rare complication: technical case report.

OBJECTIVE AND IMPORTANCE: A very unusual complication of neuroendoscopy that was caused by equipment failure is described. CLINICAL PRESENTATION: Intraoperatively, the distal lens of a reusable rigid, lenscope-type neuroendoscope became dislodged. Fortunately, this did not have any adverse consequences for the patient. DISCUSSION: The cause remains obscure but probably relates to the repeated use of the scope. Perhaps the use of a disposable neuroendoscope could have prevented this, but reusable lenscopes are designed to be used many times. CONCLUSION: The risk of such equipment failure should be weighed against the distinct advantage of a much clearer image than is provided by fiberscopes.

Cerebral Ventricles↗
PubMed1997

P2 aneurysm approached via the temporal horn: technical case report.

OBJECTIVE AND IMPORTANCE: We report the use of a transcortical transventricular approach to a P2 aneurysm, which was located near the choroidal fissure, protruded into the temporal horn, and was considered to be too difficult to approach by the conventional subtemporal route. CLINICAL PRESENTATION: An 81-year-old woman suddenly developed severe headache with vomiting and subsequently lost consciousness. Computed tomographic scans revealed a diffuse intraventricular hemorrhage and subarachnoid hemorrhage. Cerebral angiography disclosed a saccular aneurysm in the right P2 segment. INTERVENTION: On the 16th day after admission, successful neck clipping was easily performed through the temporal horn via the inferior temporal gyrus. The postoperative course was uneventful. CONCLUSION: This special approach may be preferable in such cases, because it protects the brain from the detrimental effects of strong temporal retraction and provides a wider working space.

Aged↗
PubMed1998

Color Doppler ultrasound imaging in the emergency management of an intracerebral hematoma caused by cerebral arteriovenous malformations: technical case report.

OBJECTIVE AND IMPORTANCE: Ruptured arteriovenous malformations (AVMs) are important causes of spontaneous intracerebral hemorrhages. This is a report of emergency hematoma removal, avoiding damage to the nidus of the AVM, using intraoperative color Doppler imaging. CLINICAL PRESENTATION: A 38-year-old woman suddenly presented with coma. The patient underwent emergency surgery immediately after admission, without preoperative angiographic examination, because of progressive neurological deterioration caused by a massive hematoma in the right basal ganglia, as diagnosed with computed tomographic scanning. INTERVENTION: A right frontotemporoparietal craniotomy was performed. Intraoperative ultrasound imaging with a color Doppler system (EUP-NS32, 5 MHz; Hitachi Medical, Tokyo, Japan) clearly demonstrated a nidus complex in the hematoma. Based on the imaging, effective decompression of the hematoma was performed without damage to the AVM complex. CONCLUSION: Color Doppler imaging (with real-time availability) of an atypical hematoma provided significant information on the vascular lesion causing the hematoma and could reduce the surgical risks during emergency evacuation of large intracerebral hemorrhages resulting from ruptured AVMs.

Adult↗
PubMed1998

Autologous vein-covered stent repair of a cervical internal carotid artery pseudoaneurysm: technical case report.

OBJECTIVE AND IMPORTANCE: Stenting of a cervical internal carotid pseudoaneurysm is presented using a stent covered with saphenous vein. This procedure resulted in immediate exclusion of the aneurysm and maintained patency of the carotid artery. CLINICAL PRESENTATION: A gunshot to the neck resulted in airway obstruction and respiratory arrest with neurological injury in a male patient. Angiographic investigation revealed an enlarging cervical internal carotid pseudoaneurysm, possibly the source of a cerebral embolism. Anticoagulation had to be stopped because of bleeding complications. A decision was made to conduct definitive percutaneous treatment of the pseudoaneurysm. TECHNIQUE: A Palmaz stent (JJIS, Warren, NJ) was covered with saphenous vein harvested from the patient's leg. Using standard technique and a simple innovation for stent construct introduction into the sheath, the vein-covered stent was placed across the opening of the aneurysm and dilated into position with a balloon. CONCLUSION: Immediate exclusion of a cervical internal carotid pseudoaneurysm was performed using an autologous vein-covered stent. One-month follow-up confirmed continued exclusion of the pseudoaneurysm and carotid patency without stenosis.

Adult↗
PubMed1998

Source localization determined by magnetoencephalography and electroencephalography in temporal lobe epilepsy: comparison with electrocorticography: technical case report.

OBJECTIVE AND IMPORTANCE: Source modeling by magnetoencephalography (MEG) and electroencephalography (EEG) may be useful techniques for noninvasive localization of epileptogenic zones for surgery in patients with partial seizures. CLINICAL PRESENTATION: Simultaneous recordings of MEG and EEG, obtained in two patients, were coregistered on each patient's magnetic resonance image for direct comparison of these two methods with intracranial electrocorticography. TECHNIQUE: The average difference between MEG and EEG for localization of the same interictal spikes was approximately 2 cm in one patient and 3.8 cm in the other patient. One patient experienced a complex partial seizure during testing, which permitted comparison between interictal and ictal source localization by both MEG and EEG. The EEG ictal localization differed from the interictal one, whereas the MEG ictal and interictal localizations were more similar. In this patient, the MEG interictal source seemed to localize close to the ictal source, whereas EEG did not. The patients underwent temporal lobectomy after electrocorticography, and the results were compared with the findings of MEG and EEG. Although the results of both techniques agreed with the findings of electrocorticography, in one patient the MEG localization seemed to be more accurate. Both patients experienced good surgical outcomes. CONCLUSION: Both MEG and EEG source localization can add useful and complementary information for epilepsy surgery evaluation. MEG seemed to be more accurate than EEG, especially when comparing interictal versus ictal localization. Further study is needed to evaluate the validity of source localization as useful noninvasive techniques to localize the epileptogenic zone.

Adolescent↗