Endovascular treatment of an infantile nongalenic cerebral arteriovenous fistula with cyanoacrylate.

We report the radiological features, including Doppler sonography and magnetic resonance angiography (MRA) findings, of a nongalenic arteriovenous fistula diagnosed in the neonatal period. Hypertensive hydrocephalus developed in infancy. Emergent percutaneous transarterial embolization with n-butyl-2-cyanoacrylate was successfully performed and lead to clinical improvement. MRA allowed a noninvasive follow-up.

CT-guided needle biopsy of intracranial tumours: results in 118 consecutive patients.

The purpose of this paper is to evaluate the efficacy and safety of CT-guided needle biopsies and to determine the optimal indications for this technique. The case histories of 118 patients who underwent a CT-guided biopsy for brain lesions during a six-year period, from November 1986 to September 1992, were reviewed. During a preliminary CT-scan, the entry site was determined and localized using a radio opaque marker and the safest route to the lesion was chosen. One hundred and thirty four procedures were performed in 118 patients. A positive diagnosis of tumour was obtained in 106 patients (89.8%). Repeat procedures were required in 18 patients. High-grade gliomas were the more common lesions (55.1%). Morbidity and mortality was assessed over the 30-day period after the procedure. Nine patients died during this time. Eight patients from day 3 to day 30 in the expected course of their disease and one within 48 first hours from neurological deterioration following the procedure. We found that CT-scan guided biopsies are a safe and accurate way to obtain brain tissue specimens for pathological diagnosis in selected cases. For superficial and large tumours it is a simple, fast and effective procedure.

Striatocapsular infarction: MRI and MR angiography.

We present a case of left striatocapsular infarction manifest clinically as a transient right hemiparesis. MRI showed a left striatocapsular infarct. Striatocapsular infarction, unlike lacunar infarction, is often associated with occlusive disease of the carotid artery. In order to screen the carotid vessels, cervical MR angiography (MRA) was performed during the same examination, demonstrating a left internal carotid artery occlusion, confirmed by contrast arteriography. MRA, a noninvasive modality, can be a useful adjunct to MRI, when diagnostic information concerning the cervical carotid artery is needed.

Intracranial aneurysm associated with pituitary adenoma shown by MR angiography: case report.

We present a case of aneurysm of the anterior communicating artery associated with a pituitary adenoma. Recognition of this association has important clinical implications, leading to modification of the surgical approach. The aneurysm was shown on MR angiography and confirmed with contrast arteriography and at surgery.

[Clinical and electroencephalographic manifestations during the Wada test using intracarotid injection of methohexital (Brietal)]. / Manifestations cliniques et électro-encéphalographiques lors du test de Wada par injection intra-carotidienne de méthohexital (Brietal).

In this retrospective study we report our 12 years' experience of the Wada test (intra-carotid injection of short half-life barbiturates) using Methohexital. The clinical manifestations induced by Methohexital were similar to those observed with Amobarbital. The inocuity of the test is attested by the finding that no incident or accident has been reported in 126 injections, the risk being the same as for arteriography. The two main advantages of Methohexital over Amobarbital are: 1) short hemispheric narcosis, which makes it possible to explore the two carotid arteries territories during the same session and limits the risk of drug diffusion to the two hemispheres; 2) the rare occurrence of vigilance troubles such as drowsiness or falling-asleep, which are frequently observed during Amytal Wada test. Intracarotid Methohexital injections are effective to determine the hemispheric lateralization of language and useful to evaluate the role of each hemisphere in memory, especially before the surgical treatment of drug-resistant focal epilepsies.

Treatment of experimental carotid aneurysms by endoprosthesis implantation: preliminary report.

Four experimental aneurysms were treated by implantation of an endoprosthetic stent. The aneurysms were surgically created by grafting a venous pouch on the carotid artery of mongrel dogs. Aneurysm patency was assessed angiographically. Under systemic heparinization and via a transfemoral approach, the stent measuring 20 mm in length and 5 mm in diameter, was implanted in the lumen of the parent artery at the level of the aneurysmal neck. Good angiographic results were obtained immediately following implantation, showing exclusion of the aneurysm from the circulation. Patency of the parent vessel was preserved in all the experimental aneurysms treated. In one case an angiogram performed 30 days later showed the same findings with excellent tolerance of the device. The technique of endovascular treatment of experimental aneurysms by stent implantation appears feasible and safe in vivo. Further investigations are still necessary before clinical applications.

Spontaneous calcific cerebral emboli from calcified aortic valve stenosis.

Calcific cerebral emboli (CE) are a rare complication of calcified aortic valve stenosis (CAS). These emboli usually result from diagnostic manoeuvres (e.g. left heart catheterization) or from therapeutic procedures (e.g. heart valve surgery). Spontaneous calcific emboli are exceptional. We present the cases of two subjects known to have CAS who presented with acute neurological disorders suggesting strokes. In both subjects CT scans of the skull and brain provided a diagnosis of spontaneous CE by showing calcium-dense dots located on vessels or within the cerebral parenchyma. Additional examinations enabled us to determine the origin (heart or carotid artery) of these emboli. The finding of spontaneous cerebral CE is a very strong argument in favour of surgical valve replacement in these patients.

Dural fistulae of the cavernous sinus treated by embolization. Ten cases.

We report ten cases of dural fistulae of the cavernous sinus treated by the endovascular route. The fistulae were fed by the internal and external carotid arteries. All patients presented with ophthalmic symptoms and/or headache and/or intracranial murmur. Embolization was decided on the ground of all in visual acuity, exophthalmos, ophthalmoplegia or sudden exacerbation of clinical symptoms. It was performed after selective catheterization of external carotid feeders with non-resorbable particles. The shunt was totally occluded in 7 cases, and local signs were improved in all patients: the intracranial murmur disappeared in 2 out of 4 cases and headache was relieved in 2 out of 3 cases. No permanent complication was observed. Among the various possible treatments of these dural fistulae, embolization of branches of the external carotid artery is a simple, effective and safe method, provided its principles and indications are respected.

Demonstration of subclavian steal by MR angiography.

We present three cases of subclavian steal syndrome demonstrated by MR angiography. By using a presaturation pulse located at the bottom or at the top of the acquisition volume we demonstrated the flow direction of vertebral arteries. We used a new investigational two-dimensional time-of-flight sequence.

[Tumors of the pineal region: MRI aspects. Apropos of 20 cases]. / Tumeurs de la région pinéale: aspects IRM. A propos de vingt observations.

MR imaging (0,5 T) was performed in twenty patients with a tumor of the pineal region (17 pathological correlations). To establish the place of this technique, MR imaging data are studied. There is a great variety of tumor types, but the signal of the tumor is usually non specific. The main indication of MR imaging appears to be the evaluation of the extension of the tumor before surgery.

[Percutaneous injection of methyl-metacrylate in osteoporosis and severe vertebral osteolysis (Galibert's technic)]. / Injection percutanée de méthyl-métacrylate dans le traitement de l'ostéoporose et ostéolyse vertébrale grave (technique de P. Galibert).

The authors present their preliminary experiences using methyl-metacrylate by percutaneous injection for the treatment of osteoporosis and osteolysis of the vertebral body and for vertebral angiomas. The injection of cement strengthens the vertebral body and prevents its collapse. The mixture used consist of 4.80 g of powder with 5 cm3 of monomer liquid. The technique is performed with radiological control under neuroleptanalgesia and a local anesthesia before insertion of the needle. This technique gives good results for the treatment of vertebral pain caused by osteoporosis or osteolysis.

[Neurinoma of the trigeminal nerve. Excision by combined suboccipital and pteriono-temporal approach]. / Neurinome du trijumeau. Exérèse par abord mixte sous-occipital et ptériono-temporal.

The authors report a recent personal case of trigeminal neurinoma with a topographical extension both in the cerebello pontine angle and the middle cerebral fossa. This 33 year-old female suffered from progressive sensory disturbances of her right hemiface associated with a right fifth nerve motor deficit, a right VI nerve palsy and a tinnitus. CT scan and angiogram were evocative of a right hourglass trigeminal neurinoma. Two successive operative stage through suboccipital route and a pteriono-temporal extra and intradural approach allowed a complete removal of the tumour. A post-operative rhinorrhea dried up with 10 days. The patient complained with a right hemiface anesthesia and a palsy of the masseter muscles; the VI nerve palsy recovered within 3 months. From the review of the literature (118 cases) the authors summarize the anatomical, clinical and radiological features of these tumours and point out. The difficulty of their surgical removal that was only complete in half of cases. The high frequency of hourglass neurinomas explains that a single suboccipital or subtemporal approach--even with opening of the tentorium--only allowed 23 complete removal among the 58 published or quoted interventions. This justifies that in a majority of cases a combined approach must be preferred, using successively a suboccipital and an intradural subtemporal route, the latted giving access to the cavernous sinus in case of its invasion.

[Intramandibular angioma with an arteriovenous fistula. Apropos of a case]. / Angiome intramandibulaire avec fistule artérioveineuse. A propos d'une observation.

A patient with intramandibular angioma and arteriovenous fistula (high output arterial angiodysplasia) required 4 separate hyperselective embolizations and a surgical excision. The problems of embolization, surgical technique and indications for operation of this happily rare, serious vascular malformation are analyzed.

Listening with one or two hemispheres: verbal dichotic testing after intracarotid barbiturate injection.

A verbal dichotic test was given to 16 patients during right or left hemisphere narcosis induced by intracarotid barbiturate injection (Wada's procedure). During right hemisphere narcosis patients did not repeat left ear words. This demonstrates an intrahemispheric competition within the left hemisphere at the detriment of left ipsilateral ear words. After left dominant hemisphere narcosis, when aphasia had apparently disappeared, patients temporarily did not repeat right ear words. This suggests that, during this critical time period, two competitive processes took place. First the right hemisphere selected the left ear words by an intrahemispheric competition. Second it imposed them on the recovering left hemisphere at the detriment of right ear words, because of an interhemispheric competition.

[Regressive bilocular acute pseudotumoral demyelinization. Second lesion development after 10 years of remission]. / Démyélinisation aiguë pseudo-tumorale biloculaire régressive. Seconde évolution lésionnelle à 10 ans de rémission.

The authors report what seems to be the 4th case of acute pseudotumoral demyelinating disease with regressive evolution. Onset was marked by hemiplegia with tumoral pattern on CAT-scan and pneumoencephalography and an important cystic cavity at surgery. Controlateral hemiplegia occurred 2 months later. After a period of partial recovery a long period of remission was observed, followed by a relapse 10 years after the first symptoms. This case suggests that remissions reaching 10 years are possible in such pseudotumoral demyelinating disease, but also shows that there are late secondary evolutions, as in multiple sclerosis.