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1.
AJNR Am J Neuroradiol ; 32(5): 798-808, 2011 May.
Article in English | MEDLINE | ID: mdl-20651018

ABSTRACT

During the past few decades, there have been significant advances in the understanding of spinal vascular lesions, mainly because of the evolution of imaging technology and selective spinal angiography techniques. In this article, we discuss the classification, pathophysiology, and clinical manifestations of spinal vascular lesions other than DAVFs and provide a review of the endovascular approach to treat these lesions.


Subject(s)
Arteriovenous Fistula/diagnostic imaging , Arteriovenous Fistula/therapy , Arteriovenous Malformations/diagnostic imaging , Arteriovenous Malformations/therapy , Embolization, Therapeutic/methods , Spinal Cord/blood supply , Vascular Surgical Procedures/methods , Embolization, Therapeutic/trends , Humans , Neuroradiography/methods , Radiography, Interventional/methods , Spinal Cord/abnormalities , Spinal Cord/diagnostic imaging , Vascular Surgical Procedures/trends
2.
Interv Neuroradiol ; 16(2): 199-203, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20642896

ABSTRACT

We present a case of delayed aggravation of initially-resolved symptoms in a patient after successful embolization of a T5 spinal dural arteriovenous (AV) fistula with N-butyl cyanoacrylate. The symptoms were attributed to venous thrombosis and resolved with systemic anticoagulation after five days of treatment. Although the most adequate treatment for preventing venous thrombosis after spinal dural AV fistula is not known, we describe this patient as a case for more aggressive prophylactic anticoagulation measures in the immediate post-embolization time period.


Subject(s)
Anticoagulants/therapeutic use , Central Nervous System Vascular Malformations/therapy , Embolization, Therapeutic/methods , Venous Thrombosis/drug therapy , Venous Thrombosis/prevention & control , Angiography , Central Nervous System Vascular Malformations/diagnostic imaging , Central Nervous System Vascular Malformations/pathology , Enbucrilate/therapeutic use , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Spinal Cord/diagnostic imaging , Spinal Cord/pathology
3.
Interv Neuroradiol ; 16(1): 17-21, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20377975

ABSTRACT

Palsy of the third cranial nerve (oculomotor nerve, CNIII) is a well-known clinical presentation of posterior communicating artery (P-com) aneurysm. We report a series of 11 patients with partial or complete third nerve palsy secondary to P-com aneurysm. All were treated with endovascular embolization within seven days of symptom onset. Third nerve palsy symptoms resolved in 7/11 (64%), improved in 2/11 (18%) and did not change in 2/11 (18%) patients.


Subject(s)
Cerebral Angiography , Embolization, Therapeutic/methods , Intracranial Aneurysm/complications , Intracranial Aneurysm/therapy , Oculomotor Nerve Diseases/etiology , Oculomotor Nerve Diseases/therapy , Adult , Aged , Aged, 80 and over , Female , Humans , Intracranial Aneurysm/diagnostic imaging , Male , Middle Aged , Oculomotor Nerve Diseases/diagnostic imaging , Retrospective Studies , Treatment Outcome
4.
Interv Neuroradiol ; 16(1): 71-6, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20377982

ABSTRACT

Malignant brainstem gliomas (BSG) are rare tumors in adults, associated with a grim prognosis and limited treatment options. Currently, radiotherapy represents the mainstay of treatment, although new studies suggest an increased role for certain chemotherapeutic agents. Intravenous (IV) administration of bevacizumab (Avastin, Genentech Pharmaceuticals) has been shown to be active in the treatment of some enhancing malignant brainstem gliomas. The IV route of administration, however, carries a risk of systemic side effects such as bowel perforation, wound disrepair and pulmonary embolism. In addition, the percentage of IV drug that reaches the tumor site is restricted by the blood brain barrier (BBB).Weill Cornell Brain Tumor Center, Department of Neurosurgery, Weill Cornell Medical College of Cornell University: New York, NY, USA. This technical report describes our protocol in performing superselective intra-arterial cerebral infusion (SIACI) of bevacizumab using endovascular balloon-assistance in the top of the basilar artery in a patient with a recurrent malignant brainstem glioma. It represents the first time such a technique has been performed for this disease. This method of drug delivery may have important implications in the treatment of both adult and pediatric brainstem gliomas.


Subject(s)
Antibodies, Monoclonal/administration & dosage , Brain Stem Neoplasms/diagnostic imaging , Brain Stem Neoplasms/drug therapy , Catheterization/methods , Glioma/diagnostic imaging , Glioma/drug therapy , Infusions, Intra-Arterial/methods , Adult , Antibodies, Monoclonal, Humanized , Antineoplastic Agents/administration & dosage , Bevacizumab , Humans , Male , Radiography , Treatment Outcome
5.
Minim Invasive Neurosurg ; 52(3): 149-51, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19650020

ABSTRACT

OBJECTIVE: Mucoceles are progressive, slow-growing lesions of the paranasal sinuses that, left untreated, can erode into surrounding structures. Complete obliteration and exenteration of the frontal sinus via a bicoronal skin incision and frontal craniotomy is the standard neurosurgical approach to treat these lesions. TECHNIQUE: We describe two patients who underwent a combined supraciliary "keyhole" craniotomy and endonasal endoscopic resection of mucoceles with frontal sinus obliteration. The technique takes advantage of a smaller incision, while preserving adequate visualization and the ability for surgical instrumentation. Through the craniotomy, the frontal sinus mucosa is fully exenterated, the posterior table of the sinus is removed to establish communication with the intracranial space, and the nasal frontal ducts are packed with autologous tissue. The endoscopic endonasal route allows a minimally invasive access to the frontal nasal duct to ensure its blockage from the intracranial compartment. Additionally, the endoscope can be used from above through the supraciliary approach to allow for contralateral frontal sinus exposure and mucosal exenteration. CONCLUSION: The combined supraciliary-endoscopic endonasal approach provides a minimally invasive access for the treatment of sinonasal disease with frontal sinus mucoceles that invade the intracranial cavity.


Subject(s)
Endoscopy/methods , Frontal Sinus/surgery , Minimally Invasive Surgical Procedures/methods , Mucocele/surgery , Neurosurgical Procedures/methods , Aged , Female , Humans , Treatment Outcome
6.
Interv Neuroradiol ; 15(4): 453-5, 2009 Dec.
Article in English | MEDLINE | ID: mdl-20465885

ABSTRACT

SUMMARY: During embolization of a large frontal arteriovenous malformation (AVM), Onyx-18 (eV3) was injected into an M3 branch of the middle cerebral artery via a Marathon microcatheter (eV3). After 40 minutes of embolization, the microcatheter could not be retracted due to fixation within the Onyx cast despite prolonged, robust attempts. A balloon microcatheter (Hyperform(TM), eV3) was advanced distally and inflated to provide distal counter tension, allowing microcatheter retrieval with minimal traction on the vasculature.

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