ABSTRACT
OBJECTIVE: The goal was to determine the safety and efficacy of absolute ethyl alcohol treatment in the management of intra-axial brain arteriovenous malformations (AVMs). METHODS: Seventeen patients (eight female and nine male patients; mean age, 41 yr) underwent ethanol endovascular therapy for treatment of their brain AVMs. Superselective amytal testing preceded all procedures. Neuroleptic intravenous anesthesia was used for 16 patients, and general anesthesia was used for 1 patient. Follow-up monitoring consisted of clinical evaluations, magnetic resonance imaging, and arteriography. RESULTS: In follow-up evaluations (mean follow-up period, 13 mo) after embolization of brain AVMs, neither vascular recanalization nor the neovascular recruitment phenomenon was observed in any patient. Progressive AVM thrombosis at arteriographic follow-up evaluation was a constant feature. Seven patients were cured of their AVMs with ethanol endovascular therapy alone. Three patients were cured of their lesions with ethanol embolization plus surgical resection. One patient was cured of his lesion with ethanol embolization and radiation therapy of the residual nidus. Three patients underwent only partial therapy, with significant improvement in symptoms. Three patients are currently undergoing ethanol endovascular therapy. Complications occurred with 8 of 17 patients, most of which were transient. Two patients died because of late subarachnoid hemorrhages, one patient 4 months and one patient 14 months after partial therapy. CONCLUSION: Progressive and permanent AVM occlusion is a common finding in arteriographic follow-up evaluations. In no patients did arterial recanalization or the neovascular recruitment phenomenon occur. Our initial results indicate that ethanol has a permanence that is seldom encountered with other embolic agents. With aggressive decadron therapy, the complications related to swelling in the brain are largely reversible.
Subject(s)
Embolization, Therapeutic/methods , Ethanol/administration & dosage , Intracranial Arteriovenous Malformations/therapy , Adult , Cerebral Angiography , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Intracranial Arteriovenous Malformations/diagnostic imaging , Intracranial Arteriovenous Malformations/mortality , Male , Middle Aged , Survival Rate , Treatment OutcomeABSTRACT
A 36-year-old female with delayed endolymphatic hydrops (ELH) after acoustic tumor removal of the same ear is reported. She presented at our clinic with pressure, fullness, and tinnitus involving her right ear. She had an abnormal auditory brainstem response (ABR), and a computed tomography showed a right acoustic tumor. She underwent a complete tumor removal from a suboccipital incision with significant intraoperative and postoperative ABR improvements. Preoperatively, there was no fluctuation in her hearing and her electrocochleography (ECoG) was normal. She did well postoperatively, but 18 months after the tumor surgery she complained of noticeable fluctuating hearing loss with increased tinnitus and aural fullness of her right operated ear and nausea but no vertigo. Neurotological examinations showed a positive right urea dehydration and positive right ECoG for enhanced summating potential to clicks. She was diagnosed as cochlear Meniere's disease with delayed ELH, failed medical management and then underwent a valved shunt surgery for ELH to stabilize her hearing. Eight years after her acoustic tumor surgery and 6 and a half years after her ELH surgery she has stabilized hearing with normal ABR and ECoG. Her clinical course is presented and a pathogenesis of ELH is discussed.
Subject(s)
Edema/physiopathology , Endolymph/physiology , Evoked Potentials, Auditory, Brain Stem/physiology , Neuroma, Acoustic/surgery , Postoperative Complications/physiopathology , Adult , Audiometry, Evoked Response , Brain Stem/physiopathology , Edema/diagnosis , Female , Humans , Magnetic Resonance Imaging , Neuroma, Acoustic/diagnosis , Neuroma, Acoustic/physiopathology , Postoperative Complications/diagnosis , Tomography, X-Ray ComputedABSTRACT
The efficacy of chemoprophylaxis in the treatment of basilar skull fractures was studied in 129 patients over a 2-year period; antibiotics were found ineffective in preventing central nervous system infections, and in some cases may have proved harmful. It is suggested that a more rational approach to the treatment of basilar skull fractures includes close observation of the patient for early signs of meningitis, and if these should develop, treatment with antibiotics appropriate to the organism involved.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Occipital Bone/injuries , Skull Fractures/drug therapy , Ampicillin/therapeutic use , Brain Abscess/prevention & control , Cephalothin/therapeutic use , Humans , Meningitis/prevention & control , Nasopharynx/microbiology , Prospective Studies , Retrospective Studies , Skull Fractures/complicationsABSTRACT
Transcutaneous electrical stimulation as a means of relieving acute pain was evaluated in 100 patients who underwent abdominal or thoracic operative procedures. Transcutaneous electrical stimulation proveded pain relief in 77 per cent of test patients as opposed to 17 per cent of control patients. Transcutaneous electrical stimulation is an effective method of treatment that has many advantages over analgesic drugs.
Subject(s)
Electric Stimulation/methods , Pain, Postoperative/therapy , Adolescent , Adult , Aged , Clinical Trials as Topic , Female , Humans , Male , Middle Aged , SkinABSTRACT
Of 100 consecutive patients with acute subdural hematoma, 53 survived. Blood pressure and heart rate changes were not reliable indicators of increased intracranial pressure or cerebral disaster. Electrocardiographic changes in these patients were dramatic. Forty-one patients developed a new cardiac arrhythmia. Increased intracranial pressure and brain lesions adversely affect the heart. These effects must be recognized and appropriately treated.
Subject(s)
Arrhythmias, Cardiac/etiology , Hematoma, Subdural/complications , Acute Disease , Adolescent , Adult , Aged , Alcoholism/complications , Atrial Fibrillation/etiology , Blood Pressure , Bradycardia/etiology , Cardiac Complexes, Premature/etiology , Child , Child, Preschool , Female , Heart Block/etiology , Heart Rate , Humans , Hypertension/complications , Infant , Intracranial Pressure , Male , Middle Aged , Prognosis , Tachycardia/etiology , Ventricular Fibrillation/etiologyABSTRACT
The authors describe a case of human cerebral mucormycosis following open head trauma and craniotomy, and discuss possible roles of steroids and antibiotic therapy in its pathogenesis. They suggest that the common usage of prolonged broad-spectrum chemoprophylaxis in head trauma may require critical review.
Subject(s)
Brain Diseases/etiology , Craniocerebral Trauma/complications , Mucormycosis/etiology , Amphotericin B/therapeutic use , Anti-Bacterial Agents/adverse effects , Brain Diseases/drug therapy , Brain Diseases/pathology , Cerebrospinal Fluid/microbiology , Child , Craniotomy , Fungi/isolation & purification , Humans , Male , Mucormycosis/drug therapy , Mucormycosis/pathology , Postoperative Complications , Steroids/adverse effectsSubject(s)
Circle of Willis/surgery , Intracranial Aneurysm/surgery , Adolescent , Adult , Aged , Brain/blood supply , Circle of Willis/pathology , Female , Hematoma/complications , Humans , Intracranial Aneurysm/complications , Intracranial Aneurysm/mortality , Intracranial Aneurysm/pathology , Male , Mental Disorders/etiology , Methods , Middle Aged , Neurosurgery/adverse effects , Postoperative Complications , Spasm , Unconsciousness/complicationsSubject(s)
Cranial Nerve Injuries , Horner Syndrome/etiology , Skull Fractures/complications , Sphenoid Bone/injuries , Abducens Nerve Injury , Adolescent , Adult , Arteriovenous Fistula/etiology , Carotid Artery Diseases/etiology , Carotid Artery Injuries , Cavernous Sinus , Cerebral Angiography , Child , Facial Paralysis/etiology , Female , Humans , Male , Ophthalmoplegia/etiology , Skull Fractures/diagnostic imaging , Temporal Bone/injuries , Trigeminal Nerve InjuriesABSTRACT
Although the most common aetiology of transient vertebrobasilar insufficiency is atherosclerosis, a similar syndrome may occasionally be produced by cervical osteophytes. The possibility of such a remedial lesion makes further investigation mandatory in such patients-especially if symptoms are associated with sudden movements of the head or neck. When vertebral compression results from osteophytes, it can be easily relieved by a minor modification of the usual anterior cervical fusion technique. This method has proved to be quite efficacious in two patients whose case histories are reported.
