Major complications of percutaneous embolization of skull-base tumors.

The technique of direct intratumoral injection of permanent liquid polymerizing agent was initially described in 1994 and has evolved significantly with experience. We report complications that occurred in two patients during injection of Histoacryl and offer suggestions to prevent such complications in the future. In one patient, the glue settled in the right middle cerebral artery; in the second, the glue entered the left ophthalmic artery through a collateral branch. Although the fundamental injection technique has not changed, we suggest additional precautions and modifications to make this procedure a safer and more valuable element in the overall management of patients with difficult skull-base tumors.

Therapeutic approach to arteriovenous malformations of the tongue.

Arteriovenous malformations (AVM) are developmental errors with a high complication rate because they are hemodynamically active. The aim of our study is to evaluate management of the rare subgroup of tongue AVM. From 1982 to 1994, 25 patients with AVM of the tongue presented to our department. All patients were discussed in our multidisciplinary staff consultation and were treated by embolization, surgery, or were followed-up clinically with no intervention. Thirteen patients were asymptomatic in a hemodynamically quiescent phase and did not require any kind of intervention. The 12 others underwent embolization procedures following which 6 became stable, 2 had complementary surgery, 1 was lost to follow-up, 1 had two minor bleeding episodes without the need for hospitalization, and 2 were improved. Arteriovenous malformations of the tongue must be followed clinically and treated only if they become active. Permanent embolization with a polymerizing liquid administered through supra-selective catheterization or by direct puncture of the malformation is recommended.

Puerperal seizures after post-dural puncture headache.

OBJECTIVE: To describe eight cases of postpartum women who developed seizures associated with post-dural puncture headache. METHODS: Between the years 1982-1991, more than 19,000 women at our institution underwent subarachnoid analgesia for delivery or puerperal tubal sterilization. In eight of these women, grand mal seizures developed after spinal headache. RESULTS: In all eight women, typical post-dural puncture headaches were followed by visual disturbances that progressed to cortical blindness in three. These headaches and visual disturbances culminated in generalized tonic-clonic seizures 2-7 days after dural puncture. Although some of these women had transient hypertension at the time of seizure, none had preeclampsia. In three of the women evaluated, there was evidence of regional blood flow changes; two had diffuse cerebral artery vasospasm seen on angiography, and the third had diminished blood flow detected by a xenon-flow study. CONCLUSION: We propose that cerebral vasoconstriction is the mechanism for post-dural puncture headaches and seizures. Anatomic brain displacement may incite this vasospasm. This mechanism could also be the cause of cranial nerve palsies that have been described after dural puncture.

Defining the role of structural lesions and metabolic abnormalities in periodic lateralized epileptiform discharges.

We reviewed the EEG, clinical manifestations, computed tomography (CT) and magnetic resonance imaging (MRI) scans of 39 patients with periodic lateralized epileptiform discharges (PLEDs) or bilateral periodic lateralized epileptiform discharges (BIPLEDs) to determine the role of structural lesions (SL) and metabolic abnormalities (MA) in their pathogenesis. Thirty-eight patients had CT and 7 had MRI scans. Thirty-eight had lesions on CT or MRI. All those with PLEDs consistently had lesions on the side of the discharges, and 5 of 6 with BIPLEDs had lesions on both hemispheres. A subgroup of 23 patients with metabolic determination within 24 h of EEG all showed mild to moderate MA. They all also had SL. These findings support a primary role for SL but cannot exclude an additional role for MA.

Carcinoid tumor with intradural spinal metastases.

A case of spinal intradural metastasis from a carcinoid tumor is reported. The case is of interest due to the rarity of central nervous system involvement by these tumors and the long latency period of the patient's presentation.

Value of arteriography in the evaluation of a sonolucent pancreatic mass.

A pseudoaneurysm of the pancreaticoduodenal artery secondary to chronic pancreatitis was erroneously diagnosed as a pancreatic pseudocyst by abdominal plain films, barium gastrointestinal studies, and abdominal ultrasound. Because of the operative findings, it was necessary to interrupt surgery undertaken to drain the presumed pseudocyst. Angiography is strongly recommended as a preoperative study in patients with sonolucent pancreatic masses to distinguish pseudoaneurysms of pancreatic vessels from pseudocyts.