[Progression following the embolisation of 100 intracranial arteriovenous malformations]. / Evolución tras la embolización de 100 malformaciones arteriovenosas intracraneales.

INTRODUCTION: We analysed the characteristics, progression and outcomes observed following the embolisation of 100 intracranial arteriovenous malformations (AVM) that were performed in order to achieve complete obliteration of the AVM, the elimination of associated vascular risk factors and also to reduce their size with a view to increasing the effectiveness of later treatments. PATIENTS AND METHODS: The demographic and anatomical characteristics of 110 patients with AVM were analysed over a period of 13 years, and embolisation was performed in 100 of them. In all, 203 embolisation sessions were carried out with an average of 3 embolisations per patient. Of the 100 AVM that were embolised, 36 were AVM which were treated by embolisation with no later therapy, 48 required radiosurgery after the embolisation and the other 16 were submitted to surgery following the embolisation. The type of materials used included liquid adhesive embolic agents (Hystoacryl, Glubran), non-adhesive embolic agents (Onyx) and polyvinyl alcohol particles. Patients were examined clinically and arteriographically. RESULTS: Of the 100 AVM that were embolised, complete eradication was accomplished with just embolisation in 27 cases of AVM (27%). Of the 48 AVM in which radiosurgery was carried out at a later date, the average rate of obliteration was 78% and of the 16 AVM in which surgery was carried out some time later, the average rate of obliteration was 70%. Of the 100 AVM that were embolised, some residue remained in 16 cases. Embolisation eliminated most of the associated vascular risk factors, as can be seen by the fact that associated risk factors disappeared in 28 (65%) out of the 43 AVM with such factors. The morbidity and mortality rates with embolisation were 8% and 2%, respectively. CONCLUSIONS: Embolisation eliminated most of the vascular risk factors, with complete obliteration in 27 cases and size was satisfactorily reduced for later treatment; at the same time, morbidity and mortality rates were acceptable.

Evolución tras la embolización de 100 malformaciones arteriovenosas intracraneales / Progression following the embolisation of 100 intracranial arteriovenous malformations

Introducción. Analizamos las características, evolución y resultados tras la embolización de 100 malformaciones arteriovenosas (MAV) intracraneales con el objetivo de conseguir la obliteración completa de la MAV, la eliminación de los factores de riesgo vascular asociados y disminuir su tamaño para la efectividad de posteriores tratamientos. Pacientes y métodos. Analizamos las características demográficas y anatómicas de 110 pacientes portadores de MAV durante 13 años, y se realizó una embolización a 100de éstos. Se practicaron 203 sesiones de embolización con una media de 3 embolizaciones/paciente. De las 100 MAV embolizadas, hubo 36 MAV a las que sólo se realizó embolización sin otro tratamiento posterior, a 48 se les realizó radiocirugía postembolización y a los 16 restantes cirugía postembolización. El tipo del material usado fueron agentes embólicos líquidos adhesivos (Hystoacril, Glubran®), agentes embólicos no adhesivos (Onyx) y partículas de polivinil alcohol. Se revisó a los pacientes clínica y arteriográficamente. Resultados. De las 100 MAV embolizadas, hubo una erradicación completa con sólo embolización en 27 MAV (27%). De las48 MAV a las que se les realizó radiocirugía posterior, hubo una obliteración media del 78%. De las 16 MAV a las que se realizó cirugía posterior, hubo una obliteración media del 70%. De las 100MAV embolizadas, hubo 16 en las que quedaron restos. La embolización eliminó la mayoría de los factores de riesgo vascular asociados: de 43 MAV con factores de riesgo asociados, desaparecieron en 28 MAV (65%). Con la embolización se produjo una morbilidad del 8% y mortalidad del 2%. Conclusión. La embolización eliminó la mayoría de los factores de riesgo vascular, con una obliteración completa en 27 casos y se redujo el tamaño para posteriores tratamientos de manera satisfactoria, y todo ello con una morbimortalidad aceptable (AU)

Introduction. We analysed the characteristics, progression and outcomes observed following the embolisation of 100intracranial arteriovenous malformations (AVM) that were performed in order to achieve complete obliteration of the AVM, the elimination of associated vascular risk factors and also to reduce their size with a view to increasing the effectiveness of later treatments. Patients and methods. The demographic and anatomical characteristics of 110 patients with AVM were analysed over a period of 13 years, and embolisation was performed in 100 of them. In all, 203 embolisation sessions were carried out with an average of 3 embolisations per patient. Of the 100 AVM that were embolised, 36 were AVM which were treated by embolisation with no later therapy, 48 required radiosurgery after the embolisation and the other 16 were submitted to surgery following the embolisation. The type of materials used included liquid adhesive embolic agents (Hystoacryl, Glubran ®), non adhesiveembolic agents (Onyx) and polyvinyl alcohol particles. Patients were examined clinically and arteriographically. Results. Of the 100 AVM that were embolised, complete eradication was accomplished with just embolisation in 27 cases of AVM (27%). Of the 48 AVM in which radiosurgery was carried out at a later date, the average rate of obliteration was 78% and of the 16 AVM in which surgery was carried out some time later, the average rate of obliteration was 70%. Of the 100 AVM tha twere embolised, some residue remained in 16 cases. Embolisation eliminated most of the associated vascular risk factors, as can be seen by the fact that associated risk factors disappeared in 28 (65%) out of the 43 AVM with such factors. The morbidity and mortality rates with embolisation were 8% and 2%, respectively. Conclusions. Embolisation eliminated most of the vascular risk factors, with complete obliteration in 27 cases and size was satisfactorily reduced for later treatment; at the same time, morbidity and mortality rates were acceptable (AU)

[A clinico radiological study of patients with cavernous angiomas of the spinal cord]. / Estudio clinicorradiológico de pacientes con angiomas cavernosos medulares.

AIM: To define the spectrum of signs, symptoms and radiological features in patients with spinal intramedullary cavernous angioma. We analyze surgical management and clinical follow up in these patients. PATIENTS AND METHODS: 16 adult patients, 9 women and 7 men, were studied in our hospital each with one cavernous angioma of the spinal cord. All patients were diagnosed with magnetic resonance imaging. The lesion location was intramedullary in all patients, 6 patients cervical level and 10 thoracic level. RESULTS: In 12 patients surgical resection of the malformation was performed and histological results confirmed the spinal cavernous diagnostic. In 10 patients, the clinical outcome had improved in Frankel grade. In the four nonoperated cases, successive monitoring studies demonstrated no radiological progression and the clinical symptomatology has remained stable. CONCLUSION: Women in the fertile period appear to be predisposed to develop spinal cavernous angioma. The bleeding risk, in our study, didn t have any relation with CMA level. Magnetic resonance imaging features cannot predict the CMA evolution.

[The contribution of an intraarterial electroencephalographic study in patients with deep epileptogenic foci]. / Aportación del estudio electroencefalográfico intrarterial en pacientes con focos epileptógenos profundos.

OBJECTIVES: To evaluate the diagnostic efficacy of an intra-arterial electroencephalographic recording and determine which patients obtain most benefit from this technique, to compare the results obtained using other recording techniques and to establish a standard for recording. PATIENTS AND METHODS: We made 64 intra-arterial recordings in 30 patients from one of three groups: persons with drug-resistant temporal epilepsy; patients with epileptic seizures of any type who required cerebral arteriography and patients whose illness required selective anteriography for any reason. We used a Seeker 10 guide-wire, the end of which acted as an electrode and a 2 minute recording was made. The position of the electrode varied depending on the site of the patients disorder. Activity was simultaneously measured with surface electrodes. Using the chi squared non-parametric test, we analysed the efficacy of the test. The paired t test was used to establish the concordance between observers. We compared the results obtained from the intra-arterial EEG with the simultaneous surface recording. RESULTS: We found three types of electroencephalographic patterns. The commonest was defined by the presence of high-voltage multi-spiked acute waves. The sensitivity of the test was 93.33%, the specificity was 80% and the overall value of the test was 86.66%. The chi squared test showed its reliability in the diagnosis of deep epileptogenic foci. There was high concordance between the observers in the study. No complications were seen in the patients in this study. CONCLUSION: The intra-arterial EEG recording is a semiinvasive test which may be useful in a selected group of patients and has high sensitivity and specificity.

Aportación del estudio electroencefalográfico intrarterial en pacientes con focos epileptógenos profundos / The contribution of an intra-arterial electroencephalographic study in patients with deep epileptogenic foci

Objetivos. Valorar la eficacia diagnóstica del registro electroencefalográfico intrarterial y conocer qué pacientes se benefician más de esta técnica; comparar los resultados obtenidos con los de otras técnicas de registro y establecer una pauta de registro. Pacientes y métodos. Se realizan 64 registros intrarteriales en 30 pacientes pertenecientes a uno de estos tres grupos: individuos con epilepsia temporal resistente a farmacoterapia; enfermos con crisis epilépticas de cualquier tipo que requieran arteriografía cerebral, y pacientes cuya dolencia precise la realización de arteriografía selectiva por cualquier motivo. Se emplea una guía Seeker 10, cuyo extremo distal se comporta como electrodo, y se realiza un registro de 2 minutos de duración. La situación del electrodo varía según la localización de la enfermedad del paciente. Simultáneamente se registra la actividad con electrodos superficiales. Mediante la prueba no paramétrica de la ji al cuadrado, se analiza la eficacia de la prueba y, con el test de la t pareada, la concordancia entre observadores. Se comparan los resultados obtenidos a través del EEG intrarterial y el registro de superficie simultáneo. Resultados. Se han encontrado tres tipos de patrones electroencefalográficos, el más frecuente de los cuales es el definido por la existencia de ondas agudas hipervoltadas y polipuntas. La sensibilidad de la prueba fue del 93,33 por ciento, la especificidad del 80 por ciento y el valor global de la prueba del 86,66 por ciento. La prueba de la ji al cuadrado demostró su fiabilidad en el diagnóstico de focos epileptógenos profundos. La concordancia entre observadores fue elevada. No se han descrito complicaciones en los pacientes de la muestra. Conclusión. El registro EEG intrarterial es una prueba diagnóstica seminvasiva que puede ser útil en un grupo seleccionado de pacientes y que presenta sensibilidad y especificidad elevadas (AU)

[Demyelinating pseudotumoral lesion prior to a primary cerebral lymphoma]. / Lesión pseudotumoral desmielinizante previa a linfoma cerebral primario.

INTRODUCTION: Some case of demyelinating pseudotumoral lesions preceding the appearance of primary cerebral lymphoma have been reported. The relation between the two conditions is not known. We report the case of a woman in whom a demyelinating pseudotumoral lesion had been diagnosed on biopsy and who developed a primary cerebral lymphoma 13 months later. CLINICAL CASE: In October 1997 a 38 year old woman presented with a secondarily generalized focal motor seizure. Neuroimaging showed a left frontal tumour with marked oedema and uptake of contrast medium. Based on the clinicoradiological suspicion of a primary cerebral tumour or metastasis, treatment was started with dexamethasone. Approximately two weeks later a stereotaxic biopsy was done, in which there was demyelination with conservation of the axons and perivascular inflammatory infiltration with polyclonal T and B lymphocytes. The diagnosis was 'a pseudotumoral form of a demyelinating disease'. Thirteen months later the patient had episodes of falling to the floor, followed by subsequent slight confusion and difficulty in speaking. On neuroimaging studies (cerebral CAT and MR) there was a tumour of the left basal ganglia, considerable oedema and homogeneous marking following the injection of contrast. Anatomopathological study of the lesion showed a B cell lymphoma. CONCLUSION: In cases of pseudotumoral demyelinating lesions the possibility of a primary cerebral lymphoma of the central nervous system must be remembered.