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1.
Neuroradiology ; 45(1): 19-21, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12525949

RESUMO

We reviewed the selective endosaccular coiling of eight consecutive patients with saccular basilar trunk aneurysms, seven after subarachnoid haemorrhage (SAH). All aneurysms could be coiled in a mean procedure time of 61 min. There were no procedure-related complications, but one patient died of vasospasm following the SAH. The remaining seven had a good outcome, and five of seven aneurysms were completely occluded with a stable result on follow-up angiography. Compaction of the coils occurred in one very large aneurysm necessitating additional coiling. One patient with a giant, partially thrombosed aneurysm was coiled four times in a 3-year period to obtain a satisfactory anatomical result.


Assuntos
Artéria Basilar , Embolização Terapêutica , Aneurisma Intracraniano/terapia , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Hemorragia Subaracnóidea/etiologia , Fatores de Tempo
2.
J Neurol Neurosurg Psychiatry ; 73(5): 591-3, 2002 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-12397159

RESUMO

OBJECTIVES: To compare endovascular coiling with neurosurgical clipping of ruptured basilar bifurcation aneurysms. METHODS: Patient and aneurysm characteristics, procedural complications, and clinical and anatomical results were compared retrospectively in 44 coiled patients and 44 patients treated by clipping. The odds ratios for poor outcome (Glasgow outcome scale 1, 2, 3) adjusted for age, clinical condition, and aneurysm size were assessed by logistic regression analysis. RESULTS: In the endovascular group, five patients (11%) had a poor outcome v 13 (30%) in the surgical group; the adjusted odds ratio for poor outcome after coiling v clipping was 0.28 (95% confidence interval, 0.08 to 0.99). Procedural complications were more common in the surgical group. Optimal or suboptimal occlusion of the aneurysm immediately after coiling was achieved in 41 patients (93%). Clipping was successful in 40 patients (91%). CONCLUSIONS: The results suggest that embolisation with coils is the preferred treatment for patients with ruptured basilar bifurcation aneurysms.


Assuntos
Aneurisma Roto/cirurgia , Artéria Basilar/cirurgia , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Aneurisma Roto/complicações , Aneurisma Roto/patologia , Artéria Basilar/patologia , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/patologia , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/epidemiologia , Estudos Retrospectivos
3.
Neuroradiology ; 43(4): 336-41, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11338421

RESUMO

We describe the clinical presentation, radiological and clinical results in six consecutive patients with a giant vertebrobasilar aneurysm treated by bilateral vertebral artery balloon occlusion. Five patients presented with headache and signs of brain-stem compression and one with subarachnoid haemorrhage. In all patients vertebral artery balloon occlusion was performed. In four, this followed successful test occlusion. In one patient, who did not tolerate the test occlusion, a bypass from the external carotid to the posterior cerebral artery preceded definitive vertebral artery occlusion. One patient underwent bypass surgery prior to test occlusion. At 6-22 months follow-up three patients had a good functional outcome and showed unchanged size or shrinkage of the aneurysm on MRI. Three other patients died; one from recurrent haemorrhage, and two probably from delayed brain-stem ischaemia. The presence of two large posterior communicating arteries predicted good functional outcome, which was also related to the clinical condition at presentation, and the degree of brain-stem compression and oedema on MRI. Bilateral vertebral artery balloon occlusion can be considered in patients with otherwise untreatable giant vertebrobasilar aneurysms. If test occlusion is not tolerated, a surgical bypass to the posterior circulation can be considered.


Assuntos
Aneurisma/terapia , Oclusão com Balão , Aneurisma Intracraniano/terapia , Artéria Vertebral , Adulto , Aneurisma/diagnóstico , Aneurisma/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologia
4.
Headache ; 41(4): 410-3, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11318889

RESUMO

OBJECTIVE: To describe three cases of migraine (two with aura) after an intracranial endovascular procedure. Method.-Retrospective. RESULTS: One patient had an attack of migraine with prolonged aura after embolization of a dural arteriovenous fistula. Another patient had an attack of migraine with aura (and hemiparesis) after a diagnostic angiogram. The third patient already suffered from migraine with aura and had a migraine attack after embolization of an occipital arteriovenous malformation. A quadrantanopia persisted in this patient. Outcome of the other two patients was good. CONCLUSION: Intracranial endovascular procedures can induce migraine with aura. We could not identify the underlying pathophysiological mechanism, but mechanical, chemical, immunological, or hemodynamic factors could be involved.


Assuntos
Angiografia Cerebral/efeitos adversos , Embolização Terapêutica/efeitos adversos , Enxaqueca com Aura/etiologia , Adulto , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
J Neurosurg ; 94(2): 238-40, 2001 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11213960

RESUMO

OBJECT: The aim of this study was to assess the incidence and outcome of procedure-related rupture of intracranial aneurysms in patients treated with Guglielmi detachable coils (GDCs) and to identify risk factors for this complication. METHODS: Procedure-related rupture occurred in seven of 264 treated aneurysms in 239 consecutive patients. Aneurysm size, history of previous subarachnoid hemorrhage (SAH) caused by the treated aneurysm, timing of treatment after SAH, and the use of a temporary occlusion balloon in the seven procedures in which rupture occurred were compared with the remaining 257 procedures, and these findings were correlated with data from 13 studies in the literature, in which results of 2030 aneurysm treatments were reported. CONCLUSIONS: Procedure-related rupture of intracranial aneurysms during GDC treatment occurs in 2.5% of cases and is responsible for 1% of treatment-related deaths. Risk factors are as follows: small aneurysm size, previous SAH, and probably the use of a temporary occlusion balloon.


Assuntos
Aneurisma Roto/etiologia , Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Adulto , Aneurisma Roto/mortalidade , Feminino , Humanos , Aneurisma Intracraniano/mortalidade , Pessoa de Meia-Idade , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
6.
Neurosurgery ; 47(1): 116-21; discussion 122, 2000 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10917354

RESUMO

OBJECTIVE: Validation of a new angiographic test occlusion protocol before carotid balloon occlusion in patients with carotid aneurysms. METHODS: Carotid occlusion was considered for 29 consecutive patients. From 1993 to 1995, test occlusion in four patients consisted of clinical observation for 30 minutes and during electroencephalographic registration. From 1996 onward, test occlusion in 25 patients consisted of clinical observation and angiography of collateral vessels. Permanent balloon occlusion was performed only when the cortical veins in both the occluded and the collateral vascular territories filled synchronously. RESULTS: Two of the four patients with normal clinical and electroencephalographic findings during test occlusion developed delayed hypoperfusion infarction after permanent carotid occlusion. Seventeen of 25 patients (68%) demonstrated both clinical and angiographic tolerance, and no ischemic events occurred after permanent carotid occlusion. In one patient with clinical tolerance but angiographic nontolerance, permanent carotid occlusion had to be performed, which resulted in delayed hypoperfusion infarction. In two patients with angiographic nontolerance, venous filling became synchronous after bypass surgery. Long-term clinical follow-up showed an alleviation of the symptoms of mass effect in 14 of 21 patients (67%). Magnetic resonance imaging follow-up (range, 3-70 mo) revealed a reduction in the size of the aneurysm in 19 of 21 patients (90%). CONCLUSION: Test occlusion with clinical and angiographic control is reliable, safe, and simple to perform.


Assuntos
Aneurisma/diagnóstico , Aneurisma/terapia , Oclusão com Balão/métodos , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/terapia , Adulto , Idoso , Angiografia , Protocolos Clínicos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade
7.
AJNR Am J Neuroradiol ; 19(6): 1111-2, 1998.
Artigo em Inglês | MEDLINE | ID: mdl-9672020

RESUMO

Chemical analysis of the contents of a so-called bright epidermoid of the posterior fossa with unusual CT and MR imaging characteristics suggested that a combination of high protein content and high viscosity were responsible for the atypical imaging findings.


Assuntos
Doenças Cerebelares/diagnóstico , Cisto Epidérmico/química , Imageamento por Ressonância Magnética , Albumina Sérica/análise , Tomografia Computadorizada por Raios X , Doenças Cerebelares/patologia , Cerebelo/patologia , Diagnóstico Diferencial , Cisto Epidérmico/diagnóstico , Cisto Epidérmico/patologia , Feminino , Humanos , Pessoa de Meia-Idade
10.
Ned Tijdschr Geneeskd ; 141(44): 2111-7, 1997 Nov 01.
Artigo em Holandês | MEDLINE | ID: mdl-9550773

RESUMO

OBJECTIVE: Preliminary evaluation of the combined treatment (surgery, embolization and stereotactic gamma radiosurgery) of 115 consecutive patients with a cerebral arteriovenous malformation (AVM). DESIGN: Retrospective. SETTING: St. Elisabeth Hospital, Tilburg, the Netherlands. PATIENTS AND METHODS: In a 35-month period 115 consecutive patients presented with an AVM. The mean age was 41.8 years (range: 6-72). The main clinical presentation was haemorrhage in 65 patients (56.5%), seizures in 31 patients (27.0%), neurological deficit in 7 patients (6.1%) and hydrocephalus in 2 patients (1.7%); in 10 patients (8.7%) the AVM was an incidental finding. Treatment consisted of surgery, radiosurgery with the gamma knife and embolization. Embolization was mostly used to reduce the size of an AVM before surgery or radiosurgery. RESULTS: Out of 115 patients 5 were referred for a treatment advice only and treatment was performed elsewhere. Of the remaining 110 patients 84 (76.4%) were treated and 26 (23.6%) were not treated for various reasons. Of the 84 treated patients 17 (20.2%) had surgery only, 17 (20.2%) had radiosurgery only, and 12 (14.3%) were treated with embolization only. Surgery after embolization was performed in 8 patients (9.5%) and radiosurgery after embolization in 26 patients (31.0%). In 4 patients an unusual combination of these treatment methods was used for a variety of reasons. At the time of writing 35 of 84 treated AVMs (41.7%) were completely cured, 39 patients were awaiting the definitive result of radiosurgery. Deliberate partial embolization was performed in 5 patients. In 5 patients (6.0%), the pretreatment objective was not achieved with embolization. Total permanent morbidity was 4.8% (4 patients) and mortality was 1.2% (1 patient). CONCLUSIONS: Given a multidisciplinary combination of treatment methods a treatment is indicated and possible in the majority (76.4%) of patients with an AVM. There is a reasonable chance of a complete cure with an acceptable complication rate.


Assuntos
Malformações Arteriovenosas Intracranianas/terapia , Equipe de Assistência ao Paciente , Adolescente , Adulto , Idoso , Angiografia Cerebral , Criança , Terapia Combinada/métodos , Embolização Terapêutica/métodos , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiocirurgia/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Ned Tijdschr Geneeskd ; 140(9): 491-5, 1996 Mar 02.
Artigo em Holandês | MEDLINE | ID: mdl-8628437

RESUMO

OBJECTIVE: Evaluation of endovascular treatment of inoperable cerebral aneurysms using electrolytically detachable platinum coils (Gugliemi Detachable Coils, GDC). DESIGN: Retrospective. SETTING: St. Elizabeth Hospital Tilburg, the Netherlands. METHOD: Fifteen aneurysms in 13 patients were treated using GDC; 14 of these aneurysms were inoperable and in three aneurysms surgical clipping had failed. RESULTS: Twelve of the 15 treated aneurysms were completely occluded. In another two, occlusion was 90% and in one, 70%. One patient with an inoperable basilar bifurcation aneurysm died of progressive thrombosis of both posterior cerebral arteries. One patient with an inoperable aneurysm of the anterior communicating artery developed an infarction of the A. centralis longa (recurrent artery of Heubner). CONCLUSION: GDC treatment of inoperable cerebral aneurysms is currently the only available option with a reasonable chance of success and acceptable risks.


Assuntos
Embolização Terapêutica/métodos , Aneurisma Intracraniano/terapia , Adulto , Angiografia Cerebral , Infarto Cerebral/etiologia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Embolia e Trombose Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Ned Tijdschr Geneeskd ; 139(20): 1041-4, 1995 May 20.
Artigo em Holandês | MEDLINE | ID: mdl-7777087

RESUMO

Three patients, women of 46, 63 and 47 years old, with a large or giant aneurysm of the internal carotid artery were treated by endovascular balloon occlusion of the internal carotid artery. In all three patients the aneurysm thrombosed completely. One patient became hemiplegic 12 days after carotid occlusion owing to hypoperfusion infarction.


Assuntos
Aneurisma/terapia , Doenças das Artérias Carótidas/terapia , Artéria Carótida Interna , Cateterismo/métodos , Aneurisma/diagnóstico , Doenças das Artérias Carótidas/diagnóstico , Angiografia Cerebral , Embolização Terapêutica/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade
14.
Br J Neurosurg ; 2(1): 101-7, 1988.
Artigo em Inglês | MEDLINE | ID: mdl-3268152

RESUMO

An alveolar soft part sarcoma localised in the pituitary gland extended into the suprasellar region. Three years after surgical removal there was a recurrency in the occipital horn of the right cerebral ventricle. This type of tumour predominantly occurs in the limbs and has never been reported in the pituitary region.


Assuntos
Neoplasias do Ventrículo Cerebral/secundário , Neoplasias Hipofisárias , Sarcoma/secundário , Neoplasias do Ventrículo Cerebral/patologia , Neoplasias do Ventrículo Cerebral/cirurgia , Criança , Humanos , Masculino , Sarcoma/patologia , Sarcoma/cirurgia
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