[Superselective cerebral embolization of an arteriovenous malformation in the temporal lobe following partial neurosurgical resection]. / Superselectieve cerebrale embolisatie van een arterioveneuze malformatie in de temporale lob na partiële neurochirurgische resectie.

We report a case of cerebral embolization of an arteriovenous malformation in the temporal lobe after partial neurosurgical resection. The lesion consisted of two compartments of which only the lateral part with combined large hematoma was resected. The medial compartment was treated by superselective embolization using a microcatheter and polyvinyl alcohol particles. Because of his psychiatric condition, general anaesthesia was used in this young male.

Transbrachial approach for aortic and selective supraaortic vessel catheterization using a safe and easy technique to reform the Simmons II catheter tip.

A total of 286 patients (158 outpatients) were examined by intra-arterial DSA in the evaluation of cerebrovascular disease using a transbrachial approach. In all cases a 5F introducer sheath, a 5F pigtail catheter for aortic arch injection and a 5F Simmons II catheter for selective catheterization were used. Excellent demonstration of aortic arch and supraaortic arteries (including intracranial circulation) was obtained (92.2-100%). The complication rate was favorable, with only one major complication (thrombosis of an axillary artery). The use of an introducer sheath minimizes local complications and vessel wall damage during catheter exchange. Aortic arch injection must always be performed prior to selective catheterization. The results of selective catheterization prove the suitability of the Simmons II catheter, whose typical shape was easily and safely obtained using the configuration of the pigtail catheter and a 180 cm long guide wire for catheter exchange. Using the technique as described, the transbrachial approach is a safe and easy way for optimal vascular evaluation in cerebrovascular disease, especially useful in outpatients.

CT-assisted chemonucleolysis.

The safety and success rate of chemonucleolysis are largely dependent on correct needle insertion. The neurological complications of chemonucleolysis are related to inadvertent puncture of the dura, nerve root and/or spinal nerve. To avoid this complication, a puncture angle of 50 degrees to 60 degrees above the sagittal plane is widely recommended (1). Our CT study of the location of the spinal nerve L4-L5 and L5-S1 demonstrates a great variability of this location and also explains some of the possible hazards of 50 degrees to 60 degrees puncture (2). The CT-evaluation of the relationship between the nerve root, spinal nerve and apophyseal joint with respect to the puncture angle is suitable. In our experience, this method is helpful for fast, safe and easy insertion of the needle.

Diagnosis of herniated nucleus pulposus by digital spinal phlebography with false negative CT and/or radiculosaccography.

Saccoradiculography, spinal phlebography or NMR can be performed in cases of discrepancy between CT and clinical symptoms. We believe that the introduction of DSA must generate a renewed interest in spinal phlebography for cases with radicular syndrome and normal CT.