Pub Date : 2009-12-01DOI: 10.1016/j.surneu.2009.04.009
Eubulus J. Kerr MD, Ajay Jawahar MD, MS, Stephen Kay PA-C, David A. Cavanaugh MD, Pierce D. Nunley MD
Background
As total disk arthroplasty (TDA) gains increasing acceptance as an alternative to fusion for degenerative disk disease of the lumbar spine, new complications are encountered by the physicians during and after the procedure. We hereby report a complication after TDA in the lumbar spine that is in variance from previously proposed theories and suggests the possibility of implant design as one of the etiologic factors. The purpose of the present submission is to report a case of delayed heterotopic ossification (HO) after TDA that suggests that the keel-based design of the implant might have contributed to the etiology.
Case description
The patient underwent TDA for L3-4 degenerative disk disease and had fusion surgery for L5-S1 disease about 6 months later. During follow-up, development of significant HO was noticed at the L3 and L4 level. Radiologic studies revealed the origin of HO to be the keel cut made in the body of L3 to accommodate the keel-based artificial disk.
Conclusion
The exact etiology of HO after TDA is not clear. The presented anecdote points toward vertebral body trauma due to the design of the implant as a possible factor that needs to be studied more elaborately.
{"title":"Implant design may influence delayed heterotopic ossification after total disk arthroplasty in lumbar spine","authors":"Eubulus J. Kerr MD, Ajay Jawahar MD, MS, Stephen Kay PA-C, David A. Cavanaugh MD, Pierce D. Nunley MD","doi":"10.1016/j.surneu.2009.04.009","DOIUrl":"10.1016/j.surneu.2009.04.009","url":null,"abstract":"<div><h3>Background</h3><p>As total disk arthroplasty (TDA) gains increasing acceptance as an alternative to fusion for degenerative disk disease of the lumbar spine, new complications are encountered by the physicians during and after the procedure. We hereby report a complication after TDA in the lumbar spine that is in variance from previously proposed theories and suggests the possibility of implant design as one of the etiologic factors. The purpose of the present submission is to report a case of delayed heterotopic ossification (HO) after TDA that suggests that the keel-based design of the implant might have contributed to the etiology.</p></div><div><h3>Case description</h3><p>The patient underwent TDA for L3-4 degenerative disk disease and had fusion surgery for L5-S1 disease about 6 months later. During follow-up, development of significant HO was noticed at the L3 and L4 level. Radiologic studies revealed the origin of HO to be the keel cut made in the body of L3 to accommodate the keel-based artificial disk.</p></div><div><h3>Conclusion</h3><p>The exact etiology of HO after TDA is not clear. The presented anecdote points toward vertebral body trauma due to the design of the implant as a possible factor that needs to be studied more elaborately.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 747-751"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.04.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28654354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-12-01DOI: 10.1016/j.wneu.2009.09.013
James I. Ausman MD, PhD (Editor)
{"title":"A note of gratitude to the readers of Surgical Neurology","authors":"James I. Ausman MD, PhD (Editor)","doi":"10.1016/j.wneu.2009.09.013","DOIUrl":"10.1016/j.wneu.2009.09.013","url":null,"abstract":"","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 561-562"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.wneu.2009.09.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28655691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-12-01DOI: 10.1016/j.surneu.2009.05.003
Young Seok Park MD , Jin Young Jung MD , Jung Yong Ahn MD, PhD , Dong Jun Kim MD, PhD , Sun Ho Kim MD, PhD
Background
An internal carotid artery (ICA) injury is an uncommon but potentially fatal complication of transsphenoidal surgery.
Case Description
We report a 61-year-old male patient with a right cavernous ICA injury sustained during transsphenoidal surgery and who underwent endovascular Stent graft placement. The ICA trapping was not indicated because of the absence of the left A1 on preoperative magnetic resonance angiography. During Stent graft placement, the ICA wall could not be completely fit with a stent due to its stiff nature and the carotid curve. The gap between the stent and the ICA wall was filled using a coiling procedure on the first postoperative day.
Conclusions
Endovascular Stent graft placement for posttranssphenoidal carotid artery injury is a useful technical adjunct to the management strategy and has the potential to minimize the risk of having to sacrifice the ICA. In cases of incomplete reconstruction of the Stent graft placement due to its stiff nature and the carotid curve, an additional coiling procedure could be helpful to obliterate the gap between the stent and the ICA wall. To avoid carotid injury during transsphenoidal surgery, careful preoperative evaluation of vascular structures and meticulous surgical technique are necessary.
{"title":"Emergency endovascular Stent graft and coil placement for internal carotid artery injury during transsphenoidal surgery","authors":"Young Seok Park MD , Jin Young Jung MD , Jung Yong Ahn MD, PhD , Dong Jun Kim MD, PhD , Sun Ho Kim MD, PhD","doi":"10.1016/j.surneu.2009.05.003","DOIUrl":"10.1016/j.surneu.2009.05.003","url":null,"abstract":"<div><h3>Background</h3><p>An internal carotid artery (ICA) injury is an uncommon but potentially fatal complication of transsphenoidal surgery.</p></div><div><h3>Case Description</h3><p>We report a 61-year-old male patient with a right cavernous ICA injury sustained during transsphenoidal surgery and who underwent endovascular Stent graft placement. The ICA trapping was not indicated because of the absence of the left A1 on preoperative magnetic resonance angiography. During Stent graft placement, the ICA wall could not be completely fit with a stent due to its stiff nature and the carotid curve. The gap between the stent and the ICA wall was filled using a coiling procedure on the first postoperative day.</p></div><div><h3>Conclusions</h3><p>Endovascular Stent graft placement for posttranssphenoidal carotid artery injury is a useful technical adjunct to the management strategy and has the potential to minimize the risk of having to sacrifice the ICA. In cases of incomplete reconstruction of the Stent graft placement due to its stiff nature and the carotid curve, an additional coiling procedure could be helpful to obliterate the gap between the stent and the ICA wall. To avoid carotid injury during transsphenoidal surgery, careful preoperative evaluation of vascular structures and meticulous surgical technique are necessary.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 741-746"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.05.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28309244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-12-01DOI: 10.1016/j.surneu.2009.06.017
Zhen-Wei Zhao MD, Jian-Ping Deng MD, Shi-Ming He MD, Huai-Zhou Qin MD, Li Gao MD, Guo-Dong Gao MD
Background
We investigated the safety of treatment of symptomatic intracranial atherosclerotic stenoses with the Gateway-Wingspan system and its initial effect on prevention of ischemic events.
Methods
Twenty-seven cases of symptomatic intracranial atherosclerotic stenoses were treated with angioplasty with a Wingspan stent. Location of stenoses, extent of stenoses before and after angioplasty, success rate of treatment, occurrence of procedural complications, and changes in recurrence of symptoms of ischemic events 30 days after treatment were recorded.
Results
Twenty-nine angioplasties with the Wingspan system were successfully carried out in 29 stenoses in 27 patients. Of 29 stenoses, 17 were in the posterior circulation, and 12, in the anterior circulation. The degree of stenoses was reduced from baseline 71.8% (56%-87.8%) to 24.9% (0%-45%) after stenting. Complications were seen in four patients (14.8%), 3 of which were lesion-related infarction of a perforated artery, and 1 was a non-lesion-related infarction. Two complications led to transient neurologic dysfunction, one led to defect of the visual field, and one led to hemiplegia. The prevalence of morbidity and serious morbidity were 7.4% and 3.7%, respectively, and no death occurred. No new ischemic events happened during 30 days after stenting.
Conclusion
Angioplasty with the Wingspan system to treat symptomatic intracranial atherosclerotic stenoses appears to be safe. Its initial effect on prevention of ischemic events is acceptable.
{"title":"Intracranial angioplasty with Gateway-Wingspan system for symptomatic atherosclerotic stenosis: preliminary results of 27 Chinese patients","authors":"Zhen-Wei Zhao MD, Jian-Ping Deng MD, Shi-Ming He MD, Huai-Zhou Qin MD, Li Gao MD, Guo-Dong Gao MD","doi":"10.1016/j.surneu.2009.06.017","DOIUrl":"10.1016/j.surneu.2009.06.017","url":null,"abstract":"<div><h3>Background</h3><p>We investigated the safety of treatment of symptomatic intracranial atherosclerotic stenoses with the Gateway-Wingspan system and its initial effect on prevention of ischemic events.</p></div><div><h3>Methods</h3><p>Twenty-seven cases of symptomatic intracranial atherosclerotic stenoses were treated with angioplasty with a Wingspan stent. Location of stenoses, extent of stenoses before and after angioplasty, success rate of treatment, occurrence of procedural complications, and changes in recurrence of symptoms of ischemic events 30 days after treatment were recorded.</p></div><div><h3>Results</h3><p>Twenty-nine angioplasties with the Wingspan system were successfully carried out in 29 stenoses in 27 patients. Of 29 stenoses, 17 were in the posterior circulation, and 12, in the anterior circulation. The degree of stenoses was reduced from baseline 71.8% (56%-87.8%) to 24.9% (0%-45%) after stenting. Complications were seen in four patients (14.8%), 3 of which were lesion-related infarction of a perforated artery, and 1 was a non-lesion-related infarction. Two complications led to transient neurologic dysfunction, one led to defect of the visual field, and one led to hemiplegia. The prevalence of morbidity and serious morbidity were 7.4% and 3.7%, respectively, and no death occurred. No new ischemic events happened during 30 days after stenting.</p></div><div><h3>Conclusion</h3><p>Angioplasty with the Wingspan system to treat symptomatic intracranial atherosclerotic stenoses appears to be safe. Its initial effect on prevention of ischemic events is acceptable.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 607-611"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.06.017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28654348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-12-01DOI: 10.1016/j.surneu.2009.07.040
De L. Yang PhD, MD, Qi W. Xu PhD, MD, Xiao M. Che PhD, MD, Jin S. Wu PhD, MD, Bin Sun PhD, MD
Background
Patient-specific approach design, comprehensive evaluation on perioperative data, and follow-up of postoperative life quality (KPS) were carried out to evaluate the application of VR technology of Dextroscope in procedures of patients with skull base tumors.
Methods
Eighty-four patients with skull base tumors involved in this research were randomized into 2 groups (test group and control group), each with 42 patients. Before operation, image data such as MR, MRA, or CTA of head were collected and imported into the Dextroscope workstation. The detailed preoperative plans were made in the test group, but no Dextroscope plans in control group. The resection rate of tumors, preoperative evaluation including the duration of operation, total blood loss, the postoperative LOS, the number of cases with cerebrovascular injury complications in operation, and postoperative KPS of patients on discharge and the sixth month follow-up in the 2 groups were recorded and compared.
Results
The total resection rate of tumors was 83.33% in test group and 71.42% in the control group (P > .05). The total resection rate of meningioma was 86.67% in test group and 76.47% in control group. The total resection rates of trigeminal Schwannoma in the 2 groups were all 100% (P > .05). The duration of operation and the postoperative LOS of each patient were 5.25 ± 0.64 hours and 8.50 ± 1.10 days in the test group and 7.36 ± 0.87 hours and 12.50 ± 1.52 days in the control group, respectively (P < .05). Total blood loss of each patient was 456.75 ± 55.76 mL in the test group and 523.85 ± 66.78 mL in the control group (P > 05). There were 3 cases with complications of cerebral vessels injury in the test group and 7 cases in the control group (P < .05). During follow-up, KPS of patients in the test group on discharge (85.75 ± 9.68) was significantly superior to that in the control group (81.66 ± 9.24; P < .05). The KPS of patients on the sixth-month follow-up in the test group was 92.35 ± 9.95, which was significantly superior to that in the control group (85.6 ± 9.34; P < .05). Karnofsky performance scores of patients in the test group improved significantly from discharge to the sixth month after procedure (P < .05), whereas there were adverse results in the test group (P < .05). The 2 cases with CSF leakage were cured completely.
Conclusion
The preoperative plans with VR technology in patients with skull base tumor or CSF leakage operations can help certain the diagnosis, individually locate the position of skull base lesions, and design patient-specific approach, which also facilitate to shorten operation duration and the postoperative LOS, reduce total blood loss and injury of vessels in operation, and improve the postoperative KPS.
{"title":"Clinical evaluation and follow-up outcome of presurgical plan by Dextroscope: a prospective controlled study in patients with skull base tumors","authors":"De L. Yang PhD, MD, Qi W. Xu PhD, MD, Xiao M. Che PhD, MD, Jin S. Wu PhD, MD, Bin Sun PhD, MD","doi":"10.1016/j.surneu.2009.07.040","DOIUrl":"10.1016/j.surneu.2009.07.040","url":null,"abstract":"<div><h3>Background</h3><p>Patient-specific approach design, comprehensive evaluation on perioperative data, and follow-up of postoperative life quality (KPS) were carried out to evaluate the application of VR technology of Dextroscope in procedures of patients with skull base tumors.</p></div><div><h3>Methods</h3><p>Eighty-four patients with skull base tumors involved in this research were randomized into 2 groups (test group and control group), each with 42 patients. Before operation, image data such as MR, MRA, or CTA of head were collected and imported into the Dextroscope workstation. The detailed preoperative plans were made in the test group, but no Dextroscope plans in control group. The resection rate of tumors, preoperative evaluation including the duration of operation, total blood loss, the postoperative LOS, the number of cases with cerebrovascular injury complications in operation, and postoperative KPS of patients on discharge and the sixth month follow-up in the 2 groups were recorded and compared.</p></div><div><h3>Results</h3><p>The total resection rate of tumors was 83.33% in test group and 71.42% in the control group (<em>P</em> > .05). The total resection rate of meningioma was 86.67% in test group and 76.47% in control group. The total resection rates of trigeminal Schwannoma in the 2 groups were all 100% (<em>P</em> > .05). The duration of operation and the postoperative LOS of each patient were 5.25 ± 0.64 hours and 8.50 ± 1.10 days in the test group and 7.36 ± 0.87 hours and 12.50 ± 1.52 days in the control group, respectively (<em>P</em> < .05). Total blood loss of each patient was 456.75 ± 55.76 mL in the test group and 523.85 ± 66.78 mL in the control group (<em>P</em> > 05). There were 3 cases with complications of cerebral vessels injury in the test group and 7 cases in the control group (<em>P</em> < .05). During follow-up, KPS of patients in the test group on discharge (85.75 ± 9.68) was significantly superior to that in the control group (81.66 ± 9.24; <em>P</em> < .05). The KPS of patients on the sixth-month follow-up in the test group was 92.35 ± 9.95, which was significantly superior to that in the control group (85.6 ± 9.34; <em>P</em> < .05). Karnofsky performance scores of patients in the test group improved significantly from discharge to the sixth month after procedure (<em>P</em> < .05), whereas there were adverse results in the test group (<em>P</em> < .05). The 2 cases with CSF leakage were cured completely.</p></div><div><h3>Conclusion</h3><p>The preoperative plans with VR technology in patients with skull base tumor or CSF leakage operations can help certain the diagnosis, individually locate the position of skull base lesions, and design patient-specific approach, which also facilitate to shorten operation duration and the postoperative LOS, reduce total blood loss and injury of vessels in operation, and improve the postoperative KPS.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 682-689"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.07.040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28454268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-12-01DOI: 10.1016/j.surneu.2009.01.029
Yu-Jun Lin MD , Tzu-Ming Yang MD , Jui-Wei Lin MD , Ming-Ze Song MD , Tao-Chen Lee MD
Background
Intracranial inflammatory pseudotumors are rare. This study describes an intracranial inflammatory pseudotumor at the left cerebellopontine angle. It is the second documented posterior fossa intracranial inflammatory pseudotumor, and it was treated by surgery and radiotherapy.
Case Description
A 49-year-old man presented with dizziness for 3 months and mild hoarseness for 1 month. Brain CT detected an intracranial tumor at the left cerebellopontine angle. Magnetic resonance imaging revealed a 3.6-cm heterogeneously enhancing mass. Suboccipital craniectomy with ventriculostomy was performed. The mass was well defined with a smooth surface, enclosed the low cranial nerves, and adhered to the dura matter. Pathologic examination revealed fibrous collagenous stroma with dense infiltrates of small lymphocytes and uninucleated histiocytes. Immunopositivity for T-200 and CD-68 was noted. Special staining for mycobacteria and fungus was negative. Serologic tests were positive for EBEA-Ab, EBNA-Ab, and EB-VCA-IgG. An inflammatory pseudotumor was diagnosed. Local recurrence was found 6 months later with a left oculomotor nerve palsy. Whole-brain irradiation with a total dose of 1200 cGy in 6 fractionations was done. Remission was found in follow-up neuroimages, and no recurrence was noted in 2 years' follow-up.
Conclusion
Based on serologic findings and a literature review, the pathogenetic mechanism of this rare intracranial tumor is believed to be chronic reactive EBV infection. We propose that radiotherapy may be the best treatment option in the case of local recurrent intracranial inflammatory pseudotumors.
{"title":"Posterior fossa intracranial inflammatory pseudotumor: a case report and literature review","authors":"Yu-Jun Lin MD , Tzu-Ming Yang MD , Jui-Wei Lin MD , Ming-Ze Song MD , Tao-Chen Lee MD","doi":"10.1016/j.surneu.2009.01.029","DOIUrl":"10.1016/j.surneu.2009.01.029","url":null,"abstract":"<div><h3>Background</h3><p>Intracranial inflammatory pseudotumors are rare. This study describes an intracranial inflammatory pseudotumor at the left cerebellopontine angle. It is the second documented posterior fossa intracranial inflammatory pseudotumor, and it was treated by surgery and radiotherapy.</p></div><div><h3>Case Description</h3><p>A 49-year-old man presented with dizziness for 3 months and mild hoarseness for 1 month. Brain CT detected an intracranial tumor at the left cerebellopontine angle. Magnetic resonance imaging revealed a 3.6-cm heterogeneously enhancing mass. Suboccipital craniectomy with ventriculostomy was performed. The mass was well defined with a smooth surface, enclosed the low cranial nerves, and adhered to the dura matter. Pathologic examination revealed fibrous collagenous stroma with dense infiltrates of small lymphocytes and uninucleated histiocytes. Immunopositivity for T-200 and CD-68 was noted. Special staining for mycobacteria and fungus was negative. Serologic tests were positive for EBEA-Ab, EBNA-Ab, and EB-VCA-IgG. An inflammatory pseudotumor was diagnosed. Local recurrence was found 6 months later with a left oculomotor nerve palsy. Whole-brain irradiation with a total dose of 1200 cGy in 6 fractionations was done. Remission was found in follow-up neuroimages, and no recurrence was noted in 2 years' follow-up.</p></div><div><h3>Conclusion</h3><p>Based on serologic findings and a literature review, the pathogenetic mechanism of this rare intracranial tumor is believed to be chronic reactive EBV infection. We propose that radiotherapy may be the best treatment option in the case of local recurrent intracranial inflammatory pseudotumors.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 712-716"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.01.029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28309973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Early surgical removal of cerebral AVMs is a relatively infrequent therapeutic option when dealing with a cerebral hemorrhage caused by AVM rupture: even in the case of low-grade AVMs, delayed treatment is, if possible, preferred because it is considered safer for patients and more comfortable for surgeons. To assess whether acute surgery may be a safe and effective management, we conducted a retrospective analysis of our early surgery strategy for ruptured low-grade AVMs.
Methods
We reviewed 27 patients with SM grade I-II AVM treated during 2004 to 2008 in the acute stage of bleeding (within the first 6 days after bleed). All patients showed a cerebral AVM on DSA at admission, and surgical removal was controlled by postoperative angiography. Neurological outcomes were assessed with GOS. The average length of follow-up was 22 months (48-3 months).
Results
Before surgery, 16 (59%) patients showed a GCS of 8 or less, 2 of them presenting an acute rebleeding after first hemorrhage. All patients underwent radical AVM surgical removal and hematoma evacuation in a single-stage procedure. Most patients (78%) were operated within the first day of hemorrhage. A favorable functional outcome (GOS: good recovery or moderate disability) was observed in 23 patients (85%). Mortality was 7.4%. Outcome was not significantly correlated with GCS at presentation and with presence of preoperative anisocoria.
Conclusions
Early surgery for grade I-II AVMs is a safe and definitive treatment, achieving both immediate cerebral decompression and patient protection against rebleeding, reducing time of hospital stay and allowing a more rapid rehabilitative course whenever necessary.
{"title":"Acute surgical removal of low-grade (Spetzler-Martin I-II) bleeding arteriovenous malformations","authors":"Giacomo Pavesi MD , Oriela Rustemi MD , Silvia Berlucchi MD , Anna Chiara Frigo MD , Valerio Gerunda RT , Renato Scienza MD","doi":"10.1016/j.surneu.2009.03.035","DOIUrl":"10.1016/j.surneu.2009.03.035","url":null,"abstract":"<div><h3>Background</h3><p>Early surgical removal of cerebral AVMs is a relatively infrequent therapeutic option when dealing with a cerebral hemorrhage caused by AVM rupture: even in the case of low-grade AVMs, delayed treatment is, if possible, preferred because it is considered safer for patients and more comfortable for surgeons. To assess whether acute surgery may be a safe and effective management, we conducted a retrospective analysis of our early surgery strategy for ruptured low-grade AVMs.</p></div><div><h3>Methods</h3><p>We reviewed 27 patients with SM grade I-II AVM treated during 2004 to 2008 in the acute stage of bleeding (within the first 6 days after bleed). All patients showed a cerebral AVM on DSA at admission, and surgical removal was controlled by postoperative angiography. Neurological outcomes were assessed with GOS. The average length of follow-up was 22 months (48-3 months).</p></div><div><h3>Results</h3><p>Before surgery, 16 (59%) patients showed a GCS of 8 or less, 2 of them presenting an acute rebleeding after first hemorrhage. All patients underwent radical AVM surgical removal and hematoma evacuation in a single-stage procedure. Most patients (78%) were operated within the first day of hemorrhage. A favorable functional outcome (GOS: good recovery or moderate disability) was observed in 23 patients (85%). Mortality was 7.4%. Outcome was not significantly correlated with GCS at presentation and with presence of preoperative anisocoria.</p></div><div><h3>Conclusions</h3><p>Early surgery for grade I-II AVMs is a safe and definitive treatment, achieving both immediate cerebral decompression and patient protection against rebleeding, reducing time of hospital stay and allowing a more rapid rehabilitative course whenever necessary.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 662-667"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.03.035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28309246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stent-assisted coiling is an accepted endovascular treatment (EVT) for wide-necked intracranial aneurysms. The Neuroform stent (Target Therapeutics, Fremont, Calif) is a flexible nitinol self-expandable stent that was designed to potentially overcome the limitations of balloon expandable coronary stents in the intracranial circulation. The aim of this study was to reenforce the use of this stent for EVT of wide-necked cerebral aneurysms.
Methods
Between March 2005 and March 2008, 24 patients harboring wide-necked cerebral aneurysms were treated with stent reconstruction of the aneurysm neck. Inclusion criteria restricted the group to adult patients with wide-necked intracranial aneurysms (ruptured and unruptured lesions). Immediate postprocedure angiography studies were performed to determine successful coil occlusion of the aneurysm as well as patency of the parent vessel. We assessed the clinical history, aneurysm dimensions, and technical detail of the procedures, including any difficulties with stent placement and deployment, degree of aneurysm occlusion, and complications. Clinical outcome was assessed with the Glasgow Outcome Scale (GOS).
Results
The stent was easily navigated and precisely positioned in 24 of 26 cases. However, technical difficulties occurred in 9 patients, including difficulties in crossing the stents interstice in 6 cases, inadvertent stent delivery (n = 1), and incapacity of stent delivery (n = 1) and incapacity of crossing the neck (n = 1). These latter 2 cases were classified as failures of the stent-assisted technique. A single procedural complication occurred, involving transient nonocclusive intrastent thrombus formation, which was treated uneventfully with abciximab. Seventeen patients experienced excellent clinical outcomes (GOS 5), with good outcomes (GOS 4) in 5 patients and a poor outcome (GOS 3) in 2 patients. There were no treatment-related deaths or neurologic complications (mean clinical follow-up, 12 months). Angiographic results consisted of 17 complete occlusions, 4 neck remnants, and 3 incomplete occlusions.
Conclusions
The Neuroform stent is very useful for EVT of wide-necked intracranial aneurysms because it is easy to navigate and to deploy accurately. In most cases, the stent can be deployed precisely, even in very tortuous carotid siphons. Although in some cases delivery and deployment was challenging, clinically significant complications were not observed.
{"title":"Single-center experience with the Neuroform stent for endovascular treatment of wide-necked intracranial aneurysms","authors":"Eduardo Wajnberg MD , Jorge Marcondes de Souza MD, PhD , Edson Marchiori MD, PhD , Emerson L. Gasparetto MD, PhD","doi":"10.1016/j.surneu.2009.03.038","DOIUrl":"10.1016/j.surneu.2009.03.038","url":null,"abstract":"<div><h3>Background</h3><p>Stent-assisted coiling is an accepted endovascular treatment (EVT) for wide-necked intracranial aneurysms. The Neuroform stent (Target Therapeutics, Fremont, Calif) is a flexible nitinol self-expandable stent that was designed to potentially overcome the limitations of balloon expandable coronary stents in the intracranial circulation. The aim of this study was to reenforce the use of this stent for EVT of wide-necked cerebral aneurysms.</p></div><div><h3>Methods</h3><p>Between March 2005 and March 2008, 24 patients harboring wide-necked cerebral aneurysms were treated with stent reconstruction of the aneurysm neck. Inclusion criteria restricted the group to adult patients with wide-necked intracranial aneurysms (ruptured and unruptured lesions). Immediate postprocedure angiography studies were performed to determine successful coil occlusion of the aneurysm as well as patency of the parent vessel. We assessed the clinical history, aneurysm dimensions, and technical detail of the procedures, including any difficulties with stent placement and deployment, degree of aneurysm occlusion, and complications. Clinical outcome was assessed with the Glasgow Outcome Scale (GOS).</p></div><div><h3>Results</h3><p>The stent was easily navigated and precisely positioned in 24 of 26 cases. However, technical difficulties occurred in 9 patients, including difficulties in crossing the stents interstice in 6 cases, inadvertent stent delivery (n = 1), and incapacity of stent delivery (n = 1) and incapacity of crossing the neck (n = 1). These latter 2 cases were classified as failures of the stent-assisted technique. A single procedural complication occurred, involving transient nonocclusive intrastent thrombus formation, which was treated uneventfully with abciximab. Seventeen patients experienced excellent clinical outcomes (GOS 5), with good outcomes (GOS 4) in 5 patients and a poor outcome (GOS 3) in 2 patients. There were no treatment-related deaths or neurologic complications (mean clinical follow-up, 12 months). Angiographic results consisted of 17 complete occlusions, 4 neck remnants, and 3 incomplete occlusions.</p></div><div><h3>Conclusions</h3><p>The Neuroform stent is very useful for EVT of wide-necked intracranial aneurysms because it is easy to navigate and to deploy accurately. In most cases, the stent can be deployed precisely, even in very tortuous carotid siphons. Although in some cases delivery and deployment was challenging, clinically significant complications were not observed.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 612-619"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.03.038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28309249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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