OBLITERATION DYNAMICS IN CEREBRAL ARTERIOVENOUS MALFORMATIONS AFTER CYBERKNIFE RADIOSURGERY

Neurosurgery ◽  
2009 ◽  
Vol 64 (suppl_2) ◽  
pp. A102-A109 ◽  
Author(s):  
Berndt Wowra ◽  
Alexander Muacevic ◽  
Jörg-Christian Tonn ◽  
Stefan O. Schoenberg ◽  
Maximilian Reiser ◽  
...  
Keyword(s):  
Blood Flow ◽  
Magnetic Resonance ◽  
Arteriovenous Malformations ◽  
Time Dependent ◽  
Cerebral Arteriovenous Malformations ◽  
Tof Mra ◽  
Cyberknife Radiosurgery ◽  
Group A ◽  
Group B

Abstract OBJECTIVE To investigate the time-dependent obliteration of cerebral arteriovenous malformations (cAVM) after CyberKnife radiosurgery (CKRS) (Accuray, Inc., Sunnyvale, CA) by means of sequential 3-T, 3-dimensional (3D), time-of-flight (TOF) magnetic resonance angiography (MRA), and volumetry of the arteriovenous malformation (AVM) nidus. METHODS In this prospective study, 3D TOF MRA was performed on 20 patients with cAVMs treated by single-fraction CKRS. Three-dimensional TOF MRA was performed on a 3-T, 32-channel magnetic resonance scanner (Magnetom TIM Trio; Siemens Medical Solutions, Erlangen, Germany) with isotropic voxel size at a spatial resolution of 0.6 × 0.6 × 0.6 mm3. The time-dependent relative decay of the transnidal blood flow evidenced by 3D TOF MRA was referred to as “obliteration dynamics.” Volumetry of the nidus size was performed with OsiriX imaging software (OsiriX Foundation, Geneva, Switzerland). All patients had 3 to 4 follow-up examinations at 3- to 6-month intervals over a minimum follow-up period of 9 months. Subtotal obliteration was determined if the residual nidus volume was 5% or less of the initial nidus volume. Stata/IC software (Version 10.0; Stata Corp., College Station, TX) was used for statistical analysis and to identify potential factors of AVM obliteration. RESULTS Regarding their clinical status, case history, and pretreatments, the participants of this study represent difficult-to-treat cAVM patients. The median nidus volume was 1.8 mL (range, 0.4–12.5 mL); the median minimum dose prescribed to the nidus was 22 Gy (range, 16–24 Gy) delivered to the 67% isodose line (range, 55–80%). CKRS was well tolerated, with complications in 2 patients. No further hemorrhages occurred after RS, except 1 small and clinically inapparent incident. The median follow-up period after RS was 25.0 months (range, 11.7–36.8 months). After RS, a statistically significant obliteration was observed in all patients. However, the obliteration dynamics of the cAVMs showed a pronounced variability, with 2 types of post-therapeutic behavior identified. cAVMs of Group A showed a faster reduction of transnidal blood flow than cAVMs in Group B. The median time to subtotal obliteration was 23.8 months for all patients, 11.6 months for patients in Group A, and 27.8 months for patients in Group B (P = 0.05). Logistic regression analysis revealed dose homogeneity and the circumscribed isodose to be the only variables (P < 0.01) associated with the obliteration dynamics in this study. The cumulative complete angiographic obliteration rate was 67% (95% confidence interval, 32–95%) 2 years after RS. CONCLUSION The use of sequential 3D TOF MRA at 3 T and nidus volumetry enables a noninvasive quantitative assessment of the dynamic obliteration process induced by CKRS in cAVMs. This method may be helpful to identify factors related to AVM obliteration after RS when larger patient cohorts become available.

Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1081-1089 ◽  
Author(s):  
John Sinclair ◽  
Steven D. Chang ◽  
Iris C. Gibbs ◽  
John R. Adler
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Arteriovenous Malformations ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Resonance Imaging ◽  
Intramedullary Spinal Cord ◽  
Cyberknife Radiosurgery

Abstract OBJECTIVE: Intramedullary spinal cord arteriovenous malformations (AVMs) have an unfavorable natural history that characteristically involves myelopathy secondary to progressive ischemia and/or recurrent hemorrhage. Although some lesions can be managed successfully with embolization and surgery, AVM size, location, and angioarchitecture precludes treatment in many circumstances. Given the poor outlook for such patients, and building on the successful experience with radiosurgical ablation of cerebral AVMs, our group at Stanford University has used CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) to treat selected spinal cord AVMs since 1997. In this article, we retrospectively analyze our preliminary experience with this technique. METHODS: Fifteen patients with intramedullary spinal cord AVMs (nine cervical, three thoracic, and three conus medullaris) were treated by image-guided SRS between 1997 and 2005. SRS was delivered in two to five sessions with an average marginal dose of 20.5 Gy. The biologically effective dose used in individual patients was escalated gradually over the course of this study. Clinical and magnetic resonance imaging follow-up were carried out annually, and spinal angiography was repeated at 3 years. RESULTS: After a mean follow-up period of 27.9 months (range, 3–59 mo), six of the seven patients who were more than 3 years from SRS had significant reductions in AVM volumes on interim magnetic resonance imaging examinations. In four of the five patients who underwent postoperative spinal angiography, persistent AVM was confirmed, albeit reduced in size. One patient demonstrated complete angiographic obliteration of a conus medullaris AVM 26 months after radiosurgery. There was no evidence of further hemorrhage after CyberKnife treatment or neurological deterioration attributable to SRS. CONCLUSION: This description of CyberKnife radiosurgical ablation demonstrates its feasibility and apparent safety for selected intramedullary spinal cord AVMs. Additional experience is necessary to ascertain the optimal radiosurgical dose and ultimate efficacy of this technique.

Disruption of the Finger Flexor Pulley System in Elite Rock Climbers

1998 ◽  
Vol 26 (5) ◽  
pp. 651-655 ◽  
Author(s):  
Markus Gabl ◽  
Christoph Rangger ◽  
Martin Lutz ◽  
Christian Fink ◽  
Ansgar Rudisch ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Nonoperative Treatment ◽  
Proximal Interphalangeal Joint ◽  
Magnetic Resonance Images ◽  
Resonance Imaging ◽  
Pulley System ◽  
Group A ◽  
Complete Disruption ◽  
Group B

We treated 13 elite rock climbers for isolated disruptions of the pulleys of the long fingers. Diagnosis and treatment were based on the clinical finding of bowstringing, which was confirmed by magnetic resonance imaging. Eight patients had bowstringing indicating incomplete disruption of the major pulley A2 and were treated nonoperatively (group A). Five patients showed bowstringing indicating complete disruption of the pulley A2. After failed nonoperative treatment, the pulleys were reconstructed (group B). The mechanism of injury and clinical and subjective results were evaluated. At a 31-month follow-up (range, 18 to 43 months), loss of extension in the proximal interphalangeal joint measured 5.6° (range, 0° to 10°) in group A and 4° (range, 0° to 10°) in group B. Circumference of the finger section was increased 4.2 mm in group A (range, 0 to 10 mm) and 4.8 mm in group B (range, 0 to 10 mm). Grip strength decreased 20 N in group A (range, 10 to 50 N) and 12 N in group B (range, 10 to 30 N). Four patients in group A and one in group B had bowstringing at clinical evaluation. On follow-up magnetic resonance images, bowstringing remained unchanged in group A but was reduced in all patients in group B. Good subjective results were seen in both groups.

Bifrontal encephalogaleosynangiosis for children with moyamoya disease

2012 ◽  
Vol 10 (3) ◽  
pp. 246-251 ◽  
Author(s):  
Hideki Ogiwara ◽  
Nobuhito Morota
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Moyamoya Disease ◽  
Pediatric Patients ◽  
Demographic Data ◽  
Clinical Presentations ◽  
Group A ◽  
The Mean ◽  
Group B

Object Several operative techniques have been reported to increase the cerebral blood flow (CBF) of the anterior cerebral artery (ACA) territory in patients with moyamoya disease. However, the optimal procedure has not yet been determined. This study compared the efficacy of performing bifrontal encephalogaleosynangiosis (EGS) using a craniotomy with performing EGS using bur holes. Methods The authors retrospectively analyzed surgical results of pediatric patients with moyamoya disease treated using encephaloduroarteriosynangiosis (EDAS) and bifrontal EGS with a craniotomy, or EGS with bur holes, for the purpose of improving the ischemia of the ACA territory. Patients' demographic data, clinical presentations, surgical therapies, and clinical outcomes were reviewed. Results Nine patients underwent EDAS with bifrontal EGS using a craniotomy. Three patients underwent EDAS with EGS using bur holes for 5 cerebral hemispheres (1 bur hole in 2 hemispheres, 2 bur holes in 2 hemispheres, and 3 bur holes in 1 hemisphere). The mean follow-up period was 46.8 months (range 7–96 months). Preoperative symptoms improved in all patients in each group. The collateral circulation in the ACA territory made by EGS was divided into 3 groups according to postoperative angiography results: Group A (revascularization of more than two-thirds of the ACA territory), Group B (revascularization between one-third and two-thirds), and Group C (revascularization less than one-third). Of 5 hemispheres treated with EGS using bur holes, 1 was evaluated as Group B and 4 as Group C. Of 18 hemispheres treated with bifrontal EGS using a craniotomy, 8 were evaluated as Group A, 7 as Group B, and 3 as Group C. The patients who underwent bifrontal EGS using a craniotomy showed significantly better revascularization than those who underwent EGS using bur holes (p = 0.0065). Cerebral blood flow in the ACA territory improved in 13 (92.9%) of 14 hemispheres in patients treated with bifrontal EGS. In contrast, only 3 (60%) of 5 hemispheres demonstrated an increase of CBF in patients treated with EGS using bur holes. A trend was demonstrated for better improvement with bifrontal EGS (p = 0.08). Conclusions Encephaloduroarteriosynangiosis with bifrontal EGS using a craniotomy demonstrated better revascularization and improvement of CBF in the ACA territory than with EGS using bur holes. Bifrontal EGS using a craniotomy is considered to be a simple, safe, and effective surgical procedure for improvement of the ischemia of the ACA territory in pediatric patients with moyamoya disease.

EMBOLIZATION BEFORE RADIOSURGERY REDUCES THE OBLITERATION RATE OF ARTERIOVENOUS MALFORMATIONS

Neurosurgery ◽  
2007 ◽  
Vol 60 (3) ◽  
pp. 443-452 ◽  
Author(s):  
Yuri M. Andrade-Souza ◽  
Meera Ramani ◽  
Daryl Scora ◽  
May N. Tsao ◽  
Karel terBrugge ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Linear Accelerator ◽  
Arteriovenous Malformations ◽  
Latency Period ◽  
Health Sciences ◽  
Excellent Outcome ◽  
Obliteration Rate ◽  
Group A ◽  
Group B

Abstract OBJECTIVE To evaluate the arteriovenous malformation (AVM) obliteration rate and the clinical outcome after radiosurgery in patients with and without previous embolization. METHODS Of 244 patients who underwent linear accelerator radiosurgery for AVMs at the Sunnybrook Health Sciences Centre between 1989 and 2000, 61 patients had embolization before radiosurgery and complete follow-up for at least 3 years. For 47 of these 61 patients (Group A, embolization plus radiosurgery), we were able to find 47 matching patients without previous embolization (Group B, radiosurgery alone). This group of matching patients had the same AVM volume (after embolization in Group A), location, and marginal dose. The radiosurgery-based AVM score and the obliteration prediction index were calculated. RESULTS The median follow-up period was 44 months. Nidus obliteration was achieved in 22 patients in Group A (47%) and 33 patients in Group B (70%, P = 0.036). Permanent deficit related to hemorrhage or radiation occurred in three patients (6%) in Group A and three patients (6%) in Group B. During the first 3 years after radiosurgery, two patients (4%) in Group A experienced hemorrhage; in Group B, five patients (11%) experienced hemorrhage (P = 0.2). In Group B, two patients (4%) died and two patients (4%) had their AVM surgically removed. Both deaths were related to hemorrhage during the latency period. The excellent outcome (obliteration plus no deficit) in Group A was 47% compared with 64% in Group B (P = 0.146). There was no difference in the obliteration prediction index and the radiosurgery-based AVM score between Groups A and B. The predicted rates of obliteration and excellent outcome were 55 and 62.5%, respectively, according to the obliteration prediction index and the radiosurgery-based AVM score. CONCLUSION Embolization before radiosurgery significantly decreases the obliteration rate, even in AVMs with the same volume, location, and marginal dose. Although an excellent outcome rate was higher in the group without embolization, this was not statistically significant.

Absorbable suture material in carotid surgery

VASA ◽  
2015 ◽  
Vol 44 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Vincenzo Gasbarro ◽  
Luca Traina ◽  
Francesco Mascoli ◽  
Vincenzo Coscia ◽  
Gianluca Buffone ◽  
...  
Keyword(s):  
Suture Material ◽  
Absorbable Suture ◽  
Paediatric Surgery ◽  
Carotid Surgery ◽  
Suture Materials ◽  
Absorbable Suture Material ◽  
Absorbable Sutures ◽  
Group A ◽  
Group B

Abstract. Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

2019 ◽  
Vol 14 (2) ◽  
pp. 141-146
Author(s):  
Simone Zanella ◽  
Enrico Lauro ◽  
Francesco Franceschi ◽  
Francesco Buccelletti ◽  
Annalisa Potenza ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
The Elderly ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

A Study on Frozen Shoulder and its clinical management through Nasaapana and Nasya

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Praveenkumar H. Bagali ◽  
A. S. Prashanth
Keyword(s):  
Medical Science ◽  
Frozen Shoulder ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Animal Kingdom ◽  
Shoulder Joints ◽  
Group A ◽  
Group B

The unique position of man as a master mechanic of the animal kingdom is because of skilled movements of his hands and when this shoulder joints get obstructed, we call it as Apabahuka (Frozen shoulder), we do not find satisfactory management in modern medical science. Various effective treatment modalities have been mentioned which reverse the pathogenesis, Shodhana is advised initially followed by Shamana therapies. In the present study 30 patients were selected incidentally and placed randomly into two groups A and B, with 15 subjects in each group. Group A received Amapachana with Panchakola Churna, Jambeera Pinda Sweda and Nasya Karma. Group B received Amapachana with Panchakola Churna, Jambeera pinda Sweda and Nasaapana. In both the groups two months follow up was done. Both groups showed significant improvement in the signs and symptoms of Apabahuka as well as the activities of daily livings, thereby improving the quality of life of the patients. Nasya Karma and Nasaapana provided highly significant results in all the symptoms of Apabahuka. In the present study as per the clinical data, Nasaapana is found to be more effective than Nasya Karma.

A Comparative Study of Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana in the Management of Shweta Pradara

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Renuka M. Tenahalli
Keyword(s):  
Vitamin C ◽  
Early Stage ◽  
Pathological Condition ◽  
Before And After ◽  
Group A ◽  
Phosphorus Iron ◽  
Group B ◽  
Busy Schedule ◽  
Iron And Calcium

Shweta Pradara (Leucorrhoea) is the disease which is characterized by vaginal white discharge. Vaginal white discharge this symptom is present in both physiological and pathological condition, when it becomes pathological it disturbs routine life style of the woman. Most of the women in the early stage will not express the symptoms because of hesitation and their busy schedule. If it is not treated it may leads to chronic diseases like PID (Garbhashaya Shotha etc.) Charaka mentioned Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana. This treatment is used in Shweta Pradara shown positive results, hence a study was under taken to assess its clinical efficacy. 30 diagnosed patients of Shweta Pradara were randomly selected, allocated in three groups. Group A and Group B received Amalaki Choorna with Madhu and Vata Twak Kashaya Yoni Pichu Dharana respectively and Group C received Amalaki Choorna with Madhu followed by Vata Twak Kashaya Yoni Pichu Dharana for 15 days. The patients were assessed for the severity of the symptoms subjectively and objectively before and after the treatment and at the end of the follow up. Data from each group were statistically analyzed and were compared. No side effects were noted and it may be considered as an effective alternative medicine in Shweta Pradara (leucorrhea). Amalaki is rich in natural source of vitamin C and contains phosphorus, iron and calcium. Honey contains carbohydrate, vitamin C, phosphorus iron and calcium. All together these help to increase Hb% and immunity. Vata Twak Kashaya contains tannin which helps to maintain normal pH of the vagina.

scholarly journals Oral Tranexamic Acid for the Treatment of Melasma

2014 ◽  
Vol 10 (4) ◽  
pp. 40-43 ◽  
Author(s):  
D Karn ◽  
S KC ◽  
A Amatya ◽  
EA Razouria ◽  
M Timalsina
Keyword(s):  
Tranexamic Acid ◽  
Controlled Trial ◽  
Severity Index ◽  
Sustained Improvement ◽  
Treatment Measures ◽  
Group A ◽  
Group B ◽  
Novel Concept ◽  
High Treatment

Background Melasma poses a great challenge as its treatment is unsatisfactory and recurrence is high. Treatment of melasma using tranexamic acid (oral, topical or intralesional) is a novel concept. Objective To compare the efficacy of oral tranexamic acid with routine topical therapies for the treatment of melasma. Methods It is a prospective, interventional, randomized controlled trial conducted among 260 melasma patients. Patients were divided into two groups consisting of 130 patients each. First group (Group A) was given routine treatment measures and oral Tranexamic Acid while second group (Group B) was treated only with routine topical measures. Capsule Tranexamic Acid was prescribed at a dose of 250 mg twice a day for three months and cases were followed for three months. Response was evaluated on the basis of Melasma Assessment Severity Index (MASI). Mean scores between the two groups were then compared. Results Statistically significant decrease in the mean Melasma Assessment Severity Index from baseline to 8 and 12 weeks was observed among group A patients (11.08±2.91 vs 8.95±2.08 at week 8 and vs. 7.84±2.44 at week 12; p<0.05 for both). While among group B patients the decrease in mean score was significant at 8 weeks and insignificant at 12 weeks follow up (11.60±3.40 vs 9.9±2.61 at 8 weeks and vs. 9.26±3 at 12 weeks; p<0.05 for former but p>0.05 for later). Conclusion Addition of oral tranexamic acid provides rapid and sustained improvement in the treatment of melasma. DOI: http://dx.doi.org/10.3126/kumj.v10i4.10993 Kathmandu Univ Med J 2012;10(4):40-43

scholarly journals Influence of bone cement distribution on outcomes following percutaneous vertebroplasty: a retrospective matched-cohort study

2021 ◽  
Vol 49 (7) ◽  
pp. 030006052110222
Author(s):  
Ling Mo ◽  
Zixian Wu ◽  
De Liang ◽  
Linqiang Y ◽  
Zhuoyan Cai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Bone Cement ◽  
Percutaneous Vertebroplasty ◽  
Vertebral Compression Fractures ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Cement Distribution ◽  
Group A ◽  
Group B

Objective To evaluate the influence of insufficient bone cement distribution on outcomes following percutaneous vertebroplasty (PVP). Methods This retrospective matched-cohort study included patients 50–90 years of age who had undergone PVP for single level vertebral compression fractures (VCFs) from February 2015 to December 2018. Insufficient (Group A)/sufficient (Group B) distribution of bone cement in the fracture area was assessed from pre- and post-operative computed tomography (CT) images. Assessments were before, 3-days post-procedure, and at the last follow-up visit (≥12 months). Result Of the 270 eligible patients, there were 54 matched pairs. On post-operative day 3 and at the last follow-up visit, significantly greater visual analogue scale (VAS) pain scores and Oswestry Disability Index (ODI) scores were obtained in Group B over Group A, while kyphotic angles (KAs) and vertebral height (VH) loss were significantly larger in Group A compared with Group B. Incidence of asymptomatic cement leakage and re-collapse of cemented vertebrae were also greater in Group A compared with Group B. Conclusions Insufficient cement distribution may relate to less pain relief and result in progressive vertebral collapse and kyphotic deformity post-PVP.

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