Simple Technique for Intraoperative Angiographic Localization of Small Vascular Lesions

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 818-823 ◽  
Author(s):  
Anand V. Germanwala ◽  
Quoc-Anh Thai ◽  
Gustavo Pradilla ◽  
Rafael J. Tamargo
Keyword(s):  
Intraoperative Complications ◽  
Setup Time ◽  
Vascular Lesion ◽  
Vascular Lesions ◽  
Intraoperative Angiography ◽  
Technical Errors ◽  
Wire Frame ◽  
Preoperative Diagnostic ◽  
The Wire ◽  
Middle Cerebral Artery Aneurysms

Abstract BACKGROUND Precise surgical localization of small arteriovenous malformations (AVMs), arteriovenous fistulae (AVFs), and aneurysms located in the distal portions of the intracranial arteries can be difficult OBJECTIVE We describe a simple and accurate intraoperative angiographic localization technique for small AVMs, AVFs, and distal aneurysms. METHODS All patients had routine preoperative diagnostic imaging and evaluations, including catheter angiography. Once anesthetized, the patients were prepared for intraoperative angiography following cannulation of the femoral artery. Craniometric landmarks were utilized to approximately localize the lesion. A wire in the shape of a square was placed over the proposed craniotomy site and an angiogram was performed. With use of real-time angiography, the wire localizer was manipulated until the small vascular lesion was visualized entirely within the wire frame, thus defining the extent of the required craniotomy and the surgical trajectory. RESULTS The wire localizer was used to target small vascular lesions in 9 cases of AVMs, 4 cases of distal middle cerebral artery aneurysms, and 1 case of a diploic AVF. In all 14 cases, the lesion was accurately localized intraoperatively without further image-guided techniques, and there was no change in the craniotomy. There were no intraoperative complications, and all patients had uneventful recoveries. CONCLUSION Intraoperative angiography with a simple wire localizer can effectively and accurately aid in the planning of surgery for a range of small and distal vascular lesions with virtually no added cost, minimal setup time, and limited potential for technical errors.

Analysis of Cerebral Vascular Lesion Pools in Ischemic Stroke Based on the Analysis and the Prognostic Assessment of Risk Factors in Patients with Primary and Recurrent Ischemic Stroke

2016 ◽  
pp. 65-68
Author(s):  
Oksana Mikitey
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Significant Risk ◽  
Vascular Lesion ◽  
Assessment Tools ◽  
Vascular Lesions ◽  
Global Risk ◽  
Risk Assessment Tools

Stroke is an important medical and social problem, and stroke risk assessment tools have difficulty on the interaction of risk factors and the effects of certain risk factors with analysis by age, gender, race, because this information fully available to global risk assessment tools. In addition, these tools tend to be focused and usually do not include the entire range of possible factors contributing. The aim of the study was to conduct a comparison of brain vascular lesions pool with ischemic stroke (II) based predictive analysis and assessment of the main risk factors in patients with primary and recurrent ischemic stroke. Prognostically significant risk factors for recurrent ischemic stroke is not effective antihypertensive therapy, multiple stenoses any one pool vascular brain, duration of hypertension (AH) over 5 years and regular smoking patients (p<0.001). In the initial localization in the second vertebrobasilar recurrent stroke was significantly (p<0.05) more developed in the same pool in women than in men; and the localization of the primary carotid AI in the pool, re-developed stroke often unreliable in the same pool in women than in men.

Abstract P249: Effects of Lifestyle Changes on Metabolism and Early Vascular Lesion in Healthy People

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Xu Fengcheng ◽  
Yu Chaoping ◽  
Liu Tianhu
Keyword(s):  
Healthy Lifestyle ◽  
Low Density Lipoprotein ◽  
Fasting Blood Glucose ◽  
Ankle Brachial Index ◽  
Density Lipoprotein ◽  
Vascular Lesion ◽  
Lifestyle Changes ◽  
Healthy People ◽  
Vascular Lesions ◽  
Before And After

Objective: Through propaganda and education on lifestyle change, we study the effects on metabolism and vascular lesions in healthy people. Methods: the healthy subjects that conform to the requirements, through propaganda and education on vascular health, through moderate exercise, proper control of starchy foods, low salt, low fat diet, reduce smoking and other lifestyle changes, compare changes in weight, renal function, fasting blood glucose, blood lipids and ankle brachial index (ABI), cardio ankle vascular index(CAVI) before and after lifestyle changes. Results: After lifestyle changed, the subjects’ body mass index [(23.13±3.18)kg/m 2 vs (22.67±3.36)kg/m 2 ], ABI[1.11±0.08 vs 1.09±0.09], CAVI[(7.14±1.13 ) vs (7. 01±1.18) ], serum creatinine[(84.31±22.41)umol/L vs (79.92±23.64)umol/L], blood uric acid[(337.79±102.17 )umol/L vs (328.12±88.33)umol/L], low density lipoprotein cholesterol[(2.49±0.65) mmol/L vs (2.37±0.69) mmol/L],all have good changes. Conclusion: Healthy lifestyle is good for metabolism and early vascular lesions, can improve metabolic disorder and slow the occurrence of arteriosclerosis.

Abstract 3734: Presurgical fMRI and Morbidity Outcomes in Patients with Vascular Lesions

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Andrew C Radtke ◽  
Joshua Pankratz ◽  
Ryan Holdsworth ◽  
Dovile Baniulis ◽  
Nicole Kornder ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Preoperative Planning ◽  
Binary Logistic Regression ◽  
Vascular Lesion ◽  
Vascular Lesions ◽  
Motor Deficits ◽  
Binary Logistic Regression Analysis ◽  
Language Mapping ◽  
Motor Mapping ◽  
The Relationship

Background fMRI is being increasingly used as an adjunct imaging technique for preoperative planning for patients with various brain lesions. The proximity of the lesion to eloquent cortex is a major factor in guiding surgical planning. Our group has previously reported significant association between the distance between brain tumor periphery and area of fMRI activation (Lesion-Activation Distance; LAD) and morbidity and mortality outcomes. This study investigated the relationship between vascular lesion LAD and morbidity. Methods This study was a retrospective analysis of data from patients with vascular lesions [arteriovenous malformations (AVMs) (n=49), and cavernomas (n=57)], who had received fMRI as part of their preoperative planning. The preoperative fMRI included motor mapping (n=87) and/or language mapping (n=102). The fMRI paradigms were chosen based on observed preoperative weakness (aphasia, paresis) and anticipated functional areas of the brain that may be affected by treatment. Results Multiple logistic regression analyses showed that a model that combines Age and Language LAD was a significant predictor of postoperative deficits (p= 0.04). Broca’s LAD(1-2 cm) X Age was a significant predictor of postoperative deficits (change in odds ratio (OR) =0.82, CI:0.68-0.98). The relationship between Brocas’s LAD and postoperative aphasia and Broca’s LAD and pre and postoperative aphasia trended towards significance (p = .08 and p =.07 respectively). Wernicke’s LAD, independently or combined with Age, was not a significant predictor of postoperative deficits. Binary logistic regression analysis for SMC LAD and postop deficits did not reach significance (p =.10). There were no significant differences in postoperative language or motor deficits as a function of gender or handedness. Conclusions These results suggest that both age and the proximity of a vascular lesion to language LAD are factors that can help predict postoperative outcomes, especially for Broca’s LAD. The lack of similar results when investigating the relationship between Wernicke’s LAD and postoperative deficits suggests potential brain reorganization and/or robustness of this brain region. These results have implications for the potential use of fMRI as a presurgical tool for language mapping in patients with vascular lesions.

scholarly journals Vascular dementia and the cholinergic pathways

2007 ◽  
Vol 1 (1) ◽  
pp. 2-9 ◽  
Author(s):  
Eliasz Engelhardt ◽  
Denise Madeira Moreira ◽  
Jerson Laks
Keyword(s):  
Vascular Dementia ◽  
Therapeutic Potential ◽  
Clinical Manifestations ◽  
Vascular Cognitive Impairment ◽  
Vascular Lesion ◽  
Vascular Lesions ◽  
Behavioral Integration ◽  
Cholinergic Pathways ◽  
High Prevalence ◽  
Cholinergic Hypofunction

Abstract Vascular cognitive impairment/vascular dementia have been the subject of a large number of studies, due to their high prevalence and broad preventive and compensatory therapeutic potential. The knowledge of the cerebral anatomy correlated to the vascular territories of irrigation enables understanding of clinical manifestations, as well as classification into the several types of syndromic presentations. The central cholinergic system exercises important neuromodulatory functions on cerebral circuits related to cognitive and behavioral integration, as well as on vasomotor control related to cerebral blood flow adjustments. The acquisition of data on the anatomy of the cholinergic pathways, including the localization of the nuclei of the basal prosencephalon and the routes of their projections, established an important milestone. The knowledge of the vascular distribution and of the trajectories of the cholinergic pathways allows identification of the strategic points where a vascular lesion can cause interruption. The ensuing denervation leads to cholinergic hypofunction in the involved territories. This information proves important to better evaluate the sites of vascular lesions, emphasizing their strategic localizations in relation to the cholinergic pathways, and offering more robust foundations for treatment aiming at enhancing cholinergic activity.

scholarly journals Partial cortico-hippocampectomy in cats, as therapy for refractory temporal epilepsy: A descriptive cadaveric study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244892
Author(s):  
Jessica Zilli ◽  
Monika Kressin ◽  
Anne Schänzer ◽  
Marian Kampschulte ◽  
Martin J. Schmidt
Keyword(s):  
Temporal Lobe ◽  
Tissue Injury ◽  
Histopathological Examination ◽  
Hippocampal Sclerosis ◽  
Intraoperative Complications ◽  
Temporal Cortex ◽  
Cadaveric Study ◽  
Vascular Lesions ◽  
Temporal Epilepsy ◽  
The Brain

Cats, similar to humans, are known to be affected by hippocampal sclerosis (HS), potentially causing antiepileptic drug (AED) resistance. HS can occur as a consequence of chronic seizure activity, trauma, inflammation, or even as a primary disease. In humans, temporal lobe resection is the standardized therapy in patients with refractory temporal lobe epilepsy (TLE). The majority of TLE patients are seizure free after surgery. Therefore, the purpose of this prospective cadaveric study is to establish a surgical technique for hippocampal resection in cats as a treatment for AED resistant seizures. Ten cats of different head morphology were examined. Pre-surgical magnetic resonance imaging (MRI) and computed tomography (CT) studies of the animals’ head were carried out to complete 3D reconstruction of the head, brain, and hippocampus. The resected hippocampal specimens and the brains were histologically examined for tissue injury adjacent to the hippocampus. The feasibility of the procedure, as well as the usability of the removed specimen for histopathological examination, was assessed. Moreover, a micro-CT (mCT) examination of the brain of two additional cats was performed in order to assess temporal vasculature as a reason for possible intraoperative complications. In all cats but one, the resection of the temporal cortex and the hippocampus were successful without any evidence of traumatic or vascular lesions in the surrounding neurovascular structures. In one cat, the presence of mechanical damage (a fissure) of the thalamic surface was evident in the histopathologic examination of the brain post-resection. All hippocampal fields and the dentate gyrus were identified in the majority of the cats via histological examination. The study describes a new surgical approach (partial temporal cortico-hippocampectomy) offering a potential treatment for cats with clinical and diagnostic evidence of temporal epilepsy which do not respond adequately to the medical therapy.

Response of Vascular Lesions of the Head and Neck to Argon Laser Radiation

1983 ◽  
Vol 91 (2) ◽  
pp. 203-208 ◽  
Author(s):  
Joseph R. DiBartolomeo
Keyword(s):  
Laser Radiation ◽  
Surgical Technique ◽  
Head And Neck ◽  
Excellent Result ◽  
Argon Laser ◽  
Vascular Lesion ◽  
Vascular Lesions ◽  
Hypertrophic Scars ◽  
Argon Ion

Argon laser radiation is used to treat congenital and acquired vascular lesions of the head and neck. Thirteen patients requiring a total of 36 treatments were followed up for a minimum of 1 year to assess the response of the vascular lesion to argon ion radiation. Of the 13 patients, 10 had an excellent result, with the lesion no longer being identifiable. Three of the patients had residual but minimal color remaining in the lesion. There were no complications or hypertrophic scars after 1 year of follow-up. The laser parameters used and the surgical technique followed are outlined.

Generation of Surface Models of 3D Objects From Their Wire-Frame Models

1992 ◽  
Author(s):  
S. Gupta ◽  
A. Shirkhodaie ◽  
A. H. Soni
Keyword(s):  
Common Vertex ◽  
Surface Model ◽  
Edge Information ◽  
Frame Model ◽  
3D Objects ◽  
Wire Frame ◽  
Surface Models ◽  
Plane Passing ◽  
Generate Surface ◽  
The Wire

Abstract This paper presents an algorithm to generate surface models of 3D objects from their wire-frame models. The algorithm firstly, obtains information about edges of the object from the wire-frame model of the object and uses this edge information to generate the pairs. A pair of an object is a combination of two non-collinear edges which have a common vertex. The algorithm then determines the unique plane passing through each pair and groups the coplanar pairs together. Then it sorts each of the groups of coplanar pairs to form one or more loops of edges. Finally for each group of coplanar pairs, all the loops are combined, using a few rules, to form faces of the object. Hence a surface model of the object is generated.

scholarly journals Retrosigmoid Approach for Trapping and Removal of a Distal Dissecting Superior Cerebellar Artery Aneurysm in a Child

2018 ◽  
Vol 80 (S 03) ◽  
pp. S335-S338 ◽  
Author(s):  
Javier Ros de San Pedro
Keyword(s):  
Artery Aneurysm ◽  
Vascular Lesion ◽  
Retrosigmoid Approach ◽  
Vascular Lesions ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Unsteady Gait ◽  
Cerebellar Artery ◽  
Preoperative Magnetic Resonance ◽  
Magnetic Resonance Imaging Mri

Objectives To demonstrate the feasibility of the retrosigmoid craniotomy for surgical management of vascular lesions located in the cerebellopontine angle (CPA). Method A previously healthy 2-year-old boy presented a sudden episode of torticollis to the left while sleeping. This episode was selflimited but it occurred two more times in a 6-day span. Torticollis worsened in the upright position, caused unsteady gait and refusal to walk from the child. The preoperative magnetic resonance imaging (MRI) showed the presence of a round, heterogenous vascular lesion in the left CPA. The lesion clearly enhanced after contrast administration. The preoperative angiography demonstrated the absence of left anterior inferior cerebellar artery anterior inferior cerebellar artery (AICA), being the left superior cerebellar artery (SCA) the supplier of the left lateral cerebellum. A blurred blush on the distal left SCA was compatible with a fusiform aneurysm. A standard retrosigmoid approach was planned for trapping and removal of the aneurysm. Results Through a left retrosigmoid craniotomy the aneurysm was approached, along with the different neurovascular structures of the CPA. The aneurysm leaned on the VII, VIII nerves complex and the superior petrosal vein, while tightly attached to the lateral cerebellum. Both proximal and distal SCA segments to the aneurysm were dissected, clipped, and divided for a complete trapping. Finally, the aneurysm was completely detached and removed in a whole piece. The patient fully recovered after surgery with no relapse of his symptoms. Conclusion The retrosigmoid craniotomy is a versatile approach that permits wide exposure of all CPA structures and adequate removal of distal aneurysms located in those cerebellar arteries supplying the lateral cerebellum.The link to the video can be found at: https://youtu.be/oEVfy4goFYM.

scholarly journals Clinical importance of the occipital artery in vascular lesions: A review of the literature

2019 ◽  
Vol 32 (5) ◽  
pp. 366-375 ◽  
Author(s):  
Yunbao Guo ◽  
Hao Chen ◽  
Xuan Chen ◽  
Jinlu Yu
Keyword(s):  
Clinical Importance ◽  
Vascular Supply ◽  
Vascular Lesions ◽  
Occipital Artery ◽  
Review Of The Literature ◽  
Brain Arteriovenous Malformation ◽  
Intraoperative Angiography ◽  
Supply Source ◽  
Pubmed Database ◽  
Donor Artery

The occipital artery (OA) is a critical artery in vascular lesions. However, a comprehensive review of the importance of the OA is currently lacking. In this study, we used the PubMed database to perform a review of the literature on the OA to increase our understanding of its role in vascular lesions. We also provided our typical cases to illustrate the importance of the OA. The OA has several variations. For example, it may arise from the internal carotid artery or anastomose with the vertebral artery. Therefore, the OA may provide a crucial collateral vascular supply source and should be preserved in these cases. The OA is a good donor artery. Consequently, it is used in extra- to intracranial bypasses for moyamoya disease (MMD) or aneurysms. The OA can be involved in dural arteriovenous fistula (DAVF) and is a feasible artery for the embolisation of DAVF. True aneurysms and pseudoaneurysms can occur in the OA; surgical resection and embolisation are the effective treatment approaches. Direct high-flow AVF can occur in the OA; embolisation treatment is a good option in such cases. The OA can also be involved in MMD and brain arteriovenous malformation (AVM) by forming transdural collaterals. For a patient in the prone position, if occipital and suboccipital craniotomies are performed, the OA can also be used for intraoperative angiography. In brief, the OA is a very important artery in vascular lesions.

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