Direct percutaneous cerebral angiography in neurosurgical practice

1980 ◽  
Vol 52 (4) ◽  
pp. 525-528 ◽  
Author(s):  
Jerry Bauer ◽  
Jose Luis Salazar ◽  
Oscar Sugar ◽  
Ronald P. Pawl
Keyword(s):  
High Risk ◽  
Cerebrovascular Disease ◽  
Cerebral Angiography ◽  
Complication Rate ◽  
High Risk Population ◽  
Content Type ◽  
Pros And Cons ◽  
Sixth Decade ◽  
Symptoms And Signs ◽  
Fine Print

✓ A retrospective analysis of 1171 consecutive percutaneous retrograde brachial and carotid cerebral angiograms was performed on 635 patients, 50.7% of whom were in the sixth decade or older. Symptoms and signs of cerebrovascular disease were the most frequently investigated and diagnosed, accounting for 46.7% of all the angiograms. Despite this relatively high-risk population, we have found direct percutaneous cerebral angiography to have a very low risk. The pros and cons of direct percutaneous versus transfemoral cerebral angiography are discussed. The literature of the previous 10 years is reviewed, and the complication rate of these two techniques is compared.

Complications of 1000 brachial arteriograms

1972 ◽  
Vol 36 (3) ◽  
pp. 324-332 ◽  
Author(s):  
James Rodney Feild ◽  
Ling Lee ◽  
Robert F. McBurney
Keyword(s):  
Mortality Rate ◽  
Cerebrovascular Disease ◽  
Complication Rate ◽  
Motor Deficit ◽  
Radial Pulse ◽  
Local Complication ◽  
Content Type ◽  
Transient Loss ◽  
Artery Disease ◽  
Fine Print

✓ Of 1000 patients who had 1202 brachial and 1099 carotid arteriograms between 1966–1970, 52 had mild and 15 severe complications. Cerebrovascular disease was most frequently encountered. There were 11 patients undergoing simultaneous carotid and brachial arteriography in whom complications could not be localized to an individual artery. Including this group the complication rate for brachial arteriograms was 3.99% and excluding this group the complication rate was 3.08%. There were 3.32% mild and 0.60% severe complications of brachial arteriography and a mortality rate of 0.21%. A serious complication occurred at a rate of one per 152 brachial arteriograms. The complication rate of brachial arteriography with carotid vascular disease was 2.70% and 6.41% with basilar artery disease. The total complication rate of brachial arteriography in cerebrovascular disease was 12.17%. The most common local complication was a transient loss of the radial pulse. The most common cerebral complication was a transient motor deficit.

Cerebral angiography during operation for intracranial aneurysms and arteriovenous malformations

1971 ◽  
Vol 34 (5) ◽  
pp. 706-708 ◽  
Author(s):  
Martin L. Lazar ◽  
Clark C. Watts ◽  
Bassett Kilgore ◽  
Kemp Clark
Keyword(s):  
Cerebral Angiography ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Operative Procedure ◽  
Superficial Temporal Artery ◽  
Technical Problem ◽  
Temporal Artery ◽  
Content Type ◽  
Actual Operation ◽  
Fine Print

✓ Angiography during the operative procedure is desirable, but is often difficult because of the problem of maintaining a needle or cannula in an artery for long periods of time. Cannulation of the superficial temporal artery avoids this technical problem. The artery is easily found, cannulation is simple, and obliteration of the artery is of no consequence. Cerebral angiography then provides a means for prompt evaluation of the surgical procedure at any time during the actual operation.

Craniopharyngioma arising de novo in middle age

1997 ◽  
Vol 86 (6) ◽  
pp. 1046-1048 ◽  
Author(s):  
Marc S. Arginteanu ◽  
Karin Hague ◽  
Robert Zimmerman ◽  
Mark J. Kupersmith ◽  
John H. Shaiu ◽  
...  
Keyword(s):  
Magnetic Resonance Image ◽  
De Novo ◽  
Middle Age ◽  
Benign Tumors ◽  
Fetal Life ◽  
Content Type ◽  
Steady Growth ◽  
History Of ◽  
Sixth Decade ◽  
Fine Print

✓ The authors report the case of a 55-year-old woman who developed a symptomatic craniopharyngioma within 2 years of obtaining a normal magnetic resonance image of her brain. Craniopharyngiomas are histologically benign tumors. They are thought to arise from embryonic remnants of Rathke's pouch and sac and to manifest themselves clinically after a steady growth that commences in fetal life. To the authors' knowlege, this is the first report that documents a tumor arising de novo in the sixth decade of life. This report appears to challenge the concept of the origin and natural history of craniopharyngiomas.

Hemangiopericytoma of the spinal canal

1978 ◽  
Vol 49 (6) ◽  
pp. 914-920 ◽  
Author(s):  
Darrell J. Harris ◽  
Victor L. Fornasier ◽  
Kenneth E. Livingston
Keyword(s):  
Endothelial Cells ◽  
Differential Diagnosis ◽  
High Risk ◽  
Spinal Canal ◽  
Vertebral Column ◽  
Soft Tissues ◽  
Surgical Removal ◽  
Vascular Neoplasm ◽  
Content Type ◽  
Fine Print

✓ Hemangiopericytoma is a vascular neoplasm consisting of capillaries outlined by an intact basement membrane that separates the endothelial cells of the capillaries from the spindle-shaped tumor cells in the extravascular area. These neoplasms are found in soft tissues but have rarely been shown to involve the spinal canal. This is a report of three such cases. Surgical removal of the tumor from the spinal canal was technically difficult. A high risk of recurrence has been reported but in these three cases adjunctive radiotherapy appeared to be of benefit in controlling the progression of the disease. These cases, added to the six cases in the literature, confirm the existence of hemangiopericytoma involving the vertebral column with extension into the spinal canal. This entity should be included in the differential diagnosis of lesions of the spinal canal. The risk of intraoperative hemorrhage should be anticipated.

Phenytoin and postoperative epilepsy

1983 ◽  
Vol 58 (5) ◽  
pp. 672-677 ◽  
Author(s):  
J. Brian North ◽  
Robert K. Penhall ◽  
Ahmad Hanieh ◽  
Derek B. Frewin ◽  
William B. Taylor
Keyword(s):  
Head Injury ◽  
High Risk ◽  
Seizure Control ◽  
Active Drug ◽  
Double Blind Trial ◽  
Double Blind ◽  
Content Type ◽  
Routine Prophylaxis ◽  
Risk Patients ◽  
Fine Print

✓ A double-blind trial of phenytoin therapy following craniotomy was performed to test the hypothesis that phenytoin is effective in reducing postoperative epilepsy. A significant reduction in the frequency of epilepsy was observed in the group receiving the active drug up to the 10th postoperative week. Half of the seizures occurred in the first 2 weeks and two-thirds within 1 month of cranial surgery. High rates of epilepsy were observed after surgery in patients with meningioma, metastasis, aneurysm, and head injury. Routine prophylaxis with phenytoin (in a dosage of 5 to 6 mg/kg/day) would seem to be indicated, particularly in high-risk patients and, where possible, this treatment should be started 1 week preoperatively. Seizure control is best when therapeutic levels of phenytoin are maintained.

Hemangioma calcificans

1979 ◽  
Vol 50 (1) ◽  
pp. 110-114 ◽  
Author(s):  
Michael V. DiTullio ◽  
W. Eugene Stern
Keyword(s):  
Cerebral Angiography ◽  
Previous History ◽  
Rare Entity ◽  
Content Type ◽  
Aged Woman ◽  
Pathological Evaluation ◽  
Middle Aged Woman ◽  
History Of ◽  
The Masses ◽  
Fine Print

✓ A middle-aged woman, with a previous history of medically suppressed absence attacks, presented with mild changes in mental status and a skull film demonstrating several areas of mottled, granular, intracranial calcifications. These lesions, although readily visible on computerized tomography, appeared avascular during the course of cerebral angiography. At the time of surgery the masses, which were densely calcified and generally circular, demonstrated numerous areas of superficial, white, verrucous excrescences. Microscopic, pathological evaluation confirmed the diagnosis of hemangioma calcificans. The literature describing this rare entity is briefly reviewed.

scholarly journals Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of the management of high-risk population

2020 ◽  
Vol 5 (3) ◽  
pp. 270-278
Author(s):  
Yilong Wang ◽  
Shangrong Han ◽  
Haiqiang Qin ◽  
Huaguang Zheng ◽  
Bin Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Cerebrovascular Disease ◽  
Cerebrovascular Disorders ◽  
Antiplatelet Agents ◽  
Cochrane Library ◽  
High Risk Population ◽  
Evidence Based ◽  
Risk Population ◽  
Evidence Based Guideline

AimCerebrovascular disease is the leading cause of death and disability in China, causing a huge burden among patients and their families. Hence, stroke prevention is critical, especially in the high-risk population. Here, we present the evidence-based guideline suitable for the Chinese population.MethodsLiterature search of PubMed and Cochrane library (from January 1964 to June 2019) was done. After thorough discussion among the writing group members, recommendations were listed and summarised. This guideline was reviewed and discussed by the fellow writing committees of the Chinese Stroke Association’s Stroke.ResultsThis evidence-based guideline was written in three parts: controlling the risk factors of stroke, utilisation of antiplatelet agents and assessing the risks of first-ever stroke. All recommendations were listed along with the recommending classes and levels of evidence.ConclusionsThis guideline provides recommendations for primary prevention of cerebrovascular disease among high-risk population in China. Controlling related risk factors, appropriately using antiplatelet agents, assessing the risk of developing first-ever stroke should help reduce the rate of cerebrovascular disease in China.

High-risk mild head injury

1997 ◽  
Vol 87 (2) ◽  
pp. 234-238 ◽  
Author(s):  
John N. K. Hsiang ◽  
Theresa Yeung ◽  
Ashley L. M. Yu ◽  
Wai S. Poon
Keyword(s):  
Head Injury ◽  
High Risk ◽  
Mild Head Injury ◽  
Radiographic Findings ◽  
Content Type ◽  
Head Injured ◽  
Definition Of ◽  
Gcs Score ◽  
Injured Patients ◽  
Fine Print

✓ The generally accepted definition of mild head injury includes Glasgow Coma Scale (GCS) scores of 13 to 15. However, many studies have shown that there is a heterogeneous pathophysiology among patients with GCS scores in this range. The current definition of mild head injury is misleading because patients classified in this category can have severe sequelae. Therefore, a prospective study of 1360 head-injured patients with GCS scores ranging from 13 to 15 who were admitted to the neurosurgery service during 1994 and 1995 was undertaken to modify the current definition of mild head injury. Data regarding patients' age, sex, GCS score, radiographic findings, neurosurgical intervention, and 6-month outcome were collected and analyzed. The results of this study showed that patients with lower GCS scores tended to have suffered more serious injury. There was a statistically significant trend across GCS scores for percentage of patients with positive acute radiographic findings, percentage receiving neurosurgical interventions, and percentage with poor outcome. The presence of postinjury vomiting did not correlate with findings of acute radiographic abnormalities. Based on the results of this study, the authors divided all head-injured patients with GCS scores ranging from 13 to 15 into mild head injury and high-risk mild head injury groups. Mild head injury is defined as a GCS score of 15 without acute radiographic abnormalities, whereas high-risk mild head injury is defined as GCS scores of 13 or 14, or a GCS score of 15 with acute radiographic abnormalities. This more precise definition of mild head injury is simple to use and may help avoid the confusion caused by the current classification.

Brain scans and echoencephalography in the diagnosis of chronic subdural hematoma

1974 ◽  
Vol 40 (3) ◽  
pp. 347-350 ◽  
Author(s):  
Sheldon R. Hurwitz ◽  
Samuel E. Halpern ◽  
George Leopold
Keyword(s):  
Cerebral Angiography ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Content Type ◽  
Brain Scans ◽  
Subdural Hematomas ◽  
Fine Print

✓ Eighteen patients with chronic subdural hematomas were studied by both brain scans and echoencephalography. All cases were verified by cerebral angiography. Brain scanning was accurate in predicting hematomas in 93% of the cases, and echoencephalography in 44%. When hematomas were bilateral or when frontal clots caused no shift in the diencephalic midline, the routine echoencephalogram often was negative. The two procedures are complementary, and serial studies may be helpful in the study of changing clinical situations.

Frequency and management of recurrent stenosis after carotid artery stent implantation

2005 ◽  
Vol 102 (1) ◽  
pp. 29-37 ◽  
Author(s):  
Elad I. Levy ◽  
Ricardo A. Hanel ◽  
Tsz Lau ◽  
Christopher J. Koebbe ◽  
Naveh Levy ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Doppler Ultrasonography ◽  
Velocity Ratio ◽  
Content Type ◽  
Recurrent Stenosis ◽  
Diastolic Velocity ◽  
Lost To Follow Up ◽  
Fine Print

Object. To determine the rate of hemodynamically significant recurrent carotid artery (CA) stenosis after stent-assisted angioplasty for CA occlusive disease, the authors analyzed Doppler ultrasonography data that had been prospectively collected between October 1998 and September 2002 for CA stent trials. Methods. Patients included in the study participated in at least 6 months of follow-up review with serial Doppler studies or were found to have elevated in-stent velocities (> 300 cm/second) on postprocedure Doppler ultrasonograms. Hemodynamically significant (≥ 80%) recurrent stenosis was identified using the following Doppler criteria: peak in-stent systolic velocity at least 330 cm/second, peak in-stent diastolic velocity at least 130 cm/second, and peak internal carotid artery/common carotid artery velocity ratio at least 3.8. Follow-up studies were obtained at approximate fixed intervals of 1 day, 1 month, 6 months, and yearly. Angiography was performed in the event of recurrent symptoms, evidence of hemodynamically significant stenosis on Doppler ultrasonography, or both. Treatment was repeated because of symptoms, angiographic evidence of severe (≥ 80%) recurrent stenosis, or both of these. Stents were implanted in 142 vessels in 138 patients (all but five patients were considered high-risk surgical candidates and 25 patients were lost to follow-up review). For the remaining 112 patients (117 vessels), the mean duration of Doppler ultrasonography follow up was 16.42 ± 10.58 months (range 4–54 months). Using one or more Doppler criteria, severe (≥ 80%) in-stent stenosis was detected in six patients (5%). Eight patients underwent repeated angiography. Six patients (three with symptoms) required repeated intervention (in four patients angioplasty alone; in one patient conventional angioplasty plus Cutting Balloon angioplasty; and in one patient stent-assisted angioplasty). Conclusions. In a subset of primarily high-risk surgical candidates treated with stent-assisted angioplasty, the rates of hemodynamically significant restenosis were comparable to surgical restenosis rates cited in previously published works. Treatment for recurrent stenosis incurred no instance of periprocedure neurological morbidity.

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