Polytetrafluoroethylene interposition grafts in vertebral tocarotid artery transposition

1989 ◽  
Vol 70 (2) ◽  
pp. 212-215 ◽  
Author(s):  
David A. Cavanaugh ◽  
Jim L. Story ◽  
Willis E. Brown ◽  
Lee V. Ansell ◽  
Holger E. I. Skerhut
Keyword(s):  
Myocardial Infarction ◽  
The Other ◽  
Anterior Myocardial Infarction ◽  
Content Type ◽  
Graft Placement ◽  
Follow Up Studies ◽  
Direct Anastomosis ◽  
Cerebrovascular Surgery ◽  
Fine Print

✓ Eight patients undergoing an end-to-side vertebral artery (VA) to common carotid artery transposition between August, 1979, and July, 1982, had a polytetrafluoroethylene (PTFE) interposition graft placed when a direct anastomosis was believed not to be satisfactory. Five of these patients are living; clinical and radiographic follow-up studies over periods ranging between 54 and 82 months show that their transpositions are patent. Two patients died perioperatively, one from an acute anterior myocardial infarction and the other from acute VA occlusion with a propagating thrombus. A third patient died of myocardial infarction 20 months after graft placement; the anastomosis had been found patent at 12 months. This report gives the clinical and radiographic follow-up results in a previously reported group of patients with PTFE interposition grafts. Some of these patients have been followed for over 6 years after surgery: the average radiographic follow-up period in the five survivors is 60 months, and all grafts are patent without evidence of progressive stenosis. Expanded PTFE appears to be an acceptable material for short interposition grafts in operations involving the VA; however, direct artery-to-artery anastomosis is preferred. The results of longer PTFE grafts in reconstructive cerebrovascular surgery have not been adequately studied.

Stereotactic radiation treatment planning and follow-up studies involving fused multimodality imaging

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 326-333 ◽  
Author(s):  
Klaus D. Hamm ◽  
Gunnar Surber ◽  
Michael Schmücking ◽  
Reinhard E. Wurm ◽  
Rene Aschenbach ◽  
...  
Keyword(s):  
Image Fusion ◽  
Treatment Planning ◽  
Radiation Treatment ◽  
Data Sets ◽  
Slice Thickness ◽  
Radiation Treatment Planning ◽  
Content Type ◽  
Follow Up Studies ◽  
Fine Print

Object. Innovative new software solutions may enable image fusion to produce the desired data superposition for precise target definition and follow-up studies in radiosurgery/stereotactic radiotherapy in patients with intracranial lesions. The aim is to integrate the anatomical and functional information completely into the radiation treatment planning and to achieve an exact comparison for follow-up examinations. Special conditions and advantages of BrainLAB's fully automatic image fusion system are evaluated and described for this purpose. Methods. In 458 patients, the radiation treatment planning and some follow-up studies were performed using an automatic image fusion technique involving the use of different imaging modalities. Each fusion was visually checked and corrected as necessary. The computerized tomography (CT) scans for radiation treatment planning (slice thickness 1.25 mm), as well as stereotactic angiography for arteriovenous malformations, were acquired using head fixation with stereotactic arc or, in the case of stereotactic radiotherapy, with a relocatable stereotactic mask. Different magnetic resonance (MR) imaging sequences (T1, T2, and fluid-attenuated inversion-recovery images) and positron emission tomography (PET) scans were obtained without head fixation. Fusion results and the effects on radiation treatment planning and follow-up studies were analyzed. The precision level of the results of the automatic fusion depended primarily on the image quality, especially the slice thickness and the field homogeneity when using MR images, as well as on patient movement during data acquisition. Fully automated image fusion of different MR, CT, and PET studies was performed for each patient. Only in a few cases was it necessary to correct the fusion manually after visual evaluation. These corrections were minor and did not materially affect treatment planning. High-quality fusion of thin slices of a region of interest with a complete head data set could be performed easily. The target volume for radiation treatment planning could be accurately delineated using multimodal information provided by CT, MR, angiography, and PET studies. The fusion of follow-up image data sets yielded results that could be successfully compared and quantitatively evaluated. Conclusions. Depending on the quality of the originally acquired image, automated image fusion can be a very valuable tool, allowing for fast (∼ 1–2 minute) and precise fusion of all relevant data sets. Fused multimodality imaging improves the target volume definition for radiation treatment planning. High-quality follow-up image data sets should be acquired for image fusion to provide exactly comparable slices and volumetric results that will contribute to quality contol.

Percutaneous endoscopic treatment of suprasellar arachnoid cysts: ventriculocystostomy or ventriculocystocisternostomy?

1996 ◽  
Vol 84 (4) ◽  
pp. 696-701 ◽  
Author(s):  
Philippe Decq ◽  
Pierre Brugières ◽  
Caroline Le Guerinel ◽  
Michel Djindjian ◽  
Yves Kéravel ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Flow Dynamics ◽  
The Other ◽  
Arachnoid Cysts ◽  
Csf Flow ◽  
Content Type ◽  
Secondary Closure ◽  
Fine Print

✓ The use of an endoscope in the treatment of suprasellar arachnoid cysts provides an opening of the upper and lower cyst walls, thereby allowing the surgeon to perform a ventriculocystostomy (VC) or a ventriculocystocysternostomy (VCC). To discover which procedure is appropriate, magnetic resonance (MR)—imaged cerebrospinal fluid (CSF) flow dynamics in two patients were analyzed, one having undergone a VC and the other a VCC using a rigid endoscope. Magnetic resonance imaging studies were performed before and after treatment, with long-term follow-up periods (18 months and 2 years). The two patients were reoperated on during the follow-up period because of slight headache recurrence in one case and MR—imaged CSF flow dynamics modifications in the other. In each case surgery confirmed the CSF flow dynamics modifications appearing on MR imaging. In both cases, long-term MR imaging follow-up studies showed a secondary closing of the upper wall orifice. After VCC, however, the lower communication between the cyst and the cisterns remained functional. The secondary closure of the upper orifice may be explained as follows: when opened, the upper wall becomes unnecessary and tends to return to a normal shape, leading to a secondary closure. The patent sylvian aqueduct aids this phenomenon, as observed after ventriculostomy when the aqueduct is secondarily functional. The simplicity of the VCC performed using endoscopic control, which is the only procedure to allow the opening in the cyst's lower wall to remain patent, leads the authors to advocate this technique in the treatment of suprasellar arachnoid cysts.

Natural history of postoperative aneurysm rests

1987 ◽  
Vol 66 (1) ◽  
pp. 30-34 ◽  
Author(s):  
Isaac Feuerberg ◽  
Christer Lindquist ◽  
Melker Lindqvist ◽  
Ladislau Steiner
Keyword(s):  
Natural History ◽  
Content Type ◽  
Follow Up Studies ◽  
History Of ◽  
Microsurgical Techniques ◽  
Fine Print ◽  
Saccular Aneurysms

✓ In a series of 715 patients operated on by microsurgical techniques for intracranial saccular aneurysms between 1970 and 1980, part of the aneurysmal sac was not obliterated in 28 aneurysms in 27 patients (3.8% of 715 cases). Clinical follow-up evaluation for 8 years (range 4 to 13 years) and angiographic follow-up studies for 6 years (range 2 to 10 years) in these 27 cases revealed that one aneurysm rest increased in size and bled twice, five were spontaneously obliterated, two decreased in size, 13 remained unchanged, and in seven cases no late follow-up angiography was performed. The incidence of rebleeding from an aneurysm rest was 3.7% of the 27 in whom the sac was not obliterated and 0.14% of all 715 patients who were operated on.

Spinal cord arteriovenous malformations with significant intramedullary components

1983 ◽  
Vol 59 (3) ◽  
pp. 471-478 ◽  
Author(s):  
Philip Cogen ◽  
Bennett M. Stein
Keyword(s):  
Arteriovenous Malformations ◽  
The Other ◽  
Neurological Deficits ◽  
Content Type ◽  
Postoperative Course ◽  
Microsurgical Techniques ◽  
Spinal Arteriovenous Malformations ◽  
High Degree ◽  
Fine Print

✓ Few neurosurgeons have stressed the occurrence, manifestations, and resectability of intramedullary spinal arteriovenous malformations (AVM's). In six of 17 patients in the authors' series of operable spinal AVM's, the lesions had major intramedullary components. Three of these six patients presented with subarachnoid hemorrhage, and all had catastrophic neurological deficits which gradually improved. The hemorrhages appeared to originate from large venous varices lying adjacent to the intramedullary portion of the AVM. The mechanism explaining the sudden neurological deficit in the other three patients was presumed to be thrombosis within the venous varices associated with their AVM's. The reliability of the various radiographic procedures in identifying the intramedullary components of these AVM's is discussed. These malformations may be removed totally with a high degree of safety using microsurgical techniques. The postoperative course in this series of patients was gratifying in terms of improvement of neurological deficits. Postoperative angiography was not performed on all of these patients. However, the follow-up period averaged 5 years.

Embolization of spinal dural arteriovenous fistulas: importance of occlusion of the draining vein

2005 ◽  
Vol 2 (5) ◽  
pp. 580-583 ◽  
Author(s):  
Korné Jellema ◽  
Menno Sluzewski ◽  
Willem Jan van Rooij ◽  
Cees C. Tijssen ◽  
Guus N. Beute
Keyword(s):  
Treatment Option ◽  
Additional Treatment ◽  
The Other ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Fine Print

Object. The aim of this study was to assess whether glue-induced occlusion of the draining vein predicts permanent closure of the fistula following embolization of spinal dural arteriovenous fistulas (SDAVFs). Methods. Between 1994 and 2004, 36 consecutive patients with an SDAVF were treated at the authors' institution. Twelve patients underwent surgery and 24 glue-based embolization. In 12 of 24 embolization procedures the draining vein was occluded and no recurrence or persistent fistula was seen during the follow-up period. In the other 12 patients the glue had not reached the draining vein and in eight of these the fistula recurred, necessitating additional treatment. Conclusions. In embolization of SDAVFs penetration of the glue into the draining vein predicts permanent closure of the fistula. When penetration of the glue into the draining vein can be expected, embolization is the preferred treatment option. In other cases surgery should be the treatment of choice.

Stereotactic radiation treatment planning and follow-up studies involving fused multimodality imaging

2004 ◽  
pp. 326-333 ◽  
Author(s):  
Klaus D. Hamm ◽  
Gunnar Surber ◽  
Michael Schmücking ◽  
Reinhard E. Wurm ◽  
Rene Aschenbach ◽  
...  
Keyword(s):  
Image Fusion ◽  
Treatment Planning ◽  
Radiation Treatment ◽  
Data Sets ◽  
Slice Thickness ◽  
Radiation Treatment Planning ◽  
Content Type ◽  
Follow Up Studies ◽  
Fine Print

Object. Innovative new software solutions may enable image fusion to produce the desired data superposition for precise target definition and follow-up studies in radiosurgery/stereotactic radiotherapy in patients with intracranial lesions. The aim is to integrate the anatomical and functional information completely into the radiation treatment planning and to achieve an exact comparison for follow-up examinations. Special conditions and advantages of BrainLAB's fully automatic image fusion system are evaluated and described for this purpose. Methods. In 458 patients, the radiation treatment planning and some follow-up studies were performed using an automatic image fusion technique involving the use of different imaging modalities. Each fusion was visually checked and corrected as necessary. The computerized tomography (CT) scans for radiation treatment planning (slice thickness 1.25 mm), as well as stereotactic angiography for arteriovenous malformations, were acquired using head fixation with stereotactic arc or, in the case of stereotactic radiotherapy, with a relocatable stereotactic mask. Different magnetic resonance (MR) imaging sequences (T1, T2, and fluid-attenuated inversion-recovery images) and positron emission tomography (PET) scans were obtained without head fixation. Fusion results and the effects on radiation treatment planning and follow-up studies were analyzed. The precision level of the results of the automatic fusion depended primarily on the image quality, especially the slice thickness and the field homogeneity when using MR images, as well as on patient movement during data acquisition. Fully automated image fusion of different MR, CT, and PET studies was performed for each patient. Only in a few cases was it necessary to correct the fusion manually after visual evaluation. These corrections were minor and did not materially affect treatment planning. High-quality fusion of thin slices of a region of interest with a complete head data set could be performed easily. The target volume for radiation treatment planning could be accurately delineated using multimodal information provided by CT, MR, angiography, and PET studies. The fusion of follow-up image data sets yielded results that could be successfully compared and quantitatively evaluated. Conclusions. Depending on the quality of the originally acquired image, automated image fusion can be a very valuable tool, allowing for fast (∼ 1–2 minute) and precise fusion of all relevant data sets. Fused multimodality imaging improves the target volume definition for radiation treatment planning. High-quality follow-up image data sets should be acquired for image fusion to provide exactly comparable slices and volumetric results that will contribute to quality contol.

Treatment of fractures of the atlas and axis by wiring without fusion

1972 ◽  
Vol 36 (6) ◽  
pp. 773-780 ◽  
Author(s):  
Robert L. McLaurin ◽  
Raul Vernal ◽  
James H. Salmon
Keyword(s):  
Internal Fixation ◽  
Operative Procedure ◽  
Neurological Sequelae ◽  
Content Type ◽  
Bone Fusion ◽  
Follow Up Studies ◽  
Atlas And Axis ◽  
Fine Print

✓ Fractures and dislocations involving C-1 and C-2 vertebrae have usually been treated by prolonged external immobilization or by internal fixation and fusion. This is a report of 12 patients treated by internal fixation by wiring only. Follow-up studies, up to 4 years, demonstrated healing of the bone and no late neurological sequelae. The advantage of internal fixation in reducing hospitalization and immobilization is accepted. The authors believe that in most instances the addition of bone fusion to the operative procedure is not essential and may increase morbidity.

VOLUMESERIES: a software tool for target volume follow-up studies with computerized tomography and magnetic resonance imaging

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 203-207 ◽  
Author(s):  
Stefan G. Scheib ◽  
Stefano Gianolini ◽  
Dieter Haller ◽  
Georgios N. Wellis ◽  
Jean Siegfried
Keyword(s):  
Magnetic Resonance ◽  
Computerized Tomography ◽  
Target Volume ◽  
Lesion Volume ◽  
Tumor Diameter ◽  
Content Type ◽  
Residual Lesion ◽  
Follow Up Studies ◽  
Fine Print

In clinical follow-up studies after radiosurgery, imaging modalities such as computerized tomography (CT) and magnetic resonance (MR) imaging are used. Accurate determination of the residual lesion volume is necessary for realistic assessment of the effects of treatment. Usually, the diameters rather than the volume of the lesion are measured. To determine the lesion volume without using stereotactically defined images, the software program VOLUMESERIES has been developed. VOLUMESERIES is a personal computer—based image analysis tool. Acquired DICOM CT scans and MR image series can be visualized. The region of interest is contoured with the help of the mouse, and then the system calculates the volume of the contoured region and the total volume is given in cubic centimeters. The defined volume is also displayed in reconstructed sagittal and coronal slices. In addition, distance measurements can be performed to measure tumor extent. The accuracy of VOLUMESERIES was checked against stereotactically defined images in the Leksell GammaPlan treatment planning program. A discrepancy in target volumes of approximately 8% was observed between the two methods. This discrepancy is of lesser interest because the method is used to determine the course of the target volume over time, rather than the absolute volume. Moreover, it could be shown that the method was more sensitive than the tumor diameter measurements currently in use. VOLUMESERIES appears to be a valuable tool for assessing residual lesion volume on follow-up images after gamma knife radiosurgery while avoiding the need for stereotactic definition.

Gamma knife radiosurgery for pilocytic astrocytomas

2002 ◽  
Vol 97 ◽  
pp. 677-680 ◽  
Author(s):  
Jörgen Boëthius ◽  
Elvar Ulfarsson ◽  
Tiit Ráhn ◽  
Bodo Lippitz
Keyword(s):  
Side Effects ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Content Type ◽  
Natural Time ◽  
Pilocytic Astrocytomas ◽  
Follow Up Studies ◽  
Prescription Dose ◽  
Fine Print

Object. The authors report on the follow-up studies in patients treated at the Karolinska Hospital to evaluate the efficacy of gamma knife radiosurgery (GKS) for pilocytic astrocytoma. Methods. Twelve male and seven female patients were treated (mean age 10.6 years [range 2–60 years]). Sixteen of these patients were children in whom GKS was performed to treat residual tumor after surgery. Most tumors were treated with a prescription dose of 10 to 12 Gy (range 9–20 Gy). The corresponding maximum dose varied between 22 and 30 Gy (range 10–50 Gy). The median clinical follow-up time was 7 years and mean clinical follow-up time 8.5 years. Median radiological follow-up time was 4.7 years and the mean radiological follow-up time was 5.9 years. Tumor control was achieved in all patients. In 85% of the cases a moderate tumor volume reduction was observed after GKS. This result occurred despite the low prescription dose administered. The radiological follow-up studies showed adverse radiation effects in 25% of patients with increasing contrast enhancement and some edema. These effects generally appeared within 7 months and resolved later. Cyst development occurred in two patients, which may have been treatment related. Conclusions. It appears that small pilocytic astrocytomas may be treated with low-prescription-dose GKS, resulting in satisfactory clinical outcomes and only minor side effects. There were a certain number of radiologically demonstrated side effects that appeared relatively early but subsequently resolved. This study should be regarded as a preliminary one because the number of patients is small and the follow-up period is short compared with the natural time course of the disease.

Intratumoral bleeding in meningioma after gamma knife radiosurgery

2002 ◽  
Vol 97 ◽  
pp. 657-662 ◽  
Author(s):  
Yang Kwon ◽  
Jae Sung Ahn ◽  
Sang Ryong Jeon ◽  
Jeong Hoon Kim ◽  
Chang Jin Kim ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Causative Factor ◽  
The Other ◽  
Content Type ◽  
Intratumoral Hemorrhage ◽  
Intracystic Hemorrhage ◽  
Intratumoral Bleeding ◽  
Fine Print

Object. The authors evaluated whether gamma knife radiosurgery (GKS) could be a causative factor in intratumoral bleeding in meningiomas. Methods. Gamma knife radiosurgery was used in the treatment of 173 meningiomas during a 10-year period. Four patients suffered post-GKS intratumoral hemorrhage. The course in these patients was reviewed. Four of 173 patients suffered an intratumoral hemorrhage during a follow-up period of 1 to 8 years. The risk of intratumoral bleeding after GKS for meningioma was 2.3%. Intracystic hemorrhage occurred in two patients 1 and 5 years, respectively, after radiosurgery. In the other two cases intratumoral bleeding occurred 2 and 8 years, respectively, after radiosurgery. Histological examination in three cases found no specific findings related to the postradiosurgical changes. Conclusions. Because the reported risk of spontaneous intratumoral bleeding in meningiomas is 1.3 to 2.7%, the incidence in this series was not unduly high. Radiosurgery itself could not be shown to be a significant factor in the development of the intratumoral bleeding.

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