The efficacy of endosaccular aneurysm occlusion in alleviating neurological deficits produced by mass effect

1994 ◽  
Vol 80 (4) ◽  
pp. 659-666 ◽  
Author(s):  
Van V. Halbach ◽  
Randall T. Higashida ◽  
Christopher F. Dowd ◽  
Stanley L. Barnwell ◽  
Kenneth W. Fraser ◽  
...  
Keyword(s):  
Mass Effect ◽  
Response To Therapy ◽  
Neurological Deficits ◽  
Parent Artery ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Neurological Signs ◽  
Wall Calcification ◽  
Aneurysm Occlusion ◽  
Fine Print

✓ Endovascular obliteration of intracranial aneurysms with preservation of the parent artery (endosaccular occlusion) has been advocated for patients who fail or are excluded from surgical clipping and cannot undergo Hunterian ligation therapy. To clarify the effect that endosaccular occlusion has on the presenting neurological signs, 26 patients with aneurysms and symptoms related to mass effect who underwent this therapy were followed for a mean of 60 months. Only patients with objective neurological deficits who had not suffered a hemorrhage were included in this series. Response to therapy was classified into one of three groups: “resolved,” if the patient had complete resolution of presenting signs; “improved,” if significant and sustained improvement was recorded in the neurological examinations, and “unchanged,” if no change was observed. Thirteen patients (50%) were classified as resolved, 11 (42.3%) as improved, and two (7.7%) as unchanged. A comparison of patients classified as resolved with those who were improved revealed that the former group had less wall calcification (30% vs. 60%) and a shorter duration of symptoms. Patients with neurological sign resolution (62%) were more likely to have totally occluded aneurysms on late follow-up arteriograms than those who had improvement (28%) or were unchanged (0%). This study suggests that endosaccular embolization therapy can improve or alleviate presenting neurological signs unrelated to hemorrhage or distal embolization in the majority of cases.

Unruptured aneurysms presenting with mass effect sypmtoms: response to endosaccular treatment with Guglielmi detachable coils.

1998 ◽  
Vol 89 (6) ◽  
pp. 956-961 ◽  
Author(s):  
Tim W. Malisch ◽  
Guido Guglielmi ◽  
Fernando Viñuela ◽  
Gary Duckwiler ◽  
Y. Pierre Gobin ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Mass Effect ◽  
Guglielmi Detachable Coils ◽  
Intraluminal Thrombus ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Wall Calcification ◽  
Detachable Coils ◽  
Fine Print

Object. Embolization of intracranial aneurysms by using Guglielmi detachable coils (GDCs) is proving to be a safe method of protecting aneurysms from rupture. Occasionally, patients with unruptured intracranial aneurysms present with symptoms related to the aneurysm's mass effect on either the brain parenchyma or cranial nerves. In the present study, the authors conducted a retrospective review to evaluate the response to GDC embolization in a series of 19 patients presenting with cranial nerve dysfunction due to mass effect. Methods. Aneurysms were classified by size, shape, wall calcification, and amount of intraluminal thrombus. Patients were classified by duration of symptoms prior to GDC treatment (range < 1 month to > 10 years). Clinical assessment was performed within days of the GDC procedure and at later follow-up appointments (range 1–70 months, mean 24 months). In the immediate post-GDC period, four patients experienced worsening of cranial nerve deficits. Two of the four patients had transient worsening of visual acuity, which later improved to better than baseline status. Another patient who had presented with headache and seventh and eighth cranial nerve deficits from a vertebrobasilar junction aneurysm had improvement in these symptoms, but developed a new diplopia. The fourth patient had worsening of her visual acuity, which had not resolved at the 1-month follow-up examination; this patient later underwent surgical decompression. Conclusions. On late follow-up review, the response was classified as complete resolution of symptoms in six patients (32%), improvement in eight patients (42%), no significant change in four patients (21%), and symptom worsening in one patient (5%). Patients with smaller aneurysms and those with shorter pretreatment duration of symptoms were more likely to experience an improvement in their symptoms following GDC treatment, although statistical significance was not reached in this series (p = 0.603 and p = 0.111, respectively). The presence of aneurysmal wall calcification (six patients) or intraluminal thrombus (12 patients) showed no correlation with the response of mass effect symptoms in these patients.

Delayed neurological deficits detected by an ischemic pattern in the extracellular cerebral metabolites in patients with aneurysmal subarachnoid hemorrhage

2004 ◽  
Vol 100 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Jane Skjøth-Rasmussen ◽  
Mette Schulz ◽  
Soren Risom Kristensen ◽  
Per Bjerre
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Metabolism ◽  
Brain Infarction ◽  
Neurological Deficits ◽  
Parent Artery ◽  
Glycerol Concentration ◽  
Microdialysis Probe ◽  
Content Type ◽  
Fine Print

Object. In the treatment of patients with aneurysmal subarachnoid hemorrhage (SAH), early occlusion of the aneurysm is necessary as well as monitoring and treatment of complications following the primary bleeding episode. Monitoring with microdialysis has been studied for its ability to indicate and predict the occurrence of delayed ischemic neurological deficits (DINDs) in patients with SAH. Methods. In 42 patients with aneurysmal SAH microdialysis monitoring of metabolites was performed using a 0.3-µl/minute perfusion flow over several days, and the results were correlated to clinical events and to brain infarction observed on computerized tomography scans. The microdialysis probe was inserted into the territory of the parent artery of the aneurysm. The authors defined an ischemic pattern as increases in the lactate/glucose (L/G) and lactate/pyruvate (L/P) ratios that were greater than 20% followed by a 20% increase in glycerol concentration. This ischemic pattern was found in 17 of 18 patients who experienced a DIND and in three of 24 patients who did not experience a delayed clinical deterioration. The ischemic pattern preceded the occurrence of a DIND by a mean interval of 11 hours. Maximum L/G and L/P ratios did not correlate with the presence of DIND or outcome, and there was no association between the glycerol level and subsequent brain infarction. Conclusions. Microdialysis monitoring of the cerebral metabolism in patients with SAH may predict with high sensitivity and specificity the occurrence of a DIND. Whether an earlier diagnosis results in better treatment of DINDs and, therefore, in overall better outcomes remains to be proven, as it is linked to an efficacious treatment of cerebral vasospasm.

Intracranial cavernous angioma: presentation and management

1986 ◽  
Vol 64 (5) ◽  
pp. 720-723 ◽  
Author(s):  
Patricio Tagle ◽  
Isidro Huete ◽  
Jorge Méndez ◽  
Sergio del Villar
Keyword(s):  
Cerebellopontine Angle ◽  
Unusual Case ◽  
Clinical Presentation ◽  
Ct Scanning ◽  
Cavernous Angioma ◽  
Mass Effect ◽  
Ct Scans ◽  
Content Type ◽  
Neurological Signs ◽  
Fine Print

✓ Thirteen cases of cerebral cavernous angiomas are reported, and their radiological and pathological features are reviewed. The clinical presentation was variable: 53.8% of patients had seizures, 30.8% intracerebral hemorrhage, and 15.4% focal neurological signs, including one unusual case that presented as a cerebellopontine angle tumor. The computerized tomography (CT) scans were abnormal in all cases. Angiography was positive only when there was mass effect due to associated hematoma. Surgery was performed in 12 cases with good results. The prognosis of the 13 cases was favorable, with no mortality in this series. These data suggest that the combination of a recent seizure disorder with a hyperdense intracerebral nodule on the CT scanning should alert the neurosurgeon to the possibility of a cavernous angioma.

Neurological deterioration after coil embolization of a giant basilar apex aneurysm with resolution following parent artery clip ligation

2002 ◽  
Vol 97 (3) ◽  
pp. 705-708 ◽  
Author(s):  
Stephen M. Russell ◽  
P. Kim Nelson ◽  
Jafar J. Jafar
Keyword(s):  
Basilar Artery ◽  
Mass Effect ◽  
Parent Artery ◽  
Pertinent Literature ◽  
Content Type ◽  
Cranial Nerve Dysfunction ◽  
Brainstem Compression ◽  
Peduncular Hallucinosis ◽  
Nerve Dysfunction ◽  
Fine Print

✓ The authors present the case of a patient who suffered from progressive cranial nerve dysfunction, radiographically documented brainstem compression, and peduncular hallucinosis after undergoing endosaccular coil placement in a giant basilar apex aneurysm. Symptom resolution was achieved following clip ligation of the basilar artery. The pathogenesis of aneurysm mass effect due to coil placement is discussed and the pertinent literature is reviewed.

Management of depressed skull fracture in the newborn

1976 ◽  
Vol 44 (1) ◽  
pp. 62-64 ◽  
Author(s):  
John D. Loeser ◽  
H. Lee Kilburn ◽  
Tim Jolley
Keyword(s):  
Surgical Therapy ◽  
Epileptiform Activity ◽  
Skull Fracture ◽  
Neurological Deficits ◽  
Skull Fractures ◽  
Content Type ◽  
Depressed Skull Fracture ◽  
Neurological Signs ◽  
The Absolute ◽  
Fine Print

✓ The authors describe three cases of neonatal depressed skull fracture subsequent to difficult delivery, treated without surgical elevation. None of the patients developed neurological deficits, cosmetic deformity or electroencephalographic signs of epileptiform activity. Neonatal depressed skull fractures not associated with focal neurological signs may not require surgical therapy; we are not certain what the absolute criteria for operation should be.

Endovascular thrombolysis for symptomatic cerebral venous thrombosis

1999 ◽  
Vol 90 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Matthew F. Philips ◽  
Linda J. Bagley ◽  
Grant P. Sinson ◽  
Eric C. Raps ◽  
Steven L. Galetta ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Venous Occlusion ◽  
Neurological Deficits ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Oral Contraceptive Pills ◽  
Contraceptive Pills ◽  
Deep Cerebral Venous Thrombosis ◽  
Fine Print

Object. The authors sought to treat potentially catastrophic intracranial dural and deep cerebral venous thrombosis by using a multimodality endovascular approach.Methods. Six patients aged 14 to 75 years presented with progressive symptoms of thrombotic intracranial venous occlusion. Five presented with neurological deficits, and one patient had a progressive and intractable headache. All six had known risk factors for venous thrombosis: inflammatory bowel disease (two patients), nephrotic syndrome (one), cancer (one), use of oral contraceptive pills (one), and puerperium (one). Four had combined dural and deep venous thrombosis, whereas clot formation was limited to the dural venous sinuses in two patients. All patients underwent diagnostic cerebral arteriograms followed by transvenous catheterization and selective sinus and deep venous microcatheterization. Urokinase was delivered at the proximal aspect of the thrombus in dosages of 200,000 to 1,000,000 IU. In two patients with thrombus refractory to pharmacological thrombolytic treatment, mechanical wire microsnare maceration of the thrombus resulted in sinus patency. Radiological studies obtained 24 hours after thrombolysis reconfirmed sinus/vein patency in all patients. All patients' symptoms and neurological deficits improved, and no procedural complications ensued. Follow-up periods ranged from 12 to 35 months, and all six patients remain free of any symptomatic venous reocclusion. Factors including patients' age, preexisting medical conditions, and duration of symptoms had no statistical bearing on the outcome.Conclusions. Patients with both dural and deep cerebral venous thrombosis often have a variable clinical course and an unpredictable neurological outcome. With recent improvements in interventional techniques, endovascular therapy is warranted in symptomatic patients early in the disease course, prior to morbid and potentially fatal neurological deterioration.

Postoperative swelling of pericranial pedicle graft producing intracranial mass effect

1999 ◽  
Vol 91 (1) ◽  
pp. 124-127 ◽  
Author(s):  
Ric Jensen ◽  
Ian E. McCutcheon ◽  
Franco DeMonte
Keyword(s):  
Skull Base ◽  
Mass Effect ◽  
Frontal Bone ◽  
The Other ◽  
Neurological Deficits ◽  
Content Type ◽  
Intracranial Mass ◽  
Graft Removal ◽  
Postoperative Swelling ◽  
Fine Print

✓ Two cases of florid swelling of pericranial pedicle grafts are reported. Intracranial mass effect produced by the grafts necessitated reoperation with graft removal in one case and graft revision in the other. No permanent neurological deficits were incurred by either patient. Venous congestion and associated swelling within the graft were considered to be related to constriction of the graft base at the frontal bone flap-skull base interface in one patient and torsion of the graft base in the other.

Temporal characteristics of radiosurgical lesions in an animal model

1994 ◽  
Vol 80 (6) ◽  
pp. 1046-1055 ◽  
Author(s):  
David R. Blatt ◽  
William A. Friedman ◽  
Frank J. Bova ◽  
Daniel P. Theele ◽  
J. Parker Mickle
Keyword(s):  
Mr Imaging ◽  
Mass Effect ◽  
Intermediate Stage ◽  
Neurological Deficits ◽  
Blue Dye ◽  
Content Type ◽  
Vascular Proliferation ◽  
Peripheral Areas ◽  
Histopathological Studies ◽  
Fine Print

✓ To characterize the temporal course of radiosurgical lesions, 19 cats were irradiated in an animal linear accelerator radiosurgical device. The animals were followed clinically and, at 3.5, 6, 12, 18, 23, 29, and 63 weeks, were studied with gadolinium-enhanced magnetic resonance (MR) imaging. They were then sacrificed after Evans blue dye perfusion, and gross pathological and histopathological studies were performed. Mild neurological deficits developed between 3.5 and 4.5 weeks, correlating with the onset of mass effect both grossly and radiographically and with the maximum amount of white matter edema on T2-weighted MR imaging and microscopic examination. Clinical improvement occurred within several weeks as these resolved. The lesions were of similar size at all time intervals. Gadolinium-enhanced MR imaging demonstrated lesions with peripheral areas of enhancement and central nonenhancing regions which correlated histologically with areas of vascular proliferation and radiation necrosis, respectively. In the early lesions at 3.5 and 6 weeks, necrosis and edema were predominant. From 12 to 29 weeks, an intermediate stage was observed, with resorption of the necrotic debris as evidenced by progressive cavitation and microglial response and by increased perilesional vascularity. At 63 weeks, resorption was still taking place, but gliosis and diminution of the vascular response were seen.

Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils

1996 ◽  
Vol 84 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Y. Pierre Gobin ◽  
Fernando Viñuela ◽  
John H. Gurian ◽  
Guido Guglielmi ◽  
Gary R. Duckwiler ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Guglielmi Detachable Coils ◽  
Parent Vessel ◽  
Content Type ◽  
Parent Artery Occlusion ◽  
Detachable Coils ◽  
Fine Print

✓ Results in nine patients with large or giant fusiform intracranial aneurysms that were treated with Guglielmi detachable coils (GDCs) are reported. There were six males and three females between the ages of 12 and 63. Four patients presented with subarachnoid hemorrhage (SAH) and four with mass effect; in one patient the aneurysm was asymptomatic and located in an arterial feeder of an arteriovenous malformation. Five aneurysms were supratentorial and four were in the posterior fossa. Five were giant and four were large. Selective occlusion with preservation of the parent artery was attempted in three cases, and complete occlusion of the aneurysm and the parent artery was performed in six patients. The tolerance to parent artery occlusion was assessed by angiography, balloon test occlusion, and amytal testing. Six aneurysms were permanently occluded and two partially recanalized. In one case, GDC embolization was not possible. The four patients who presented with SAH made an excellent clinical recovery. Three of the four patients presenting with mass effect recovered completely and one remained unchanged. The patient with an incidental aneurysm remained asymptomatic. There were no permanent complications. In conclusion, GDCs were useful for the occlusion of large and giant intradural fusiform aneurysms. Occlusion of the aneurysm and the parent artery afforded the greatest opportunity for a complete cure. Advantages of GDCs compared to balloons include: occlusion of a shorter segment of normal artery, no traction on the parent vessel, and safer and easier catheterization techniques.

Chronic expanding intracerebral hematoma

1986 ◽  
Vol 65 (5) ◽  
pp. 611-614 ◽  
Author(s):  
Eugenio Pozzati ◽  
Giuliano Giuliani ◽  
Giulio Gaist ◽  
Giancarlo Piazza ◽  
Gilberto Vergoni
Keyword(s):  
Clinical Presentation ◽  
White Matter Lesions ◽  
Mass Effect ◽  
Postoperative Hemorrhage ◽  
Intracerebral Hematoma ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Collagenous Tissue ◽  
Perifocal Edema ◽  
Fine Print

✓ The cases of 10 normotensive patients with chronic intracerebral hematomas are reported. The patients' median age at diagnosis was 42 years. The median duration of symptoms was 22 days. Seizures were thepresenting symptom in 50% of the cases. Computerized tomography almost consistently demonstrated ring-shaped lesions with mass effect and perifocal edema. Arteriography revealed that all but one of the lesions were avascular. All patients had superficial white matter lesions, mostly in the frontoparietal region. All patients were treated surgically. Most of the hematomas were encapsulated and contained blood in various stages of organization. The thick capsule consisted of an outer layer of collagenous tissue and an inner layer of granulation tissue. Occult cerebrovascular malformations were detected in two instances. There were two deaths, both related to recurrent postoperative hemorrhage. This entity can present much like a brain malignancy and should be considered in the differential diagnosis of ring-shaped lesions whatever the clinical presentation. Strategies of treatment are discussed.

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