The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas

1996 ◽  
Vol 85 (5) ◽  
pp. 830-837 ◽  
Author(s):  
Mark A. Davies ◽  
Karel TerBrugge ◽  
Robert Willinsky ◽  
Terry Coyne ◽  
Jamshid Saleh ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Clinical Presentation ◽  
Type I ◽  
Type Ii ◽  
Content Type ◽  
Type Iii ◽  
Arteriovenous Fistulas ◽  
Type Iv ◽  
Type V ◽  
Fine Print

✓ A number of classification schemes for intracranial dural arteriovenous fistulas (AVFs) have been published that claim to predict which lesions will present in a benign or aggressive fashion based on radiological anatomy. We have tested the validity of two proposed classification schemes for the first time in a large single-institution study. A series of 102 intracranial dural AVFs in 98 patients assessed at a single institution was analyzed. All patients were classified according to two grading scales: the more descriptive schema of Cognard, et al. (Cognard) and that recently proposed by Borden, et al. (Borden). According to the Borden classification, 55 patients were Type I, 18 Type II, and 29 Type III. Using the Cognard classification, 40 patients were Type I, 15 Type IIA, eight Type IIB, 10 Type IIA+B, 13 Type III, 12 Type IV, and four Type V. Intracranial hemorrhage (ICH) or nonhemorrhagic neurological deficit was considered an aggressive presenting clinical feature. A total of 16 (16%) of 102 intracranial dural AVFs presented with hemorrhage. Eleven of these hemorrhages (69%) occurred in either anterior cranial fossa or tentorial lesions. When analyzed according to the Borden classification, none (0%) of 55 Type I intracranial dural AVFs, two (11%) of 18 Type II, and 14 (48%) of 29 Type III intracranial dural AVFs presented with hemorrhage (p < 0.0001). After exclusion of visual or cranial nerve deficits that were clearly related to cavernous sinus intracranial dural AVFs, nonhemorrhagic neurological deficits were a feature of presentation in one (2%) of 55 Type I, five (28%) of 18 Type II, and nine (31%) of 29 Type III patients (p < 0.0001). When combined, an aggressive clinical presentation (ICH or nonhemorrhagic neurological deficit) was seen most commonly in intracranial dural AVFs located in the tentorium (11 (79%) of 14) and the anterior cranial fossa (three (75%) of four), but this simply reflected the number of higher grade lesions in these locations. Aggressive clinical presentation strongly correlated with Borden types: one (2%) of 55 Type I, seven (39%) of 18 Type II, and 23 (79%) of 29 Type III patients (p < 0.0001). A similar correlation with aggressive presentation was seen with the Cognard classification: none (0%) of 40 Type I, one (7%) of 15 Type IIA, three (38%) of eight Type IIB, four (40%) of 10 Type IIA+B, nine (69%) of 13 Type III, 10 (83%) of 12 Type IV, and four (100%) of four Type V (p < 0.0001). No location is immune from harboring lesions capable of an aggressive presentation. Location itself only raises the index of suspicion for dangerous venous anatomy in some intracranial dural AVFs. The configuration of venous anatomy as reflected by both the Cognard and Borden classifications strongly predicts intracranial dural AVFs that will present with ICH or nonhemorrhagic neurological deficit.

Syntheses of Post-Iboga Alkaloids

Synthesis ◽  
2019 ◽  
Vol 51 (14) ◽  
pp. 2737-2758 ◽  
Author(s):  
Hyeonggeun Lim ◽  
Sikwang Seong ◽  
Sunkyu Han
Keyword(s):  
Secondary Metabolites ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Type Iv ◽  
Synthetic Studies ◽  
Type V

Post-iboga alkaloids are secondary metabolites that are biosynthetically derived from iboga-type alkaloids via rearrangements of the indole and/or isoquinuclidine moieties. Herein, we categorize post-iboga alkaloids into five types based on the biosynthetic mode of transformation of the iboga scaffold. We then describe reported syntheses of post-iboga alkaloids, including our laboratory’s recent contributions, based on our own categorization.1 Introduction1.1 Iboga and Post-Iboga Alkaloids1.2 Classification of Post-Iboga Alkaloids1.2.1 Introduction to Type I Post-Iboga Alkaloids1.2.2 Introduction to Type II Post-Iboga Alkaloids1.2.3 Introduction to Type III Post-Iboga Alkaloids1.2.4 Introduction to Type IV Post-Iboga Alkaloids1.2.5 Introduction to Type V Post-Iboga Alkaloids2 Syntheses of Post-Iboga Alkaloids2.1 Syntheses of Type I Post-Iboga Alkaloids2.1.1 Syntheses of Monomeric Type I Post-Iboga Alkaloids2.1.2 Syntheses of Dimeric Type I Post-Iboga Alkaloids2.2 Syntheses of Type II Post-Iboga Alkaloids2.3 Synthetic Studies Toward Type III Post-Iboga Alkaloids2.4 Syntheses of Type IV Post-Iboga Alkaloids2.5 Synthesis of Type V Post-Iboga Alkaloids3 Conclusion and Outlook

Prognostic significance of intracranial dissemination of glioblastoma multiforme in adults

2005 ◽  
Vol 102 (4) ◽  
pp. 622-628 ◽  
Author(s):  
Andrew T. Parsa ◽  
Scott Wachhorst ◽  
Kathleen R. Lamborn ◽  
Michael D. Prados ◽  
Michael W. McDermott ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Tumor Progression ◽  
Prognostic Significance ◽  
Type I ◽  
Type Ii ◽  
Content Type ◽  
Type Iii ◽  
Multifocal Lesions ◽  
Tumor Dissemination ◽  
Fine Print

Object. The clinical outcome and treatment of adult patients with disseminated intracranial glioblastoma multiforme (GBM) is unclear. The objective in the present study was to assess the prognostic significance of disseminated intracranial GBM in adults at presentation and at the time of tumor progression. Methods. Clinical data from 1491 patients older than 17 years and harboring a GBM that had been diagnosed between 1988 and 1998 at the University of California at San Francisco neurooncology clinic were retrospectively reviewed. Dissemination of the GBM (126 patients) was determined based on Gd-enhanced magnetic resonance images. Classification of dissemination was as follows: Type I, single lesion with subependymal or subarachnoid spread; Type II, multifocal lesions without subependymal or subarachnoid spread; and Type III, multifocal lesions with subependymal or subarachnoid spread. Subgroups of patients were compared using Kaplan—Meier curves that depicted survival probability. The median postprogression survival (PPS), defined according to neuroimaging demonstrated dissemination, was 37 weeks for Type I (23 patients), 25 weeks for Type II (50 patients), and 10 weeks for Type III spread (19 patients). Patients with dissemination at first tumor progression (52 patients) overall had a shorter PPS than those in a control group with local progression, after adjusting for age, Karnofsky Performance Scale score, and time from tumor diagnosis to its progression (311 patients). When analyzed according to tumor dissemination type, PPS was significantly shorter in patients with Type II (33 patients, p < 0.01) and Type III spread (11 patients, p < 0.01) but not in those with Type I spread (eight patients, p = 0.18). Conclusions. Apparently, the presence of intracranial tumor dissemination on initial diagnosis does not in itself preclude aggressive treatment if a patient is otherwise well. A single focus of GBM that later demonstrates Type I dissemination on progression does not have a worse prognosis than a lesion that exhibits only local recurrence.

Primary extradural meningiomas: a report on nine cases and review of the CT-era literature

2000 ◽  
Vol 93 (6) ◽  
pp. 940-950 ◽  
Author(s):  
Frederick F. Lang ◽  
O. Kenneth Macdonald ◽  
Gregory N. Fuller ◽  
Franco DeMonte
Keyword(s):  
Skull Base ◽  
Death Rate ◽  
Benign Tumors ◽  
Data Sets ◽  
Type I ◽  
Type Ii ◽  
Content Type ◽  
Type Iii ◽  
Clinical Records ◽  
Fine Print

Object. Primary meningiomas arising outside the intracranial compartment (primary extradural meningiomas [PEMs]) are rare tumors. To develop a better understanding of these tumors and to establish a comprehensive classification scheme for them, the authors analyzed a series of patients treated at the M. D. Anderson Cancer Center (MDACC) and reviewed all cases reported in the English-language literature since the inception of the use of computerized tomography (CT) scanning.Methods. Clinical records, results of radiographic studies, and histological slides were reviewed for all cases of PEM at MDACC. Demographic features, symptoms, tumor location, histological grade, and patient outcome were assessed in all cases. A comprehensive literature search identified 168 PEMs in 142 patients reported during the CT era. These reports were also analyzed for common features. Tumors for both data sets were classified as purely extracalvarial (Type I), purely calvarial (Type II), and calvarial with extracalvarial extension (Type III). Type II and Type III tumors were further categorized as convexity (C) or skull base (B) lesions.The incidence of PEMs at MDACC was 1.6%, which was consistent with the rate reported in the literature. In both data sets, the male/female ratio was nearly 1:1. The most common presenting symptom was a gradually expanding mass. The age of patients at diagnosis of PEM was bimodal, peaking during the second decade and during the fifth to seventh decades. In all MDACC cases and in 90% of those reported in the literature the PEMs were located in the head and neck. The majority of tumors originated in the skull (70%).In the MDACC series and in the literature review, the majority (67% and 89%, respectively) of tumors were histologically benign. Although fewer PEMs were malignant or atypical (33% at MDACC and 11% in the literature), their incidence was higher than that observed for primary intracranial meningiomas. Distant metastasis was not a common feature reported for patients with PEMs (6% in the literature).Outcome data were available in 96 of the cases culled from the CT-era literature. The combination of the MDACC data and the data obtained from the literature demonstrated that patients with benign Type IIB or Type IIIB lesions were more likely to experience recurrence than patients with benign Type IIC or Type IIIC tumors (26% compared with 0%, p < 0.05). The more aggressive atypical and malignant tumors were associated with a statistically significant higher death rate (29%) relative to benign tumors (4.8% death rate, p < 0.004).Conclusions. Defining a tumor as a PEM is dependent on the tumor's relation to the dura mater and the extent and direction of its growth. Classification of PEMs as calvarial or extracalvarial and as convexity or skull base lesions correlates well with clinical outcome.

scholarly journals Study On The Application of Preoperative Three-Dimensional CT Angiography of Perigastric Arteries In Laparoscopic Radical Gastrectomy

2022 ◽  
Author(s):  
Peng Liu ◽  
Wenbin Yu ◽  
Meng Wei ◽  
Danping Sun ◽  
Xin Zhong ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Three Dimensional ◽  
Classification Model ◽  
Type I ◽  
Radical Gastrectomy ◽  
Type Ii ◽  
Type Iii ◽  
Type Iv ◽  
Type V

Abstract Objection: To investigate the clinical value and significance of preoperative three-dimensional computerized tomography angiography (CTA) in laparoscopic radical gastrectomy for gastric cancer.Methods: The clinical data were analyzed retrospectively from 214 gastric cancer patients. We grouped according to whether to perform CTA. The gastric peripheral artery was classified according to CTA images of patients in the CTA group, and we compared and analyzed the difference of the data between the two groups.Results: The celiac trunk was classified according to Adachi classification: Type I (118/125, 94.4%),Type II (3/125, 2.4%),Type III (0/125, 0%),Type IV (1/125, 0.8%),Type V (2/125, 1.6%),Type VI (1/125, 0.8%).Hepatic artery classification was performed according to Hiatt classification standard:Type I (102/125, 81.6％),Type II (9/125, 7.2%),Type III (6/125, 4.8%),Type IV (2/125, 1.6%),Type V (3/125, 2.4%),Type VI (0, 0%),Others (3/125, 2.4%).And this study combined vascular anatomy and clinical surgical risk to establish a new splenic artery classification model. It was found that the operation time and estimated blood loss in the CTA group were significantly lower than those in the non-CTA group. In addition, the blood loss in the CTA group combined with ICG (Indocyanine Green) labeled fluorescence laparoscopy was significantly less than that in the group without ICG labeled. Conclusion: Preoperative CTA can objectively evaluate the vascular course and variation of patients, and then avoid the risk of operation, especially in combination with ICG labeled fluorescence laparoscopy, can further improve the quality of operation.

A Review and Proposed Classification System for the No-Option Patient With Chronic Limb-Threatening Ischemia

2020 ◽  
pp. 152660282096391
Author(s):  
Tanner I. Kim ◽  
Shant S. Vartanian ◽  
Peter A. Schneider
Keyword(s):  
Treatment Strategies ◽  
Major Amputation ◽  
Occlusive Disease ◽  
Tissue Loss ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Type Iv ◽  
Foot Anatomy ◽  
Type V

A growing, but poorly defined subset of patients with chronic limb-threatening ischemia (CLTI) have “no option” for revascularization. One notable subgroup includes patients with severe ischemia and advanced pedal artery occlusive disease, termed “desert foot,” who are at high risk for major amputation due to a lack of conventional revascularization options. Although new therapies are being developed for no-option patients with desert foot anatomy, this subgroup and the broader group of no-option patients are not well defined, limiting the ability to evaluate outcomes. Based on a systematic review, a classification of the no-option CLTI patient was constructed for use in clinical practice and studies. Several no-option conditions were identified, including type I—severe and pedal occlusive disease (desert foot anatomy) for which there is no accepted method of repair; type II—lack of suitable venous conduit for bypass in the setting of an acceptable target for bypass; type III—extensive tissue loss with exposure of vital structures that renders salvage impossible; type IV—advanced medical comorbidities for which available revascularization options would pose a prohibitive risk; and type V—presence of a nonfunctional limb. While type I and type II patients may have no option for revascularization, type III and type V patients have wounds, infection, comorbidities, or functional status that may leave them with few options for revascularization. As treatment strategies continue to evolve and novel methods of revascularization are developed, the ability to identify no-option patients in a standardized fashion will aid in treatment selection and assessment of outcomes.

Gamma surgery for vein of Galen malformations

2000 ◽  
Vol 93 (2) ◽  
pp. 229-236 ◽  
Author(s):  
Bryan Rankin Payne ◽  
Dheerendra Prasad ◽  
Melita Steiner ◽  
Hernan Bunge ◽  
Ladislau Steiner
Keyword(s):  
Additional Patient ◽  
Consecutive Series ◽  
Type I ◽  
Vein Of Galen ◽  
Content Type ◽  
Type Iii ◽  
Type Iv ◽  
Flow Through ◽  
Fine Print

Object. The goal of this study was to evaluate the results of gamma surgery in nine patients treated for vein of Galen malformations (VGMs).Methods. A consecutive series of nine VGMs in eight children aged 4 to 14 years and in one adult were treated with gamma surgery. Six of the patients were male, including the adult, and three were female. Among these patients there were three Yaşargil Type I, one Type II, two Type III, and three Type IV malformations. Previous embolization had failed in four cases. Three VGMs were treated with gamma surgery twice. An additional patient with a Type III VGM underwent stereotactic angiography in preparation for gamma surgery but was judged to be suitable for direct embolization.Follow-up angiograms were obtained in eight of the VGMs treated. Four no longer filled; one has probably been obliterated, but this cannot be confirmed because the patient refused to undergo final angiography; one patient has residual fistulas not included in the initial treatment field, which were retreated recently; and two other patients have marked reduction of flow through their VGMs.Conclusions. Gamma surgery is a viable option in the treatment of VGMs in clinically stable patients. Combined endovascular therapy and gamma surgery is of benefit in complex malformations.

scholarly journals ANALISIS KESALAHAN SISWA DALAM MENYELESAIKAN SOAL CERITA MATERI SISTEM PERSAMAAN LINEAR DUA VARIABEL KELAS VIII SMP NEGERI 7 SALATIGA

2018 ◽  
Vol 1 (1) ◽  
pp. 66 ◽  
Author(s):  
Irham Fuadi ◽  
Sutriyono Sutriyono
Keyword(s):  
Linear Equations ◽  
Type I ◽  
Type Ii ◽  
Reading Error ◽  
Process Skill ◽  
Type Iii ◽  
Type Iv ◽  
Type V ◽  
Descriptive Qualitative

Abstrak: Penelitian ini bertujuan untuk menganalisis kesalahan siswa dalam menyelesaikan soal cerita materi sistem persamaan linear dua variable. Metode yang digunakan dalam penelitian ini adalah deskiptif kualitatif. Sampel yang diambil adalah siswa kelas VIII H SMP Negeri 7 Salatiga dengan jumlah subjek sebanyak 3 siswa. Hasil penelitian ini menunjukan siswa masih melakukan kesalahan pada type I (reading error) sebesar 0%, kesalahan pada type II (comprehension error) sebesar 19%, kesalahan pada type III (transformasion error) sebesar 14%, kesalahan pada type IV (process skill error) sebesar 24%, dan kesalahan pada type V (enconding error) sebesar 44%. Abstract:  This study aims to analyze students' errors in solving the material story of the system of two linear equations. The method used in this study is descriptive qualitative. The samples are taken from VIII H grade students of SMP Negeri 7 Salatiga with the number of subjects as many as three students. The result of this research showed students still made an error on type I ( reading error ) as much as 0 % , an error on type II ( comprehension error) is approximately 19 % , an error on type III ( transformation error) 14 %  , an error on type IV (process skill error) 24 %, and an error on type V ( enconding error ) as much as 44 % .

scholarly journals Hypoplastic Left Heart Syndrome: Prognostic Significance of Morphological Variants of the Heart in the Choice of Treatment Approach

2021 ◽  
pp. 53-59
Author(s):  
V. Zakharova ◽  
T. Savchuk ◽  
Ya. Truba ◽  
V. Lazoryshynets ◽  
O. Rudenko
Keyword(s):  
Right Ventricle ◽  
Prognostic Significance ◽  
Type I ◽  
Type Ii ◽  
Hypoplastic Left Heart ◽  
Type Iii ◽  
Type Iv ◽  
The Right ◽  
Type V ◽  
Left Heart Syndrome

Hypoplastic left heart syndrome (HLHS) is one of the most complicated congenital heart defects which leads to the inevitable fatal outcome in the natural course of the disease. Currently, Norwood procedure and fetal aortic valvuloplasty are considered the major approaches for surgical treatment of HLHS. However, the prognosis of such surgeries is often unpredictable. The aim. To study morphological variations of the left ventricle (LV) in HLHS and evaluate the prognostic significance of each of them in the choice of surgical approach. Materials. The main group included 63 hearts of newborns with HLHS, the comparison group included 53 hearts of newborns without cardiac pathology. Methods. The methods used were survey microscopy, as well as macro- and micromorphometry of various parameters of the heart, calculation of the ratio of their absolute values (indices) with subsequent statistical data processing. Results. Five types of LV were identified in HLHS patients based on the size and shape of the cavity, wall thickness, presence or absence of fibroelastosis: slit-like hypoplastic (Type I) (n = 10; 15.9%); slit-like hypertrophic (Type II) (n = 19; 30.2%); cylindrical (Type III) (n = 22; 34.9%); lacunar (Type IV) (n = 6; 9.5% ); lacunar-cylindrical (Type V) (n = 6; 9.5%). In Type I left ventricles, the interventricular index (IVI) (the ratio of the areas of the free walls of the left and right ventricles on the cross sections of the heart) was the smallest: 0.13 ± 0.03 units versus normal 1.96 ± 0.31 units. In Type II left ventricles, the value was equal to 1.69 ± 0.23 units; in Type III it was 1.59 ± 0.64 units; in Type IV it was 1.31 ± 0.03 units; in Type V it was 1.05 ± 0.52 units. The index of the working area of the right ventricular myocardium (RVI) (the ratio of the area of the free wall of the right ventricle to the sum of the areas of the free wall and interventricular septum) in Type I LV was the highest: 81.3 ± 5.7% versus normal 57.1 ± 2.02%; in Type II it was 49.7 ± 6.4%; in Type III it was 39.8 ± 2.9%; in Type IV it was 69.7 ± 16.1%; in Type V it was 41.3 ± 24.4%.Type III–V LVs have always been associated with fibroelastosis, in contrast to Type I and II LVs. Conclusions. In HLHS, Type I hearts are the most eligible for the Norwood procedure, since the LV, due to its minimal size, is not an excess ballast for the working right ventricle. Type II LV is optimal for the fetal aortic valvuloplasty, since during the II-III trimesters of gestation they can join the circulatory system due to remodeling. HLHS with LV fibroelastosis (Types III, IV, V) seem to be the least favorable for both pre- and postnatal surgery, especially in the presence of fibroelastosis of the right ventricle.

scholarly journals Endovascular strategies for treatment of posterior communicating artery aneurysm according to angiographic architecture: Preservation vs. sacrifice of posterior communication artery

2017 ◽  
Vol 23 (6) ◽  
pp. 620-627 ◽  
Author(s):  
Jung Ho Ko ◽  
Young-Joon Kim
Keyword(s):  
Treatment Strategies ◽  
Artery Aneurysm ◽  
Posterior Communicating Artery ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Type Iv ◽  
Ischemic Complications ◽  
Type V

We report ischemic complications related to obstruction of the posterior communicating artery (PcomA) and suggest treatment strategies according to the angiographic characteristics of the PcomA and the posterior cerebral artery (PCA). Twenty-one patients with PcomA aneurysm who had initially undergone endovascular treatment and had an identifiable PcomA occlusion on immediate or follow-up angiography were enrolled. We classified PcomA aneurysm according to the characteristics of the PcomA and PCA (P1) on baseline angiography, as follows: type I was defined as PcomA aneurysm with an absent PcomA and a normal-sized P1. Type II was defined as a hypoplastic PcomA and a normal-sized P1. Type III was defined as a normal-sized PcomA and an absent P1. Type IV was defined as a normal-sized PcomA and a hypoplastic P1. Type V was a normal-sized PcomA and a normal-sized P1. Among all cases of PcomA obstruction, 15 (71.4%) were type II PcomA aneurysms, four were type IV, one was type III, and one was type V. Ischemic events related to PcomA obstruction occurred in three cases (type II, III and VI), which included two tuberothalamic infarctions (type III and IV) and one cortical infarction in the territory of the PCA (type II). Follow-up angiographies showed flow change in the PcomA in 14 cases. It is relatively safe to sacrifice type II PcomA if necessary. However, physicians should pay attention to unexpected flow changes, such as recanalization or occlusion of the PcomA, which are possible after treatment.

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