Ruptured cerebral pseudoaneurysm caused by the removal of a ventricular catheter

1999 ◽  
Vol 91 (6) ◽  
pp. 1031-1033 ◽  
Author(s):  
Reizo Shirane ◽  
Takeo Kondo ◽  
Yasuko K. Yoshida ◽  
Susumu Furuta ◽  
Takashi Yoshimoto
Keyword(s):  
Mr Angiography ◽  
Three Dimensional ◽  
Ct Scanning ◽  
Neurological Deficits ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Content Type ◽  
Pseudoaneurysm Formation ◽  
Left Lateral Ventricle ◽  
Fine Print

✓ A rare case of cerebral pseudoaneurysm located at the internal carotid artery (ICA) was caused by the removal of a ventricular catheter in an infant. This 4-month-old girl underwent ventriculoperitoneal shunt revision, during which the old ventricular catheter was removed from the posterior horn of the left lateral ventricle, but the choroid plexus was pulled out by the tip of the catheter. Intraventricular hemorrhage (IVH) and subarachnoid hemorrhage were observed postoperatively. Magnetic resonance (MR) angiography performed on the 12th postoperative day revealed ICA stenosis and aneurysm formation at the C1 portion of the left ICA. Contrast-enhanced computerized tomography (CT) scans obtained on the 21st postoperative day revealed recurrent IVH and enlargement of the lesion. The patient underwent surgery for treatment of the aneurysm. Operative findings revealed a pseudoaneurysm arising from the left ICA at the proximal end of the anterior choroidal artery (AChA). The aneurysm was removed and the wall of the ICA was reconstructed. Postoperative three-dimensional CT scanning and MR angiography demonstrated disappearance of the aneurysm and preservation of the ICA. The patient was discharged without additional neurological deficits.Many complications, including IVH, are associated with removal of a ventricular catheter. This case shows that pseudoaneurysm formation can occur in a remote region due to avulsion of the AChA from the ICA. In most circumstances a ventricular catheter can be removed without difficulty. However, precision and caution should be exercised when removing a ventricular catheter.

Progressive neurological deficits with benign intracerebral cysts

1986 ◽  
Vol 65 (5) ◽  
pp. 706-709 ◽  
Author(s):  
Yoko Nakasu ◽  
Jyoji Handa ◽  
Kazuyoshi Watanabe
Keyword(s):  
Histological Examination ◽  
Computerized Tomography ◽  
Cyst Wall ◽  
Benign Lesion ◽  
Ct Scanning ◽  
Neurological Deficits ◽  
Review Of The Literature ◽  
Content Type ◽  
Ct Findings ◽  
Fine Print

✓ Two patients with benign intracerebral cysts are reported and a brief review of the literature is given. Although computerized tomography (CT) scanning is useful in detecting a variety of intracerebral cysts, the CT findings are not specific for any lesion. An exploratory operation with establishment of an adequate route of drainage and a histological examination of the cyst wall are mandatory in the management of patients with a progressive but benign lesion.

Three-dimensional computerized tomography angiography in patients with hyperacute intracerebral hemorrhage

1999 ◽  
Vol 91 (3) ◽  
pp. 424-431 ◽  
Author(s):  
Yasuo Murai ◽  
Ryo Takagi ◽  
Yukio Ikeda ◽  
Yasuhiro Yamamoto ◽  
Akira Teramoto
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Three Dimensional ◽  
Ct Scanning ◽  
3D Ct ◽  
Content Type ◽  
Hematoma Enlargement ◽  
3D Ct Angiography ◽  
Fine Print

Object. The authors confirm the usefulness of extravasation detected on three-dimensional computerized tomography (3D-CT) angiography in the diagnosis of continued hemorrhage and establishment of its cause in patients with acute intracerebral hemorrhage (ICH).Methods. Thirty-one patients with acute ICH in whom noncontrast and 3D-CT angiography had been performed within 12 hours of the onset of hemorrhage and in whom conventional cerebral angiographic studies were obtained during the chronic stage were prospectively studied. Noncontrast CT scanning was repeated within 24 hours of the onset of ICH to evaluate hematoma enlargement.Findings indicating extravasation on 3D-CT angiography, including any abnormal area of high density on helical CT scanning, were observed in five patients; three of these demonstrated hematoma enlargement on follow-up CT studies. Thus, specificity was 60% (three correct predictions among five positives) and sensitivity was 100% (19 correct predictions among 19 negatives). Evidence of extravasation on 3D-CT angiography indicates that there is persistent hemorrhage and correlates with enlargement of the hematoma.Regarding the cause of hemorrhage, five cerebral aneurysms were visualized in four patients, and two diagnoses of moyamoya disease and one of unilateral moyamoya phenomenon were made with the aid of 3D-CT angiography. Emergency surgery was performed without conventional angiography in one patient who had an aneurysm, and it was clipped successfully.Conclusions. Overall, 3D-CT angiography was found to be valuable in the diagnosis of the cause of hemorrhage and in the detection of persistent hemorrhage in patients with acute ICH.

Nonsurgical treatment of subdural empyema

1985 ◽  
Vol 63 (1) ◽  
pp. 128-130 ◽  
Author(s):  
Henk W. Mauser ◽  
Robert A. P. Ravijst ◽  
Arthur Elderson ◽  
Jan van Gijn ◽  
Cees A. F. Tulleken
Keyword(s):  
Computerized Tomography ◽  
Antibiotic Treatment ◽  
Ct Scanning ◽  
Subdural Empyema ◽  
Nonsurgical Treatment ◽  
Neurological Deficits ◽  
Content Type ◽  
Intracranial Infection ◽  
Fine Print

✓ The nonsurgical treatment of a case of interhemispheric subdural empyema is reported. At the time of diagnosis, the patient had a mild decrease in consciousness and only moderate focal neurological deficits. Computerized tomography (CT) confirmed the limited (interhemispheric) extent of the intracranial infection. After drainage of the nasal sinuses and antibiotic treatment, the patient recovered, although the lesion was initially increased in size on CT scanning.

Three-dimensional volume rendering for magnetic resonance angiography in the screening and preoperative workup of intracranial aneurysms

1996 ◽  
Vol 85 (6) ◽  
pp. 1050-1055 ◽  
Author(s):  
Philippe P. Maeder ◽  
Reto A. Meuli ◽  
Nicolas de Tribolet
Keyword(s):  
Magnetic Resonance ◽  
Volume Rendering ◽  
Intracranial Aneurysms ◽  
Mr Angiography ◽  
Three Dimensional ◽  
Time Of Flight ◽  
Conventional Angiography ◽  
Content Type ◽  
Aneurysm Neck ◽  
Fine Print

✓ This study was undertaken to evaluate the capacity of three-dimensional (3-D) time-of-flight (TOF) magnetic resonance (MR) angiography with VoxelView (VV) 3-D volume rendering to detect and characterize intracranial aneurysms and to compare this rendering technique with that of maximum intensity projection (MIP). Forty patients with a total of 53 intracranial aneurysms (10 giant and subgiant, 43 saccular) were consecutively admitted to University Hospital, Lausanne, Switzerland, and investigated with 3-D TOF MR angiography. Source images of the 43 saccular aneurysms were processed with both MIP and VV. The aneurysm detection rate of the two techniques and their ability to characterize features of an aneurysm, such as its neck and its relation to the parent vessel, were compared. Intraarterial digital subtraction angiography was used as the gold standard to which these techniques could be compared and evaluated. Four aneurysms, less than 3 mm in size, were missed using MIP compared to three missed using VV. The representation of aneurysmal morphology using VV was superior to that found using conventional angiography in nine cases, equal in 16 cases, and inferior in seven cases. The representation of the aneurysm neck using VV was superior to MIP in 21 cases, equal in 17 cases, and inferior in one case; it was superior to that shown using conventional angiography in 10 cases, equal in 18 cases, and inferior in four cases. Time-of-flight MR angiography in conjunction with both MIP and VV 3-D reconstruction was able to visualize all aneurysms that were larger than 3 mm. Compared to MIP, VV provides a better definition of the aneurysm neck and the morphology of saccular aneurysms, making VV valuable for use in a preoperative diagnostic workup.

Three-dimensional angiography for radiosurgical treatment planning for arteriovenous malformations

2003 ◽  
Vol 98 (3) ◽  
pp. 536-543 ◽  
Author(s):  
Federico Colombo ◽  
Carlo Cavedon ◽  
Paolo Francescon ◽  
Leopoldo Casentini ◽  
Umberto Fornezza ◽  
...  
Keyword(s):  
Treatment Planning ◽  
Imaging Modality ◽  
Treatment Plan ◽  
Three Dimensional ◽  
Ct Scanning ◽  
New Method ◽  
Rotational Angiography ◽  
Content Type ◽  
3D Rotational Angiography ◽  
Fine Print

Object. Radiosurgical treatment of a cerebral arteriovenous malformation (AVM) requires the precise definition of the nidus of the lesion in stereotactic space. This cannot be accomplished using simple stereotactic angiography, but requires a combination of stereotactic biplanar angiographic images and stereotactic contrast-enhanced computerized tomography (CT) scans. In the present study the authors describe a method in which three-dimensional (3D) rotational angiography is integrated into stereotactic space to aid treatment planning for radiosurgery. Methods. Twenty patients harboring AVMs underwent treatment planning prior to linear accelerator radiosurgery. Planning involved the acquisition of two different data sets, one of which was obtained using the standard method (a combination of biplanar stereotactic angiography with stereotactic CT scanning), and the other, which was procured using a new technique (nonstereotactic 3D rotational angiography combined with stereotactic CT scanning by a procedure of image fusion). The treatment plan that was developed using the new method was compared with that developed using the standard one. For each patient the number of isocenters and the dimension of selected collimators were the same, based on the information supplied in both methods. Target coordinates were modified in only five cases and by a limited amount (mean 0.7 mm, range 0.3–1 mm). Conclusions. The new imaging modality offers an easier and more immediate interpretation of 3D data, while maintaining the same accuracy in target definition as that provided by the standard technique. Moreover, the new method has the advantage of using nonstereotactic 3D angiography, which can be performed at a different site and a different time with respect to the irradiation procedure.

Cerebrospinal fluid edema: a rare complication of shunt operations for hydrocephalus

1982 ◽  
Vol 57 (5) ◽  
pp. 697-700 ◽  
Author(s):  
Yasuhiro Chiba ◽  
Hiroshi Takagi ◽  
Fumoto Nakajima ◽  
Satoshi Fujii ◽  
Takao Kitahara ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
White Matter ◽  
Rare Complication ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Operation ◽  
Low Density ◽  
Content Type ◽  
Low Density Area ◽  
Fine Print

✓ Three cases are presented in which a rare complication occurred after a shunt operation for hydrocephalus. On postoperative computerized tomography (CT) scans, extensive low-density areas appeared in the white matter along the ventricular catheter. After shunt revision, gradual resolution or disappearance of the low-density area was clearly demonstrated on CT. In one patient, a collection of cerebrospinal fluid (CSF) was confirmed at operation and appeared to lie in the extracellular spaces of the white matter. The phenomenon is considered to be localized CSF edema, different from porencephaly.

Detailed anatomy of the motor and sensory roots of the trigeminal nerve and their neurovascular relationships: a magnetic resonance imaging study

2004 ◽  
Vol 101 (3) ◽  
pp. 427-434 ◽  
Author(s):  
Indra Yousry ◽  
Bernhard Moriggl ◽  
Markus Holtmannspoetter ◽  
Urs D. Schmid ◽  
Thomas P. Naidich ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Trigeminal Nerve ◽  
Mr Angiography ◽  
Three Dimensional ◽  
Content Type ◽  
Cerebellar Artery ◽  
Motor Root ◽  
Sensory Root ◽  
Angiography Sequences ◽  
Fine Print

Object. The trigeminal nerve conducts both sensory and motor impulses. Separate superior and inferior motor roots typically emerge from the pons just anterosuperomedial to the entry point of the sensory root, but to date these two motor roots have not been adequately displayed on magnetic resonance (MR) images. The specific aims of this study, therefore, were to identify the superior and inferior motor roots, to describe their exact relationship to the sensory root, and to assess the neurovascular relationships among all three roots of the trigeminal nerve. Methods. Thirty-three patients and seven cadaveric specimens (80 sides) were studied using three-dimensional (3D) Fourier transform constructive interference in steady-state (CISS) imaging. The 33 patients were also studied by obtaining complementary time-of-flight (TOF) MR angiography sequences with and without contrast enhancement. At least one motor root was identified in all sides examined: in 51.2% of the sides a single motor root, in 37.5% two motor roots, and in 11.2% three motor roots. The superior cerebellar artery (SCA) and the anterior inferior cerebellar artery (AICA) contacted the sensory root in 45.5% of patients and 42.9% of specimens. The SCA often contacted the superior motor root (48.5% of patients and 50% of specimens) and less frequently the inferior motor root (26.5% of patients and 20% of specimens). Conclusions. Three-dimensional CISS and complementary 3D TOF MR angiography sequences reliably display sensory, superior motor, and inferior motor roots of the trigeminal nerve and their relationships to the SCA and AICA.

Computer-assisted stereotaxic laser resection of intra-axial brain neoplasms

1986 ◽  
Vol 64 (3) ◽  
pp. 427-439 ◽  
Author(s):  
Patrick J. Kelly ◽  
Bruce A. Kall ◽  
Stephan Goerss ◽  
Franklin Earnest
Keyword(s):  
Brain Stem ◽  
Three Dimensional ◽  
Ct Scanning ◽  
Vascular Lesions ◽  
Computer Assisted ◽  
Lower Grade ◽  
Metastatic Tumors ◽  
Content Type ◽  
Contrast Enhanced Ct ◽  
Fine Print

✓ Computer interpolation of stereotaxic computerized tomography (CT) scanning data allows the transposition of a tumor volume in stereotaxic space. A stereotaxically directed and computer-monitored CO2 laser is then utilized to vaporize that volume as the surgeon monitors the position of a cursor representing the laser beam against planar contours of the tumor displayed on an operating room computer monitor. Computer-assisted stereotaxic laser microsurgery provides precise three-dimensional control for aggressive resection of deep-seated tumors from neurologically important areas with acceptable postoperative results. Thus, a significant cytoreduction can be achieved in addition to providing a tissue diagnosis and internal decompression. The authors report 83 computer-assisted stereotaxic laser procedures for tumor excision in 78 patients. The tumors were located in the thalamus/basal ganglia in 15 patients, ventricular system in five, corpus callosum in four, brain stem in three, and deep and centrally in the hemispheres in 51. Histologically, there were 26 glioblastomas, seven grade III astrocytomas, 14 grade II astrocytomas, 14 metastatic tumors, nine vascular lesions, and eight miscellaneous lesions. Resection of these subcortical lesions was confirmed by postoperative contrast-enhanced CT scanning. Neurological examinations performed 1 week after the 83 procedures revealed that 48 patients had improved from their preoperative level and 23 were unchanged (12 were neurologically normal preoperatively). Twelve patients had an increase in a preoperative neurological deficit, three of whom died in the postoperative period: one from infection, one from pulmonary emboli, and one from brain-stem edema. The average survival period (37.6 weeks) of patients having glioblastomas treated by this technique and irradiation was no different from that of patients having glioblastomas in more favorable locations treated by conventional surgery and irradiation. Patients with circumscribed lower-grade astrocytomas did better in terms of morbidity and completeness of resection than those with infiltrative neoplasms. Other circumscribed lesions, such as metastatic tumors, vascular lesions, and intraventricular tumors, were easily resected by the technique described.

Cervical laminoplasty: evaluation of bone bonding of a high porosity hydroxyapatite spacer

2003 ◽  
Vol 98 (2) ◽  
pp. 137-142 ◽  
Author(s):  
Tetsuhiro Iguchi ◽  
Aritetsu Kanemura ◽  
Akira Kurihara ◽  
Koichi Kasahara ◽  
Shinichi Yoshiya ◽  
...  
Keyword(s):  
Cervical Spondylosis ◽  
Hounsfield Unit ◽  
Ct Scanning ◽  
Posterior Longitudinal Ligament ◽  
Neurological Deficits ◽  
High Porosity ◽  
Cervical Laminoplasty ◽  
Content Type ◽  
Bone Regrowth ◽  
Fine Print

Object. The purpose of this study was to evaluate the usefulness of a high-porosity hydroxyapatite (HA) spacer in cervical laminoplasty. Bone—spacer bonding rates, complications associated with the implant, and factors related to bone bonding were examined. Methods. The authors evaluated 33 consecutive patients with cervical myelopathy who underwent high-porosity HA spacer—assisted laminoplasty and were followed for at least 1 year (mean 30 months). The results of bone—spacer bonding of the 147 implants were evaluated using computerized tomography (CT) scanning. The symptoms significantly improved in 30 patients. No difference in results was detected between patients with cervical spondylosis and those with ossification of posterior longitudinal ligament. Breakage of seven spacers occurred in four patients without causing neck pain or neurological deficits. There were no other HA spacer—related complications. The spacers became rigidly bound to bone in 61% of the cases, and bone regrowth developed around the spacer in 91%. The rate of bone—spacer bonding increased over time, and the CT-documented attenuation value (Hounsfield unit) of the spacer adjacent to the bone—spacer junction in the group in which union occurred was significantly higher than in the nonunion group. Conclusions. High-porosity HA spacer—augmented laminoplasty produced good bonding-related results. Bone bonding continued to progress 1 year after surgery, indicating the good osteoconductive capability of high-porosity HA. To avoid breakage of a spacer, a minimum 7-mm distance between spacers is necessary.

Comprehensive assessment of hemorrhage risks and outcomes after stereotactic brain biopsy

2001 ◽  
Vol 94 (4) ◽  
pp. 545-551 ◽  
Author(s):  
Melvin Field ◽  
Timothy F. Witham ◽  
John C. Flickinger ◽  
Douglas Kondziolka ◽  
L. Dade Lunsford
Keyword(s):  
Platelet Count ◽  
Brain Biopsy ◽  
Ct Scanning ◽  
Neurological Deficits ◽  
Imaging Studies ◽  
Stereotactic Brain Biopsy ◽  
Acute Hemorrhage ◽  
Content Type ◽  
Risk Of Hemorrhage ◽  
Fine Print

Object. Stereotactic brain biopsy has played an integral role in the diagnosis and management of brain lesions. At most centers, imaging studies following biopsy are rarely performed. The authors prospectively determined the acute hemorrhage rate after stereotactic biopsy by performing immediate postbiopsy intraoperative computerized tomography (CT) scanning. They then analyzed factors that may influence the risk of hemorrhage and the diagnostic accuracy rate. Methods. Five hundred consecutive patients undergoing stereotactic brain biopsy underwent immediate postbiopsy intraoperative CT scanning. Before surgery, routine preoperative coagulation studies were performed in all patients. All medical charts, laboratory results, preoperative imaging studies, and postoperative imaging studies were reviewed. In 40 patients (8%) hemorrhage was detected using immediate postbiopsy intraoperative CT scanning. Neurological deficits developed in six patients (1.2%) and one patient (0.2%) died. Symptomatic delayed neurological deficits developed in two patients (0.4%), despite the fact that the initial postbiopsy CT scans in these cases did not show acute hemorrhage. Both patients had large intracerebral hemorrhages that were confirmed at the time of repeated imaging. The results of a multivariate logistic regression analysis of the risk of postbiopsy hemorrhage of any size showed a significant correlation only with the degree to which the platelet count was below 150,000/mm3 (p = 0.006). The results of a multivariate analysis of a hemorrhage measuring greater than 5 mm in diameter also showed a correlation between the risk of hemorrhage and a lesion location in the pineal region (p = 0.0086). The rate at which a nondiagnostic biopsy specimen was obtained increased as the number of biopsy samples increased (p = 0.0073) and in accordance with younger patient age (p = 0.026). Conclusions. Stereotactic brain biopsy was associated with a low likelihood of postbiopsy hemorrhage. The risk of hemorrhage increased steadily as the platelet count fell below 150,000/mm3. The authors found a small but definable risk of delayed hemorrhage, despite unremarkable findings on an immediate postbiopsy head CT scan. This risk justifies an overnight hospital observation stay for all patients after having undergone stereotactic brain biopsy.

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