Cerebrovascular stereolithographic biomodeling for aneurysm surgery

2004 ◽  
Vol 100 (1) ◽  
pp. 139-145 ◽  
Author(s):  
Gabriele Wurm ◽  
Berndt Tomancok ◽  
Peter Pogady ◽  
Kurt Holl ◽  
Johannes Trenkler
Keyword(s):  
Surgical Simulation ◽  
Imaging Techniques ◽  
Cerebral Aneurysms ◽  
Imaging Data ◽  
Anatomical Structures ◽  
Content Type ◽  
Prospective Comparison ◽  
Relationship Of ◽  
The Relationship ◽  
Fine Print

✓ Stereolithographic (SL) biomodeling is a new technology that allows three-dimensional (3D) imaging data to be used in the manufacture of accurate solid plastic replicas of anatomical structures. The authors describe their experience with a patient series in which this relatively new visualization method was used in surgery for cerebral aneurysms. Using the rapid prototyping technology of stereolithography, 13 solid anatomical biomodels of cerebral aneurysms with parent and surrounding vessels were manufactured based on 3D computerized tomography scans (three cases) or 3D rotational angiography (10 cases). The biomodels were used for diagnosis, operative planning, surgical simulation, instruction for less experienced neurosurgeons, and patient education. The correspondence between the biomodel and the intraoperative findings was verified in every case by comparison with the intraoperative video. The utility of the biomodels was judged by three experienced and two less experienced neurosurgeons specializing in microsurgery. A prospective comparison of SL biomodels with intraoperative findings proved that the biomodels replicated the anatomical structures precisely. Even the first models, which were rather rough, corresponded to the intraoperative findings. Advances in imaging resolution and postprocessing methods helped overcome the initial limitations of the image threshold. The major advantage of this technology is that the surgeon can closely study complex cerebrovascular anatomy from any perspective by using a haptic, “real reality” biomodel, which can be held, allowing simulation of intraoperative situations and anticipation of surgical challenges. One drawback of SL biomodeling is the time it takes for the model to be manufactured and delivered. Another is that the synthetic resin of the biomodel is too rigid to use in dissecting exercises. Further development and refinement of the method is necessary before the model can demonstrate a mural thrombus or calcification or the relationship of the aneurysm to nonvascular structures. This series of 3D SL biomodels demonstrates the feasibility and clinical utility of this new visualization medium for cerebrovascular surgery. This medium, which elicits the intuitive imagination of the surgeon, can be effectively added to conventional imaging techniques. Overcoming the present limitations posed by material properties, visualization of intramural particularities, and representation of the relationship of the lesion to parenchymal and skeletal structures are the focus in an ongoing trial.

A simple, inexpensive technique for accurate mass localization by computerized tomography

1980 ◽  
Vol 52 (5) ◽  
pp. 733-735 ◽  
Author(s):  
John I. Moseley ◽  
Steven L. Giannotta ◽  
Justin W. Renaudin
Keyword(s):  
Computerized Tomography ◽  
Accurate Mass ◽  
Content Type ◽  
Accurate Localization ◽  
Relationship Of ◽  
The Relationship ◽  
Inexpensive Technique ◽  
Tomography Scanning ◽  
Fine Print

✓ A simple wire template is placed on the patient's head during computerized tomography scanning, and the results of the scan are later reproduced on the scalp prior to surgery. Measurements of the distance between the wires and the relationship of the mass provide the key to accurate localization of the mass on the scalp surface.

Relationship of perfusion pressure and size to risk of hemorrhage from arteriovenous malformations

1992 ◽  
Vol 76 (6) ◽  
pp. 918-923 ◽  
Author(s):  
Robert F. Spetzler ◽  
Ronald W. Hargraves ◽  
Patrick W. McCormick ◽  
Joseph M. Zabramski ◽  
Richard A. Flom ◽  
...  
Keyword(s):  
Perfusion Pressure ◽  
Feeding Artery ◽  
Content Type ◽  
Arterial Blood ◽  
The Mean ◽  
Feeding Pressure ◽  
Risk Of Hemorrhage ◽  
Relationship Of ◽  
The Relationship ◽  
Fine Print

✓ The relationship between the size of an arteriovenous malformation (AVM) and its propensity to hemorrhage is unclear. Although nidus volume increases geometrically with respect to AVM diameter, hemorrhages are at least as common, in small AVM's compared to large AVM's. The authors prospectively evaluated 92 AVM's for nidus size, hematoma size, and arterial feeding pressure to determine if these variables influence the tendency to hemorrhage. Small AVM's (diameter ≤ 3 cm) presented with hemorrhage significantly more often (p < 0.001) than large AVM's (diameter > 6 cm), the incidence being 82% versus 21%. Intraoperative arterial pressures were recorded from the main feeding vessel(s) in 24 of the 92 patients in this series: 10 presented with hemorrhage and 14 presented with other neurological symptoms. In the AVM's that had hemorrhaged, the mean difference between mean arterial blood pressure and the feeding artery pressure was 6.5 mm Hg (range 2 to 15 mm Hg). In the AVM's that did not rupture, this difference was 40 mm Hg (range 17 to 63 mm Hg). Smaller AVM's had significantly higher feeding artery pressures (p < 0.05) than did larger AVM's, and they were associated with large hemorrhages. It is suggested that differences in arterial feeding pressure may be responsible for the observed relationship between the size of AVM's and the frequency and severity of hemorrhage.

Laboratory experience with a magnetically guided intravascular catheter system

1973 ◽  
Vol 38 (2) ◽  
pp. 145-154 ◽  
Author(s):  
Herbert L. Cares ◽  
J. Richard Hale ◽  
D. Bruce Montgomery ◽  
Howard A. Richter ◽  
William H. Sweet
Keyword(s):  
Intravascular Catheter ◽  
Selective Angiography ◽  
Content Type ◽  
Laboratory Experience ◽  
Arteriovenous Fistulas ◽  
Catheter System ◽  
Relationship Of ◽  
The Relationship ◽  
Fine Print

✓ An improved magnetically-guided intravascular catheter system in dogs is described as safe, requiring little attention, allowing the application of flow surges to aid propulsion of the tip, and providing for angiography of good quality. Current concepts of the relationship of magnetic and flow guidance are discussed. The uses of the system demonstrated include selective angiography, perfusion of isobutyl-2-cyanoacrylate into experimental arteriovenous fistulas, and perfusion of microparticulate iron suspensions into experimental aneurysms. A unique detachable macroballoon that may function as a reversible tethered embolus is reported.

Immunobiology of primary intracranial tumors

1977 ◽  
Vol 47 (6) ◽  
pp. 871-885 ◽  
Author(s):  
Ronald E. Woosley ◽  
M. Stephen Mahaley ◽  
Jane L. Mahaley ◽  
Gary M. Miller ◽  
William H. Brooks
Keyword(s):  
Effector Cell ◽  
Intracranial Tumors ◽  
Content Type ◽  
Postoperative Course ◽  
Immune Parameters ◽  
Relationship Of ◽  
The Relationship ◽  
Cytotoxic Responses ◽  
Fine Print

✓ Fifty-six in vitro microcytotoxicity assays were conducted on 30 patients with intracranial tumors at various times during their postoperative course. Significant specific cellular cytotoxic responses were found in nine of 56 assays, humoral cytotoxic responses in nine of 54 assays, and host effector cell-dependent, antibody-dependent cytotoxic responses in four of 28 assays. Variables that might influence the occurrence of cytotoxicity were studied, and the relationship of these findings to other immune parameters was discussed.

No ordinary time, no ordinary men: the relationship between Harvey Cushing and Franklin D. Roosevelt, 1928–1939

2001 ◽  
Vol 95 (2) ◽  
pp. 354-368 ◽  
Author(s):  
Richard L. Rovit ◽  
William T. Couldwell
Keyword(s):  
Personal Relationship ◽  
Content Type ◽  
Harvey Cushing ◽  
Medical Issues ◽  
Ordinary Time ◽  
The Times ◽  
Franklin Delano Roosevelt ◽  
Relationship Of ◽  
The Relationship ◽  
Fine Print

✓ The authors elucidate the strong personal relationship that developed between Dr. Harvey Cushing and Franklin Delano Roosevelt (FDR) from 1928 to 1939, as manifested in their frequent letters to each other. The relationship was initiated by the marriage of their children. Through his correspondence with FDR, Cushing was able to affect several medical issues of the period. The relationship of these two individuals is set within the historical, social, and political contexts of the times.

Relation of preoperative angiographic characteristics of the posterior communicating artery to the results of common carotid ligation

1972 ◽  
Vol 36 (5) ◽  
pp. 564-568 ◽  
Author(s):  
Kenneth Tuerk ◽  
Norman E. Chase ◽  
Irvin I. Kricheff ◽  
Joseph P. Lin ◽  
Joseph Ransohoff
Keyword(s):  
Contrast Material ◽  
Posterior Communicating Artery ◽  
Carotid Angiography ◽  
Content Type ◽  
Carotid Ligation ◽  
Before And After ◽  
Relationship Of ◽  
The Relationship ◽  
Fine Print

✓ Twenty patients with posterior communicating artery aneurysms were treated with common carotid ligation. Postligation visualization was accomplished in 16 cases by ipsilateral brachial angiography. Two other aneurysms were visualized by contralateral brachial and contralaterial carotid angiography. The size of the aneurysm was measured before and after ligation. The relationship of postoperative reduction in size to preoperative angiographic characteristics was studied. Reduction in the size of the aneurysm occurred most often when preoperative angiography showed that the sac was long and its neck narrow, and when there was stasis of contrast material in the aneurysm.

Thrombosis: the relationship of hemostatic mechanisms to drug therapy

1981 ◽  
Vol 54 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Stanford Wessler ◽  
Sanford N. Gitel
Keyword(s):  
Drug Therapy ◽  
Content Type ◽  
Relationship Of ◽  
The Relationship ◽  
Fine Print

✓ The mechanisms of arteriovenous and microcirculatory thrombosis and embolism are presented. Drugs affecting the hemostatic balance and their specific actions and indications are reviewed.

Meningomyelocele and progressive hydromyelia

1975 ◽  
Vol 43 (4) ◽  
pp. 457-463 ◽  
Author(s):  
Peter V. Hall ◽  
Robert L. Campbell ◽  
John E. Kalsbeck
Keyword(s):  
Clinical Improvement ◽  
Sensory Loss ◽  
Ventricular Drainage ◽  
Prominent Feature ◽  
Content Type ◽  
Relationship Of ◽  
The Relationship ◽  
Progressive Paraparesis ◽  
Fine Print

✓ Five cases of myelodysplasia with progressive paraparesis are presented. Three of the five patients developed spasticity, but dissociated sensory loss and loss of sphincter control was not a prominent feature. All were found to have compensated hydrocephalus and extensive communicating hydromyelia. The use of myelography and ventriculography in the diagnosis of hydromyelia is discussed. Ventricular drainage led to clinical improvement in two cases and radiological improvement in one. The relationship of compensated hydrocephalus, meningomyelocele, and progressive hydromyelia postnatally may support the hydrodynamic hypothesis of myelodysplasia.

Surgical anatomy of the dorsal scapular nerve

2005 ◽  
Vol 102 (5) ◽  
pp. 910-911 ◽  
Author(s):  
R. Shane Tubbs ◽  
Elizabeth C. Tyler-Kabara ◽  
Alan C. Aikens ◽  
Justin P. Martin ◽  
Leslie L. Weed ◽  
...  
Keyword(s):  
Trapezius Muscle ◽  
Spinal Nerve ◽  
Surgical Anatomy ◽  
Anterior Border ◽  
Content Type ◽  
Levator Scapulae ◽  
Human Cadavers ◽  
Relationship Of ◽  
The Relationship ◽  
Fine Print

Object. There is a paucity of literature regarding the surgical anatomy of the dorsal scapular nerve (DSN). The aim of this study was to elucidate the relationship of this nerve to surrounding anatomical structures. Methods. Ten formalin-fixed human cadavers (20 sides) were dissected, and measurements made between the DSN and related structures. The nerve pierced the middle scalene muscle at a mean distance of 3 cm from its origin from the cervical spine and was more or less centrally located at this exit site. It lay a mean distance of 1.5 cm medial to the vertebral border of the scapula between the serratus posterior superior, posterior scalene, and levator scapulae muscles. It was found to have a mean distance of 2.5 cm medial to the spinal accessory nerve as it traveled on the anterior border of the trapezius muscle. The nerve intertwined the dorsal scapular artery in all specimens and was found along the anterior border of the rhomboid muscles. On 19 sides the DSN originated solely from the C-5 spinal nerve, and on one side it arose from the C-5 and C-6 spinal nerves. Conclusions. Knowledge of the anatomy of the DSN will aid the surgeon who wishes to explore and decompress this structure.

Delayed appearance of carbon granulomas of the scalp after use of carbon fiber pins for refixation of a stereotactic head frame

2001 ◽  
Vol 95 (1) ◽  
pp. 129-131 ◽  
Author(s):  
William E. McCormick ◽  
Gene H. Barnett ◽  
David M. Peereboom ◽  
Glen H. J. Stevens ◽  
Charles V. Biscotti
Keyword(s):  
Carbon Fiber ◽  
Carbon Deposition ◽  
Treatment Strategies ◽  
Content Type ◽  
Head Fixation ◽  
Multiple Organs ◽  
Cutaneous Granuloma ◽  
Relationship Of ◽  
The Relationship ◽  
Fine Print

✓ The authors present a case involving the formation of several carbon granulomas in the scalp of a woman 7 years after she underwent craniotomy. Her operation had included the use of carbon fiber pins for refixation of a stereotactic head frame. Carbon granulomas have been noted in multiple organs following surgical or traumatic carbon deposition, but have not been reported in association with neurosurgical carbon fiber pins used for head fixation. The lesions in this case arose a few months after initiation of chemotherapy for the patient's brain tumor. The relationship of carbon and cutaneous granuloma formation to adjuvant therapies and treatment strategies is discussed.

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