Cerebral cavernous malformations: serial magnetic resonance imaging findings in patients with and without gamma knife surgery.
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To classify the cerebral cavernous malformations and to investigate the natural history of cavernous malformations according to the classification, 41 patients with 61 cavernous malformations (40 cavernous malformations from 22 patients treated with gamma knife surgery) were regularly followed up using magnetic resonance (MR) imaging for a mean period of 25.5 months in treated cavernous malformations and 20.7 months in untreated cavernous malformations, respectively. Cavernous malformations were classified into four types: type I, extralesional gross hemorrhage beyond cavernous malformation; type II, mixture of subacute and chronic hemorrhage; type III, area of hemosiderin with small central core; and type IV, area of hemosiderin deposition without central core. Follow-up MR images were analyzed to evaluate changes in size, signal intensity, rebleeding, and perilesional adverse reaction of irradiation. A total of 61 cavernous malformations including 17 in type I, 23 in type II, 10 in type III, and 11 in type IV showed usual degradation of blood product in 22 cavernous malformations, no change in shape and signal intensity in 31 cavernous malformations, and eight cavernous malformations with rebleedings in the serial MR images. In these eight cavernous malformations with rebleedings, six occurred in type II and two in type III, but none in type I or IV. Rebleedings were more frequent in type II than in other types (p = 0.044). Adverse reaction of irradiation was observed in five of 22 patients treated with gamma knife surgery. Although most cerebral cavernous malformations showed evolution of hemorrhage or no change in size or shape on follow-up MR images, cerebral cavernous malformations represented as mixture of subacute and chronic hemorrhage with hemosiderin rim (type II) have a higher frequency to rebleed than other types of cerebral cavernous malformations. Cerebral cavernous malformations represented as hemosiderin deposition without central core (type IV) have a lower tendency to rebleed than other types and do not need any treatment. Most of the adverse reaction of irradiation after gamma knife surgery around cavernous malformations are transient findings and are considered to be perilesional edema. (+info)
Direct anastomotic bypass for cerebrovascular moyamoya disease.
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Therapeutic result and pitfalls in the surgical treatment of cerebrovascular moyamoya disease are evaluated. During the recent 15 years, 268 patients with moyamoya disease have been treated in our clinic. Among them, 238 patients showed ischemic symptoms. Superficial temporal artery to middle cerebral artery anastomoses combined with temporal muscle grafting (encephalo-myo-synangiosis) were performed for most of the cases. Complete remission and clinical improvement were obtained in 34.0% and 64.2% of the patients, respectively. Symptomatic aggravation due to ischemic complication followed the operation in five patients (1.9%). Normocapnic control during general anesthesia with sufficient hydration is essential to avoid perioperative ischemic complications. Omental graft was performed in 16 patients. In 13 patients, omental graft was performed for the progressing ischemia in the posterior cerebral artery or anterior cerebral artery distribution. In the other three patients, omental graft was used for marked brain atrophy. (+info)
Tissue response of a small saccular aneurysm after incomplete occlusion with a Guglielmi detachable coil.
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A 49-year-old woman had a small saccular aneurysm that was incompletely occluded with a Guglielmi detachable coil (GDC). She died from rupture of another aneurysm 42 days after the treatment. Autopsy for the embolized aneurysm revealed no neoendothelium at the aneurysmal neck, but an organized thrombus was observed limited to the periphery of the aneurysmal lumen. Although isolation of the aneurysm was not apparent, loose embolization with this method may help to reinforce the aneurysmal wall. (+info)
Long-term histopathologic findings in two cerebral aneurysms embolized with Guglielmi detachable coils.
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We present gross pathologic autopsy findings of a patient who was treated for two aneurysms with Guglielmi detachable coils (GDCs), and who died 33 months after the procedure. Histologic findings are also presented. In both aneurysms, the coils were firmly attached to the aneurysmal wall, making it impossible to remove them from the sac. The ostium of one aneurysm was covered by collagenous tissue and a single layer of endothelium. (+info)
Reduction of aneurysm clip artifacts on CT angiograms: a technical note.
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We describe a head tilt technique for use with CT angiography that reduces beam-hardening artifacts in patients with aneurysm clips. This simple maneuver directs the artifacts away from pertinent anatomy, thus increasing the chances for diagnostic accuracy. No significant changes in the CT angiographic protocol are required, and the maneuver can easily be combined with other artifact-minimizing strategies. (+info)
Multiple dural arteriovenous shunts in a 5-year-old boy.
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We describe a rare case of multiple dural arteriovenous shunts (DAVSs) in a 5-year-old boy. MR imaging performed at 1 year of age showed only a dilated anterior part of the superior sagittal sinus; however, angiography at 5 years of age revealed an infantile-type DAVS there and two other DAVSs of the adult type. The pathophysiological evolution of DAVSs in children and their treatment strategies are discussed. (+info)
Cerebral blood flow velocity during neonatal seizures.
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AIM: To determine if cerebral blood flow velocity increases during all types of neonatal seizure, and whether the effect is due solely to an increase in blood pressure, transmitted to the cerebral circulation when autoregulation is impaired. METHODS: Seizures were diagnosed in 11 high risk neonates using cotside 16 channel video-EEG polygraphy. EEG, cerebral blood flow velocity (CBFV) using transcranial Doppler ultrasound, and arterial blood pressure (ABP) measurements were made. At least two 5-10 minute epochs of simultaneous measurements were performed on each infant. These epochs were then reviewed to eliminate artefacts, and one minute data periods containing a clear seizure onset were created. Each period contained 20 seconds before the seizure. Data periods without seizures from the same infants were also analysed and compared with seizure periods. RESULTS: Four infants had purely electrographic seizures-without clinical manifestations. Six infants had electroclinical seizures. One infant displayed both seizure types. A random effects linear regression analysis was used to determine the effect of seizures on CBFV and ABP. A significant increase was found in mean CBFV in those periods containing seizures. The mean percentage change in velocity for all infants was 15.6%. Three infants showed a significant increase in mean ABP after seizures but the overall increase in ABP for all infants was not significant. CONCLUSION: Electroclinical and electrographic neonatal seizures produce an increase in CBFV. In some infants the increase is not associated with an increase in blood pressure. These preliminary results suggest that electrographic seizures are associated with disturbed cerebral metabolism. Treatment of neonatal seizures until electrographic seizure activity is abolished may improve outcome for these infants. (+info)
Does endothelin-1 reduce superior mesenteric artery blood flow velocity in preterm neonates?
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AIM: To compare plasma endothelin-1 (ET-1) concentrations in preterm neonates from pre-eclamptic and normal mothers; and to evaluate whether ET-1 has a role in altered arterial blood flow velocity. METHODS: Umbilical arterial blood and neonatal arterial blood were sampled on days 1 and 3 for gas analysis and measurement of plasma ET-1. Doppler ultrasonography of the middle cerebral, renal, and superior mesenteric arteries (SMA) was performed. RESULTS: Neonates in the pre-eclampsia (n = 18) and control (n = 18) groups had mean (SD) gestational ages of 31.1 (2.5) weeks and 30.4 (2.1) weeks; their birth-weights were 1432 (SD 676) g and 1692 (SD 500) g, respectively. In the pre-eclampsia group mean umbilical arterial PO2 was lower--1.88 (0.75) kPa compared with 3.27 (1.41) kPa (p < 0.01)--and mean plasma ET-1 concentration was higher in the umbilical artery--40.6 (SD 15.0) compared with 30.5 (SD 13.8) pg/ml (p = 0.04) and day 1 blood--54.9 (35.0) pg/ml compared with 33.6 (14.6) pg/ml (p = 0.03). Middle cerebral artery peak systolic velocity was higher and SMA time averaged, peak systolic, and mean peak velocities were lower in the pre-eclampsia group. SMA time averaged velocity was inversely related to plasma ET-1 concentration. CONCLUSION: The association between increased production of ET-1 and reduction in SMA time averaged velocity suggests a possible mechanism for hypoperfusion of the intestinal wall in neonates. (+info)