RESUMO
OBJECTIVE: We aimed to compare flat detector computed tomography cerebral blood volume (FD-CBV) imaging to single-photon emission computed tomography (SPECT) as an adjunctive technique during balloon test occlusion (BTO) in patients with intracranial aneurysms or tumors. METHODS: Twelve patients who underwent SPECT (99mTc-ethyl cysteinate dimer) and FD-CBV imaging during BTO were enrolled. Color-coded cerebral blood flow (CBF) images and color-coded FD-CBV images were generated and visually inspected whether there were asymmetries between the ipsilateral and contralateral cerebral hemispheres. Region of interest measurements were performed on the color-coded images at the same locations for both modalities. The mean interhemispheric region of interest ratios were calculated, and the ratio between these were estimated using linear regression models. RESULTS: Ten patients had no symptoms during BTO. Two patients developed subtle but inconclusive neurologic changes approximately 10 minutes after balloon inflation; their images showed asymmetric color-coded images with decreased CBF and FD-CBV in the ipsilateral hemisphere. The mean interhemispheric ratio of CBF was significantly smaller in patients with subtle changes than in those without (0.84 vs. 0.98; P < 0.001). Similarly, the mean interhemispheric ratio of FD-CBV was significantly smaller in patients with subtle changes than in those without (0.88 vs. 1.06; P = 0.01). No patient showed increased CBF or FD-CBV in the ipsilateral hemisphere. CONCLUSIONS: The patients with decreased CBF on SPECT also showed decreased FD-CBV in the ipsilateral hemisphere. FD-CBV imaging may be useful as an adjunctive technique for BTO before potential therapeutic carotid artery occlusion.
Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Oclusão com Balão/métodos , Doenças das Artérias Carótidas/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Arteriopatias Oclusivas/cirurgia , Doenças das Artérias Carótidas/cirurgia , Circulação Cerebrovascular/fisiologia , Feminino , Humanos , Masculino , Neuroimagem/métodosRESUMO
BACKGROUND AND PURPOSE: The natural history of unruptured intracranial aneurysms remains unclear, and management strategy is not well defined. METHODS: From January 2003 to December 2012, we enrolled patients with aneurysm in our institution. In total, 2252 patients with 2897 aneurysms were eligible for analysis, and 1960 eligible aneurysms were conservatively managed. Precise 3-dimensional evaluation was conducted using computed tomography angiography, digital subtraction angiography, or magnetic resonance angiography. We then assessed the risk of aneurysm rupture, mortality, and morbidity associated with aneurysm characteristics, demographics, and known health/lifestyle risk factors. RESULTS: The mean follow-up duration was 7388 aneurysm-years. During observation, 56 aneurysms ruptured, resulting in an overall rupture rate per year of 0.76% (95% confidence interval, 0.58-0.98). The mean initial visit to rupture interval was 547 days. Aneurysm size, location, daughter sac, and history of subarachnoid hemorrhage were significant independent predictors for aneurysm rupture. Aneurysms that were ≥5 mm were associated with a significantly increased risk of rupture when compared with 2- to 4-mm aneurysms (unadjusted hazard ratio, 12.24; 95% confidence interval, 7.15-20.93). Of 56 patients who experienced hemorrhage, 29 (52 %) died or were rendered severely disabled. Of the patients who had large or giant aneurysms, none recovered without deficits, and the mortality rate after rupture was 69%. For aneurysms sized <5 mm, the mortality rate was 18%. CONCLUSIONS: Larger aneurysms are at greater risk for rupture and poor outcome. Ethnic factors may play a role in the risk of rupture.
Assuntos
Aneurisma Roto/epidemiologia , Aneurisma Intracraniano/diagnóstico , Ruptura Espontânea/epidemiologia , Hemorragia Subaracnóidea/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/mortalidade , Angiografia Digital , Angiografia Cerebral , Estudos de Coortes , Feminino , Humanos , Incidência , Aneurisma Intracraniano/epidemiologia , Estudos Longitudinais , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Risco , Fatores de Risco , Ruptura Espontânea/mortalidade , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Cytokines play important roles in cardiac repair and regeneration. Recently, we demonstrated that interleukin (IL)-6 family cytokines induce the endothelial differentiation of Sca-1+ cardiac resident stem cells through STAT3/Pim-1 signaling pathway. In contrast, the biological functions of IL-12 family cytokines in heart remain to be elucidated, though they show structural homology with IL-6. In the present study, we examined the effects of IL-12 family cytokines on the transdifferentiation of cardiac Sca-1+ cells into cardiac cells. RT-PCR analyses revealed that IL-27 receptor α (IL-27Rα), but not IL-12R or IL-23R, was expressed in cardiac Sca-1+ cells. The transcript expression of IL-27 was elevated in murine hearts in cardiac injury models. Intriguingly, IL-27 stimulation for 14 days induced the endothelial cell (EC) marker genes, such as CD-31 and VE-cadherin. Immunoblot analyses clarified that IL-27 treatment rapidly phosphorylated STAT3. IL-27 upregulated the expression of Pim-1, but the overexpression of dominant negative STAT3 abrogated the induction of Pim-1 by IL-27. Finally, adenoviral transfection of dominant negative Pim-1 inhibited IL-27-induced EC differentiation of cardiac Sca-1+ cells. These findings demonstrated that IL-27 promoted the commitment of cardiac stem cells into the EC lineage, possibly leading to neovascularization as a novel biological function. IL-27 could not only regulate the inflammation but also contribute to the maintenance of the tissue homeostasis through stem cell differentiation at inflammatory sites.
Assuntos
Interleucinas/farmacologia , Miocárdio/citologia , Proteínas Proto-Oncogênicas c-pim-1/metabolismo , Fator de Transcrição STAT3/metabolismo , Células-Tronco/citologia , Animais , Caderinas/biossíntese , Diferenciação Celular/fisiologia , Transdiferenciação Celular/fisiologia , Células Cultivadas , Células Endoteliais/citologia , Traumatismos Cardíacos/patologia , Interleucina-12/imunologia , Interleucinas/imunologia , Camundongos , Camundongos Endogâmicos C57BL , Fosforilação/efeitos dos fármacos , Molécula-1 de Adesão Celular Endotelial a Plaquetas/biossíntese , Proteínas Proto-Oncogênicas c-pim-1/biossíntese , Receptores de Citocinas/biossíntese , Receptores de Interleucina/biossíntese , Receptores de Interleucina-12/biossínteseRESUMO
BACKGROUND: Although most neurovascular diseases can be treated either by microsurgical or endovascular means, a subset of patients may require a combined approach. Patient transfer from the operating room (OR) to the angiosuite has been a fundamental drawback of this type of approach. OBJECTIVE: The purpose of this study is to report our clinical experience performing combined surgical and endovascular procedures for neurovascular diseases in the hybrid OR. METHODS: 29 patients with neurovascular diseases underwent combined endovascular and surgical procedures in a single session: 16 were scheduled combined treatment and 13 were emergency combined procedures. Of the emergency cases, three were rescue surgeries after endovascular complications. Three patients had ruptured intracranial aneurysms, eight had unruptured intracranial aneurysms, eight had arteriovenous malformations and eight had arteriovenous fistulae; two patients had either a spinal tumor or dural arteriovenous fistulae. RESULTS: All combined procedures were performed in a single session without changing the patient's surgical position. In cases of ruptured arteriovenous malformations or aneurysms with hematoma, an emergency embolization was performed to assist the surgical procedure. Combined superficial temporal artery-middle cerebral artery (STA-MCA) bypass followed by endovascular parent artery trapping were successfully performed for complex large or giant aneurysms. There were two periprocedural ischemic complications. Of the three patients who underwent surgical rescue after endovascular complications, two remained intact and one died despite immediate surgical procedures. CONCLUSION: A combined endovascular and surgical approach conducted in a hybrid OR provides a new strategy for the treatment of complex neurovascular diseases.
Assuntos
Transtornos Cerebrovasculares/cirurgia , Procedimentos Endovasculares/métodos , Procedimentos Neurocirúrgicos/métodos , Salas Cirúrgicas/organização & administração , Angiografia Digital , Artérias Cerebrais/patologia , Artérias Cerebrais/cirurgia , Embolização Terapêutica , Serviços Médicos de Emergência , Arquitetura de Instituições de Saúde , Humanos , Aneurisma Intracraniano/cirurgia , Malformações Arteriovenosas Intracranianas/cirurgia , Artéria Cerebral Média/cirurgia , Artérias Temporais/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Fully equipped high-end digital subtraction angiography (DSA) within the operating room (OR) environment has emerged as a new trend in the fields of neurosurgery and vascular surgery. OBJECTIVE: To describe initial clinical experience with a robotic DSA system in the hybrid OR. METHODS: A newly designed robotic DSA system (Artis zeego; Siemens AG, Forchheim, Germany) was installed in the hybrid OR. The system consists of a multiaxis robotic C arm and surgical OR table. In addition to conventional neuroendovascular procedures, the system was used as an intraoperative imaging tool for various neurosurgical procedures such as aneurysm clipping and spine instrumentation. RESULTS: Five hundred one neurosurgical procedures were successfully conducted in the hybrid OR with the robotic DSA. During surgical procedures such as aneurysm clipping and arteriovenous fistula treatment, intraoperative 2-/3-dimensional angiography and C-arm-based computed tomographic images (DynaCT) were easily performed without moving the OR table. Newly developed virtual navigation software (syngo iGuide; Siemens AG) can be used in frameless navigation and in access to deep-seated intracranial lesions or needle placement. CONCLUSION: This newly developed robotic DSA system provides safe and precise treatment in the fields of endovascular treatment and neurosurgery.
Assuntos
Angiografia Digital/métodos , Procedimentos Neurocirúrgicos/métodos , Salas Cirúrgicas/métodos , Robótica/métodos , Adulto , Idoso , Angiografia Digital/tendências , Feminino , Humanos , Procedimentos Neurocirúrgicos/tendências , Salas Cirúrgicas/tendências , Robótica/tendênciasRESUMO
Modern imaging technologies, such as computed tomography (CT) angiography, magnetic resonance (MR) angiography, and digital subtraction (DS) angiography are widely used for pretreatment evaluation of cerebral aneurysms, but the relative accuracies of these modalities are unclear. This study compared the measurements of aneurysm neck and dome height and width on CT angiography, time-of-flight (TOF)-MR angiography, and DS angiography using a three-dimensional workstation. An elastic model of a side-wall aneurysm was connected to an artificial heart pulsatile circuit system. The aneurysm model was prepared using a silicone membrane of 0.6-mm thickness under normal physiological circulation parameters. Using this aneurysm model, three-dimensional TOF-MR angiography, contrast-enhanced CT angiography, and DS angiography were performed. Source images were post-processed on a dedicated workstation to calculate the aneurysm size. DS angiography measurements were found to be the most accurate. In contrast, aneurysm neck sizes measured on CT angiography were significantly wider than actual values (p < 0.05) and aneurysm heights measured using TOF-MR angiography were significantly lower than actual values (p < 0.01). In this in-vitro model, at least one aneurysm dimension measured with CT angiography and with TOF-MR angiography differed significantly from actual values. Aneurysm neck width markedly affects therapeutic planning, as a wide neck requires craniotomy or endovascular treatment using an adjunctive device, so inaccuracies should be considered when aneurysm treatment is planned using modern methods of visualization.
Assuntos
Angiografia Digital/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/patologia , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Angiografia Digital/normas , Humanos , Aneurisma Intracraniano/fisiopatologia , Imageamento por Ressonância Magnética/normas , Tomografia Computadorizada por Raios X/normasRESUMO
INTRODUCTION: Several different bioabsorbable polymeric coil materials are currently used with the goal of improving treatment outcomes of endovascular embolization of intracranial aneurysms. However, little is known about the correlation between polymer degradation profiles and concomitant tissue responses in a blood vessel. The authors describe in vitro degradation characteristics of nine different polymeric materials and their corresponding tissue responses induced in rabbit carotid arteries. METHODS: Mass loss and molecular weight loss of nine commercially available bioabsorbable sutures were evaluated in vitro up to16 weeks. The same nine materials, as well as platinum coils, were implanted into blind-end carotid arteries (n = 44) in rabbits, and their tissue reactions were evaluated histologically 14 days after the implantation. RESULTS: Five of the nine polymers elicited moderate to strong tissue reactions relative to the remaining materials. While polymer mass loss did not correlate with their histologic findings, polymers that showed a faster rate of molecular weight loss had a tendency to present more active tissue reactions such as strong fibrocellular response around the implanted material with a moderate inflammatory cell infiltration. Maxon exhibited the fastest rate of molecular weight loss and poly-l-lactic acid the slowest. CONCLUSIONS: The rate of molecular weight loss may be an important factor that is associated with the degree of bioactivity when bioabsorbable polymers are implanted into blood vessels. For further quantitative analysis, additional experiments utilizing established aneurysm models need to be conducted.
Assuntos
Implantes Absorvíveis/efeitos adversos , Artéria Carótida Primitiva/efeitos dos fármacos , Artéria Carótida Primitiva/patologia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Polímeros/efeitos adversos , Suturas/efeitos adversos , Animais , Coelhos , Estatística como AssuntoRESUMO
OBJECTIVE: We developed a new liquid embolic agent, an aqueous solution of thermoreversible gelation polymer (TGP) for the treatment of cerebral aneurysms. This polymer solution has the unique characteristics that allow it to solidify at a specific temperature without solvent. We performed an experimental aneurysm embolization using this liquid embolic agent with and without different protective devices to evaluate its technical feasibility for the treatment of aneurysms. METHODS: Fourteen side-wall aneurysms were surgically constructed on 14 common carotid arteries of 7 swine. Embolizations were conducted in combination with balloon protection (balloon group, n = 4), microstent protection (stent group, n = 4), and microcoil and microstent protection (stent-coil group, n = 4). Two aneurysms were used as controls. One control aneurysm was not embolized, and the other received control stent placement only. Angiographic follow-up was performed on day 14 and was followed by histopathological evaluation. RESULTS: Successful TGP solution delivery was conducted in all cases. Complete aneurysm occlusion was achieved in all cases without TGP migration. Follow-up angiograms demonstrated complete occlusion in the stent and stent-coil groups. A small recurrence was observed in the balloon group. Histopathological findings demonstrated neoendothelialization across the necks of the aneurysms. CONCLUSION: Experimental aneurysms were safely embolized using TGP. Further modifications related to mechanical stability and long-term safety evaluation results are necessary before clinical application.
Assuntos
Sistemas de Liberação de Medicamentos/métodos , Embolização Terapêutica/métodos , Aneurisma Intracraniano/terapia , Polivinil/administração & dosagem , Temperatura , Animais , Cateterismo/métodos , Angiografia Cerebral/métodos , Terapia Combinada , Modelos Animais de Doenças , Sistemas de Liberação de Medicamentos/instrumentação , Estudos de Viabilidade , Feminino , Seguimentos , Gelatina/administração & dosagem , Stents , Suínos , Resultado do TratamentoRESUMO
BACKGROUND: To investigate biomaterials seeking for their possible use for aneurysm treatment, in vivo screening tests using a number of potential materials are required. However, there is no established animal model that is suitable for such purpose. Some models require special preparation of tested materials for transcatheter delivery and others are inappropriate in view of their cost-effectiveness. The purpose of this study is to establish an animal model that overcomes these limitations and help us select potential materials before the preclinical evaluation. METHODS: Bilateral CCAs in a rabbit were surgically ligated, and a 2-cm segment of either a bare platinum coil or a polymeric coil (a platinum coil coated with PLGA 10/90) was implanted into each blind-ended arterial segment (n = 26). They were harvested at day 1, 7, 10, 14, or 30, respectively. Angiographic and histologic evaluations as well as quantitative analysis on the development of the organized thrombus were performed. RESULTS: One day after the implantation, both platinum and PLGA coils were surrounded by immature thrombus that was induced by blood flow stagnation in the arterial segment. At day 7, minimal thrombus organization was observed around both types of materials. At postimplantation days 10 and 14, fibrocellular responses, the early findings of the thrombus organization process, were observed in both material groups. Such histologic findings were more prominent in the PLGA coil group as compared to the platinum coil group (day 10, P = .051; day 14, P = .011). Well-organized thrombus was observed in both material groups at day 30 without showing statistical difference (P = .12). CONCLUSION: Given the cost-effectiveness, the simple material preparation process, and its feasible histologic evaluation methods, this new animal model can be useful in screening other potential biomaterials for the development of new coil devices.
Assuntos
Materiais Revestidos Biocompatíveis , Modelos Animais de Doenças , Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Ácido Láctico , Teste de Materiais , Platina , Ácido Poliglicólico , Angiografia Digital , Animais , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/patologia , Doenças das Artérias Carótidas/terapia , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/patologia , Angiografia Cerebral , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/patologia , Copolímero de Ácido Poliláctico e Ácido Poliglicólico , Coelhos , Resultado do Tratamento , Grau de Desobstrução Vascular/fisiologiaRESUMO
INTRODUCTION: To evaluate potential feasibility of new liquid embolic agent, thermoreversible gelation polymer (TGP), for embolotherapy. METHODS: TGP is a liquid polymer that was originally developed as a cell culture medium for tissue engineering. TGP becomes liquid at temperatures lower than the sol-gel transition temperature (TT) and becomes a gel at temperatures higher than the TT. The TT can be adjusted from 10 degrees C to 40 degrees C, allowing gelation at body temperature without solvent. The renal arteries in six swine were embolized with TGP. Angiographic evaluations were obtained 0, 3 h, and 14 days after embolization. The animals were sacrificed at day 14 after angiogram. RESULTS: All renal arteries were successfully embolized with TGP using cooling catheter. No acute and chronic clinical complication was observed. Follow-up angiogram demonstrated complete or near complete occlusion of renal arteries. No untoward inflammatory response was observed in acute and chronic specimen. CONCLUSION: This embolic material has potential feasibility to be used in the treatment of cerebral arteriovenous malformations, aneurysms, or hyper vascular tumors.
Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Embolização Terapêutica/métodos , Hemostáticos/administração & dosagem , Hemostáticos/química , Artéria Renal/efeitos dos fármacos , Artéria Renal/fisiologia , Animais , Estudos de Viabilidade , Temperatura Alta , Soluções , SuínosRESUMO
UNLABELLED: Backgrounds and Purpose- The authors evaluated the incidence of rupture of unruptured intracranial saccular aneurysm during observation. METHODS: Between January 2003 and December 2006, a total of 419 patients with 529 unruptured intracranial saccular aneurysms were observed without treatment. The mean follow-up duration was 905.3 days. Aneurysm size was measured by 3-dimensional CT angiography. Clinical and 3-dimensional CT angiography follow-up were obtained every 6 months. RESULTS: Nineteen aneurysms ruptured during observation resulting in a 1.4% rupture rate per year. A history of subarachnoid hemorrhage (hazard ratio, 7.3; 95% CI, 2.5 to 21.2), posterior circulation aneurysm (hazard ratio, 2.9; 95% CI, 1.1 to 8), and large size were significant independent predictors for aneurysm rupture. CONCLUSIONS: Size, history of subarachnoid hemorrhage, and posterior circulation aneurysms were significant risk factors for prediction of rupture of unruptured intracranial saccular aneurysms.
Assuntos
Artérias Cerebrais/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/epidemiologia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/epidemiologia , Idoso , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/epidemiologia , Infarto Encefálico/patologia , Angiografia Cerebral , Artérias Cerebrais/patologia , Artérias Cerebrais/fisiopatologia , Comorbidade , Progressão da Doença , Feminino , Humanos , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Recidiva , Fatores de Risco , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/patologia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: DynaCT is a clinical application protocol to create computed tomographic (CT)-like images allowing soft-tissue visualization acquired from an angiography system. A cone beam three-dimensional CT reconstruction is produced from the acquisition of two-dimensional projection images by rotating the c-arm with x-ray source and image receptor around the patient. The purpose of this study is to evaluate the clinical efficacy of DynaCT in the operating room. METHODS: DynaCT was performed in 100 patients undergoing cerebral or spinal interventional procedures in the new-concept operating room. Specially designed AXIOM Artis BA (conventional image intensifier system; 55 patients; Siemens Medical Solutions, Erlangen, Germany) and AXIOM Artis dBA (flat-panel detector; 45 patients; Siemens Medical Solutions) biplane neuroangiographic systems (Siemens Medical Solutions, Germany) were installed in the operating room. The volumetric data set from the AXIOM Artis systems were reconstructed immediately on the three-dimensional workstation in the operating room. We compared DynaCT images with the use of multidetector computed tomography. RESULTS: DynaCT was performed successfully in all patients. High-contrast structures, such as bone, calcified lesions, and metallic materials, were visualized on DynaCT as well as in multidetector computed tomography for each group. Although contrast differentiation of soft tissue such as cerebral cortex, muscle, and hematoma on DynaCT were inferior to multidetector CT scans, the images were sufficiently used as intraoperative CT-like images. However, DynaCT images acquired from flat panel detector-based systems were found to be superior to those images acquired from image intensifier-based systems. Striking ring artifacts were exhibited and resulted in major limitations in the image intensifier group. CONCLUSION: DynaCT has the potential to be used as a powerful tool for endovascular and neurosurgical procedures and will open new possibilities for neurosurgical management.
Assuntos
Angiografia Cerebral/instrumentação , Tecido Conjuntivo/diagnóstico por imagem , Mielografia/instrumentação , Tomografia Computadorizada Espiral/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral/métodos , Criança , Pré-Escolar , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mielografia/métodos , Procedimentos Neurocirúrgicos/métodos , Salas Cirúrgicas , Projetos Piloto , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada Espiral/métodos , Resultado do TratamentoRESUMO
OBJECT: The purpose of this study was to evaluate initial experiences in a surgical operating room (OR) with a multipurpose angiography unit, which offers integrated neurosurgical and radiological capabilities. METHODS: A specially designed biplane digital subtraction (DS) angiography system was installed in the neurosurgery OR. The new suite, which allows three-dimensional DS angiography with C-arm for computerized tomography and microsurgery capabilities, allows the neurosurgeon to perform a wide range of neurosurgical and endovascular procedures. Three hundred thirty-two procedures were performed in the endovascular OR between November 2003 and March 2005. Patients arriving in the emergency department were transferred to the endovascular OR without delay. The neurovascular team performed diagnostic angiography followed by endovascular interventional procedures or surgery. CONCLUSIONS: The newly designed endovascular OR facilitates safe and systemic treatment of neurovascular disease.
Assuntos
Encefalopatias/diagnóstico por imagem , Encefalopatias/cirurgia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Angiografia Cerebral/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Idoso , Feminino , Humanos , Imageamento Tridimensional/instrumentação , Pessoa de Meia-Idade , Salas Cirúrgicas/organização & administração , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Aneurysms of the petrous internal carotid artery are rare, and surgical treatment of the aneurysm in the petrous bone carries high risk with procedure. We report a case of large petrous internal carotid artery aneurysm associated with otitis media. A 58-year-old female was admitted to our institution with left hearing loss and facial palsy. She had 4-year history of left exudative otitis media. Imaging studies demonstrated a 17 mm left petrous internal carotid artery aneurysm, destroying osseous partition between carotid canal and Eustachian tube, and protruding into left middle cranial fossa. Endosaccular coil embolization with balloon assist technique was performed successfully without neurological deficit. Follow up magnetic resonance angiogram demonstrated complete obliteration of the aneurysm without parent artery occlusion. Traumatic, mycotic, radiation, and congenital origin have been implicated for petrous internal carotid artery aneurysm. In a review of the literature, 11 cases of mycotic aneurysms in this location were reported and all of them were complicated with chronic otitis media. Because of its close proximity of middle ear and Eustachian tube, adventitial infection of the artery weakens the arterial wall, and gives rise to formation of aneurysm. We conclude that our case is of mycotic origin, and endosaccular coil embolization is effective and less invasive treatment.
Assuntos
Aneurisma/etiologia , Doenças das Artérias Carótidas/etiologia , Artéria Carótida Interna , Embolização Terapêutica/métodos , Otite Média/complicações , Aneurisma/terapia , Angioplastia com Balão , Doenças das Artérias Carótidas/terapia , Doença Crônica , Feminino , Humanos , Pessoa de Meia-Idade , Otite Média/terapiaRESUMO
INTRODUCTION: Total removal of the tumor is the most acceptable therapeutic modality in the management of craniopharyngioma; however, there are innumerable factors that can upset treatment plans. Unresectable lesions are often treated with gamma knife surgery (GKS). Reduction of the cystic volume is necessary, to decrease the area to be treated with GKS. An Ommaya reservoir system is usually placed during open surgery or by stereotactic access. MATERIALS AND METHODS: The authors use a neuroendoscope for safer and less invasive placement of the Ommaya reservoir into deep-seated cystic lesions. The cystic component is aspirated, and the Ommaya reservoir tube is precisely guided and placed into the cyst cavity under neuroendoscopic control with a newly developed two-burr-hole technique. This neuroendoscopic procedure could make it easier to reduce cystic volume prior to GKS as the final procedure. This technique may also be used for instillation of chemotherapeutic agents and for repeat aspirations, making the achievement of cystic control more likely. This type of neuroendoscopic management is a safe and effective procedure and could be considered as an alternative management technique for some stubborn cystic craniopharyngiomas.