Direct thrombosis of aneurysms with cellulose acetate polymer. Part II: Preliminary clinical experience.

The authors report the treatment of seven intracranial aneurysms in six patients with direct infusion of cellulose acetate polymer solution, a new liquid thrombotic material. These aneurysms were considered inoperable because of their size or location, or because of the patient's neurological condition. This material avoids the difficulties associated with balloon occlusion, and completely fills even irregularly shaped aneurysms. Cellulose acetate polymer solution hardens in about 5 minutes and remains solid once inside the aneurysm. Because this technique is less invasive than surgery, it can be used for high-risk patients in the acute stage of subarachnoid hemorrhage. Transient motor aphasia occurred in one patient. A small residual neck, which caused rebleeding 3 months after the treatment, remained in another patient. This article describes the new material, the procedure for direct thrombosis, and preliminary clinical results.

Artificial embolization with isobutyl-2-cyanoacrylate for the treatment of carotid-ophthalmic aneurysm.

A large carotid-ophthalmic aneurysm was successfully obliterated by the combined treatment of clipping the aneurysmal neck and intraaneurysmal injection of isobutyl-2-cyanoacrylate. Reflux of the glue into the artery was prevented by temporary trapping of the carotid artery. The obliteration of an aneurysm with isobutyl-2-cyanoacrylate is an effective procedure in cases where clipping of the aneurysmal neck is not completed due to technical difficulties.

[A new treatment by occluding spring embolus for carotid-cavernous fistula].

The authors describe a new technique for simple, direct and safe obliteration of a carotid cavernous fistula (CCF) with occluding spring embolus (OSE), preserving the carotid artery flow. The patient was 47 year-old man who was admitted to our department on September 3, 1984 complaining of left conjunctival injection, exophthalmos and bruit at the left temporal region. Angiograms revealed a typical cavernous dural AVM (spontaneous CCF) on the left side with bilateral dural ECA-ICA blood supply. He was treated with transvascular Ivalon embolization of the bilateral ECA. A clinical symptom after transvascular embolization improved transiently, but one month later he developed progressive chemosis in addition to the previous symptom. A left frontotemporal craniotomy was done and six OSEs through polyethylene tube was inserted into the cavernous sinus and the fistula was closed completely. Angiogram during procedure was taken to establish the topographical relationship of OSE, carotid artery and the cavernous sinus. Postoperatively his chemosis and conjunctival injection were decreased and gradually cleared up within three weeks. Postoperative angiogram showed complete closure of the fistula.

[Primary empty sella syndrome treated by transsphenoidal extradural balloon expansion--a case report].

A 34-year-old woman was admitted for the chief complaints of headache and blurred vision. She had bilateral papilledema and slight increase in CSF pressure (175mmH2O) with normal visual acuity and field. Neurological and hormonal examination were normal except for over response of PRL and TSH to TRH test. The sella was enlarged and MRI and metrizamide CT demonstrated intrasellar CSF filling with remodeling of the pituitary gland. The patient was diagnosed as primary empty sella syndrome associated with benign intracranial hypertension. The complaints did not subside for six months. The patient was treated via the transsphenoidal approach. The dura mater of the floor of the sella was elevated by extradural balloon expansion filled with silicone, and subsequently the empty sella was obliterated. Her headache disappeared and amblyopic attack also improved. Obliteration of the empty sella with an extradural silicone balloon via the transsphenoidal approach seemed to have been effective for headache and visual complaints of primary empty sella syndrome which did not respond to medical therapy.

[Direct embolization with occluding spring embolus for large aneurysm and carotid-cavernous fistula].

The authors describe a technique using occluding spring emboli for direct obliteration of an unclippable large aneurysm, and carotid-cavernous fistula (CCF) which failed to be occluded by transarterial and transvenous approaches. Case 1: This 44 year-old man had a history of head trauma 30 years ago. He was admitted to our department on October 16, 1989, because of an aneurysm incidentally found by a CT scan taken for the examination of his vertigo. Angiograms revealed a large aneurysm at the C3 portion of the right internal carotid artery. A right frontal craniotomy was performed on November 2, 1989, but neck clipping of the aneurysm was impossible, because it was a pseudoaneurysm with quite a fragile neck. Subsequently, fourteen occluding spring emboli were inserted into the aneurysm through a polyethylene catheter directly into the aneurysmal dome. Postoperative angiograms showed almost complete obliteration of the aneurysm with good preservation of the parent artery. Case 2: This 26 year-old woman without a history of head trauma was admitted to our department on May 10, 1989, complaining of right conjunctival injection and exophthalmos. Angiograms revealed a spontaneous CCF which had a single orifice at the C4 portion of the right internal carotid artery and drained through the superior ophthalmic vein and inferior petrosal sinus. Initially, transarterial and transvenous approaches were tried, but the attempts were unsuccessful. Subsequently, a right frontotemporal craniotomy was performed on August 8, 1989, and 27 occluding spring emboli were placed into the cavernous sinus through a polyethylene catheter which had been inserted directly.(ABSTRACT TRUNCATED AT 250 WORDS)

Inhibition of nociceptive neurons by internal capsule stimulation.

The mechanism of pain relief by internal capsule (IC) stimulation was investigated in 32 adult cats. Nociceptive neuronal activity of the nucleus ventralis posteromedialis (VPM), responding to contralateral pulp stimulation, was suppressed by IC stimulation to a greater extent than activity in the posterior nuclear group (PO) or centre-median nucleus. On the contrary, suppression of neuronal firing by intraventricular morphine-HCl predominated in PO neurons. These results suggest that pain relief by IC stimulation may be mediated through inhibitory effects on nociceptive neurons of the thalamic sensory relay nuclei.