The Effects of 5 Minutes of Static Stretching on Joint Flexibility and Muscle Strength Are Comparable Between Ballet Dancers and Non-Dancers.

Introduction: Ballet dancers have a special morphology, such as a large muscle thickness that affects passive torque. Ballet dancers also possess specialized mechanical, and neural properties of muscles and tendons. These characteristics may produce different static stretching effects than non-dancers. Therefore, this study aimed to determine the differences in the effects of static stretching on joint range of motion, passive torque, and muscle strength between ballet dancers and non-dancers. Methods: This study included 13 ballet dancers and 13 college students. The muscle and tendon thicknesses were assessed using ultrasonography. In the right lower extremity, torque-angle data and muscle-tendon junction displacement measurements were obtained during isokinetic passive dorsiflexion before and after a 5-minute static stretch against the right plantar flexors. The relative stretching intensity was calculated by dividing the stretching angle by the maximal dorsiflexion angle pre-stretch. Additionally, the isometric maximal voluntary plantar flexion torque on the left ankle was measured before and after 5 minutes of static stretching against the left plantar flexors. Results: Ballet dancers had significantly greater muscle thickness than non-dancers (22.4 ± 2.2 vs 18.1 ± 1.7 mm), whereas no significant difference was observed in the Achilles tendon thickness. No significant difference was observed in the stretching angle; however, the relative stretching intensity was higher in the control group (65.9 ± 19.8 vs 127.5 ± 63.8%). Static stretching increased the maximal dorsiflexion angle (dancer: 30.4° ± 9.6° to 33.9° ± 9.5°, non-dancer: 18.4° ± 8.6° to 20.5° ± 9.5°) and maximal passive torque in both groups, whereas the maximal isometric plantar flexion torque and submaximal passive torque decreased. However, no significant differences were observed in the changes between the groups. Conclusion: These results indicate that despite having a lower relative stretching intensity, ballet dancers experienced similar changes as non-dancers after 5 minutes of static stretching.

Combined Effects of Static and Dynamic Stretching on the Muscle-Tendon Unit Stiffness and Strength of the Hamstrings.

ABSTRACT: Takeuchi, K, Nakamura, M, Matsuo, S, Samukawa, M, Yamaguchi, T, and Mizuno, T. Combined effects of static and dynamic stretching on the muscle-tendon unit stiffness and strength of the hamstrings. J Strength Cond Res 38(4): 681-686, 2024-Combined static and dynamic stretching for 30 seconds is frequently used as a part of a warm-up program. However, a stretching method that can both decrease muscle-tendon unit (MTU) stiffness and increase muscle strength has not been developed. The purpose of this study was to examine the combined effects of 30 seconds of static stretching at different intensities (normal-intensity static stretching [NS] and high-intensity static [HS]) and dynamic stretching at different speeds (low-speed dynamic [LD] and high-speed dynamic stretching [HD]) on the MTU stiffness and muscle strength of the hamstrings. Thirteen healthy subjects (9 men and 4 women, 20.9 ± 0.8 years, 169.3 ± 7.2 cm, 61.1 ± 8.2 kg) performed 4 types of interventions (HS-HD, HS-LD, NS-HD, and NS-LD). Range of motion (ROM), passive torque, MTU stiffness, and muscle strength were measured before and immediately after interventions by using an isokinetic dynamometer machine. In all interventions, the ROM and passive torque significantly increased (p < 0.01). Muscle-tendon unit stiffness significantly decreased in HS-HD and HS-LD (both p < 0.01), but there was no significant change in NS-HD (p = 0.30) or NS-LD (p = 0.42). Muscle strength significantly increased after HS-HD (p = 0.02) and NS-LD (p = 0.03), but there was no significant change in HS-LD (p = 0.23) or NS-LD (p = 0.26). The results indicated that using a combination of 30 seconds of high-intensity static stretching and high-speed dynamic stretching can be beneficial for the MTU stiffness and muscle strength of the hamstrings.

Acute effects of static stretching on passive stiffness in older adults: A systematic review and meta-analysis.

BACKGROUND: Static stretching has been demonstrated to improve the health of older adults. One of its goals is to decrease passive stiffness of the muscle-tendon unit (MTU) and/or muscles. Decreased passive stiffness in older adults could increase the range of motion and movement efficiency. Herein, we conducted a meta-analysis of the acute effects of static stretching on passive stiffness in older adults as well as a meta-analysis of differences in these effects between older and young adults. BACKGROUND: PubMed, Web of Science, and EBSCO were searched for studies published before June 28, 2023. Manual searches were performed to identify additional studies. All included studies were critically reviewed by five authors. Meta-analyses of muscle and tendon injuries were performed using a random effect model. Of 4643 identified studies, 6 studies were included in the systematic review. RESULTS: The main meta-analysis in older adults showed that static stretching could decrease the passive stiffness of the MTU or muscles (effect size, 0.55; 95 % confidence interval, 0.27 to 0.84; p < 0.01; and I2 = 0.0 %). Moreover, for the comparison between young and old adults, three studies were included in the meta-analysis. The results revealed no significant difference in the effects of static stretching interventions on stiffness between older and young adults (effect size, 0.136; 95 % confidence interval, -0.301 to 0.5738; p = 0.541; and I2 = 17.4 %). Static stretching could decrease the passive stiffness of the MTU and/or muscles in older adults to a small magnitude, and the effects were comparable between older and young adults.

Acute and Long-Term Effects of Static Stretching on Muscle-Tendon Unit Stiffness: A Systematic Review and Meta-Analysis.

Static stretching can increase the range of motion of a joint. Muscle-tendon unit stiffness (MTS) is potentially one of the main factors that influences the change in the range of motion after static stretching. However, to date, the effects of acute and long-term static stretching on MTS are not well understood. The purpose of this meta-analysis was to investigate the effects of acute and long-term static stretching training on MTS, in young healthy participants. PubMed, Web of Science, and EBSCO published before January 6, 2023, were searched and finally, 17 papers were included in the meta-analysis. Main meta-analysis was performed with a random-effect model and subgroup analyses, which included comparisons of sex (male vs. mixed sex and female) and muscle (hamstrings vs. plantar flexors) were also performed. Furthermore, a meta-regression was conducted to examine the effect of total stretching duration on MTS. For acute static stretching, the result of the meta-analysis showed a moderate decrease in MTS (effect size = -0.772, Z = -2.374, 95% confidence interval = -1.409 - -0.325, p = 0.018, I2 = 79.098). For long-term static stretching, there is no significant change in MTS (effect size = -0.608, Z = -1.761, 95% CI = -1.284 - 0.069, p = 0.078, I2 = 83.061). Subgroup analyses revealed no significant differences between sex (long-term, p = 0.209) or muscle (acute, p =0.295; long-term, p = 0.427). Moreover, there was a significant relationship between total stretching duration and MTS in acute static stretching (p = 0.011, R2 = 0.28), but not in long-term stretching (p = 0.085, R2 < 0.01). Whilst MTS decreased after acute static stretching, only a tendency of a decrease was seen after long-term stretching.

Effects of patterned electrical sensory nerve stimulation and static stretching on joint range of motion and passive torque.

Static stretching and proprioceptive neuromuscular facilitation stretching techniques can modulate specific neural mechanisms to improve the range of motion. However, the effects of modulation of these neural pathways on changes in the range of motion with static stretching remain unclear. Patterned electrical stimulation of the sensory nerve induces plastic changes in reciprocal Ia inhibition. The present study examined the effects of patterned electrical stimulation and static stretching on a range of motion and passive torque in plantarflexion muscles. The subjects were 14 young men (age 20.8 ± 1.3 years). The effects of patterned electrical stimulation (10 pulses at 100 Hz every 1.5 s) or uniform electrical stimulation (one pulse every 150 ms) to the common peroneal nerve for 20 min on reciprocal Ia inhibition of the Hoffman reflex (H-reflex) were examined. Reciprocal Ia inhibition was evaluated as short-latency suppression of the soleus H-reflex by conditioning stimulation of the common peroneal nerve. Then, the effects of transcutaneous electrical nerve stimulation (patterned electrical stimulation or uniform electrical stimulation) or prolonged resting (without electrical stimulation) and static 3-min stretching on the maximal dorsiflexion angle and passive torque were investigated. The passive ankle dorsiflexion test was performed on an isokinetic dynamometer. Stretch tolerance and stiffness of the muscle-tendon unit were evaluated by the peak and slope of passive torques, respectively. Patterned electrical stimulation significantly increased reciprocal Ia inhibition of soleus H-reflex amplitude (9.7 ± 6.1%), but uniform electrical stimulation decreased it significantly (19.5 ± 8.8%). The maximal dorsiflexion angle was significantly changed by patterned electrical stimulation (4.0 ± 1.4°), uniform electrical stimulation (3.8 ± 2.3°), and stretching without electrical stimulation (2.1 ± 3.3°). The increase in stretch tolerance was significantly greater after patterned electrical stimulation and uniform electrical stimulation than after stretching without electrical stimulation. Stiffness of the muscle-tendon unit was significantly decreased by patterned electrical stimulation, uniform electrical stimulation, and stretching without electrical stimulation. Transcutaneous electrical nerve stimulation and static stretching improve stretch tolerance regardless of the degree of reciprocal Ia inhibition.

Long-term static stretching can decrease muscle stiffness: A systematic review and meta-analysis.

Stretch training increases the range of motion of a joint. However, to date, the mechanisms behind such a stretching effect are not well understood. An earlier meta-analysis on several studies reported no changes in the passive properties of a muscle (i.e., muscle stiffness) following long-term stretch training with various types of stretching (static, dynamic, and proprioceptive neuromuscular stretching). However, in recent years, an increasing number of papers have reported the effects of long-term static stretching on muscle stiffness. The purpose of the present study was to examine the long-term (≥2 weeks) effect of static stretching training on muscle stiffness. PubMed, Web of Science, and EBSCO published before December 28, 2022, were searched and 10 papers met the inclusion criteria for meta-analysis. By applying a mixed-effect model, subgroup analyses, which included comparisons of sex (male vs. mixed sex) and type of muscle stiffness assessment (calculated from the muscle-tendon junction vs. shear modulus), were performed. Furthermore, a meta-regression was conducted to examine the effect of total stretching duration on muscle stiffness. The result of the meta-analysis showed a moderate decrease in muscle stiffness after 3-12 weeks of static stretch training compared to a control condition (effect size = -0.749, p < 0.001, I2 = 56.245). Subgroup analyses revealed no significant differences between sex (p = 0.131) and type of muscle stiffness assessment (p = 0.813). Moreover, there was no significant relationship between total stretching duration and muscle stiffness (p = 0.881).

Combined Static Stretching and Electrical Muscle Stimulation Induce Greater Changes in Range of Motion, Passive Torque, and Tendon Displacement Compared with Static Stretching.

The purpose of this study was to determine the combined effects of static stretching and electrical muscle stimulation on maximal dorsiflexion angle and passive properties. Sixteen healthy subjects participated in three randomly ordered experimental trials: combined static stretching and electrical muscle stimulation, static stretching alone, and control. In combined trial, subjects performed 5 min of calf stretching while receiving electrical muscle stimulation of the gastrocnemius medialis. In static stretching trial, subjects performed calf stretching only. Maximal dorsiflexion angle, passive torque, and muscle displacement were measured before and after intervention. Tendon displacement was also calculated. The difference from pre- to post-intervention in maximal dorsiflexion angle in combined trial was greater compared with that in the control (p = 0.026), but the static stretching trial exhibited no significant difference (both p > 0.05). Passive torque at submaximal dorsiflexion angles was significantly decreased only after combined trial (all p < 0.05). Muscle displacement at maximal dorsiflexion angle was significantly increased in all conditions (all p < 0.05). Tendon displacement at maximal dorsiflexion angle was higher after combined trial compared with static stretching trial (p = 0.030). These results revealed additional effects of adding electrical muscle stimulation to static stretching on maximal dorsiflexion angle, passive torque, and tendon displacement.

Effects of Speed and Amplitude of Dynamic Stretching on the Flexibility and Strength of the Hamstrings.

Dynamic stretching for more than 90 seconds is useful for improving muscle strength, although dynamic stretching for 30 seconds or less is commonly used in sports settings. The effects of dynamic stretching are influenced by the speed and amplitude of stretching, but no study examined these factors for 30 seconds of dynamic stretching. Therefore, the purpose of the present study was to examine the effects of speed (fast- or slow-speed) and amplitude (normal- or wide amplitude) of dynamic stretching for 30 seconds on the strength (peak torque during maximum isokinetic concentric contraction) and flexibility (range of motion, passive torque at maximum knee extension angle, and muscle-tendon unit stiffness) of the hamstrings. The passive torque and muscle-tendon unit stiffness reflect stretching tolerance and viscoelastic properties of the hamstrings, respectively. Fifteen healthy participants performed 4 types of 30 seconds of dynamic stretching. The muscle strength and flexibility were measured before and immediately after the dynamic stretching. The range of motion did not change after dynamic stretching at low speed and normal amplitude (p = 0.12, d = 0.59, 103.3%), but it was increased by other interventions (p < 0.01, d = 0.90-1.25, 104.5-110.1%). In all interventions, the passive torque increased (main effect for time, p < 0.01, d = 0.51 - 0.74, 111.0 - 126.9%), and muscle-tendon unit stiffness did not change. The muscle strength increased only after dynamic stretching at fast speed with normal amplitude (p < 0.01, d = 0.79, 107.1%). The results of the present study indicated that 30 seconds of dynamic stretching at fast speed and with normal amplitude can be beneficial for the measured parameters.

Effects of Dynamic Stretching Velocity on Joint Range of Motion, Muscle Strength, and Subjective Fatigue.

ABSTRACT: Mizuno, T. Effects of dynamic stretching velocity on joint range of motion, muscle strength, and subjective fatigue. J Strength Cond Res 36(9): 2440-2447, 2022-The purpose of this study was to determine the effects of 2 different dynamic stretching (DS) velocities on joint range of motion (ROM), isometric muscle strength, and subjective fatigue during DS. Fifteen healthy male subjects performed DS at 2 different velocities: maximal active ankle plantar flexion-dorsiflexion velocity (DS100) and 50% of maximal velocity (DS50). A passive dorsiflexion test and isometric maximal voluntary contractions (MVCs) of the ankle plantar flexors and dorsiflexors were performed before and after DS. During the passive dorsiflexion test, ankle ROM and passive torque were measured when the ankle was passively dorsiflexed at 1°·s -1 to its maximal ROM. The DS consisted of 4 sets of 10 ankle plantar flexions/dorsiflexions. For DS100, subjects flexed and extended their ankle as quickly as possible, whereas for DS50 the rhythm of the DS was controlled by a metronome. Subjective fatigue during DS was assessed using a visual analog scale. Maximal ankle ROM and passive torque at the maximal dorsiflexion angle were significantly increased after both DS100 and DS50 ( p < 0.05), although there was no significant difference between these trials. The passive torque at submaximal angles and the isometric MVC of the ankle plantar flexors and dorsiflexors were not changed in either condition. However, there was a greater difference in subjective fatigue from prestretching to after 4 sets after DS100 than DS50 ( p < 0.05). These results indicate that DS velocity did not influence subsequent joint flexibility. However, DS of moderate speed is recommended because faster DS seems to be associated with greater fatigue.

Mechanical factors affecting the foot eversion moment during the stance phase of running in non-rearfoot strikers.

This study aimed to identify the primary factors that induce rearfoot external eversion moments due to ground reaction force (GRF) in non-rearfoot strikers. The data were compared with those of rearfoot strikers. Totally, 11 healthy males who were habitually non-rearfoot strikers ran barefoot. Rearfoot external eversion/inversion moments due to GRF (Mtot) were decomposed into two components based on mediolateral (Mxy) and vertical (Mz) GRFs. The height of the ankle joint centre and the mediolateral distance from the centre of pressure (COP) to the ankle joint centre (a_cop) were calculated as the lever arms to the Mxy and Mz components. Just after foot contact, non-rearfoot strikers demonstrated a significantly larger Mz, which was strongly dependent on a_cop and produced most of the Mtot, whereas Mxy dominated Mtot in rearfoot strikers. During the consecutive loading phase, non-rearfoot strikers demonstrated a significantly larger Mxy, which was strongly dependent on the mediolateral GRF and substantially contributed to Mtot, unlike the rearfoot strikers, whose Mtot was almost dominated by Mz during the loading phase. It was found that since the factor of generating the moment differs depending on the foot contact pattern, the strategies for suppressing the moment may be different for each foot contact pattern.

Clipping on Crossed Wrapping Method for Ruptured Blood Blister-Like Aneurysm of the Internal Carotid Artery: Technical Note and Long-Term Results.

BACKGROUND: We have been performing the clipping on crossed wrapping (COCW) method using 2 strips of cotton on patients with an internal carotid artery blood blister-like aneurysm (IC-BLA). This method is reliable in preventing the clips from slipping off and the aneurysm walls from being damaged during clipping, and it enables more appropriate and safer clipping. Here we report the technical details of this method and the long-term outcomes of patients receiving this procedure. METHODS: Fifteen of 1275 (1.5%) patients with a ruptured cerebral aneurysm who received treatment at the Saiseikai Kumamoto Hospital during the period from January 1, 1999, to December 31, 2016, had an IC-BLA. All 15 patients were treated with COCW, except for the first patient, who was treated using a single strip of cotton. The long-term outcome of the treatment was analyzed. RESULTS: The mean follow-up period was 74 months. The first patient experienced rerupture of an aneurysm 10 days after the operation. No complications or regrowth of an aneurysm were observed in the remaining 14 patients during the follow-up period, except for 1 patient who received a reoperation for the regrowth of an aneurysm. As the final outcome, the numbers of patients with a Modified Rankin Score of 0, 3, and 6 were 13, 1, and 1, respectively. CONCLUSIONS: It is suggested that COCW is a treatment that enables safe and long-term management of lesions in IC-BLAs.

Combined Effects of Static Stretching and Electrical Stimulation on Joint Range of Motion and Muscle Strength.

Mizuno, T. Combined effects of static stretching and electrical stimulation on joint range of motion and muscle strength. J Strength Cond Res 33(10): 2694-2703, 2019-The purpose of this study was to examine the effects of the combination of static stretching (SS) and electrical stimulation (ES) for 8 weeks on joint range of motion (ROM), muscle strength, and muscle architecture. Thirty-one subjects were divided into 3 groups: the SS combined with ES (SS + ES) group, SS group, and control group. The SS + ES group performed calf stretching simultaneously with ES to the gastrocnemius medialis, whereas the SS group performed calf stretching only. The training regimen consisted of four 30-second sets of stretching, with 30-second rest intervals, 3 days per week for 8 weeks. The control group did not perform any intervention exercise. Before and after training, measurements were taken to determine the ankle ROM, plantar flexion 1 repetition maximum strength, muscle thickness, pennation angle, and circumference of the lower leg. The results showed that 8 weeks of training led to significant improvements in the ankle ROM and muscle thickness in both the SS + ES and SS groups. There were significant increases in plantar flexion 1 repetition maximum strength and pennation angle in all 3 groups. For all parameters, there was no difference between the SS + ES and SS groups. These results clarify that 8 weeks of SS improves joint ROM and muscle thickness and shows that there is no additional benefit gained by combining ES with SS in this particular training regime.

A new type of hyperplastic anterior choroidal artery.

Hyperplastic anomaly of the anterior choroidal artery (hyperplastic AchA) and posterior communicating artery of duplicate origin (duplicated Pcom) are rare vessel anomalies. With some literature review, we here report three cases of hyperplastic AchA, one of which was considered a new type of hyperplastic AchA. This case was not categorized into Takahashi classification.

Cathodal transcranial direct current stimulation over the Cz increases joint flexibility.

Joint flexibility depends on both mechanical and neural factors. However, the contribution of neural factors is not fully understood. To test the hypothesis that the sensorimotor cortex is involved in joint flexibility, we investigated whether transcranial direct current stimulation (tDCS) over the Cz modifies ankle and wrist flexibility in healthy human participants. In eight male participants, range of motion of the left ankle and wrist were measured during a passive-dorsiflexion test. We also assessed passive torque, which represents involuntary resistance to dorsiflexion at the ankle. Participants performed passive-dorsiflexion tests before and after anodal, cathodal, and sham tDCS over the Cz. The current was applied for 10min with an intensity of 2.0mA during anodal and cathodal tDCS. Cathodal tDCS resulted in a 10.5% increase in range of motion of the ankle, but no significant increase in range of motion of the wrist. Neither anodal nor sham tDCS had a significant effect. Cathodal tDCS over the Cz may have affected neural factors, such as perception of joint angle or pain, because the passive torque at 0°, 5°, 10°, and 15°, which indicates mechanical effects, did not change. These results suggest that the sensorimotor cortex is involved in joint flexibility.

Changes in joint range of motion and muscle-tendon unit stiffness after varying amounts of dynamic stretching.

The purpose of this study was to examine the effects of varying amounts of dynamic stretching (DS) on joint range of motion (ROM) and stiffness of the muscle-tendon unit (MTU). Fifteen healthy participants participated in four randomly ordered experimental trials, which involved one (DS1), four (DS4) and seven (DS7) sets of DS, or control conditions/seated at rest (CON). Each DS set consisted of 15 repetitions of an ankle dorsiflexion-plantarflexion movement. The displacement of the muscle-tendon junction (MTJ) was measured using ultrasonography while the ankle was passively dorsiflexed at 0.0174 rad · s‒1 to its maximal dorsiflexion angle. Passive torque was also measured using an isokinetic dynamometer. Ankle ROM was significantly increased after DS4 and DS7 compared with the pre-intervention values (P < 0.05), but there were no significant differences in ankle ROM between DS4 and DS7. No differences were observed in ankle ROM after DS1 and CON. In addition, the stiffness of the MTU, passive torque and displacement of the MTJ at submaximal dorsiflexion angles did not change in any of the experimental conditions. These results indicate that DS4 increased ankle ROM without changing the mechanical properties of the MTU, and that this increase in ankle ROM plateaued after DS4.

Acute vascular effects of carbonated warm water lower leg immersion in healthy young adults.

Endothelial dysfunction is associated with increased cardiovascular mortality and morbidity; however, this dysfunction may be ameliorated by several therapies. For example, it has been reported that heat-induced increases in blood flow and shear stress enhance endothelium-mediated vasodilator function. Under these backgrounds, we expect that carbon dioxide (CO2)-rich water-induced increase in skin blood flow improves endothelium-mediated vasodilation with less heat stress. To test our hypothesis, we measured flow-mediated dilation (FMD) before and after acute immersion of the lower legs and feet in mild warm (38°C) normal or CO2-rich tap water (1000 ppm) for 20 min in 12 subjects. Acute immersion of the lower legs and feet in mild warm CO2-rich water increased FMD (P < 0.01) despite the lack of change in this parameter upon mild warm normal water immersion. In addition, FMD was positively correlated with change in skin blood flow regardless of conditions (P < 0.01), indicating that an increase in skin blood flow improves endothelial-mediated vasodilator function. Importantly, the temperature of normal tap water must reach approximately 43°C to achieve the same skin blood flow level as that obtained during mild warm CO2-rich water immersion (38°C). These findings suggest that CO2-rich water-induced large increases in skin blood flow may improve endothelial-mediated vasodilator function while causing less heat stress.

Stretching-induced deficit of maximal isometric torque is restored within 10 minutes.

The purpose of this study was to clarify the time course of the stretching-induced decrease in maximal isometric plantar flexion torque. Nineteen women participated in 2 randomly ordered experimental trials: static 5-minute stretching or control with no stretching. The participants performed isometric maximal voluntary contractions (MVCs) of the right plantar flexor muscles, whereas electromyographic (EMG) amplitude (root mean square) was calculated for the medial and lateral gastrocnemius muscles. Measurements were conducted preintervention; immediately after intervention; and 5, 10, 15, and 30 minutes postintervention. The static 5-minute stretching trial consisted of dorsiflexion to the end range of motion and holding that position for 1 minute, 5 times, whereas the control trial consisted of 5 minutes of resting. As a result, the MVC torque was significantly decreased immediately after, and 5 minutes after the static 5-minute stretching intervention compared with the preintervention value (p < 0.05), and this change recovered within 10 minutes. However, the EMG amplitude did not change from preintervention to postintervention under any conditions. These results suggest that the deficits of static stretching are disabled in a short time after static stretching.

Preoperative cellulose porous beads for therapeutic embolization of meningioma: provocation test and technical considerations.

INTRODUCTION: Cellulose porous beads (CPBs) are exceptionally uniform in size and nonabsorbable and they provide highly effective tumor devascularization. The risk of cranial nerve palsy must not be overlooked when embolization with CPBs is considered in meningioma patients. We attempted to identify patients at risk of cranial nerve palsy after meningioma embolization. METHODS: Prior to preoperative superselective embolization with 200 mum diameter CPBs, 141 patients with meningioma underwent provocation test with lidocaine and amytal. They were divided into two groups on the basis of whether they were or were not considered eligible for embolization. We evaluated the differences between the two groups with respect to tumor anatomy, angiographic findings, and clinical presentation and recorded complications associated with the embolization of the meningioma. RESULTS: Of the 141 patients, 128 underwent CPB embolization (group 2); 13 were not embolized because their provocation test results were positive (group 1, n = 11) or because they showed vasospasm (n = 2). Group 1 patients had meningioma in the cavernous sinus or petroclival region. Characteristically, the feeders were of middle meningeal artery origin and exhibited a posteromedial course toward the petrous apex or cavernous sinus. In group 2 patients the middle meningeal artery was the feeder, but it lacked branches coursing posteromedially. Three of these patients experienced complications which included intratumoral hemorrhage (n = 2) and post-embolization hearing disturbance (n = 1). CONCLUSION: Patients with meningioma whose tumor-feeding arteries run posteromedially toward the petrous apex or cavernous sinus are at increased risk of post-embolization cranial nerve palsy. Appropriate protocols, including lidocaine and amytal provocation tests, may reduce the risk of complications after CPB embolization of the external carotid territory in this group of patients.

Treatment strategy for giant aneurysms in the cavernous portion of the internal carotid artery.

BACKGROUND: As direct surgery to treat giant aneurysms of the ICA is difficult, ICA occlusion is the conventional treatment in patients with BTO tolerance. To determine whether bypass surgery should be performed after carotid occlusion by trapping or proximal occlusion, we developed a treatment strategy that includes BTO and SPECT. METHODS: We report 19 patients with symptomatic giant aneurysms in the cavernous portion of ICA. The appropriate type of bypass surgery was determined by the results of BTO and SPECT. The type of ICA occlusion selected was based on the evaluation of retrograde filling of the aneurysm during BTO. RESULTS: In all 19 patients, the ICA was sacrificed; 10 patients also underwent bypass surgery (low-flow bypass with STA-MCA anastomosis, n = 7; medium-flow bypass with radial artery graft, n = 2; high-flow bypass with vein graft, n = 1). Coil trapping was performed in 11 patients; proximal occlusion in 8. In 18 patients, there were no ischemic complications after treatment; 1 patient who had been treated by proximal ICA occlusion developed transient ischemia due to an intra-aneurysmal thrombus. Cranial nerve palsies were improved in 16 patients. CONCLUSIONS: Based on our experience, we recommend that patients with giant aneurysms in the cavernous portion of the ICA be evaluated by BTO and SPECT. In conjunction with bypass surgery, ICA trapping or proximal occlusion constitutes an effective treatment strategy.

Arteriovenous fistulas at the cervicomedullary junction presenting with subarachnoid hemorrhage: six case reports with special reference to the angiographic pattern of venous drainage.

BACKGROUND AND PURPOSE: Cases with spinal perimedullary arteriovenous fistulas (SPAVFs) or spinal dural arteriovenous fistulas (SDAVFs) at the cervicomedullary junction are rare. We performed a retrospective, angiographic study of 6 such patients to assess whether available angiographic data were predictive of the risk for hemorrhage. METHODS: We report 6 patients with arteriovenous fistulas at the cervicomedullary junction. All presented with subarachnoid hemorrhage (SAH). Angiography demonstrated that 4 of the 6 fistulas were SDAVFs fed by the meningeal branch of the vertebral artery; the other 2 were SPAVFs fed by the anterior spinal artery. Drainage was via the perimedullary vein of the cervicomedullary junction. RESULTS: An ascending venous route into the intracranial sinus was recognized in all 6 cases; in 3 the draining system contained varices. In 2 cases, the venous route was on the ventral side of the brain stem with drainage into the cavernous sinus. In 4 cases, the venous route was lateral at the brain stem with drainage into the inferior petrosal sinus. CONCLUSION: SPAVFs and SDAVFs at the cervicomedullary junction that manifest an ascending venous route into the intracranial sinus present an increased risk for SAH.