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1.
World Neurosurg ; 136: e447-e459, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31953092

RESUMO

OBJECTIVE: To review the microsurgical anatomy of the donor arteries for extracranial-intracranial bypass, namely, the superficial temporal artery (STA), occipital artery (OA), and internal maxillary artery (IMA). METHODS: Seven cadaveric specimens were dissected to identify the relationships between each artery and its surrounding structures. Nineteen computed tomographic angiographic images of Japanese adult patients (38 sides) were analyzed to examine the course of each artery and to measure the diameters and distances from various anatomic landmarks to each artery. RESULTS: The courses of the STA, OA, and IMA, which must be exposed during revascularization procedures, were shown via cadaver dissection with special reference to the following relationships to surrounding structures: STA, soft tissue layers of the temporoparietal region and facial nerve; OA, suboccipital muscles; and IMA, mandibular nerve. In addition, we measured the diameter of the anastomotic site for each artery and its relationship with surrounding muscles. CONCLUSIONS: A precise understanding of the anatomic characteristics of the donor arteries and their relationships with surrounding structures provides safe access to these arteries.


Assuntos
Artérias Cerebrais/anatomia & histologia , Idoso , Anastomose Cirúrgica , Pontos de Referência Anatômicos , Prótese Vascular , Cadáver , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/cirurgia , Revascularização Cerebral , Angiografia por Tomografia Computadorizada , Dissecação/métodos , Humanos , Masculino , Artéria Maxilar/anatomia & histologia , Artéria Maxilar/diagnóstico por imagem , Artéria Maxilar/cirurgia , Pessoa de Meia-Idade , Artérias Temporais/anatomia & histologia , Artérias Temporais/diagnóstico por imagem , Artérias Temporais/cirurgia , Doadores de Tecidos
3.
World Neurosurg ; 128: 532-540, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30974277

RESUMO

Cerebral revascularization is used in the treatment of complex aneurysms and acute and chronic cerebral occlusive disease. Although superficial temporal artery-middle cerebral artery remains the workhorse of extracranial-intracranial bypass, several approaches have been developed during the past half century. The maxillary artery has shown feasibility in cadaveric studies, and usefulness in living patients, for achieving successful surgical revascularization. Although technically challenging and unfamiliar, maxillary-intracranial bypass offers the advantages of higher flow, good caliber matching, shorter graft length, calvarial protection of the interposition graft, and versatility for revascularizing multiple intracranial targets, including the intracranial internal carotid, proximal and middle cerebral, posterior cerebral, and superior cerebellar arteries. We discuss and review the evolution of, operative approaches for, and clinical applications of maxillary artery to intracranial bypass.


Assuntos
Revascularização Cerebral/métodos , Artéria Maxilar/cirurgia , Humanos
4.
Acta Neurochir (Wien) ; 161(6): 1183-1189, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30968180

RESUMO

Serpentine aneurysms of the posterior cerebral artery (PCA) treated by the internal maxillary artery (IMA) bypass are rare. Here, the authors report the case of a 34-year-old male patient who presented with a half-year history of gradual severe headache and right-sided limb monoparesis and paresthesia lasting for 1 week. Preoperative angiograms showed a serpentine aneurysm in the left distal PCA, which was treated with internal maxillary artery-radial artery-posterior cerebral artery (IMA-RA-PCA) bypass followed by parent artery occlusion (PAO). The postoperative course was uneventful; radiological images revealed that the aneurysm disappeared, and there was good graft patency and excellent perfusion of the distal PCA territories. To the authors' knowledge, this is the first and only case of distal PCA serpentine aneurysm to be treated by IMA-RA-PCA bypass followed by proximal PAO. These findings suggest that IMA bypass surgery is a good and feasible treatment option for serpentine aneurysms of the PCA that can preserve the parent artery. Moreover, the anatomic segments of the PCA and different treatment options available for PCA serpentine aneurysms are also discussed in this study.


Assuntos
Revascularização Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Enxerto Vascular/métodos , Adulto , Angiografia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Artéria Maxilar/cirurgia , Artéria Cerebral Posterior/cirurgia , Artéria Radial/cirurgia , Radiografia
5.
Am J Case Rep ; 20: 562-566, 2019 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-31005959

RESUMO

BACKGROUND Pseudomonal infection is the most common cause of malignant otitis externa (MOE), which typically affects elderly diabetic patients. Fungi are a rare cause of MOE. MOE can be life-threatening if not recognized and treated promptly. It can result in a wide spectrum of complications, including skull-base osteomyelitis, cranial nerve palsy, cerebral venous thrombosis, and brain abscess. Pseudoaneurysm formation of the intracranial vessels is a life-threatening complication of MOE that is seldom reported in the literature. CASE REPORT We report the case of a 66-year-old diabetic man with MOE who was initially treated with antipseudomonal antibiotics after negative initial culture results. His MOE resulted in a cascade of complications, including facial nerve palsy, skull base osteomyelitis, and sigmoid sinus thrombosis, and culminated in left maxillary artery pseudoaneurysm formation resulting in massive epistaxis and hemodynamic instability. Endovascular embolization resulted in a successful obliteration of the pseudoaneurysm. A subsequent functional endoscopic sinus surgical (FESS) tissue biopsy confirmed Candida glabrata as the etiological agent. The patient was successfully treated with antibiotics and antifungal and anticoagulation therapy, and was discharged home in good condition. CONCLUSIONS A high index of suspicion for the diagnosis of fungal MOE, particularly in intractable cases of MOE with negative initial cultures, should be maintained. Pseudoaneurysm formation is a life-threatening complication of MOE that is seldom reported in the literature and should be suspected in any patient with MOE who presents with epistaxis or intracranial bleeding.


Assuntos
Falso Aneurisma/cirurgia , Endoscopia/métodos , Artéria Maxilar/cirurgia , Otite Externa/patologia , Infecções por Pseudomonas/complicações , Idoso , Falso Aneurisma/diagnóstico por imagem , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Embolização Terapêutica/métodos , Epistaxe/etiologia , Epistaxe/patologia , Humanos , Masculino , Artéria Maxilar/fisiopatologia , Otite Externa/etiologia , Otite Externa/fisiopatologia , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/tratamento farmacológico , Medição de Risco , Resultado do Tratamento
6.
Neurosurg Focus ; 46(2): E10, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30717068

RESUMO

OBJECTIVEThe rapid innovation of the endovascular armamentarium results in a decreased number of indications for a classic surgical approach. However, a middle cerebral artery (MCA) aneurysm remains the best example of one for which results have favored microsurgery over endovascular intervention. In this study, the authors aimed to evaluate the experience and efficacy regarding surgical outcomes after applying internal maxillary artery (IMA) bypass for complex MCA aneurysms (CMCAAs).METHODSAll IMA bypasses performed between January 2010 and July 2018 in a single-center, single-surgeon practice were screened.RESULTSIn total, 12 patients (9 males, 3 females) with CMCAAs managed by high-flow IMA bypass were identified. The mean size of CMCAAs was 23.7 mm (range 10-37 mm), and the patients had a mean age of 31.7 years (range 14-56 years). The aneurysms were proximally occluded in 8 cases, completely trapped in 3 cases, and completely resected in 1 case. The radial artery was used as the graft vessel in all cases. At discharge, the graft patency rate was 83.3% (n = 10), and all aneurysms were completely eliminated (83.3%, n = 10) or greatly diminished (16.7%, n = 2) from the circulation. Postoperative ischemia was detected in 2 patients as a result of graft occlusion, and 1 patient presenting with subarachnoid hemorrhage achieved improved modified Rankin Scale scores compared to the preoperative status but retained some neurological deficits. Therefore, neurological assessment at discharge showed that 9 of the 12 patients experienced unremarkable outcomes. The mean interval time from bypass to angiographic and clinical follow-up was 28.7 months (range 2-74 months) and 53.1 months (range 19-82 months), respectively. Although 2 grafts remained occluded, all aneurysms were isolated from the circulation, and no patient had an unfavorable outcome.CONCLUSIONSThe satisfactory result in the present study demonstrated that IMA bypass is a promising method for the treatment of CMCAAs and should be maintained in the neurosurgical armamentarium. However, cases with intraoperative radical resection or inappropriate bypass recipient selection such as aneurysmal wall should be meticulously chosen with respect to the subtype of MCA aneurysm.


Assuntos
Revascularização Cerebral/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Artéria Maxilar/diagnóstico por imagem , Artéria Maxilar/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
J Craniofac Surg ; 30(1): 137-140, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30480638

RESUMO

Ligation of the sphenopalatine and posterior nasal arteries is indicated for posterior epistaxis as initial treatment or when conservative measures fail. In some patients, a transnasal approach or its alternative transantral approach are not possible due to tumor filling the nasal corridor, pterygopalatine fossa, or maxillary sinus. Aim of this study was to evaluate feasibility of endoscopically assisted transoral approach for the ligation of the maxillary artery (MA). Six fresh cadaver specimens (12 sides), previously prepared with intravascular injections of colored latex, were dissected. A combined transnasal and transoral approach exposed the MA from the deep belly of the temporalis muscle laterally to its terminal branches medially. Anatomical relationships of the MA with the deep belly of the temporalis muscle and the lower head of the lateral pterygoid muscle, and feasibility of access to the MA via a transoral approach were assessed. In all specimens, the MA was found at the point where horizontal fibers of the lower head of the lateral pterygoid muscle cross the vertical fibers of the deep belly of the temporalis muscle. In 5 specimens, the artery ran anteriorly and laterally to lower head of the lateral pterygoid muscle, and in 1 specimen, it ran posteriorly and medially to this muscle, diving between its fibers. The modified endoscopically assisted transoral approach is feasible to ligate the MA. It can be used for proximal vascular control in cases when transnasal and transantral approaches are not viable.


Assuntos
Angiofibroma/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Condrossarcoma/cirurgia , Endoscopia/métodos , Neoplasias de Cabeça e Pescoço/cirurgia , Artéria Maxilar/anatomia & histologia , Artéria Maxilar/cirurgia , Músculos Pterigoides/anatomia & histologia , Músculo Temporal/anatomia & histologia , Adolescente , Pontos de Referência Anatômicos , Cadáver , Estudos de Viabilidade , Feminino , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Boca , Fossa Pterigopalatina
8.
World Neurosurg ; 122: 58, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30347305

RESUMO

Although the extracranial-to-intracranial bypass has been widely used for 5 decades, the substantive modification in this technique has rarely presented except for the internal maxillary artery (IMaxA) bypass. Recently, the IMaxA bypass has been redefined as the new "workhorse" for high-flow arterial reconstruction and replaced the cervical artery bypass as the results of sparing second incision, short graft harvesting, and well-matched caliber between donor and recipient. This video demonstrates a 37-year-old female who presented with a 1-month history of severe headache. Her complex middle cerebral artery (MCA) aneurysm was treated by IMaxA bypass with radial artery graft. Preoperative neuroimaging revealed a giant, fusiform, thrombosed aneurysm that extensively involved the sphenoidal (M1) and insular (M2) segments of the MCA. After a multidisciplinary discussion, the reversal high-flow IMaxA bypass was performed, followed by proximal MCA occlusion. We approached the aneurysm using a frontotemporal craniotomy with zygomatic osteotomy to expose the pterygoid segment of IMaxA (IM2), which is defined as the "SHI" IMaxA bypass method. Simultaneously, the radial artery graft was harvested and prepared before being anastomosed in an end-to-end fashion to the IM2 using No. 9-0 polypropylene. The free end of the RAG was then brought to the sylvian fissure and anastomosed to the M2 in an end-to-side manner. The proximal part of M1 after the bypass takeoff was then occluded with a permanent aneurysm clip (Aesculap Instruments Corp., Tuttlingen, Germany). Complete elimination of the aneurysm with a patent graft artery was observed postoperatively, and the patient was discharged with intact neurologic function (modified Rankin Scale score 0).


Assuntos
Aneurisma Intracraniano/cirurgia , Artéria Maxilar/cirurgia , Artéria Cerebral Média/cirurgia , Adulto , Craniotomia , Feminino , Humanos , Artéria Radial/transplante
9.
Auris Nasus Larynx ; 46(2): 306-310, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29980404

RESUMO

Juvenile nasopharyngeal angiofibroma (JNA) is a hypervascular tumor and uncontrolled hemorrhage makes its removal very difficult. Although preoperative intravascular embolization of a feeding artery is recommended, serious complications such as iatrogenic thrombosis in the brain and insufficient decrease in blood flow to the tumor are concerns. Recently, coblation plasma technology has been reported to be useful for tumor removal with minimum hemorrhage under a clear surgical field. Here we report successful removal of advanced JNA without preoperative embolization, using intraoperative ligation of the maxillary artery and coblation plasma technology. The left nasal cavity of a 23-years-old man was closed by a JNA tumor at Radkowski stage IIC, which was 65mm in size and extended from the nasal cavity to the infratemporal fossa. MRA imaging showed the maxillary artery running along the posterior wall of the maxillary sinus. Therefore, the maxillary artery was first clipped using an endoscopic modified medial maxillectomy (EMMM) approach and endoscopic endonasal en bloc resection of the tumor was then completed using coblation technology with no need for blood transfusion. This case illustrates that preoperative embolization is dispensable in JNA surgery even at Stage IIC if the maxillary artery can be ligated during surgery and a coblation device can be utilized.


Assuntos
Técnicas de Ablação/métodos , Angiofibroma/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Artéria Maxilar/cirurgia , Neoplasias Nasofaríngeas/cirurgia , Gases em Plasma , Angiofibroma/irrigação sanguínea , Angiofibroma/patologia , Angiografia por Tomografia Computadorizada , Humanos , Ligadura , Masculino , Neoplasias Nasofaríngeas/irrigação sanguínea , Neoplasias Nasofaríngeas/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
Oper Neurosurg (Hagerstown) ; 16(1): 37-44, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29688445

RESUMO

BACKGROUND: The nasoseptal flap is the main pedicled flap used for endoscopic cranial base reconstruction. For large anterior cranial base defects, the anterior edge is a concern for the nasoseptal flap reach. OBJECTIVE: To present a surgical technique that completely releases the vascular pedicle of the nasoseptal flap from the sphenopalatine artery (SPA) foramen improving considerably the reach of the flap. METHODS: A patient with left anterior cranial base fracture involving the posterior table of the frontal sinus, who presented with cerebrospinal fluid leak and contused brain herniation to the ethmoid and frontal sinuses. Unilateral endoscopic endonasal anterior cranial base reconstruction was performed with left sided nasoseptal flap. The nasoseptal flap pedicle was dissected and completely released from the SPA foramen. The flap was left attached only to the internal maxillary artery (IMAX) vascular bundle. RESULTS: The flap covered the entire left anterior cranial base, from the planum sphenoidale to the posterior table of the frontal sinus. There was complete obliteration of the cerebrospinal fluid fistula postoperatively with resolution of the radiographic pneumocephalus and the patient's rhinorrhea. CONCLUSION: The complete release of the nasoseptal flap pedicle from the SPA foramen is feasible and remarkably improves the reach of the flap. It also increases the reconstructive area of the flap since the entire septal mucosa can be used for reconstruction and the pedicle length is based exclusively upon the SPA/IMAX.


Assuntos
Vazamento de Líquido Cefalorraquidiano/cirurgia , Artéria Maxilar/cirurgia , Septo Nasal/cirurgia , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fraturas Cranianas/cirurgia , Retalhos Cirúrgicos , Acidentes de Trânsito , Vazamento de Líquido Cefalorraquidiano/etiologia , Dissecação , Humanos , Masculino , Base do Crânio/cirurgia , Fraturas Cranianas/complicações , Adulto Jovem
12.
Oper Neurosurg (Hagerstown) ; 16(1): 79-85, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29660062

RESUMO

BACKGROUND: The maxillary artery (MA) has been described as a reliable donor for extracranial-intracranial high-flow bypass. Existing techniques to harvest MA require brain retraction and drilling of the middle fossa (with or without a zygomatic osteotomy), carrying the potential risks of venous bleeding, injury to the branches of the maxillary or mandibular nerves, muscular transection, or temporomandibular junction disorders. OBJECTIVE: To describe a novel technique to expose the MA without bony drilling and with minimal impact to surrounding structures. METHODS: A conventional curvilinear incision was performed in 10 cadaveric specimens, prior to elevating the scalp to expose the zygomatic root and lateral orbital rim. The sphenozygomatic suture was followed to the anterolateral edge of the inferior orbital fissure (IOF) to locate and harvest the pterygoid segment of the MA. Topographic anatomy was assessed using surrounding landmarks and 3D Cartesian coordinates to define the surgical area. The number of visible MA branches and their lengths were recorded. RESULTS: The MA was successfully exposed in all specimens. This approach allowed 6 branches of MA to be exposed. The average length of exposure was 23.3 ± 8.3 mm and the average surgical area was 2.8 ± 0.9 cm2. The IOF was 11.5 ± 4.2 mm from the MA. CONCLUSION: Our technique provides landmarks to identify the distal pterygoid segment of MA as a donor for extracranial-intracranial bypasses without the need for additional craniectomies. Clear anatomical landmarks, including the sphenozygomatic suture, anterolateral edge of IOF, infraorbital artery, and the pterygomaxillary fissure defined a trajectory to efficiently localize the MA with minimal risk to surrounding structures.


Assuntos
Revascularização Cerebral/métodos , Fossa Infratemporal/cirurgia , Artéria Maxilar/cirurgia , Procedimentos Neurocirúrgicos/métodos , Cadáver , Humanos
13.
World Neurosurg ; 120: e503-e510, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30149162

RESUMO

BACKGROUND: The internal maxillary artery (IMA) is a reliable donor for extracranial-intracranial high-flow bypasses. However, previously described landmarks and techniques to harvest the IMA are complex and confusing and require extensive bone drilling, carrying significant neurovascular risk. The objective of our study was to describe a minimally invasive technique for exposing the IMA and to assess the feasibility of using the IMA as a donor for anterior-circulation recipient vessels using 2 different local interposition vessels. METHODS: Via a minimally invasive technique, the IMA was harvested in 10 cadaveric specimens and a pterional craniotomy was performed. Two interposition grafts-the superficial temporal artery (STA) and middle temporal artery-were evaluated individually. Transsylvian exposure of the second segment of middle cerebral artery (M2), the supraclinoid internal carotid artery, and the proximal postcommunicating anterior cerebral artery segment was completed. Relevant vessel calibers and graft lengths were measured for each bypass model. RESULTS: The mean caliber of the IMA was 2.7 ± 0.5 mm. Of all 3 recipients, the shortest graft length was seen in the IMA-STA-M2 bypass, measuring 42.0 ± 8.4 mm. There was a good caliber match between the M2 (2.4 ± 0.4 mm) and STA (2.3 ± 0.4 mm) at the anastomotic site. The harvested middle temporal artery was sufficient in length in only 30% cases, with a mean distal caliber of 2.0 ± 0.7 mm. CONCLUSIONS: This study confirmed the technical feasibility of IMA as a donor for an extracranial-intracranial bypass to the second segment of the anterior cerebral artery, M2, and the supraclinoid internal carotid artery. However, IMA-STA-M2 was observed to be the most suitable bypass model.


Assuntos
Artéria Cerebral Anterior/anatomia & histologia , Artéria Cerebral Anterior/cirurgia , Vasos Sanguíneos/transplante , Revascularização Cerebral/métodos , Artéria Maxilar/anatomia & histologia , Artéria Maxilar/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Anastomose Cirúrgica , Cadáver , Craniotomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artérias Temporais/anatomia & histologia , Artérias Temporais/cirurgia , Artérias Temporais/transplante
15.
Am J Rhinol Allergy ; 32(3): 188-193, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29676168

RESUMO

Background Transnasal endoscopic sphenopalatine artery ligation (TESPAL) and selective embolization both provide excellent treatment success rate in the management of intractable epistaxis. Few long-term studies comparing these approaches have been previously published. Recommendations often present these techniques as alternatives, but there is no clear consensus. Objective The purpose of this study was to evaluate and compare the clinical efficacy of sphenopalatine artery ligation versus embolization to control intractable epistaxis. Methods We performed a retrospective study including all patients referred to our tertiary medical center for severe epistaxis and treated by surgical ligation and/or embolization. The patients were classified into 2 groups: those who underwent TESPAL only and those who underwent endovascular embolization only. We evaluate and compare long-term clinical outcomes after surgical ligation or embolization for the control of intractable epistaxis in terms of effectiveness (recurrence rate) and safety (complication rate). Results Forty-one procedures of supraselective embolization and 39 procedures of surgical ligation for intractable epistaxis are reported and analyzed. No significant difference was observed between the groups in terms of demographic factors, comorbidities, or average length of hospital stay. The 1-year success rate was similar (75%) in both groups. Complications (minor and/or major) occurred in 34% cases in the embolization group and in 18% in the surgical group ( P = .09, ns). Bilateral embolization including facial artery was the only treatment method associated with a significant risk of complications ( P = .015). Conclusion TESPAL seems to provide a similar control rate with a decrease in the number of complications compared to selective embolization in the context of intractable epistaxis. Further studies are required.


Assuntos
Embolização Terapêutica , Endoscopia , Epistaxe/terapia , Artéria Maxilar/cirurgia , Seio Esfenoidal/irrigação sanguínea , Idoso , Embolização Terapêutica/efeitos adversos , Seguimentos , Humanos , Ligadura/efeitos adversos , Recidiva , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
17.
World Neurosurg ; 113: 320-332, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29524709

RESUMO

Internal maxillary artery (IMA) bypass has gained momentum in the last 5 years for the treatment of complex cerebrovascular disorders and skull base tumors. However, some issues regarding this treatment modality have been proposed. As one of the most experienced neurosurgical teams to perform internal maxillary artery bypass in the world (>100 clinical cases), we reviewed the literature in aspects of basic anatomy of maxillary artery with its variations to the lateral pterygoid muscle, initial anastomosis modalities, and subsequent exposure techniques in cadaver studies, preoperative arterial evaluation methods, optimal interposed graft selections, and surgical outcome in the management of complex aneurysms, skull base tumors, and steno-occlusive disorders.


Assuntos
Revascularização Cerebral/métodos , Transtornos Cerebrovasculares/cirurgia , Artéria Maxilar/cirurgia , Neoplasias da Base do Crânio/cirurgia , Revascularização Cerebral/tendências , Transtornos Cerebrovasculares/diagnóstico , Humanos , Artéria Maxilar/patologia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Neoplasias da Base do Crânio/diagnóstico , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/tendências
18.
J Neurointerv Surg ; 10(11): 1085-1091, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29444961

RESUMO

INTRODUCTION: Mechanical thrombectomy (MT) has been widely accepted as a safe and effective treatment for acute ischemic stroke (AIS). Development of stent retriever devices has been intensively developed over the past two decades. In this study, we compared the effectiveness and safety of a new thrombectomy device with Solitaire FR for the treatment of AIS models. METHODS: Mechanical performance of stent retrievers was tested in vitro. Thrombin-induced thrombus was pre-injected into the right distal external carotid-maxillary artery in 18 dogs to create an acute thrombus occlusion model, and these animals were divided into a Tonbridge group (n=9, with Tonbridge stent Tonbridge Medical Technology) and a Solitaire group as control (n=9, with Solitaire stent, ev3 Neurovascular). Final flow restoration, side branches, recanalization time, distal vessel embolism, and device-related complications were recorded and compared. A post-procedure angiogram was obtained at 30 and 90 days after thrombectomy. Device manipulation-related damage to the arterial walls was evaluated histologically. RESULTS: In vitro test showed that the maximum friction within the microcatheter was 0.763 for the Tonbridge device and 0.784 n for the Solitaire (P>0.05). Slight increase in radial force was noticed for the Tonbridge (0.035 N/mm vs 0.031 N/mm of Solitaire, P>0.05). Eighteen and 16 retriever attempts were done in the Tonbridge (mean 2.0 attempts) and the Solitaire (mean 1.8 attempts) groups (P=0.74). The Tonbridge device led to good flow restoration in all nine (100%) models compared with eight (88.9%) in the Solitaire group (P=0.30). Side branches' influence (P=0.39), distal thromboembolism (P=0.60), and device-related complications (P=1.00) found no difference between the two groups. The rates of disruption of the internal elastic lamina (IEL) were 8.3% (2/24) and 4.2% (1/24) of the specimens, respectively (P=0.683). TICI 2b/3 flow of the right CCA were similar between the two groups at 1 (6/6 vs 6/6) and 3 months (6/6 vs 6/6) follow-up (P>0.05). CONCLUSION: Our preliminary study indicated this new device was technically feasible and effective to be used in thrombectomy for the treatment of acute thrombus occlusion in canine models.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Externa/cirurgia , Artéria Maxilar/cirurgia , Stents Metálicos Autoexpansíveis , Trombectomia/métodos , Trombose/cirurgia , Animais , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/cirurgia , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Externa/diagnóstico por imagem , Cães , Humanos , Artéria Maxilar/diagnóstico por imagem , Stents Metálicos Autoexpansíveis/normas , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia/instrumentação , Trombectomia/normas , Trombose/diagnóstico por imagem , Resultado do Tratamento
19.
Rhinology ; 56(2): 144-148, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29292416

RESUMO

OBJECTIVE: Analysis of the efficacy of sphenopalatine artery (SPA) and internal maxillary artery (IMAX) ligation within the pterygopalatine fossa to control posterior epistaxis. METHODS: Demographic and clinical data were collected in sixty-two consecutive patients who had SPA/IMAX ligation surgery. Clinical outcomes such as re-bleed rates and complications were acquired. RESULTS: A total of 62 patients were studied. Thirty-eight percent of patients had previously undergone silver nitrate nasal cautery for epistaxis. Nine patients had undergone previous attempt of SPA procedure or embolization in other services. Two patients returned to the operating room for anterior ethmoid ligation. There was one mortality within 30 days of surgery. Follow up ranged from 3 months to 56 months (median= 28 months). CONCLUSIONS: Dual SPA and IMAX ligation is effective in the control of difficult epistaxis cases, even in those patients with prior surgical intervention.


Assuntos
Epistaxe/cirurgia , Ligadura/métodos , Artéria Maxilar/cirurgia , Fossa Pterigopalatina/irrigação sanguínea , Procedimentos Cirúrgicos Vasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde
20.
Br J Neurosurg ; 32(4): 412-417, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29191051

RESUMO

OBJECTIVE: To evaluate the preoperative diagnostic value of duplex ultrasonography in moyamoya spontaneous anastomosis of combined revascularization donor vessels in adults. METHODS: A total of 99 preoperative adult patients who underwent superficial temporal artery-to-middle cerebral artery (STA-MCA) anastomosis were retrospectively analyzed. Each side of the cerebral hemisphere was examined as a separate procedure. A total of 198 cerebral hemispheres were divided into three groups: a collateral, non-collateral, and control group based on digital subtraction angiography (DSA). Hemodynamic parameters, including peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) were analyzed. RESULTS: There were only four of cases (5%, 4/198) of STA spontaneous anastomosis, whereas those of maxillary artery (MA) anastomosis were 44 (23.7%, 44/186). Compared with the control group, MA PSV and EDV of the collateral group increased significantly, while RI decreased significantly (p < .05). The area under the curve (AUC) of MA RI was 0.654. As a predictor of MA spontaneous anastomosis, duplex ultrasonography had high specificity but poor sensitivity. In collateral group, PSV and EDV detected two weeks post-surgery were significantly higher than those detected pre-operatively (PSV: p = .018, EDV: p = .025). By contrast, there were no significant difference of the PSV and EDV detected six months post-surgery compared with pre-operation (PSV: p = .450, EDV: p = .099). Additionally, MA RI in two weeks after the surgery was comparable with preoperative values. CONCLUSIONS: Duplex ultrasonography could be applied to evaluate the adult moyamoya spontaneous anastomoses of MA preoperatively. Despite its poor sensitivity, this diagnostic modality is still reliable and specific. STA-MCA anastomosis combined with EDMS did not affect MA pre-operative spontaneous anastomosis.


Assuntos
Anastomose Cirúrgica/métodos , Revascularização Cerebral/métodos , Doença de Moyamoya/diagnóstico por imagem , Doença de Moyamoya/cirurgia , Procedimentos Neurocirúrgicos/métodos , Cuidados Pré-Operatórios/métodos , Adulto , Idoso , Angiografia Digital , Feminino , Hemodinâmica , Humanos , Masculino , Artéria Maxilar/cirurgia , Pessoa de Meia-Idade , Artéria Cerebral Média/cirurgia , Estudos Retrospectivos , Artérias Temporais/cirurgia , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Resistência Vascular
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