Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 538
Filtrar
1.
Stroke ; 51(7): 2051-2057, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32568647

RESUMO

BACKGROUND AND PURPOSE: To evaluate outcome and safety of endovascular treatment beyond 6 hours of onset of ischemic stroke due to large vessel occlusion in the anterior circulation, in routine clinical practice. METHODS: From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke of known onset beyond 6 hours. Additional inclusion criteria were prestroke modified Rankin Scale score ≤2 and ASPECTS score ≥6. Patients were selected on individual basis by a combination of CT perfusion mismatch (difference between total hypoperfusion and infarct core sizes) and CT collateral score. The primary outcome measure was the score on modified Rankin Scale at 90 days. Safety outcomes were 90-day mortality and the occurrence of symptomatic intracranial hemorrhage. Data were compared with those from patients treated within 6 hours. RESULTS: Out of 3057 patients, 327 were treated beyond 6 hours. Their mean age was 66.8±14.9 years, the median baseline National Institutes of Health Stroke Scale 16, and the median onset to groin puncture time 430 minutes. The most frequent site of occlusion was middle cerebral artery (45.1%). Functional independence (90-day modified Rankin Scale score, 0-2) was achieved by 41.3% of cases. Symptomatic intracranial hemorrhage occurred in 6.7% of patients, and 3-month case fatality rate was 17.1%. The probability of surviving with modified Rankin Scale score, 0-2 (odds ratio, 0.58 [95% CI, 0.43-0.77]) was significantly lower in patients treated beyond 6 hours as compared with patients treated earlier No differences were found regarding recanalization rates and safety outcomes between patients treated within and beyond 6 hours. There were no differences in outcome between people treated 6-12 hours from onset (278 patients) and those treated 12 to 24 hours from onset (49 patients). CONCLUSIONS: This real-world study suggests that in patients with large vessel occlusion selected on the basis of CT perfusion and collateral circulation assessment, endovascular treatment beyond 6 hours is feasible and safe with no increase in symptomatic intracranial hemorrhage.


Assuntos
Isquemia Encefálica/cirurgia , Hemorragias Intracranianas/cirurgia , Acidente Vascular Cerebral/cirurgia , Trombectomia , Idoso , Angiografia Cerebral/métodos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Artéria Cerebral Média/cirurgia , Trombectomia/métodos , Fatores de Tempo
2.
Seizure ; 80: 53-55, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32540636
3.
World Neurosurg ; 138: 408-410, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32247791

RESUMO

Civilian gunshot wounds to the brain are associated with high overall mortality; however, outcomes can vary significantly depending on bullet trajectory. This report details the outcome of a patient who sustained a bifrontal gunshot wound with multiple associated calvarial and frontal sinus fractures. Although surgery for penetrating brain injury is most frequently employed for relief of mass effect and decompression of vital structures, this case report describes a more comprehensive technique involving duroplasty, obliteration of the frontal sinus, and cranial vault reconstruction with the aim of decreasing the rate of cerebrospinal fluid leak, infection, reoperation, and readmission.


Assuntos
Encéfalo/cirurgia , Craniotomia/métodos , Traumatismos Cranianos Penetrantes/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ferimentos por Arma de Fogo/cirurgia , Encéfalo/patologia , Drenagem , Feminino , Traumatismos Cranianos Penetrantes/etiologia , Traumatismos Cranianos Penetrantes/patologia , Humanos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/cirurgia , Pessoa de Meia-Idade , Crânio/patologia , Crânio/cirurgia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/patologia
4.
J Stroke Cerebrovasc Dis ; 29(6): 104811, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32312630

RESUMO

AIM: The purpose of this study was to compare the 5-year prognosis of combined superficial temporal artery- middle cerebral artery (STA-MCA) bypass and Encephalodurosynangiosis (EDAS) and EDAS alone in hemorrhagic moyamoya disease (MMD). METHODS: This study included 123 adult patients admitted to Beijing Tiantan Hospital with hemorrhagic MMD between 2010 and 2015. The surgical procedures included combined revascularization of STA-MCA anastomosis with EDAS (n = 79) or EDAS alone (n = 44). We recorded basic demographic data as well as several risks factors, and used multivariate regression analysis to evaluate the predictive factor of overall survival and rebleeding-free survival. RESULTS: Of the 123 patients with hemorrhagic MMD, the mean age was 37.97 ± 11.04 years old and the mean follow-up period was 65.9 months (ranging from 12 to 100 months). A total of 21 rebleeding events occurred in 19 patients, yielding an annual incidence of rebleeding of 3.1%. Of the 19 patients with rebleeding, 11 (57.8%) patients died of rebleeding and one patient experience 3 rebleeding events. In the combined revascularization group, 9 (11.3%) patients experienced rebleeding, of which 5 (6.3%) died. This incidence was lower than in the indirect group, where 22.7% of patients experienced rebleeding events and 13.6% died. However, no significant difference was found between these 2 groups. In Kaplan-Meier survival analysis, the combined revascularization group had a better prognosis than the EDAS alone group, and multivariate regression analysis revealed that the combined revascularization procedure was associated with a better outcome. CONCLUSIONS: Both combined revascularization and EDAS alone can reduce the risk of rebleeding in hemorrhagic MMD. Combined revascularization was found to be superior to EDAS alone in terms of preventing rebleeding events.


Assuntos
Revascularização Cerebral , Hemorragias Intracranianas/cirurgia , Artéria Cerebral Média/cirurgia , Doença de Moyamoya/cirurgia , Artérias Temporais/cirurgia , Adulto , Pequim , Revascularização Cerebral/efeitos adversos , Revascularização Cerebral/mortalidade , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/mortalidade , Hemorragias Intracranianas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/diagnóstico por imagem , Doença de Moyamoya/mortalidade , Doença de Moyamoya/fisiopatologia , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
World Neurosurg ; 138: 352-354, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32217178

RESUMO

BACKGROUND: Fetal trauma during pregnancy can have a significant impact on the developing brain. Fetal trauma can lead to several intracranial pathologies including hypoxic-ischemic injury, skull fractures, and intracranial hemorrhages. Blunt trauma to a fetus resulting in the need for neurosurgical intervention is a rare occurrence and seldom described in the literature. CASE DESCRIPTION: Here we present the case of a 28-year-old, 36-week pregnant woman who was brought to the hospital by ambulance following a high-speed motor vehicle collision as the restrained driver. On computed tomography of the abdomen, the fetus was found to have a left-sided skull fracture with intracranial hemorrhage. The fetus was emergently delivered by way of caesarean section for lack of fetal movement and indeterminate heart tracings. Postnatally, the neonate had a Glasgow Coma Scale of 7. A postnatal head computed tomography better defined the skull fractures and multiple areas of intracranial hemorrhage. The baby was taken to the operating room for evacuation of the hematomas. At 16 months of age, the baby was well with only mild developmental delay, although a ventriculoperitoneal shunt was needed in a delayed fashion at 3 months of age. CONCLUSIONS: We present a rare situation where emergent caesarean section delivery followed by neonatal craniotomy was necessary. Our case illustrates that good outcomes can be achieved with rapid identification of fetal intracranial injury and intervention.


Assuntos
Craniotomia/métodos , Hemorragias Intracranianas/cirurgia , Lesões Pré-Natais/cirurgia , Fraturas Cranianas/cirurgia , Acidentes de Trânsito , Adulto , Feminino , Humanos , Recém-Nascido , Hemorragias Intracranianas/etiologia , Gravidez , Lesões Pré-Natais/etiologia , Fraturas Cranianas/etiologia
9.
World Neurosurg ; 136: 1-5, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31901499

RESUMO

BACKGROUND: Anterior ethmoid aneurysms are rare with 5 cases of intracranial rupture and 3 cases of life-threatening epistaxis described in recent literature. We present a case of an intracranial ruptured anterior ethmoid aneurysm treated surgically with a favorable outcome. CASE DESCRIPTION: A 64-year-old male presenting with a headache was found to have a right frontal intracranial hemorrhage with an associated 1.5 cm length × 1.8 cm maximal width anterior ethmoidal artery aneurysm. No definitive etiology of the aneurysm was identified. The aneurysm was treated using a bifrontal craniotomy with interhemispheric microdissection, clip ligation, and resection of the aneurysm dome for pathologic analysis, which ruled out a mycotic etiology. He recovered uneventfully and returned to work with no identifiable neurologic deficit. CONCLUSIONS: Consistent with prior reports, an intracranial, anterior ethmoidal artery aneurysm can occur in isolation without an associated vascular malformation. On the basis of a literature review and this case, surgical ligation is considered effective and possibly superior over endovascular treatment due to the risk of injury to the orbital vascular supply with transarterial treatment.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma Intracraniano/cirurgia , Aneurisma Roto/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Resultado do Tratamento
10.
J Neurointerv Surg ; 12(4): 350-355, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31401563

RESUMO

BACKGROUND: It is uncertain whether mechanical thrombectomy (MT) increases the probability of a good outcome (modified Rankin Scale (mRS) 0-2) in patients with Alberta Stroke Program Early CT Score (ASPECTS) 0-6. OBJECTIVE: To assess the impact of MT in patients with pretreatment ASPECTS 0-6. METHODS: According to PRISMA guidelines, we performed a systematic search of three databases for series of patients with ASPECTS 0-6 treated by MT. Random-effects meta-analysis was used to pool the following: rate of mRS 0-2 at 3 months follow-up, symptomatic intracranial hemorrhage (sICH), and mortality rates. RESULTS: We included 17 studies and 1378 patients with ASPECTS 0-6 (1194 MT, 184 medical management). The rate of mRS 0-2 was 30.1% and 3.2% after MT and medical management, respectively. MT gave higher odds of mRS 0-2 (OR 4.76, p=0.01). Patients with ASPECTS 6 and 5 had comparable rates of good outcome (37.7% and 33.3%, respectively). Overall, the rate of mRS 0-2 was 17.1% in patients with ASPECTS 0-4: 22.1% and 13.9% of patients with ASPECTS 4 and 0-3 were functionally independent, respectively. Successful recanalization (Thrombolysis in Cerebral Infarction grade 2b-3) gave higher odds of mRS 0-2 than unsuccessful reperfusion (OR 5.2, p=0.001). The MT group tended to have lower odds of sICH compared with the controls (OR 0.48, p=0.06). Patients aged <70 years had higher rates of mRS 0-2 than those aged >70 years (40.3% vs 16.2%). CONCLUSIONS: Patients with ASPECTS 0-6may benefit from MT. Successful reperfusion increases the probability of 3-month functional independence without increasing the risk of sICH. Patients with ASPECTS 5 and 6 have comparable outcomes. MT can still enable approximately one in four patients with ASPECTS 4 to be independent, whereas only 14% of subjects with ASPECTS 0-3 regain a good functional outcome.


Assuntos
Isquemia Encefálica/cirurgia , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Idoso , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/epidemiologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/epidemiologia , Infarto Cerebral/cirurgia , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
11.
World Neurosurg ; 136: 382-389.e6, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31698131

RESUMO

OBJECTIVE: To explore whether endoscopy surgery (ES) and extraventricular drainage (EVD) combined with intraventricular fibrinolytic (IVF) are superior to EVD alone in patients with intraventricular hemorrhage (IVH) and to determine which procedure is more suitable in such patients. METHODS: We searched the following databases: PubMed, MEDLINE, Ovid, Embase, and Cochrane Library. Randomized controlled trials and nonrandomized studies comparing ≥2 different interventions in patients with IVH were included. The quality of the included studies was assessed. Pairwise and network meta-analysis were performed using software Stata 13.0 and Revman 5.3. RESULTS: Compared with the EVD-alone intervention, the ES regimen, EVD combined with urokinase (UK), and EVD combined with recombinant tissue plasminogen activator (rt-PA) regimens all resulted in better survival and prognosis in patients with IVH. For both survival rate and prognosis, the order from best to worst was ES, EVD combined with UK, EVD combined with rt-PA, and EVD-alone. However, EVD combined with IVF had a high risk of intracranial rebleeding; the order of intracranial rebleeding risk from lowest to highest was ES, EVD-alone, EVD combined with rt-PA, and EVD combined with UK. The risk of intracranial infection in EVD combined with rt-PA was lower than that of EVD-alone, but EVD combined with UK also had a higher risk than did EVD-alone. The risk of intracranial infection from lowest to the highest was ES, EVD combined with rt-PA, EVD-alone, and EVD combined with UK. CONCLUSIONS: Our analysis showed that ES is more suitable for patients with IVH. ES not only improved the survival and prognosis but also had the lowest risk of ventriculoperitoneal shunt and intracranial rebleeding or infection.


Assuntos
Ventrículos Cerebrais/cirurgia , Hemorragias Intracranianas/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Humanos , Metanálise em Rede , Segurança do Paciente
12.
Catheter Cardiovasc Interv ; 95(4): 734-738, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31729148

RESUMO

We present the case of a child with congenital heart disease repaired in infancy with diffuse central venous occlusions resulting in central venous insufficiency, superior vena cava (SVC) syndrome, and intracranial bleeds. He presented to the catheterization laboratory for multiple transcatheter interventions to recanalize central venous channels which were unsuccessful by conventional methods. Therefore, extravascular venous channels were created to decompress his upper body by creation of a neo-SVC and his lower body with a neo-azygos vein to the neo-SVC. The latter procedure required direct percutaneous access from a paraspinal approach in order to obtain continuity with the azygos vein. At latest follow-up the patient is clinically well and asymptomatic.


Assuntos
Veia Ázigos/cirurgia , Procedimentos Cirúrgicos Cardíacos , Descompressão Cirúrgica , Cardiopatias Congênitas/cirurgia , Hemorragias Intracranianas/cirurgia , Síndrome da Veia Cava Superior/cirurgia , Estruturas Criadas Cirurgicamente , Procedimentos Cirúrgicos Vasculares , Veia Cava Superior/cirurgia , Insuficiência Venosa/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Pré-Escolar , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/fisiopatologia , Masculino , Recuperação de Função Fisiológica , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/fisiopatologia , Resultado do Tratamento , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/etiologia , Insuficiência Venosa/fisiopatologia
13.
Ann Thorac Surg ; 110(1): e19-e21, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31863754
14.
World Neurosurg ; 134: 25-32, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31629928

RESUMO

BACKGROUND: Arteriovenous malformations (AVMs) can occur in all regions of the brain and spinal cord, with clinical consequences and risks varying by location. Delayed AVM rupture despite digital subtraction angiography-confirmed obliteration post-radiation is exceedingly rare. CASE DESCRIPTION: To our knowledge, we present the first documented case of delayed hemorrhage associated with a cerebellar AVM 5 years after linear accelerator-based radiation in a man aged 31 years despite apparent angiographic obliteration. CONCLUSIONS: Intracranial hemorrhage after radiosurgery in digital subtraction angiography-confirmed obliterated AVMs is rare, with limited understanding of risk factors, appropriate preventative management, and mechanisms of occurrence. This case serves to demonstrate the need for greater awareness of this rare complication, as well as the need for appropriate surveillance and management strategies.


Assuntos
Doenças Cerebelares/radioterapia , Malformações Arteriovenosas Intracranianas/radioterapia , Hemorragias Intracranianas/prevenção & controle , Ruptura Espontânea/prevenção & controle , Adulto , Angiografia Digital , Doenças Cerebelares/diagnóstico por imagem , Doenças Cerebelares/patologia , Angiografia Cerebral , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/patologia , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/patologia , Hemorragias Intracranianas/cirurgia , Masculino , Radiocirurgia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/patologia , Ruptura Espontânea/cirurgia , Falha de Tratamento
15.
World Neurosurg ; 133: 1-7, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31541759

RESUMO

BACKGROUND: Recent studies have confirmed the effectiveness of minimally invasive endoscopic surgery for intracerebral hematoma (ICH). However, improvements are needed because incomplete hematoma removal may offset the surgical benefits of the technique. We describe a technique of neuroendoscopic surgery using an image detectable sheath, intraoperative computed tomography (iCT) scan, and a navigation system. METHODS: This is a retrospective study of 15 consecutive patients with spontaneous ICH who received neuroendoscopic surgery. During the surgery, a transparent sheath was fastened tightly to the scalp with 3.0 nylon. The patient's head was covered with a sterilized vinyl sheet and subsequent iCT scan visualized the orientation of the endoscopic sheath and the extent of residual hematoma, allowing the surgeon to decide to continue to remove the hematoma or to finish the treatment. RESULTS: The median hematoma evacuation rate was 93% (interquartile range, 82.2%-95.9%). The Glasgow Coma Scale score of all patients significantly improved at 1 week after the operation (P < 0.05). No complications associated with the procedure were observed. CONCLUSIONS: The combination of our techniques improves accuracy and safety of minimally invasive surgical evacuation of hematoma. Performing surgery with iCT scan also improves the spatial recognition of surgeons and therefore may be of educational value.


Assuntos
Hemorragias Intracranianas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Monitorização Intraoperatória/métodos , Neuroendoscopia/métodos , Neuronavegação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neuroendoscópios , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Am J Case Rep ; 20: 1852-1856, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31822651

RESUMO

BACKGROUND Antiphospholipid antibody syndrome (APS) is a systemic autoimmune disease associated with arterial and venous thromboembolism and pregnancy complications. There have been several reports of APS with systemic lupus erythematosus (SLE) complicated with aortic dissection. However, none of them has been primary APS, which is APS without SLE. CASE REPORT A 42-year-old woman with primary APS and APS nephropathy on warfarin and aspirin therapy presented with coma due to cerebellar hemorrhage. The effect of warfarin was immediately reversed with prothrombin complex concentrate. We performed emergent evacuation of the hematoma, and her level of consciousness improved to normal on postoperative day (POD) 1. She had acute hypertension on arrival, which was resistant to multiple antihypertensives and was stabilized on POD 3. She also had exacerbation of chronic kidney disease after using contrast and prothrombin concentrate complex, and was on temporary renal replacement therapy from POD 3. Aortic dissection was found accidentally on echocardiography on POD 7, and she was subsequently treated medically. She was transferred to the rehabilitation hospital with mild dysarthria and truncal ataxia on POD 59. CONCLUSIONS We report the first case in the English literature of primary APS complicated with cerebellar hemorrhage and aortic dissection. Acute hypertension following hemorrhage and exacerbation of APS nephropathy likely triggered the dissection of the aortic wall, the integrity of which might have been compromised by longstanding antiphospholipid antibody and vasa vasorum thrombosis.


Assuntos
Aneurisma Dissecante/etiologia , Síndrome Antifosfolipídica/complicações , Hipertensão/etiologia , Hemorragias Intracranianas/etiologia , Adulto , Aneurisma Dissecante/cirurgia , Doenças Cerebelares/cirurgia , Coma , Feminino , Humanos , Hemorragias Intracranianas/cirurgia , Insuficiência Renal Crônica/etiologia
17.
BMC Ophthalmol ; 19(1): 259, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842792

RESUMO

BACKGROUND: We report a rare case of sudden bilateral vision loss due to third ventricular cavernous angioma with intratumoral hemorrhage. CASE PRESENTATION: A 45-year-old woman presented decreased visual acuity in both eyes. Her best corrected visual acuity was 0.1 in the right eye and 0.15 in the left eye. Goldmann perimetry showed bilateral central scotomas and bitemporal visual field defects. MRI demonstrated a lesion with mixed hypo- and hyperintensity at the optic chiasm, which was thought to be an intratumoral hemorrhage. The patient underwent bifrontal craniotomy. The tumor was exposed via an anterior interhemispheric approach, and histological evaluation of the mass led to a diagnosis of cavernous angioma. Six months after the surgery, her best corrected visual acuity was 0.9 in the right eye and 0.9 in the left, with slight bitemporal visual field defects. CONCLUSION: Third ventricular cavernous angioma is considered in the differential diagnosis of chiasmal syndrome. Contrast-enhanced MRI and FDG-PET might be useful for differential diagnosis of cavernous angioma from other chiasmal tumors including glioblastoma.


Assuntos
Cegueira/etiologia , Neoplasias Encefálicas/complicações , Hemangioma Cavernoso/complicações , Hemorragias Intracranianas/complicações , Terceiro Ventrículo/patologia , Cegueira/diagnóstico por imagem , Cegueira/fisiopatologia , Cegueira/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/fisiopatologia , Neoplasias Encefálicas/cirurgia , Craniotomia , Feminino , Fluordesoxiglucose F18/administração & dosagem , Lateralidade Funcional , Hemangioma Cavernoso/diagnóstico por imagem , Hemangioma Cavernoso/fisiopatologia , Hemangioma Cavernoso/cirurgia , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/fisiopatologia , Hemorragias Intracranianas/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/administração & dosagem , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologia
18.
Sci Rep ; 9(1): 13224, 2019 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-31519971

RESUMO

Acute basilar artery occlusion (BAO) is a rare but potentially life-threatening neurological condition. While endovascular therapy (EVT) has been shown to improve outcome, there is limited knowledge about prognostic factors beyond early recanalization. We studied whether blood pressure (BP) exceeds or falls below suggested thresholds during intervention and whether these changes are associated with complications and outcome. BP measurements mostly with one-minute intervals were available in 39 patients. An individual systolic blood pressure (SBP) reference value was defined as the median of the first five intra-procedural measurements. Half of the patients (51.3%) received drugs for BP augmentation and two a BP lowering drug (5.1%). Thrombolysis in cerebral infarction grade 2b and 3 (TICI) was achieved in 29 (74.4%) and 23 patients (58.9%) had good outcome at three months. We observed a continuous intra-procedural increase of median SBP (+11%) and mean arterial pressure (MAP, +10%, both p < 0.001), and a unique temporal pattern of intermittent peaks and troughs. Successful recanalization was more common in patients whose intra-procedural duration with SBP under 140 mmHg was shorter (p = 0.009). Patients with isolated tip of basilar artery (TBA) occlusion had significantly more BP excursion of 20% below the reference SBP and required more frequent use of sympathomimetic drugs compared to vertebrobasilar occlusion (p = 0.008 and p = 0.041, respectively). Brain hemorrhage was more prevalent in patients who experienced SBP excursions at least 20% above the individual reference value (p = 0.038) and a longer duration of time spent with SBP above 180 mmHg (p = 0.029). Patients with higher pre-procedural mean SBP had a greater chance of a good outcome (p = 0.03). This study using high resolution BP monitoring suggests a relationship between intra-procedural BP characteristics and recanalization, hemorrhagic complications and outcome in patients receiving EVT for acute posterior circulation cerebrovascular syndromes. Differences with regard to BP regulation during recanalization therapy for vertebrobasilar and TBA occlusion deserves further attention.


Assuntos
Arteriopatias Oclusivas/patologia , Artéria Basilar/patologia , Procedimentos Endovasculares/métodos , Hemorragias Intracranianas/patologia , Acidente Vascular Cerebral/patologia , Trombectomia/métodos , Idoso , Arteriopatias Oclusivas/sangue , Arteriopatias Oclusivas/cirurgia , Artéria Basilar/cirurgia , Determinação da Pressão Arterial , Feminino , Humanos , Hemorragias Intracranianas/sangue , Hemorragias Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/cirurgia , Resultado do Tratamento
19.
World Neurosurg ; 132: 177-181, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505281

RESUMO

BACKGROUND: Reconstructive endovascular treatment is a method that can ameliorate vertebral artery dissecting aneurysm (VADA) and preserve the parent artery. Recently, 2 or 3 overlapping stents have been used to treat VADAs through the flow-diversion effect. However, little is known about the use of >3 overlapping stents for acute treatment of hemorrhagic VADA. CASE DESCRIPTION: A 69-year-old woman was admitted to our institute with the sudden onset of a headache. Brain computed tomography revealed a subarachnoid hemorrhage. Cerebral angiography revealed a VADA in the right intracranial vertebral artery. The contralateral vertebral artery was hypoplastic; thus we performed a reconstructive endovascular procedure using multiple overlapping stents combined with coiling. We used 5 overlapping stents with the aim of preventing coil herniation, fixing the jailed microcatheter, and reinforcing flow diversion and achieved immediate occlusion of the aneurysmal component. Postoperative imaging showed no apparent infarction in the brainstem. Six months after the treatment, angiography revealed complete occlusion of the aneurysm. Therefore in this case, hemorrhagic VADA was successfully treated in the acute setting by 5 overlapping Enterprise stents and coiling, which also preserved the parent artery. CONCLUSIONS: Reconstructive endovascular treatment using multiple overlapping stents and coiling may be a beneficial therapy for hemorrhagic VADA, especially when the contralateral vertebral artery is aplastic or hypoplastic. Using >3 overlapping stents may represent a promising, feasible technique for achieving immediate occlusion by increasing flow diversion.


Assuntos
Procedimentos Endovasculares/métodos , Hemorragias Intracranianas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Stents , Dissecação da Artéria Vertebral/cirurgia , Idoso , Implante de Prótese Vascular , Angiografia Cerebral , Feminino , Humanos , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Artéria Vertebral/cirurgia , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/diagnóstico por imagem
20.
AJNR Am J Neuroradiol ; 40(10): 1744-1751, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31537516

RESUMO

BACKGROUND AND PURPOSE: The efficacy and safety of transvenous embolization for brain arteriovenous malformations remains unclear, given the very limited number of cases reported. This prospective study was performed to assess this technique in ruptured AVMs. MATERIALS AND METHODS: Twenty-one consecutive patients with ruptured brain AVMs who underwent transvenous embolization were prospectively followed between November 2016 and November 2018. The Spetzler-Martin grade was I in 3 AVMs (14.3%), II in four (19.0%), III in eleven (52.4%), and IV in three (14.3%). The complete AVM occlusion rate was calculated from 6-month follow-up DSA images. Occurrence of hemorrhage and infarction after embolization was evaluated using CT and MR imaging within 1 month after the operation. The mRS was used to assess the functional outcomes. RESULTS: Complete AVM nidus obliteration was shown in 16 (84%) of 19 patients with technically feasible AVMs immediately after embolization. One (5%) patient with a small residual nidus after treatment showed complete obliteration at 13-month follow-up. There were 5 hemorrhages and 1 infarction; 4 patients' symptoms improved gradually. The percentage of cases with mRS ≤ 2 rose from 57.1% (12/21) before embolization to 66.7% (14/21) at 1-month follow-up. Both the morbidity and mortality rates were 4.8% (1/21). CONCLUSIONS: Transvenous embolization can be performed only in highly selected hemorrhagic brain AVMs with high complete obliteration rates, improved functional outcomes, and acceptable morbidity and mortality rates, but it should not be considered as a first-line treatment.


Assuntos
Fístula Arteriovenosa/cirurgia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Malformações Arteriovenosas Intracranianas/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Hemorragias Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA