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1.
Oper Neurosurg (Hagerstown) ; 24(2): 131-137, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36637297

RESUMO

BACKGROUND: Surgical proximal parent artery occlusion (PAO) is one of the treatments for partially thrombosed vertebral artery aneurysms (PTVAs). However, whether long-term changes in size and perforating arteries through the blind end can be truly preserved remain unknown. OBJECTIVE: To evaluate the efficacy and safety of surgical proximal PAO for PTVAs, focusing on the transition in size and preservation of perforating arteries. METHODS: We retrospectively reviewed 14 consecutive cases of unruptured large PTVAs. The cases were treated with surgical proximal PAO without trapping or thrombectomy. Preservation of the perforating arteries was confirmed through intraoperative indocyanine green video angiography. The aneurysm size was evaluated by measuring the maximum diameter on axial T2-weighted magnetic resonance images. Post-treatment outcomes were assessed using the modified Rankin Scale at the last follow-up examination. RESULTS: Thirteen patients (excluding 1 with morbidity) had a mean follow-up time of 33.2 months (range, 12-60 months) and a mean reduction rate of 71% (range, 32%-95%). Only 1 patient (7.2%) experienced postoperative stroke, and 13 patients (92.8%) showed no worsening of the modified Rankin Scale score at the final follow-up examination. The symptoms were improved in 5 of the 6 symptomatic patients (83.3%). In 10 patients (71.4%), a perforating branch that could not be identified on preoperative imaging was identified intraoperatively. CONCLUSION: Surgical proximal PAO without trapping or thrombectomy for PTVAs allows long-term reduction of aneurysm size and improves treatment safety by preserving the perforating artery, especially in cases wherein direct reconstruction is not feasible.


Assuntos
Aneurisma Intracraniano , Trombose , Humanos , Aneurisma Intracraniano/cirurgia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Artéria Vertebral/patologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Vasculares/métodos , Resultado do Tratamento
2.
Oper Neurosurg (Hagerstown) ; 24(2): 145-153, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36637299

RESUMO

BACKGROUND: Extracranial-intracranial bypass is an effective treatment option for moyamoya disease and in well-selected cases of anterior circulation intracranial atherosclerotic disease; however, the effectiveness of bypass is less evident in posterior circulation atherosclerosis. Updated surgical techniques and clinical guidelines necessitate modern appraisal of arterial bypass for symptomatic patients with posterior circulation atherosclerotic disease who are refractory to medical management. OBJECTIVE: To evaluate the complications, graft patency, and postoperative outcomes of arterial bypass for posterior circulation intracranial atherosclerotic disease. METHODS: Perioperative records of consecutive bypass patients were retrospectively evaluated to determine the clinical course and surgical outcomes. RESULTS: Arterial bypass was performed in 8 cases with a median age of 62 years. All 8 patients underwent direct bypass with an autologous occipital artery donor vessel. Recipient vessel selection varied on a case-by-case basis, with the superior cerebellar artery used in 4 cases, the posterior inferior cerebellar artery in 3 cases, and the anterior inferior cerebellar artery in 1 case. There were no significant intraoperative or postoperative complications. Postoperatively, all 8 patients displayed clinical improvement of their preoperative symptoms, with a significant decrease of 2.5 points on the modified Rankin Scale (P < .001). Postoperative imaging confirmed full graft patency in 7 patients and partial patency in 1 patient. CONCLUSION: Excellent postoperative outcomes and no major complications after posterior circulation arterial bypass for intracranial atherosclerotic disease highlight the utility of this intervention for the treatment of medically refractory or symptomatic posterior circulation intracranial atherosclerotic disease. Larger studies may be valuable to validate these findings.


Assuntos
Aterosclerose , Revascularização Cerebral , Arteriosclerose Intracraniana , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Revascularização Cerebral/métodos , Artéria Vertebral/cirurgia , Aterosclerose/diagnóstico por imagem , Aterosclerose/cirurgia , Aterosclerose/etiologia , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/cirurgia
3.
Neurosurgery ; 92(1): 205-212, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36519864

RESUMO

BACKGROUND: Dural arteriovenous fistulas (dAVFs) located at craniocervical junction are extremely rare (1%-2% of intracranial/spinal dAVFs). Their angio-architectural complexity renders endovascular embolization to be challenging given multiple small feeders with risk of embolysate reflux into vertebral artery and limited transvenous access. The available literature discussing microsurgery for these lesions is limited to few case reports. OBJECTIVE: To report a multicenter experience assessing microsurgery safety/efficacy. METHODS: Prospectively maintained registries at 13 North American centers were queried to identify craniocervical junction dAVFs treated with microsurgery (2006-2021). RESULTS: Thirty-eight patients (median age 59.5 years, 44.7% female patients) were included. The most common presentation was subarachnoid/intracranial hemorrhage (47.4%) and myelopathy (36.8%) (92.1% of lesions Cognard type III-V). Direct meningeal branches from V3/4 vertebral artery segments supplied 84.2% of lesions. All lesions failed (n = 5, 13.2%) or were deemed inaccessible/unsafe to endovascular treatment. Far lateral craniotomy was the most used approach (94.7%). Intraoperative angiogram was performed in 39.5% of the cases, with angiographic cure in 94.7% of cases (median imaging follow-up of 9.2 months) and retreatment rate of 5.3%. Favorable last follow-up modified Rankin Scale of 0 to 2 was recorded in 81.6% of the patients with procedural complications of 2.6%. CONCLUSION: Craniocervical dAVFs represent rare entity of lesions presenting most commonly with hemorrhage or myelopathy because of venous congestion. Microsurgery using a far lateral approach provides robust exposure and visualization for these lesions and allows obliteration of the arterialized draining vein intradurally as close as possible to the fistula point. This approach was associated with a high rate of angiographic cure and favorable clinical outcomes.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Embolização Terapêutica , Doenças da Medula Espinal , Hemorragia Subaracnóidea , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Malformações Vasculares do Sistema Nervoso Central/complicações , Doenças da Medula Espinal/cirurgia , Embolização Terapêutica/métodos , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Artéria Vertebral/patologia , Hemorragia Subaracnóidea/complicações
4.
J Clin Neurosci ; 107: 98-105, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36527812

RESUMO

BACKGROUND: Endovascular stenting has emerged as an effective treatment for patients with symptomatic vertebral artery origin stenosis (VAOS), but the incidence of severe restenosis is concerning. Angioplasty alone with a drug-coated balloon (DCB) is a potential treatment for VAOS. The purpose of this systematic review and meta-analysis was to assess the utility of DCB angioplasty for VAOS. METHODS: A systematic search of the Medline (PubMed), Embase, CNKI, and Cochrane databases for studies on the treatment of VAOS by DCB angioplasty published in English and Chinese before June 15, 2022 was conducted. Data were extracted using standardized methods. The incidence rates of restenosis, technical success, and perioperative complication in the follow-up period were pooled using Freeman-Tukey double arcsine transformation with random or fixed-effect models. Tests for heterogeneity and publication bias were performed. RESULTS: A total of seven studies containing 159 patients were included in this review and meta-analysis. The pre-treatment stenosis rate of the vertebral artery in the DCB group ranged from 70.0 % to 86.3 %, and the median follow-up time ranged from 6.0 to 14.1 months. The pooled restenosis incidence was 11.9 % (95 % CI: 3.4 %-23.4 %; I2 = 59 %, p = 0.02) during the follow-up period. The pooled technical success rate was 96.6 % (95 % CI: 91.4 %-99.7 %; I2 = 37 %, p = 0.14). The overall perioperative complication rate was 2.9 % (95 % CI: 0.3 %-6.9 %; I2 = 0 %, p = 0.64). According to the funnel diagram and Egger's test, there was no evidence of publication bias. CONCLUSION: It is suggested in this review and meta-analysis that angioplasty with DCB may be a potential treatment for VAOS. However, randomized studies including a large representative sample of VAOS patients are needed to validate our findings.


Assuntos
Angioplastia Coronária com Balão , Angioplastia com Balão , Humanos , Constrição Patológica , Artéria Vertebral/cirurgia , Angioplastia com Balão/métodos , Resultado do Tratamento , Materiais Revestidos Biocompatíveis
5.
AJNR Am J Neuroradiol ; 44(1): 65-69, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36521964

RESUMO

BACKGROUND AND PURPOSE: A cardiogenic embolus could reach the posterior circulation through the right vertebral artery because of a relatively larger diameter in cases of left vertebral artery hypoplasia. Hence, we investigated whether left vertebral artery hypoplasia is associated with cardiac embolisms with atrial fibrillation in the posterior circulation and its functional outcomes. MATERIALS AND METHODS: In this monocentric retrospective study, patients with acute cardioembolic stroke with atrial fibrillation were enrolled and underwent CT or neck MRA, which visualized the aortic arch and subclavian arteries. The laterality and size of vertebral artery hypoplasia were recorded. Posterior circulation stroke, basilar artery occlusion, and the functional outcomes after 3 months were investigated. RESULTS: This study included 407 patients; the patients with left vertebral artery hypoplasia experienced a higher rate of posterior circulation stroke (19 versus 73; 42.2% versus 20.2%; P = .001) and basilar artery occlusion (5 versus 10; 11.1% versus 2.8%; P = .005) than the patients without left vertebral artery hypoplasia. Multivariate analysis revealed that left vertebral artery hypoplasia showed an association with lower odds of achieving a good functional outcome 3 months after the stroke (OR = 0.4; 95% CI, 0.2-0.9; P = .027). CONCLUSIONS: Patients with cardioembolic stroke and left vertebral artery hypoplasia had posterior circulation stroke, basilar artery occlusion, and poor functional outcomes after 3 months.


Assuntos
Arteriopatias Oclusivas , Fibrilação Atrial , AVC Embólico , Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Humanos , Artéria Vertebral/diagnóstico por imagem , AVC Embólico/complicações , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Aorta Torácica , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Arteriopatias Oclusivas/complicações , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/diagnóstico por imagem
6.
AJNR Am J Neuroradiol ; 44(1): 111-114, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36581455

RESUMO

BACKGROUND AND PURPOSE: Dominant radiculomedullary arteries such as the artery of lumbar enlargement and the artery of cervical enlargement are well-documented. However, variability exists as to the size, number, and location of other radiculomedullary arteries contributing supply to the anterior spinal artery. The aim of this anatomic study was to document the prevalence and characteristics of the dominant anterior thoracic artery in cadaveric specimens. MATERIALS AND METHODS: Microsurgical dissection of cadaveric human spinal cord specimens (n = 50) was conducted. The artery of lumbar enlargement was injected with colored latex until the small-caliber arterial vessels were filled. The dominant anterior thoracic artery was identified, injected, and filled with diluted industrial paint. The course, diameter, and location of the dominant anterior thoracic artery, artery of lumbar enlargement, and artery of cervical enlargement were documented. RESULTS: The artery of lumbar enlargement was identified between T3 and L2 in all 50 specimens (100%), and the artery of cervical enlargement was identified in 84% of specimens (42/50). At least 1 dominant anterior thoracic artery distinct from the artery of lumbar enlargement and the artery of cervical enlargement was identified between T1 and T11 in 47 of the 50 specimens (94%). The most frequent origin of the dominant anterior thoracic artery was at the level of T4 on the left. The average size of the dominant anterior thoracic artery was 0.446 mm (range, 0.300-0.759 mm on the left and 0.270-0.569 mm on the right). CONCLUSIONS: A dominant anterior thoracic artery is present in 94% of individuals. Variations of the arterial supply to the anterior thoracic cord are of great importance due to their implications for ischemic events as well as surgical and endovascular procedures.


Assuntos
Medula Espinal , Artéria Vertebral , Humanos , Medula Espinal/diagnóstico por imagem , Medula Espinal/irrigação sanguínea , Artérias Torácicas , Dissecação , Cadáver
7.
Medicine (Baltimore) ; 101(47): e31444, 2022 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-36451392

RESUMO

RATIONALE: Intracranial vertebrobasilar dissecting aneurysms (VBDAs) are associated with a greater tendency to rupture and a greater risk of worse outcomes than anterior circulation aneurysms. Spontaneous healing of a VBDA is very rare, and there have been very few case reports of spontaneous healing of an aneurysm. We describe a case of intracranial vertebral artery dissecting aneurysm that healed spontaneously and disappeared completely on follow-up images. PATIENT CONCERNS: A 40-years-old woman was referred to the neurology department because of a persistent headache, especially in the left occiput. DIAGNOSES: Magnetic resonance angiography and computed tomography angiography showed a left vertebral artery dissection-like aneurysm (4.5 × 2.0 × 2.5 mm in size) with proximal parent artery mild stenosis (40%). INTERVENTIONS: Flunarizine hydrochloride was administered for symptomatic treatment and follow-up angiography was performed. OUTCOMES: Digital subtraction angiography and magnetic resonance angiography showed that the aneurysm had completely disappeared at 3 months follow-up. High-resolution magnetic resonance vessel wall imaging revealed intimal thickening and mild stenosis in the left intracranial vertebral artery without an aneurysm signal. In addition, enhancement scanning revealed that the aneurysm area was moderately enhanced. MR-vessel wall imaging at 7 months follow-up showed that the enhancement was slightly reduced compared with the previous time. LESSONS: This case illustrates the relatively plastic nature of a vertebral dissecting aneurysm, indicating that spontaneous healing remains possible.


Assuntos
Dissecação da Artéria Vertebral , Feminino , Humanos , Adulto , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/tratamento farmacológico , Artéria Vertebral/diagnóstico por imagem , Constrição Patológica , Angiografia por Ressonância Magnética , Angiografia Digital
8.
BMC Neurol ; 22(1): 489, 2022 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-36536304

RESUMO

BACKGROUND: The definition of sudden sensorineural hearing loss (SSNHL) is broadly accepted as acute sensorineural hearing loss of more than 30 dB over at least three consecutive frequencies in a pure-tone audiogram (PTA). Acute audiovestibular loss is common with ischaemic stroke in the territory of the anterior inferior cerebellar artery (AICA). However, cases in which SSNHL and vertigo occur with hypoperfusion alone are very rare. We describe a patient who developed unilateral SSNHL and vertigo as initial symptoms caused by cerebellar hypoperfusion by vertebral artery (VA) dissection without the occurrence of infarction. CASE PRESENTATION: A 51-year-old man suddenly developed acute hearing loss (AHL) in his left ear and vertigo. On neurological examination, he had vibration-induced right-beating nystagmus and left-beating nystagmus after a head-shaking test. Additionally, he had apogeotropic nystagmus during head turns to either side. The head impulse test (HIT) was normal. PTA showed mild unilateral SSNHL in the left ear. Diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) showed territorial perfusion deficits in the left posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA) without infarction. Two months later, the patient had no vertigo but still had hearing impairment in his left ear. A follow-up PTA documented persistent unilateral SSNHL in the left ear. Additionally, perfusion computed tomography (CT) showed that perfusion deficits remained in the left cerebellum along the PICA and AICA territories. CONCLUSIONS: Our case highlights a case of AHL and vertigo presented by isolated cerebellar hypoperfusion without infarction. It is necessary to consider the possibility of a central cause in patients with AHL and vertigo, and it is important to confirm this possibility through brain magnetic resonance imaging (MRI), including PWI, and magnetic resonance angiography (MRA).


Assuntos
Isquemia Encefálica , Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Perda Auditiva Unilateral , Nistagmo Patológico , Acidente Vascular Cerebral , Dissecação da Artéria Vertebral , Masculino , Humanos , Pessoa de Meia-Idade , Isquemia Encefálica/complicações , Perda Auditiva Unilateral/complicações , Perda Auditiva Unilateral/patologia , Dissecação da Artéria Vertebral/complicações , Acidente Vascular Cerebral/complicações , Vertigem/etiologia , Infarto/complicações , Cerebelo/patologia , Perda Auditiva Neurossensorial/diagnóstico , Artéria Vertebral
9.
J Orthop Surg Res ; 17(1): 495, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36384627

RESUMO

OBJECTIVE: This study aims to investigate the clinical application and feasibility of C2 subfacetal screws in patients with Klippel-Feil syndrome (KFS), narrow C2 pedicles, and high-riding vertebral arteries (HRVAs). METHODS: The clinical data of seven patients with KFS, atlantoaxial dislocation, narrow C2 pedicles, and HRVAs treated with C2 subfacetal screws were analyzed in this retrospective study. The internal height, isthmus height, and pedicle width of C2 vertebra were measured using preoperative computed tomography (CT). Subfacetal screws were inserted for 7 patients (12 sides). The position and length of the screws were observed using postoperative CT. Intraoperative dura mater and vertebral artery (VA) injuries were recorded. Bone fusion was observed using follow-up CT. RESULTS: The internal height was 10.5 ± 3.2 mm, the isthmus height was 3.7 ± 1.8 mm, the pedicle width was 3.0 ± 1.4 mm, and the screw length was 19.7 ± 1.5 mm. All patients had HRVAs and narrow pedicles. No injury to the dura mater and vertebral artery (VA) occurred in this group of patients. Bone fusion was achieved in all patients during follow-up. CONCLUSIONS: In patients with KFS, HRVA, and a narrow C2 pedicle, there is sufficient space below the C2 articular surface for screw insertion. When the pedicle is narrow and the C2 pedicle screw is not suitable for placement due to possible injury to the VA, subfacetal screws are a feasible alternative.


Assuntos
Luxações Articulares , Síndrome de Klippel-Feil , Parafusos Pediculares , Fusão Vertebral , Humanos , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Artéria Vertebral/lesões , Síndrome de Klippel-Feil/complicações , Síndrome de Klippel-Feil/diagnóstico por imagem , Síndrome de Klippel-Feil/cirurgia , Estudos Retrospectivos , Fusão Vertebral/métodos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia
11.
Niger J Clin Pract ; 25(11): 1883-1888, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36412296

RESUMO

Background: Carotid and vertebral Doppler ultrasonography (USG) is the primary diagnostic tool for the detection of extra cranial atherosclerotic disease and measurement of posterior fossa blood flow volume. The examination is performed while the patient lies on supine position. However, in daily practice we occasionally encounter patients who are not able to lie down on supine position for different reasons, such as kyphosis, severe dyspnea, or severe back pain. Aim: We aimed to compare the doppler spectral measurements of carotid and vertebral arteries obtained in supine and sitting positions. Patients and Methods: Fifty-three patients were recorded in the first group, to whom carotid and vertebral (CV) Doppler Ultrasound examination was initially performed while sitting, and another 52 patients were examined as the second group where initial measurements were done in a supine position. Peak systolic velocity (PSV), end diastolic velocity (ED) from each vessel, internal carotid artery (ICA)/common carotid artery (CCA) ratio, and volume flow of vertebral artery (VA) were measured in supine and sitting positions. Also, another 83 patients with a complaint of vertigo were included in the third group but only VA measurements were compared. Results: In the first group, there was a difference between sitting and supine positions in right ICA diastolic, right and left VA diastolic, and left CCA diastolic velocities (P < 0.05). In the second group, there was a difference in sitting and supine positions in right CCA systolic, right CCA diastolic, and left CCA diastolic velocities (P < 0.05). In the third group, there was a difference in sitting and supine positions in right and left VA diastolic velocities, left VA volume flow, and total VA volume flow (P < 0.05). A strong correlation was detected between supine and sitting positions regarding right and left ICA stenoses. Alterations in waveforms were noted in three patients' unilateral VAs, in supine and sitting positions. Conclusion: Our results suggest that CV doppler examinations may be performed in the sitting positions. Examination in the sitting position may be helpful in recognizing pre-steal and retrograde flows.


Assuntos
Postura Sentada , Artéria Vertebral , Humanos , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiologia , Velocidade do Fluxo Sanguíneo/fisiologia , Artéria Carótida Interna , Artéria Carótida Primitiva/diagnóstico por imagem
12.
Neurol India ; 70(Supplement): S144-S148, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36412361

RESUMO

Background: A number of complications following surgery aimed at atlantoaxial fixation have been reported. However, there is no report in the literature describing visual loss following vertebral artery injury. Objective: Vision loss as a complication of vertebral artery injury during surgery for atlantoaxial fixation is reported. Material and Methods: This is a report of two patients who were operated for atlantoaxial instability by the Goel technique of atlantoaxial fixation. During surgery, there was an injury to the vertebral artery and the artery had to be sacrificed. Results: Both patients suffered severe visual loss following surgery. One patient had a partial visual recovery that started within few days of surgery while the other patient remained completely blind. Conclusions: Although rare, visual loss can be a complication of vertebral artery sacrifice during surgery for atlantoaxial stabilization.


Assuntos
Articulação Atlantoaxial , Instabilidade Articular , Fusão Vertebral , Lesões do Sistema Vascular , Artéria Vertebral , Transtornos da Visão , Humanos , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Articulação Atlantoaxial/lesões , Parafusos Ósseos , Traumatismos Craniocerebrais/complicações , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Lesões do Pescoço/complicações , Lesões do Pescoço/cirurgia , Doenças da Coluna Vertebral/etiologia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/lesões , Artéria Vertebral/cirurgia , Transtornos da Visão/etiologia , Cegueira/etiologia , Lesões do Sistema Vascular/etiologia
18.
Medicine (Baltimore) ; 101(40): e30952, 2022 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-36221365

RESUMO

BACKGROUND: Neurofibromatosis type 1 (NF1) is caused by mutations in the NF1 gene on the long arm of chromosome 17, which affects the skin, nervous system, eyes, and skeleton system. Vertebral arteriovenous fistula (AVF) associated with neurofibromatosis type I (NF-1) is rare. CASE PRESENTATION: We report a 31-year-old postpartum woman with NF1 with vertebral arteriovenous fistulae (AVFs). She presented to our hospital because of neck pain, intracranial hypotension headache, and right upper limb weakness. She had a family history of NF1. After endovascular intervention, the AVF disappeared. However, a new aneurysm appeared on the right vertebral artery V5 dissection after 6 months of follow-up. CONCLUSIONS: The presence of NF1 in patients who present with neurologic signs should prompt further angiography. Awareness of the coexistence between NF1 and AVF or aneurysm is crucial to avoiding diagnostic delays. Endovascular occlusion of VV-AVF in NF-1 patients is effective and safe.


Assuntos
Aneurisma , Fístula Arteriovenosa , Embolização Terapêutica , Neurofibromatose 1 , Dissecação da Artéria Vertebral , Adulto , Aneurisma/complicações , Aneurisma/cirurgia , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/cirurgia , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Neurofibromatose 1/complicações , Neurofibromatose 1/diagnóstico , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Dissecação da Artéria Vertebral/complicações
19.
Clin Neurol Neurosurg ; 222: 107450, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36191439

RESUMO

OBJECTIVES: To investigate temporal changes in imaging findings of conservatively treated acute unruptured vertebral basilar artery dissection (VBAD) and its contributing factors. METHODS: Fifty-three patients who underwent conservative treatment for 64 cases of acute VBAD diagnosed between January 2006 and March 2019 with follow-up of at least 12 months after onset were retrospectively investigated. Statistical analyses of age, sex, medical history, pattern of onset, lesion site, imaging findings and changes over time, regular medication, and outcomes were performed. RESULTS: Changes in the vascular morphology of the lesion site during the follow-up period were observed in only 23 (43 %) patients (median time until change: 19 days). Univariate analysis of factors contributing to morphological changes at the dissection site showed that changes were significantly more likely in younger patients (p = 0.011). Patients taking antiplatelet drugs had a significantly greater rate of deterioration at the dissection site (p = 0.028) than others. On multivariate analysis, age was an independent factor contributing to changes at the dissection site, and taking antiplatelet drugs, particularly clopidogrel, was an independent factor contributing to deterioration. No patient developed intracranial hemorrhage, cerebral infarction, or worsening of neurological symptoms during follow-up. CONCLUSIONS: Morphological changes at the dissection site are more likely in younger patients with acute unruptured VBAD and those taking antiplatelet drugs. However, chances of intracranial hemorrhage, cerebral infarction, or worsening of neurological symptoms during conservative therapy are low; therefore, acute unruptured VBAD may be considered a benign condition.


Assuntos
Aneurisma Intracraniano , Dissecação da Artéria Vertebral , Humanos , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/patologia , Estudos Retrospectivos , Inibidores da Agregação Plaquetária/uso terapêutico , Clopidogrel , Dissecação da Artéria Vertebral/diagnóstico por imagem , Hemorragias Intracranianas , Infarto Cerebral , Artéria Vertebral/patologia , Aneurisma Intracraniano/terapia
20.
Contrast Media Mol Imaging ; 2022: 9551263, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36262992

RESUMO

Cervical vertigo refers to a clinical syndrome with sudden vertigo as the main symptom caused by the hemodynamic disturbance of the extracranial segment of the vertebral artery (VA) affected by cervical vertebral lesions. Small differences in pulse intervals in a patient's continuous sinus rhythm are called heart rate variability (HRV). Heart rate variability refers to the small rise and fall of instantaneous heart rate between consecutive beats and is one of the most important physiological indicators of cardiac function. Small changes between successive beats reflect some information about the heart. So, it can be used to diagnose heart disease; its parameters can be used to identify emotions. Therefore, it is possible to use the characteristics of heart rate variability to find some patterns in the high-stress state and use the computer and ECG signals to describe the high-stress state. Since the ECG signal is a universal and objective model, it is practical and convenient to use it to describe stress states. Magnetic resonance angiography (MR angiography, MRA) is a noninvasive vascular imaging method that does not require intubation and contrast agents. At present, it has been widely used in clinical practice. In order to explore the changes of short-term heart rate variability and vertebral arterial magnetic resonance angiography (MRA) in patients with cervical vertigo and their clinical significance, this paper introduces two basic analysis methods of heart rate variability and commonly used MRA techniques, TOF technology. In the analysis of heart rate variability in patients with cervical vertigo, the statistical values of time and spectrum domain parameters were found to be lower in the experimental group than in the control group1. MRA showed that the abnormal rate of VA in the PCI group and the cervical vertigo group was similar. In the RMSSD index, the male experimental group reached 29, and the control group 1 reached 22.


Assuntos
Intervenção Coronária Percutânea , Artéria Vertebral , Humanos , Masculino , Gravidez , Feminino , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologia , Angiografia por Ressonância Magnética , Frequência Cardíaca , Meios de Contraste , Intervenção Coronária Percutânea/efeitos adversos , Vertigem/diagnóstico por imagem , Vertigem/etiologia
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