Neurologic Complications of Preoperative Embolization of Spinal Metastasis: A Systemic Review of the Literature Identifying Distinct Mechanisms of Injury.

Background: Preoperative embolization of spinal metastases may improve outcomes of resection by reducing surgical blood loss and operative time. Neurologic complications are rarely reported and the mechanisms leading to injury are poorly described.

Methods: We present 2 illustrative cases of embolization-related neurologic injury from distinct mechanisms and the findings of a systemic literature review of similar complications according to the PRISMA guidelines.

Radial Artery Access for Treatment of Posterior Circulation Aneurysms Using the Pipeline Embolization Device: Case Series.

Background: The treatment of selected wide-neck and fusiform posterior circulation aneurysms is challenging for clipping as well as for endovascular route.

Objective: To describe an endovascular approach for vertebral artery aneurysm treatment using transradial access (TRA) instead of the conventional transfemoral access.

Methods: We collected cases from two institutions in which TRA was used for posterior circulation Pipeline Embolization Device (Medtronic, Dublin, Ireland) deployment.

Intraoperative Angiography for Arteriovenous Malformation Resection in the Prone and Lateral Positions, Using Upper Extremity Arterial Access.

Background: Intraoperative angiography is routinely utilized for aneurysms and arteriovenous malformations (AVMs) to verify complete occlusion and resection. Surgery for spinal and posterior fossa neurovascular lesions is usually performed in prone position. Intraoperative angiography in the prone position is challenging and there is no standardized protocol for this procedure.

Wireless mobile technology to improve workflow and feasibility of MR-guided percutaneous interventions.

Purpose: A wireless interactive display and control device combined with a platform-independent web-based user interface (UI) was developed to improve the workflow for interventional magnetic resonance imaging (iMRI).

Methods: The iMRI-UI enables image acquisition of up to three independent slices using various pulse sequences with different contrast weighting. Pulse sequence, scan geometry and related parameters can be changed on the fly via the iMRI-UI using a tablet computer for improved lesion detection and interventional device targeting.

Carotid cavernous fistulae occurring after the use of the Fogarty catheter in carotid surgery: a review.

The Fogarty catheter represents a major advancement for the effective removal of distal thrombi during vascular surgery, including carotid endarterectomy (CEA). One complication related to its use is injury to the cavernous carotid artery with development of a carotid cavernous fistula (CCF). Including a recent case at our institution, 21 patients with a Fogarty-related CCF have been reported since 1967.

Aortic response to balloon injury in obese Zucker rats.

The small diameter of the carotid artery is not compatible with the evaluation of clinically available endovascular devices in the carotid balloon-injury (BI) model. We developed an endovascular BI model in the rat descending aorta, whose size is compatible with available endovascular instruments. We also tested the hypothesis that neointima formation is enhanced in the aorta of obese Zucker rats (OZR) compared with lean Zucker rats (LZR).

Transarterial balloon assisted Onyx embolization of pericallosal arteriovenous malformations.

Summary: Preliminary experience using a balloon assisted technique (BAT) for embolization of arteriovenous malformations (AVM) is reported. Two patients with large pericallosal AVMs were successfully embolized with Onyx under Scepter C balloon catheter flow arrest.

Clinical Presentation: One patient presented with a large intraventricular hemorrhage and hydrocephalus.

Endovascular embolization of prominent intercavernous sinuses for successful transsphenoidal resection of Cushing microadenoma: case report.

Background And Importance: Prominent intercavernous sinuses may result in vigorous bleeding during transsphenoidal resection of pituitary microadenomas and lead to incomplete or aborted tumor resection. We report the use of coil embolization of the intercavernous sinuses to prevent uncontrollable bleeding before transsphenoidal surgery is reattempted.

Clinical Presentation: A 40-year-old man with Cushing disease underwent an attempt for transsphenoidal resection of an adrenocorticotrophic hormone--producing pituitary microadenoma.

Balloon-assisted coiling of the proximal lobule of a paraophthalmic aneurysm causing panhypopituitarism: Technical case report.

Background: We describe an intra-aneurysmal balloon-assisted technique to limit the coil volume in a large bilobulated paraophthalmic aneurysm. Our intent was to reduce the mass effect and presenting symptoms of diabetes insipidus (DI) with hypopituitarism.

Case Description: A 32-year-old woman presented with symptoms of DI and her work-up demonstrated hypopituitarism and partial bitemporal visual field defects.

Hypertrophic olivary degeneration after resection of a pontine cavernous malformation: a case report.

We report the case of a 35 year old African American female who developed hypertrophic olivary degeneration secondary to resection of a pontine cavernous malformation. The patient initially complained of headaches and diplopia. Unenhanced computed tomography (CT) and magnetic resonance images (MRI) of the brain revealed a left pontine cavernous malformation with scattered foci of recent and remote hemorrhage.

Advanced imaging assessment of posterior circulation stroke before and after endovascular intervention.

Background: Perfusion-computed tomography (CTP) is a relatively new technique that allows rapid semiquantitative noninvasive evaluation of cerebral perfusion aiding in the diagnosis of cerebral ischemia and infarction. There is a paucity of data on its application within the posterior circulation, especially, the brainstem. We describe a case of basilar artery thrombosis with cerebellar and brainstem CTP mismatch and discuss possible future applications of CTP for acute posterior fossa circulation and infarction.

Percutaneous placement of an external drain of the cisterna magna using interventional magnetic resonance imaging in a patient with a persistent cerebrospinal fluid fistula: technical case report.

Objective: Cerebrospinal fluid diversion from the cisterna magna has been described previously but has largely been abandoned because of high complication rates and anatomic constraints. Situations still remain in which this may be the best or only alternative. We describe the use of interventional magnetic resonance imaging (iMRI) for the application of this largely forgotten procedure.

The vascular plug: a new device for parent artery occlusion.

Parent artery occlusion (PAO) is still indicated at times for the treatment of craniocervical vascular disease. Because of the unavailability of silicone and latex balloons in the United States, costly combinations of detachable and pushable coils have been required to achieve PAO. We describe our experience with a simple and less expensive alternative for PAO in 4 carotid arteries and 1 vertebral artery.

Thrombus formation during intracranial aneurysm coil placement: treatment with intra-arterial abciximab.

Background And Purpose: The management of thrombus formation during coil placement in an intracranial aneurysm is important in minimizing periprocedural morbidity and mortality. We report on seven cases in which the primary treatment for thrombus formation during such coil placement was intra-arterial abciximab infusion.

Methods: Clinical and radiologic records of 100 consecutive patients who underwent coil placement in intracranial aneurysms at our institution during a 1-year period were reviewed.

A cohort study of the safety and feasibility of intraventricular urokinase for nonaneurysmal spontaneous intraventricular hemorrhage.

Background And Purpose: Small case series have reported potential benefit from thrombolysis after spontaneous intraventricular hemorrhage (IVH). Our objective was to review our experience using intraventricular urokinase (UK) in treating selected patients with IVH.

Methods: Using medical records, we identified all patients who received ventriculostomies for CT-confirmed nonaneurysmal nontraumatic spontaneous IVH from December 1992 through November 1996.

Use of an open stereotactic ring for neurosurgical procedures.

We describe an open ring as a new design to the Zamorano-Dujovny (Z-D) stereotactic unit. The titanium base ring has an opening of 45 degrees that can be located in any chosen position. Imaging studies such as computed tomography, X-ray, positron emission tomography, digital angiography, and digital substraction angiography can be performed with the open stereotactic ring for multimodality image localization.

Radiosurgical treatment of meningiomas.

From January 1992 to November 1996, 17 patients with the diagnosis of intracranial meningioma underwent radiosurgical treatment. Of these, 7 patients were treated using a Linac-based system (group 1), and 10 using the Leksell Gamma Knife unit (group 2). The follow-up ranged between 12 and 48 (median 33) months for group 1 and between 1 and 11 (median 5) months for group 2, consisting of clinical and MRI assessments every 3 months during the first year, and every 6 months thereafter.

Interactive image-guided resection of cerebral cavernous malformations.

Between July 1992, and February 1997, 15 patients with cavernous malformations underwent interactive image-guided resection of their lesions. There were eight women and seven men in the group, ranging in age from 6 years to 62 years (mean 34 years). Clinical presentations included seizures (n = 7), headache (n = 4), and hemorrhage (n = 4).

Application accuracy study of a semipermanent fiducial system for frameless stereotaxis.

The accuracy of a semipermanent fiducial marker system developed at Wayne State University in collaboration with Fisher-Leibinger (Freiburg, Germany) was compared with reference to a standard stereotactic frame (Zamorano-Dujovny Localizing Unit; Fisher-Leibinger). For each patient in our study, 10 semipermanent markers were placed on the skull through a small incision and a pilot hole drilled for the marker; five markers were used for registration, and five were used for comparison. Gadolinium-enhanced magnetic resonance imaging was performed, and, upon registration using both ring and fiducial markers, 184 random points were collected by infrared digitization.

Interactive intraoperative localization during the resection of intraventricular lesions.

Mass lesions located in the ventricular system can be surgically challenging. These tumors are often slow growing and reach considerable size before they are diagnosed. These lesions commonly cause multiple obstructions to the circulation of cerebrospinal fluid with subsequent hydrocephalus.