Search results for "Intracranial"
showing 10 items of 288 documents
Subtemporal Keyhole Approach to the Suprasellar and Petroclival Region: Microanatomic Considerations and Clinical Application
1997
OBJECTIVE: To minimize surgical invasiveness, the keyhole concept is applied to the subtemporal approach. METHODS: Anatomic features were studied in 14 sides of adult cadaver heads, and the technique was used in 162 interventions. Although most of the lesions treated were 3 cm in size or smaller, larger lesions were also treated using this technique. In some cases, if needed, an endoscope-assisted microsurgical technique was used. RESULTS: The cadaveric study provided intimate experience with the microsurgical anatomy of the approach. The 162 consecutive patients who were operated on harbored various types of lesions; the most recent 43 consecutive interventions were investigated in detail.…
How angioarchitecture of cerebral arteriovenous malformations should influence the therapeutic considerations.
1995
PURPOSE To evaluate the angioarchitectural criteria of complex cerebral arteriovenous malformations (AVMs), concerning the risk of hemorrhage and therapy planing. METHODS The magnetic resonance (MR) imaging and neuroangiographic findings of 227 AVMs (223 patients) were retrospectively evaluated. Statistical analysis was used to define the relative frequency of these lesions for hemorrhage in correlation with various parameters (i.e. age of the patient, size, location, associated aneurysms). RESULTS Onset of symptoms was between 21 and 40 years of age in 50% of cases. The ratio of centrally to convexially located lesions was 1:2. Convexial AVMs are classified by MR imaging into sulcal and gy…
Does Endovascular Treatment with Curative Intention Have Benefits for Treating High-Grade Arteriovenous Malformation versus Radiosurgery? Efficacy, S…
2021
Background The treatment of high-grade arteriovenous malformations (AVMs) remains challenging. Microsurgery provides a rapid and complete occlusion compared with other options but is associated with undesirable morbidity and mortality. The aim of this study was to compare the occlusion rates, incidence of unfavorable outcomes, and cost-effectiveness of embolization and stereotactic radiosurgery (SRS) as a curative treatment for high-grade AVMs. Methods A retrospective series of 57 consecutive patients with high-grade AVM treated with embolization or SRS, with the aim of achieving complete occlusion, was analyzed. Demographic, clinical, and angioarchitectonic variables were collected. Both t…
3D TOF MR Angiography of Cerebral Arteriovenous Malformations after Radiosurgery
1993
To investigate the potential of three-dimensional time-of-flight MR angiography (MRA) to complement SE imaging, 18 patients with intracerebral arteriovenous malformations were prospectively followed after undergoing radiosurgery. Vessel occlusion after stereotaxic single high dose radiotherapy develops slowly. The MRA detected signs of nidus obliteration earlier and with a higher sensitivity than did SE imaging. Six months after radiosurgery, MRA showed a reduction of the nidus flow signals in nine patients and after 1 year it showed reduction in 15 of the 18 patients. As shown by MRA, the loss of flow signals was related to a reduction of the nidus size in 4 patients after 6 months and in …
Stereotactically guided cavernous malformation surgery.
1996
The incidence of a significant hemorrhage in the natural history of cavernomas is below 1% per year, but the risk of a second hemorrhage in patients with initial bleeding cavernomas is between 14% and 29%. In the light of these figures, all cavernomas ought to be resected if surgical-related morbidity can be minimized. Stereotactically guided neurosurgery offers the advantage of planning the least traumatic approach before craniotomy due to the knowledge of the exact localisation of the lesion. During a 2-year period 12 patients (age 16-54 years) with intracranial supratentorial cavernomas (size 0.5-1.8 cm) were treated by stereotactically guided microsurgery. The cavernomas were seated in …
Cerebral angiomas: Influence of morphological aspects such as size and site on their clinical behavior with special reference to the mode of bleeding
1987
The following paper presents analysis of 182 cases of arteriovenous malformations treated surgically at the Neurosurgical Department of the Johannes Gutenberg-Universität Mainz, FRG. Although the behavior of AVMs remains unpredictable, morphological features of AVMs have an important bearing on their clinical presentation, especially the mode of bleeding.
Endovascular treatment of head and neck arteriovenous malformations: long-term angiographic and quality of life results.
2016
AimTo present the long-term angiographic and subjective results of patients with head and neck arteriovenous malformations (HNAVMs) after endovascular treatment.MethodsWe retrospectively analyzed the medical files of 14 patients with HNAVM who were treated between 2000 and 2014. The treatment of choice was a transarterial superselective microcatheter-based approach followed by embolization using liquid embolic agents. The patients were asked to answer a quality of life questionnaire about the following symptoms before and after treatment: pain, functional impairment, cosmetic deformity, impairment in daily life, and bleeding.ResultsComplete or >90% closure of the AVM was achieved in 6 of…
Early Osmotherapy in Severe Traumatic Brain Injury: An International Multicenter Study
2020
The optimal osmotic agent to treat intracranial hypertension in patients with severe traumatic brain injury (TBI) remains uncertain. We aimed to test whether the choice of mannitol or hypertonic saline (HTS) as early (first 96 h) osmotherapy in these patients might be associated with a difference in mortality. We retrospectively analyzed data from 2015 from 14 tertiary intensive care units (ICUs) in Australia, UK, and Europe treating severe TBI patients with intracranial pressure (ICP) monitoring and compared mortality in those who received mannitol only versus HTS only. We performed multi-variable analysis adjusting for site and illness severity (Injury Severity Score, extended IMPACT scor…
High-frequency oscillatory ventilation in adults with traumatic brain injury and acute respiratory distress syndrome
2005
This study observed adverse events of rescue treatment with high-frequency oscillatory ventilation (HFOV) in head-injured patients with acute respiratory distress syndrome (ARDS).Data of five male patients with ARDS and traumatic brain injury, median age 28 years, who failed to respond to conventional pressure-controlled ventilation (PCV) were analyzed retrospectively during HFOV. Adjusted mean airway pressure at initiation of HFOV was set to 5 cm H2O above the last measured mean airway pressure during PCV. Frequency of pulmonary air leak, mucus obstruction, tracheal injury, and need of HFOV termination due to increased intracranial pressure, decreased cerebral perfusion pressure, or deteri…
The Effects of Isoflurane and Desflurane on Intracranial Pressure, Cerebral Perfusion Pressure, and Cerebral Arteriovenous Oxygen Content Difference …
2003
Background Desflurane is a volatile anesthetic agent with low solubility whose use in neurosurgery has been debated because of its effect on intracranial pressure and cerebral blood flow. The purpose of this study was to determine the variations on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) as well as on cerebral arteriovenous oxygen content difference (AVDo(2)) in normocapnic patients scheduled to undergo removal of supratentorial brain tumors with no evidence of mass effect during anesthesia with isoflurane or desflurane. Methods In 60 patients scheduled to undergo craniotomy and removal of supratentorial brain tumors with no evidence of midline shift, anesthesia w…