Our results lend further support to the safety and efficacy of DPTE in the management of hypervascular neoplasms of the head and neck. With our increasing experience, this technique is evolving into a primary therapeutic modality for optimal tumor devascularization.
This report shows the feasibility of performing safe and effective mechanical thrombolysis with percutaneous transluminal angioplasty coronary balloon microcatheters within the major dural sinuses. This technique can probably accelerate clot disruption and thrombolysis, possibly resulting in a more rapid restoration of venous flow.
Research Forum-Monday P93 group had a positive Minor's test on the nonoperated side of the face. Results were analyzed using the X 2 test, which showed them to be statistically significant (P < 0.05). In conclusion, it would appear that the use of a sternomastoid muscle flap during parotidectomy in appropriately selected patients seems to reduce the incidence of Frey's syndrome. It is a technically straightforward procedure with no additional morbidity encountered by our patients.
We report an unusual case of precipitous worsening of vasospasm associated with subarachnoid haemorrhage that developed during endosaccular coil embolisation of a ruptured posterior communicating aneurysm. The acutely worsening vasospasm occurred in the distal ipsilateral anterior circulation remote from the site of microcatheter manipulation, resulting in transient occlusion. Despite successful endovascular treatment of both the aneurysm and vasospasm, the patient continued to clinically decline and eventually died. This case raises important issues regarding the potential mechanisms and optimal therapeutic strategies for this complication, which are reviewed.
The ability to have on-site access to cross-sectional imaging in a biplane neuroangiography suite has tremendous potential for enhancing current neurointerventional practice. Although a few prototypical multimodality suites have been created, several problems/limitations have prevented widespread implementation. Recently, a portable CT scanner has been developed, which may overcome previous shortcomings. We review our recent clinical experience with this new modality, exploring numerous adjunctive diagnostic and therapeutic applications. Forty-one patients underwent periprocedural CT using the Tomoscan M/EG portable CT (Philips). The portable CT scanner is kept at the “head-end” of the biplane neuroangiography suite, being moved into position as needed before, after, or during a procedure. A pivoting angiographic table permits excellent z-plane mobility for rapid gantry to fluoroscopy positioning. Five mm slices at five mm increments were obtained. High quality images were obtained in all cases. The portable CT scanner could be quickly positioned and activated within five min. Total scanning time for a typical case, including initial positioning and set-up was 10–12 min. Twelve of 41 cases were performed adjunctively during diagnostic angiography; 29/41 were performed in an interventional setting. Twenty of 29 scan evaluated baseline or post-therapeutic status of the brain (e.g., Guglielmi detachable coil aneurysm obliteration, arteriovenous malformation (AVM) embolisation, local thrombolysis); 9/29 provided cross-sectional guidance to various interventions (direct puncture embolisation, percutaneous vertebroplasty, spinal biopsy, discography). Use of the portable CT scanner permitted rapidly accessible high quality cross sectional imaging within the biplane neuroangiography suite, which augmented diagnostic and therapeutic decision-making, and therapeutic intervention.
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