As a result of continuing progress in the development of intervention materials but also due to growing understanding of pathophysiological relationships, the prevalence and significance of endovascular interventions in the head and neck region have continued to increase. This applies to procedures for recanalization, which were addressed in detail in an earlier article, as well as to techniques used for vessel occlusion. This contribution first presents the techniques and materials employed in embolization in the head and neck region. Based on this description the application of endovascular procedures for vessel occlusion are explained with respect to different disease entities in the head and neck region. In this context particular attention is given to the treatment of intracranial aneurysms, cerebral arteriovenous malformations, dural AV fistulae, vascular malformations, and tumors in the head and neck region.
Vascular interventions in the head and neck region are becoming increasingly more important due to acquisition of knowledge on the pathophysiological principles of various vascular diseases and the development of new intervention materials. This article gives a review of the materials and techniques used in interventions in the head and neck region. Special attention is given to the description of a safety-oriented approach to avoid potentially severe complications. Based on this the value of endovascular therapeutic procedures for recanalization of various diseases will be discussed, in particular the treatment of extracranial and intracranial stenoses and the reopening of vascular occlusions in acute stroke using PTA, stents, lysis and mechanical thrombus removal.
arteriovenous malformations (AVM) that underwent previous endovascular procedures. Background Radiosurgery is an effective treatment for brain AVM, nonetheless delayed radiation-induced complications remain a significant problem, especially for late cerebral radiation necrosis, that usually occurs within 3 years after radiosurgical treatment. In the recent past, endovascular treatment by using liquid embolic materials has been extensively used to reduce the size of large AVM prior to Radiosurgery. Methods From 2008 to 2018, 414 AVMs were treated with Gamma Knife in our hospital. 36 out of 414 AVMs underwent at least 2 endovascular treatments in adjunct to the radiosurgical treatment. A follow-up of at least 3 years was available for all these patients. Results Five patients developed late symptomatic cerebral radionecrosis; in three patients, post-irradiative cystic formation with mass effect and signs of hemorrhage was found and two patients developed edematous solid mass lesions. Conclusions A relevant percentage (5 out of 36 = 14%) of patients that received at least two endovascular plus radiosurgery treatments developed subsequent radiation necrosis This series highlights the need for a defined strategy prior to initiation of treatment in brain AVMs and shows how repeated endovascular procedures in addition to radiosurgery can play a cumulative role in the development of late radionecrosis and cystic formations.
infarction identified within 3 days from the onset of bleeding not related to aneurysm repair. Circulatory failure and severe intracranial hypertension prior to ECI, or within 3 days from bleeding if no ECI, were retrospectively determined. The association between ECI, prior circulatory failure, severe intracranial hypertension and patient outcomes was tested using uniand multivariate analyses. Results Seven-hundred-and-fifty-three patients with aSAH were included. ECI were observed in 40 patients with a prevalence of 5.3% (95% CI; 3.7-6.9%). New ECI lesions developed in-hospital in 70% of cases. Circulatory failure or severe intracranial hypertension was more common in patients with ECI compared to those without ECI (90% vs.11% respectively <0.001). In ECI patients, in-hospital occurrence of circulatory failure or severe intracranial hypertension was observed in 60% of cases, and was significantly associated new in-hospital ECI lesions (71%vs.33% in patients without new in-hospital ECI lesions, P=0.036). ECI was independently associated with WFNS grade (OR=2.
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