Experiences in the endovascular treatment of cerebral arteriovenous angiomas

Percutaneous superselective balloon catheterization for the treatment of large cerebral arteriovenous malformations, for which direct operation is infeasible, is described. Both a detachable balloon technique and a "calibrated leak" free embolization have been applied, based on a new hardening silicone material elaborated by the authors. The experiences of operations performed since 1978 are represented by four selected case studies.     

在复合手术室治疗脑动静脉畸形的初步探讨

目的 总结在复合手术室治疗脑动静脉畸形的经验。方法 2013年12月至2014年12月在复合手术室治疗27例脑动静脉畸形患者,均行手术切除,术中造影判断畸形团是否残留,其中3例一期行切除术和血管内栓塞术。结果 27例中,4例（14.8%）术中血管造影显示畸形团残留,再次切除后行术中造影,显示畸形团消失;一期行切除术和血管内栓塞术3例（均为Spetzler-Martin分级Ⅲ级以上）,术中出血明显减少,均完全切除畸形团。所有患者无造影相关的并发症。术后24例随访6个月至1年,失访3例;其中19例恢复良好,5例有轻度神经功能障碍。结论 在复合手术室治疗脑动静脉畸形能够提高疗效,降低手术相关并发症,为脑动静脉畸形治疗提供了一个新的安全有效的平台。     

Correlation of SPECT, EEG and CT in patients with epilepsy. A preliminary report

Single photon emission computed tomography (SPECT) were performed in 14 patients with epilepsy. Among 6 patients with GTC, five had no focal abnormalities in EEG and CT scan, SPECT also showed no changes of regional cerebral perfusion. In another one patient EEG was normal, CT scan showed hypodensity in right frontal area, SPECT showed decreased regional cerebral perfusion in right frontotemporal area. AVM in frontal lobe was found at operation. In 3 patients with complex partial seizures and 5 patients with complex partial seizures and GTC, SPECT showed regional cerebral perfusion coincided with the area of focal epileptic form discharges in EEG. In one patient with complex partial seizures and GTC EEG showed right antero-temporal focal sharp wave discharges, discrete calcification in superior suprasella cisterna on CT, SPECT showed decreased regional perfusion in right temporal area, pathological examination revealed hematoma in right temporal lobe. SPECT is useful for localizing epileptogenic foci in epileptics.     

SPECT imaging in psychiatry. A review.

In the last two decades, brain imaging has become an integral part of clinical and research psychiatry. Single photon computed emission tomography (SPECT) is rapidly gaining acceptance as one of the major imaging techniques available, along with computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). Each of these techniques has its assets and drawbacks. This review concerns SPECT, a highly prevalent imaging technique whose potential value in brain imaging has not been appreciated until recently. Its purpose is to expose practicing clinicians and research psychiatrists alike to the attributes of this instrument, which is available in most nuclear medicine departments today. An effort is made to provide a comprehensive account of this technique, including a brief summary of the basic principles, the various methods of its application, and recent findings in most psychiatric disorders. Analogies to its "aristocratic cousin," PET, are presented to emphasize similarities and differences. Finally, directions for future development and implementation of SPECT are suggested.     

幕上脑内海绵状血管瘤与癫痫(46例报告)

目的探讨幕上脑内海绵状血管瘤所致癫痫的临床特点及治疗方法。方法1998—2003年在北京天坛医院顺序入院的72例幕上脑内海绵状血管瘤患者中，46例伴有癫痫发作。详细记录和分析癫痫发作的临床类型和特点，同时给予手术和药物治疗。并对治疗效果进行随访。结果46例患者行显微手术治疗，其中40例术前均给予抗癫痫药物治疗。药物治疗后27例发作次数减少，13例病情无改善。手术治疗后，癫痫均得到良好控制。结论幕上脑内海绵状血管瘤伴发癫痫单纯通过药物控制效果不佳，而显微外科手术效果良好。     

The results of operating upon cerebral aneurysms and angiomas in children and adolescents. II. Cerebral angiomas.

Symptomatic angiomas of the brain, brain stem or cerebellum are uncommon in all age groups. They usually present by subarachnoid and intraparenchymatous hemorrhage, but they may act as expanding mass lesions, as causes of ingavescent neurological deficit (?'steal phenomenon'), as epilepticogenic foci, or as a source of relentless headache. We have operated upon 20 patients, 18 years of age of less, with symptomatic angiomas. There has been no surgical mortality, and no patient has been made worse by operation.     

Single-proton tomographic study of regional cerebral blood flow in epilepsy. A preliminary report

Regional cerebral blood flow (rCBF) may be measured with a single-photon-emission computed tomograph (SPECT) after inhalation of xenon 133. Our SPECT studies of rCBF in a group of 18 patients with seizure disorders, when compared with studies in 32 normal control subjects, have shown enhanced flow to an active seizure focus and ischemia of brain areas in certain subjects between seizures. Thus, SPECT determination of rCBF has demonstrated a number of findings recently observed with positron-emission tomography and may become a useful modality in the study of patients who have epilepsy.     

123I-ADAM SPECT imaging of serotonin transporter binding in patients with night eating syndrome: a preliminary report

Night eating syndrome (NES) represents a delay in the circadian pattern of food intake, manifested by evening hyperphagia and/or nocturnal awakenings accompanied by ingestions of food. A neurobiological marker of NES has been implicated with the recently discovered therapeutic response to the selective serotonin reuptake inhibitor (SSRI) sertraline. This pilot SPECT (single photon emission computed tomography) study compared the serotonin transporter (SERT) uptake ratios of night eaters with those of healthy controls. Six night eaters underwent SPECT imaging using the radiopharmaceutical (123)I-ADAM. Uptake, compared with that of the cerebellum, was obtained for the midbrain, basal ganglia, and temporal lobes; uptake ratios in night eaters were compared with those of six healthy controls. Night eaters had significantly greater SERT uptake ratios in the midbrain than healthy controls. These findings, in conjunction with the therapeutic response of NES to sertraline, indicate that the serotonin system is involved in the pathophysiology of NES.     

Occult cerebral arteriovenous malformations.

Angiographically occult arteriovenous malformations in the brain are rare but cause considerable diagnostic difficulty. Four personal cases are presented in which CT scans showed hypodense lesions with minimal or no enhancement, and angiograms showed only an avascular mass. Gliomas, a dermoid and an infarct were suspected before histological examination of biopsies or excised specimens. The patients had presented in early adult life with epilepsy and focal deficits.     

Changes in cerebral oxygen saturation with change in posture: A preliminary report.

Background. Disease of the major vessels in the neck can disrupt autoregulation and lead to changes in the cerebral blood flow and cerebral autoregulation. These changes can be reflected by means of cerebral oxygen saturation. Methods. We measured cerebral oxygen saturation in 20 patients with atherosclerotic disease of the carotid and vertebral arteries and compared results with 10 normal subjects. Saturation was measured using a noninvasive near-infrared device, the transcranial cerebral oximeter. Results. There were marked decreases in cerebral oxygen saturation in patients with carotid-vertebral artery disease when the position of the patient was changed, from supine to erect. Conclusion. Changes in regional cerebral oxygen saturation inpatients with carotid-vertebral artery disease may reflect disruption of cerebral autoregulation.     

Giant arteriovenous angiomas of the brain with scant clinical manifestations

Two patients are described with large intracranial arteriovenous angioma with minimal neurological symptoms. The first patient suffered from repeated right fronto-temporal headache. Migraine was diagnosed and he was treated with analgesic drugs. We carried out scintigraphic investigation and computerized tomography of the brain. The results of these examinations suggested the presence of large brain lesion (tumour or vascular malformation). Bilateral carotid angiography and aortic arch angiography were done in this patient. A large arteriovenous angioma was discovered in the right occipital area. The second patient complained of throbbing headaches. A bruit could be heard over the left eye which was exophthalmic. Angiograms showed a carotid-cavernous fistula on the left side and a large angioma in the fronto-parietal area. The angioma was clinically "silent". It diminished the symptoms of the carotid-cavernous fistula through the uptake of blood. Both patients were regarded as unsuitable for surgery. The reasons were the great dimension of these angiomas and a large number of supplying arteries.     

The surgical management of cerebral cavernous angiomas

Abstract

Caver~ou: angioma (CA) is a h.amartomatous hemorrhagic lesion which has received a great deal of atention In recent years due to Improvement of neuroimaging with magnetic resonance and heightened clInIcal awareness. Long consIdered to be rare, its actual prevalence is now recognized to be of 0.9%. Cavernous angiomas may be multiple, particularly in patients with familial form. It may be associated with a variety of clinical syndromes attributed to focal microhemorrhages or less frequently to gross bleeding. CA are usually dIagnosed between the age of 20 and 50 with a highest clinical. incidence in the fourth decade. A female predominance is observed in regard to bleeding. The male patients are more at risk for seizures. The recent series ofMR ima~ing confirm that CA even when multiple can be asymptomatic in a significant number of cases. Surgery IS the treatment of choice in order to eliminate the risk of hemorrhage and improve the control of seizures. Minimally invasive approaches are now adopted with reduced postopertive .morbldlty. We report our expenence in surgical management of cerebral CA and suggest a clasSIfication of the lesIons accordIng to surgical accessibility and residual morbidity. [Neural Res 1998 20: 597–606]     

De novo multiple dural arteriovenous fistulas and arteriovenous malformation after embolization of cerebral arteriovenous fistula: case report

Background

A cerebral arteriovenous fistula is a rare neurovascular abnormality. It is very scarce when presenting with other cerebral arteriovenous malformations after embolization.

Method

We reported a case primarily presenting with cerebral arteriovenous fistula. When the fistula was embolized completely, de novo multiple dural arteriovenous fistulas and a small arteriovenous malformation occurred due to the hemodynamic change after the embolization. Embolization of parts of the fistulas for the second time led to an untreatable malformation which became curable. At the third time, the remaining fistula was cured.

Results

The mechanism of the dural arteriovenous fistula and treatment strategy were discussed.

Conclusion

Venous hypertension is the main factor causing a dural arteriovenous fistula. Embolization of the fistulas step by step is recommended.     

4D-DSA在脑动静脉畸形影像学评估中的应用

目的 探讨4D-DSA在脑动静脉畸形（AVM）影像学评估中的临床应用价值。方法 回顾性分析2018年1月至2019年1月收治的37例脑AVM的临床资料和影像学资料。所有病人均接受2D-DSA及4D-DSA序列采集,并在西门子DSA机4D工作站中进行4D-DSA影像重建。以2D-DSA、3D-DSA影像结果定义为标准诊断结果,2位具有副主任医师职称并且未参与手术治疗的神经外科介入医师对4D连续动态三维影像分别独立进行评估。结果 37例中,SM分级Ⅲ级26,Ⅳ级9例;Ⅴ级2例。畸形血管团位于额叶8例、颞叶9例、顶叶3例、枕叶3例、小脑4例,其余10例畸形畸形团分布2个脑叶以上。4D-DSA在畸形血管团的评估中均与标准诊断结果均具有较强的一致性（一致性系数≥0.77）。在复杂畸形团评估中,4D-DSA对畸形血管团的血管结构显像更加精准。同时,4D-DSA对畸形团血流动力学评估结果与iFlow成像技术一致。结论 4D-DSA与传统的2D-DSA及3D-DSA相比,对脑AVM的血管构筑学,尤其是对病灶及血流动力学具有更清晰精准的显示,更能帮助提高脑AVM的诊治水平     

SPECT and depressive pseudo-dementia. A case report]

The SPECT (Single Photon Emission Computed Tomography), a new advance in medical imagery, allows the measure of cerebral blood flow and could be of interest in studying mental disorders. We report here a case of pseudo-dementia for which a SPECT has been performed before and after treatment. Mrs V., a 49 years old female, has been suffering from a dementia-like syndrome for several months. She is divorced, has two children, lives with a boy-friend, and has been working in a factory for 25 years. The first psychiatric disorders began three years ago with a gradual apragmatism and muteness. A neuroleptic treatment gave no result. One year later, without any reason, Mrs V. recovered a normal way of life. Nevertheless, from time to time, she had some periods of subexcitation. Few months later, she relapsed in her previous state of apragmatism and muteness. During a new hospitalization, neuroleptic treatment is tried again without any success. Mrs V. is then referred to us for medical screening of a dementia syndrome. In the Unit, it is difficult to communicate with her; she looks sad or amimic and has motor stereotypies (like rubbing her feet continuously against the floor). She has polidypsia and glutonny. Neurologic examination is normal, as well as EEG, X Scan, Nuclear Magnetic Resonance. The Folstein Mini Mental State score is 9/30.(ABSTRACT TRUNCATED AT 250 WORDS)