Transvenous embolisation of dural carotid-cavernous fistulas by multiple venous routes: a series of 27 cases

Summary.  Background: Transvenous embolisation is an effective option in the treatment of dural carotid-cavernous fistulas (DCCFs). This can be achieved via a number of venous routes.  Method: From 1997 to 2001, 27 patients with DCCFs (15 unilateral and 12 bilateral) were treated by transvenous embolisation with Guglielmi detachable coils and fibered platinum coils. The transvenous embolisation routes included inferior petrosal sinus (IPS) alone (18 patients), IPS and inter-cavernous sinus (6 patients), IPS and clival plexus (1 patient), superior ophthalmic vein (SOV) via facial vein (1 patient) and SOV via superficial temporal vein (1 patient). One patient required further transarterial embolisation with polyvinyl alcohol particles.  Findings: The follow-up period ranged from 4 to 57 months (average 26 months). Two patients had transient ophthalmoplegia and 2 patients had symptomatic recurrence of the DCCF during the follow-up. There was no permanent procedure-related morbidity. Clinical cure was achieved in 26 patients (96%) and complete angiographic obliteration was documented in 24 patients (89%).  Interpretation: DCCFs can be successfully treated by transvenous embolisation via different venous routes. Published online January 14, 2003 Acknowledgments  We thank Lap-Chung Tang for the hand drawings and Dr. Kwok-Hung Lai for computer graphics. We also thank Kwun-Lin Man, Marina Lee and Emily Tin for assistance in the secretarial work.  Correspondence: K.-M. Cheng, Department of Neurosurgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China.     

Endovascular coil trapping for ruptured vertebral artery dissecting aneurysms by using double microcatheters technique in the acute stage

Summary ?Background. In the treatment of vertebral artery (VA) dissecting aneurysms, only proximal occlusion of the VA does not necessarily prevent rerupture. We evaluated the efficacy of coil trapping for the ruptured VA dissecting aneurysms using the double microcatheters technique. Methods. We treated 11 patients who presented with subarachnoid haemorrhage (SAH) due to rupture of a VA dissecting aneurysm which did not involve the posterior inferior cerebellar artery at the site of dissection. All patients tolerated the balloon occlusion test. Within 3 days of the SAH, the dissection site was trapped with a Guglielmi detachable coil (GDC) using the double microcatheters technique. The proximal and distal sites of the dissecting aneurysm were embolized simultaneously. Findings. GDC trapping at the affected site was successful in all 11 patients. Radiographic findings showed complete occlusion of the dissection site and patency of the unaffected artery. Although one patient experienced transient dysphagia, there were no major complications. Interpretation. The double microcatheters technique is effective for coil trapping of ruptured VA dissecting aneurysms in selected patients. The risks posed by this simple technique are minimal, even in the acute stage. Published online May 26, 2003     

带旋髂深血管髂骨--蝶形骨膜瓣复合移植治疗四肢骨不连

目的探讨四肢骨不连的治疗方法及疗效.方法 30例骨不连者采用髂骨-蝶形骨膜瓣复合移植结合坚强内、外固定.结果术后经1～2年随访,全部达到骨性愈合,其中1例股骨头坏死,1例股骨颈短缩愈合.临近关节功能恢复满意.结论带旋髂深血管髂骨-蝶形骨膜瓣复合移植治疗骨不连方法可靠,疗效肯定.     

Periorbital Rejuvenation Combining Fat Grafting and Blepharoplasties

Most surgical techniques intended to rejuvenate the midface do not address the palpebro-malar junction. With the advent of lipostructure, it appeared possible to perform at the same time surgery of the upper and lower eyelid and fat grafting. The technical method and instruments are described. The results are more natural than with a standard blepharoplasty because fat grafting restores a more youthful three-dimensional appearance.     

Use of filterwire EX for distal embolic protection during complex percutaneous coronary interventions: four case studies.

We describe four successful cases demonstrating the use of a novel filter-guidewire (FilterWire EX) during complex percutaneous coronary interventions in saphenous vein grafts (n = 3) and native coronary artery (n = 1) for prevention of distal embolization and consequently myonecrosis.     

Analysis and Outcomes of Right Lobe Hepatectomy in 101 Consecutive Living Donors

The shortage of deceased organ donors has created a need for right lobe living donor liver transplantation (RLDLT) in adults. Concerns regarding donor safety, however, necessitate continuous assessment of donor acceptance criteria and documentation of donor morbidity. We report the outcomes of our first 101 donors who underwent right lobectomy between April 2000 and November 2004. The cohort comprised 58 men and 43 women with a median age of 37.8 years (range: 18.6-55 years); median follow-up is 24 months. The middle hepatic vein (MHV) was taken with the graft in 55 donors. All complications were recorded prospectively and stratified by grade according to Clavien's classification. Overall morbidity rate was 37%; all complications were either grade 1 or 2, and the majority occurred during the first 30 days after surgery. Removal of the MHV did not affect morbidity rate. There were significantly fewer complications in the later half of our experience. All donors are well and have returned to full activities. With careful donor selection and specialized patient care, low morbidity rates can be achieved after right hepatectomy for living donor liver transplantation.     

Torsional Strength of Cortical and Cancellous Bone Grafts After Rigid Plate Fixation

Mechanical properties of cortical and cancellous interposition grafts in rabbit tibio-fibular bones fixed with 6-hole DCP/ASIF plates were tested with torsional loading after intervals of 3 to 52 weeks postoperatively.

In the cortical grafts maximum torque moment at fracture, energy absorption capacity and rigidity increased from 3 to 12 weeks, while the cancellous grafts were more plastic with lower rigidity, higher angular deformation and higher energy absorption.

From 12 to 52 weeks maximum torque moment at fracture, energy absorption, rigidity and angular deformation decreased in grafts of both types, the respective means at 36 weeks being 39, 34, 57 and 82 per cent of the control values for the cortical grafts, and 26, 17, 42 and 58 per cent of the control values for the cancellous grafts. The differences between the torsional properties of the two graft types decreased with time.     

Rhinoseptoplasty

Severe deviations of the nasal septum and entire nasal bony and cartilaginous framework can be treated adequately only by a classical rhinoplasty coupled with an atypical submucous resection. All of the cartilaginous and osseous septum are removed and the operation is completed with the insertion of a cartilaginous support formed from cartilage strip grafts obtained from the resected septal cartilage.     

EVT® Endovascular graft for abdominal aortic anerysm

Background : A variety of prostheses are now available for the endovascular treatment of abdominal aortic aneurysm (AAA). Significant advantages of the EVT^® device are its unibody design, secure hook attachment system and graft fabric approximating that used in conventional surgery. Methods : Implantation of the EVT^® device was attempted in 60 patients who were studied prospectively with an analysis of subsequent problems encountered. Results : Conversion to open repair was required in four cases (6.7%). There were nine tube grafts inserted, 13 aorto‐unilateral iliac with crossover grafts and 34 aorto‐bi‐iliac grafts. There was one death (mortality 1.7%). Endoleaks were identified in eight patients (14%), none of which were proximal; three sealed spontaneously, two were treated with coil embolization, two are being observed and one patient had an iliac attachment converted to an open anastomosis. Access vessel problems were seen in 21 patients (35%); two‐thirds were corrected at the time of initial surgery. Seven patients (12%) had primary graft limb problems identified and treated before leaving the operating room. Nine patients (16%) developed secondary graft limb problems, which were diagnosed and treated after the initial surgery. Endovascular treatment was used in eight and was successful in six with surgical revision required in two. On review of these cases to assess if the problem could have been predicted at the time of initial surgery, it was felt that more aggressive treatment of intraoperatively diagnosed graft limb stenoses, even though considered mild, may have prevented 50% of subsequent secondary graft limb occlusions. Conclusion : Although the EVT^® device has significant advantages in the endovascular management of aortic aneurysm, potential graft limb problems need to be actively identified with the majority able to be successfully managed by supplementary endovascular techniques.