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1.
F. Al-Mufti G. Kaur K. Amuluru J.B. Cooper K. Dakay M. El-Ghanem J. Pisapia C. Muh R. Tyagi C. Bowers C. Cole S. Rosner J. Santarelli S. Mayer C. Gandhi 《AJNR. American journal of neuroradiology》2021,42(5):916
BACKGROUND AND PURPOSE:Embolization of the middle meningeal artery for treatment of refractory or recurrent chronic subdural hematomas has gained momentum during the past few years. Little has been reported on the use of the n-BCA liquid embolic system for middle meningeal artery embolization. We present the technical feasibility of using diluted n-BCA for middle meningeal artery embolization.MATERIALS AND METHODS:We sought to examine the safety and technical feasibility of the diluted n-BCA liquid embolic system for middle meningeal artery embolization. Patients with chronic refractory or recurrent subdural hematomas were prospectively enrolled from September 2019 to June 2020. The primary outcome was the safety and technical feasibility of the use of diluted n-BCA for embolization of the middle meningeal artery. The secondary end point was the efficacy in reducing hematoma volume.RESULTS:A total of 16 patients were prospectively enrolled. Concomitant burr-hole craniotomies were performed in 12 of the 16 patients. Two patients required an operation following middle meningeal artery embolization for persistent symptoms. The primary end point was met in 100% of cases in which there were no intra- or postprocedural complications. Distal penetration of the middle meningeal artery branches was achieved in all the enrolled cases. A 7-day post–middle meningeal artery embolization follow-up head CT demonstrated improvement (>50% reduction in subdural hematoma volume) in 9/15 (60%) patients, with 6/15 (40%) showing an unchanged or stable subdural hematoma. At day 21, available CT scans demonstrated substantial further improvement (>75% reduction in subdural hematoma volume).CONCLUSIONS:Embolization of the middle meningeal artery using diluted n-BCA and ethiodized oil (1:6) is safe and feasible from a technical standpoint. The use of a dextrose 5% bolus improves distal penetration of the glue.Despite traditional treatment with surgical evacuation, chronic subdural hematomas (cSDHs) tend to have an indolent course with frequent recurrences.1 In recent years, embolization of the middle meningeal artery (MMA) for treatment of refractory or recurrent cSDH has gained momentum, with recent literature showing a significant reduction in the size of the cSDH as well as lower rates of recurrence.2 The primary endovascular techniques used to date have involved the use of polyvinyl alcohol particles (PVA) and Onyx liquid embolic (ethylene-vinyl alcohol dissolved in dimethyl-sulfoxide; Medtronic). Another commonly used liquid embolic agent in the neurointerventional area is n-BCA, which is a liquid adhesive that polymerizes rapidly on contact with ionic substances and can be injected to achieve permanent vessel occlusion. The rates of polymerization and flow and the penetration depth can be modified using varying amounts of ethiodized oil as well as concurrent infusion of dextrose 5% in water (D5W) during n-BCA (Trufill, Cordis Neurovascular) injection (D5W-push technique).3 Data on the use of n-BCA as an embolic agent in cases of cSDH are extremely limited. Herein, we sought to study the safety and technical feasibility of using diluted n-BCA for embolization of the MMA for cSDHs. 相似文献
2.
Intracranial circulation: pulse-sequence considerations in three- dimensional (volume) MR angiography 总被引:2,自引:0,他引:2
The technique and feasibility of magnetic resonance (MR) angiography of intracranial vessels were studied in 35 healthy volunteers. Variations in image orientation, repetition time (TR), and flip angle were evaluated to determine their effects on flow-related enhancement. Gradient modifications--including echo time (TE), motion compensation, bandwidth, and field of view--were also studied in an effort to reduce motion-induced phase shifts. Results indicated that a FISP (fast imaging with steady precession) sequence with a TR of 50 msec, TE of 15 msec, velocity compensation in the read and section-select directions, acceleration compensation in the read direction, anisotropic volume, and a 1.25-mm partition thickness produced three-dimensional angiographic MR images that were accurate and reproducible in the depiction of the major intracranial vessels. Difficulties with field of view, persistent signal void secondary to higher-order motion, and spatial resolution remain major problems requiring additional study. 相似文献
3.
Maxillary sinusitis in adults: an evaluation of placebo-controlled double-blind trials 总被引:1,自引:0,他引:1
BACKGROUND: In general practice, acute sinusitis is frequently diagnosed
and treated with antibiotics. OBJECTIVE: This study aimed to determine the
evidence for the effectiveness of antibiotic treatment in acute maxillary
sinusitis in adults by assessing the methodological quality of
placebo-controlled double-blind randomized trials. METHOD: An evaluation by
four raters through a 35-item scoring-scale for internal and external
validity of all placebo-controlled double-blind randomized trials on acute
sinusitis found between January 1966 and July 1996. RESULTS: Eighty-five
trials were excluded because they were not placebo-controlled,
double-blind, randomized, or were carried out in patients with chronic
sinusitis or in children. The three remaining trials were performed in
different populations (one in general practice) between 1973 and 1978. Only
one study claimed superiority of antibiotic treatment. Different inclusion
criteria and major outcome measures were used by the authors. The
reliability of major outcome events was reported poorly or not at all and
in two studies outcome measures were clinically inappropriate. The studies
scored 30-62% of the maximum attainable score for internal validity and
10-20% for external validity. CONCLUSION: The effectiveness of antibiotic
treatment in acute maxillary sinusitis in a general practice population is
not based sufficiently on evidence.
相似文献
4.
A case of deep vein thrombosis of the axillary vein treated with local thrombolytic therapy with streptokinase in a superficial vein of the hand and controlled phlebographically, is reported. Therapeutic effectiveness, simplicity of the method and absence of hemorrhagic complications are underlined. 相似文献
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6.
H Angus-Leppan GA Lambert J Michalicek 《Cephalalgia : an international journal of headache》1997,17(6):625-630
Co-existence of facial and occipital pain may occur in occipital neuralgia, migraine and cluster headache; suggesting convergence of trigeminal and cervical afferents. Such convergence has been shown in humans and other animals, but the site and extent of this are uncertain. In anaesthetized adult cats, the superior sagittal sinus and occipital nerve were stimulated electrically, and extracellular recordings made in the dorsolateral area of the upper cervical cord using glass-coated tungsten electrodes. Of 49 units in 10 cats, 33 (67%) had input from the superior sagittal sinus and the occipital nerve. Thirteen (27%) had superior sagittal sinus input and 3 (6%) had occipital nerve input. Convergent receptive fields were identified mechanically in 7 units. These experiments in cats show convergent input from occipital nerve and superior sagittal sinus on dorsolateral area units in two-thirds of cases studied. This experimental site of trigeminocervical convergence may relate to referral of pain in occipital neuralgia and other headaches. 相似文献
7.
In patients with PG-dependent renal function, NSAID administration
constantly reduces GFR and RBF in a dose-dependent fashion. In this
situation, the risk of overt acute renal failure is high and should be
taken into proper account. In contrast, the incidence of NSAID-related
renal structural alterations appears to be very low, yet the absolute
number of patients may be significant considering the wide use of such
drugs. Concerning the antiproteinuric effect of NSAIDs, the unfavourable
ratio risk/benefit does not seem to support their indication in proteinuric
nephropathies. The development of PGHS-2 selective inhibitors is promising,
and may open new therapeutical strategies in the treatment of the
progression of renal disease.
相似文献
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