Search

Intracranial aneurysms bear a high risk of morbidity and mortality especially when they have become symptomatic due to rupture or represent a space occupying lesion. Therefore operative treatment is aimed at the obliteration of the aneurysm to eliminate the risk of hemorrhage. Planning of treatment requires a diagnostic resolution capable of showing aneurysms and their anatomic relationship to the adjacent structures. Due to technical advances computed tomography has reached a diagnostic accuracy sufficient to plan aneurysm treatment. This report describes the present state of three-dimensional spiral-CT angiography (3D-spiral-CTA) and our protocol to examine the arteries of the Circle of Willis for the presence and microanatomy of aneurysms. The experience of 46 patients with 64 aneurysms is reported and the diagnostic value of the method in comparison to conventional angiography is evaluated.

Purpose: Intraspinal metastasis of Wilms' tumors is a rare event with only 6 cases documented in the literature., Patient and Methods: We report a case of an intraspinal metastasis by a young child with anaplastic Wilms' tumor (stage I). A 9-year-old girl developed 8 months following nephrectomy and pre-operative chemotherapy strong back pain. Within 2 weeks signs of beginning of spinal cord compression were obtained. The magnetic resonance imaging showed a spinal cord compression with an intraspinal tumor mass Th 8 to 10., Results: The child underwent immediate spinal cord decompression followed by chemotherapy and an additional radiotherapy of the metastatic region up to 30 Gy with most of neurologic recovery within 6 weeks., Conclusions: The case illustrates the importance of rapidly responding neurologic complications in patients with Wilms' tumor, even in stage I.

Case reports are presented on 2 children who had suffered traumatic luxations in the region of the cranial cervical spine. In both children, there was interruption of spinal cord continuity by severance with respiratory arrest and tetraplegia. As a rule, death occurs immediately at the site of accident. With a well-developed emergency ambulance system in conurbations, however, such cases may be admitted to hospital after resuscitation. After 16 hours, a child admitted to hospital died of a progressive bradycardia with subsequent asystole in respiratory paralysis. The second child survived for 10 months until it died of pneumonia.

We present the results of a series of 105 patients with cerebral arteriovenous malformations (AVMs) who were treated by a combined protocol including endovascular occlusive measures and open surgical resection. 25 patients were treated only by surgical intervention, 72 patients underwent preoperative endovascular embolization and 8 patients were treated only by embolization, seven of which were only treated for palliation. After superselective angiography the vascular territories suitable for endovascular or microsurgical approach were defined, and in most cases these territories were complementary to each other. In 56 cases, only one embolization was necessary and due to an advantageous co-localization of the departments the whole combined endovascular/neurosurgical procedure was done in one anesthesia. If several endovascular sessions were necessary (16 patients), the resection was mostly carried out immediately after the last neuroradiological session in the same anesthesia with total time of such combined procedure now averaging about 7 hours. According to the proposed grading system by Spetzler we treated 25 grade 1, 24 grade 2, 40 grade 3, 11 grade 4, and 5 grade 5 lesions. The overall success rate defined as complete resection without additional permanent neurological deficit was 89.6% (87 out of 97 surgical cases). The benefits of such combined approach to cerebral AVMs become apparent in shortened and safer surgical procedures as well as in a low complication rate.

We report on a group of 76 patients who had been treated during a period in which preoperative embolization using interventional neuroradiologic technique was standard procedure. During this time, 20 consecutive patients were operated on without embolization, eight patients were treated with embolization only, and 48 patients were operated on after embolization. In 35 cases surgery immediately followed the last embolization procedure. All arteriovenous malformations (AVMs) were classified and the outcome analyzed according to Spetzler [J Neurosurg 1986; 65: 476-83]. Those lesions treated with a combination of embolization and surgery had higher Spetzler grading than those that had been operated without previous embolization. The overall recovery rate was 82.9%. In 7.9% of the cases the AVMs were not totally extirpated. The overall complication rate was 9.2%. It is concluded that preoperative embolization facilitates surgery and reduces the risk of severe morbidity and mortality, especially in high-grade lesions. In addition to the clinical results, the application and usefulness of Ethibloc as an embolizing agent is reported.

The use of Gadolinium-DTPA as a paramagnetic contrast agent in MRI with adults and juveniles concerning brain and spinal cord pathology is well proven since years. Tolerance and safety were excellent. In the FRG it is only introduced for children over two years of age. Therefore this report deals with the experience in four infants and small children under the age of two, who received gadolinium-DTPA for diagnostic purposes in pre- or post-operative circumstances. They all were suffering from neurological tumors and got additional diagnostic information in three cases. Clinical side-effects like urticaria, vomiting or convulsions had not been observed nor had pathologic changes of the biochemical parameters been noticed.

Interventional neuroradiology (INR) includes such occlusive procedures as, for example, pre-operative embolization of cerebral and spinal arteriovenous malformation (AVM) and extracerebral head and neck tumors (meningioma, angiofibromas, etc.). In addition to this combined neuroradiological/surgical treatment, cranial and spinal dural fistulas, and traumatic arteriovenous fistulas as well as certain aneurysms at the base of the skull, may also be indications for transvascular embolization treatment alone. Recanalizing procedures (local fibrinolysis, percutaneous transluminal angioplasty (PTA] are employed for the most part in the vertebrobasilar and, with reservations, also in the carotid territories.

In 1095 patients 2770 brain supplying arteries have been studied by i.a.-DSA. Definitive neurological deficits occurred in 0.09%, transient deficits were observed in 0.45%. The reduced complication rate in comparison to former studies seems to be a continued effect of technical progress (DSA) and the use of new isoosmotic contrast media. In order to reduce the "training hospital effect" as to complication rate careful supervision of trainees is necessary. The average fluoroscopy time per vessel is proposed as an objective measure of the investigational skill of a neuroradiologist.

Local intraarterial fibrinolytic therapy (LIF) in patients with acute vertebrobasilar occlusion (AVBO) is a rational and if successful a life saving treatment. The recent progress in this field is determined by the use of microcatheters for superselective basilar artery catheterisation and a "short time, highdose" regimen using 750.000 IU Urokinase in not more than two h. Two out of 7 patients died and 1 did not improve to a better than a locked-in-state. Four patients however survived with excellent outcome.

Percutaneous embolization using detachable balloons was successfully performed in a series of nine patients with intracranial carotid aneurysms. The clinical progress and the results of MR examination are reported. Up to 4 months after treatment, MR imaging did not show any significant change in size of the artificially thrombosed aneurysms. Complete resorption cannot be expected in less than 6-8 months, but resorption does eventually occur. The intensity pattern observed in the evolution of the thrombus was similar to that of intra- and extra-cranial hematomas.

A case of dissecting stab wound injury to the right vertebral artery with a vertebro-vertebral fistula is reported. Since a complete occlusion of a VV-fistula was not possible from a proximal approach with detachable balloons only retrograde catheterisation of the right vertebral artery via the left vertebral artery was undertaken (cross over technique). The introduction of thrombogenic platinum-coils led to a successful and complete occlusion of the fistula.