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Biomedical subjects

A Berenstein

Publications and source records attributed to A Berenstein.

At least 19 recordsLinked to original sources
PubMed1992

Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils.

In a multicenter study, 120 patients with intracranial aneurysms presenting a high surgical risk were treated using electrolytically detachable coils and electrothrombosis via an endovascular approach. The results of treatment in patients with posterior fossa aneurysms (42 patients with 43 aneurysms) are presented. The most frequent clinical presentation was subarachnoid hemorrhage (24 cases). The clinical follow-up periods ranged from 1 week to 18 months. Complete aneurysm occlusion was obtained in 13 of 16 aneurysms with a small neck and in four of 26 wide-necked aneurysms. A 70% to 98% thrombosis of the aneurysm was achieved in 22 of 26 aneurysms with a wide neck and in three of 16 small-necked aneurysms. One aneurysm could not be treated due to a technical complication. Two cases required postprocedural surgical clipping of a residual aneurysm. One patient (originally in Hunt and Hess Grade V) experienced procedural rupture of the aneurysm requiring an emergency parent artery occlusion. He eventually died 5 days later. Another patient (originally in Grade IV) had coil migration and posterior cerebral artery territory ischemia. A third patient developed a permanent neurological deficit (hemianopsia) after complete occlusion of a wide-necked basilar bifurcation aneurysm. One patient, harboring an inoperable giant basilar bifurcation aneurysm, died from aneurysm bleeding 18 months after partial occlusion. Overall morbidity and mortality rates related to treatment were 4.8% (two cases) and 2.4% (one case), respectively (2.6% and 0% if considering only patients in Hunt and Hess Grades I, II, and III). It is suggested that this technique is a viable alternative in the management of patients with posterior fossa aneurysms associated with high surgical risk. Longer angiographic and clinical follow-up study is necessary to determine the long-term efficacy of this recently developed endovascular occlusion technique. Close postoperative angiographic and clinical monitoring of patients with wide-necked subtotally occluded aneurysms is mandatory to check for potential aneurysmal recanalization, regrowth, and rupture.

Adolescent↗
PubMed1992

The benign course of cavernous carotid artery aneurysms.

Recently, the benign nature of aneurysms of the cavernous carotid artery has been questioned. In a review of cases evaluated from 1980 to 1990 with this developmental aneurysm, the authors found 70 patients with 79 cavernous carotid artery aneurysms. As expected, the great majority (59 patients) had ophthalmoplegia as the initial problem. Retro-orbital pain (three cases) and a carotid-cavernous fistula (five cases) were infrequently the sole manifestation. Mirror-image asymptomatic aneurysms were found in nine patients and asymptomatic cavernous aneurysms were found in three additional patients. Thirty-four patients not surgically treated were followed for a mean of 2.8 years, and 36 surgical patients were followed for a mean of 4.1 years prior to treatment. Of the 79 aneurysms, one (1.3%) ruptured into the subarachnoid space during this period. Other than optic neuropathy or cranial neuropathy, no patient had a permanent neurological deficit; the 12 asymptomatic aneurysms remained asymptomatic. It is concluded that an aneurysm of the cavernous carotid artery is rarely associated with life-threatening complications, and treatment should be considered principally for patients with intolerable pain or problems related to vision.

Aged↗
PubMed1992

Interventional neuroradiology.

Recent technical developments and improvements in angiographic equipment, variable stiffness microcatheters, embolic materials, and better training increased efficacy, safety, and growing acceptance of endovascular procedures by various specialties. Additional treatment options, frequently supplementary to neurosurgical procedures can be offered to patients with intracranial vascular lesions, using existing vascular pathways and avoiding the need for surgical exposure. For endovascular embolization of unclippable aneurysms coils which are soft, retrievable, and thrombogenic appear a better alternative than detachable balloons. New understanding and capabilities in brain arteriovenous malformations (AVMs) as an adjunct to microsurgical resection, or as the sole form of treatment may improve results and long-term outcome. Experience with intravascular thrombolysis and balloon angioplasty of extracranial and intracranial vessels will potentially improve neurological deficits in cerebrovascular or vasospastic occlusive disease. Safety, efficacy, and long-term follow up are needed to maintain and improve standards of practice and offer new therapeutic alternatives.

Angioplasty, Balloon↗
PubMed1991

The clinical importance of the inferolateral trunk of the internal carotid artery.

The inferolateral trunk (ILT) of the internal carotid artery (ICA) is a branch that arises inferiorly from the C4 segment of the cavernous ICA. It provides blood supply to the 3rd, 4th, and 6th cranial nerves, as well as to the gasserian ganglion. The ILT anastomoses to branches of the internal maxillary artery, providing collateral circulation between the external carotid artery and the ICA systems. Retinal and cerebral emboli can arise from the external carotid artery system and travel via the ILT to the ICA. Cranial nerve palsies may result after occlusion of the ILT. We present the cases of four patients who had iatrogenic neurological dysfunction subsequent to intravascular procedures that involved the ILT. These cases provide further clinical confirmation of the importance of this blood vessel. A 5th case involving iatrogenic occlusion of the ILT and no neurological deficit is also presented, demonstrating that the ILT is not the sole blood supply of the cranial nerves in the cavernous sinus.

Adult↗
PubMed1991

Neonatal vein of Galen malformations: experience in developing a multidisciplinary approach using an embolization treatment protocol.

A multidisciplinary team approach using a staged transcatheter embolization and neurosurgical protocol was applied to 22 patients with neonatal presentation of vein of Galen malformations over a 12 year period. Aggressive medical therapy was combined with interventions including: ventricular shunting, transcatheter embolization, retrograde transtorcular embolization, and neurosurgical obliteration. There was a high frequency of high output cardiac failure, multiple organ system dysfunction, seizures, hydrocephalus, visual, developmental and neurological disability. Of the first 11 patients, five survived; four with seizures and three with marked retardation. Of the last 11 patients, six survived; five with seizures but only one with retardation. Despite persistently high morbidity and mortality, our continuously evolving protocol offers these otherwise hopeless patients some chance of survival.

Cerebral Veins↗
PubMed1991

A sacral dural arteriovenous fistula presenting with an intermittent myelopathy aggravated by menstruation. Case report.

The case is reported of a woman with a spinal dural arteriovenous fistula whose intermittent myelopathy became aggravated with menstruation. Her symptoms recurred in spite of successful acrylic embolization of the lateral sacral arteriovenous fistula. Repeat angiography showed venous drainage from the uterus toward the medullary vein. Total abdominal hysterectomy cured her symptoms. The pathophysiological basis for this peculiar clinical manifestation and its management are discussed.

Arteries↗
PubMed1990

Irrigation device for neuroangiographic procedures.

A simple irrigation device for use in diagnostic and interventional neuroangiographic procedures is described. The device is used to flush bubbles and blood clots from catheter hubs. The authors also describe a technique in which this device can be used to prevent filling a catheter with air when a guide wire is removed.

Angiography↗
PubMed1990

Treatment of spinal metastases from kidney cancer by presurgical embolization and resection.

Surgical treatment of bone metastases from kidney cancer is often complicated by profuse blood loss. The authors report the results of a retrospective review of 30 consecutive patients who underwent surgery for spinal metastases from kidney cancer. Seventeen patients (57%) were operated on after failing radiation therapy. Prior to operation, selective spinal angiography and embolization were performed in 17 patients with no permanent neurological deficits resulting. Gross total resection of the tumor and stabilization of the spine were then accomplished with acceptable blood loss. Twenty-seven (90%) of the 30 patients improved neurologically following surgery. There was a median survival time of 16 months, a 2-year survival rate of 33%, and a 5-year survival rate of 15%. Major surgical complications in this series were related to excessive blood loss in patients without embolization. These data suggest that patients with spinal metastases from kidney cancer should undergo spinal angiography and embolization prior to resection of the tumor. To improve upon current results, such treatment should be carried out prior to external radiation therapy.

Adult↗
PubMed1989

Real-time intraoperative monitoring during neurosurgical and neuroradiological procedures.

A real-time intraoperative evoked potential (EP) monitoring system is described and evaluated. Unique features include (1) online artifact rejection to reduce noise contamination, (2) optimum digital filtering to improve the signal-to-noise ratio of the EP signal, (3) statistically defined confidence intervals to determine significant EP peak latency deviations, and (4) sliding windows of EP subaverages of various sizes to minimize feedback time to the surgeon. The reliability and validity of this system were determined by comparison with conventional intraoperative EP averaging and by examining the correlation of EP parameter changes with concurrent surgical and radiological manipulations. This system was clearly superior to conventional averaging systems. Reliable EPs could be obtained from neurologically compromised patients within the electrically hostile operating room environment, in cases in which conventional averaging failed to extract a stable EP signal. EP update times of 10-20 s were quite common and allowed direct moment-to-moment correlations with surgical and radiological events. Case histories are presented that show the utility of this system for aiding in the prevention of neurological complications. This utility is examined for neurosurgical and neuroradiological procedures involving spinal cord, brainstem, midbrain, and cortical structures, and affecting the somatosensory, motor, auditory, and visual system pathways.

Adult↗
PubMed1988

Congenital arteriovenous malformation of the female pelvis: a gynecologic perspective.

Nine female patients with the rare congenital arteriovenous malformation of the pelvis were treated at New York University Medical Center in the past 8 years. The patients varied significantly in the anatomic location of the arteriovenous malformation, clinical presentation, and natural course of disease. A gynecologic perspective on the management of this condition is presented, which ranges from a conservative approach with preservation of childbearing potential to extensive pelvic surgery. The important role of modern interventional radiology technology and the multidisciplinary approach are stressed. The unpredictable course of disease after any intervention should be emphasized in planning the management of pelvic arteriovenous malformation.

Adult↗
PubMed1988

Management of nontraumatic vascular shunts involving the cavernous sinus.

The authors managed 38 consecutive cases of nontraumatic vascular shunts involving the cavernous sinus. Selective angiography demonstrated 12 carotid cavernous fistulas (CCFs) and 26 dural arteriovenous shunts (DAVSs). Visual disability occurred from glaucoma, venous retinopathy, optic neuropathy, or diplopia. Ten patients with slow-flow shunts and minimal dysfunction were treated medically to lower intraocular pressure (IOP) and/or instructed in manual compression of the internal carotid artery, ipsilateral to the lesion, using the contralateral hand. Percutaneous intraarterial embolization using detachable balloons, isobutylcyanoacrylate, or polyvinyl alcohol particles was successful in 16/18 DAVSs and 9/10 CCFs. The neuro-ophthalmic signs resolved in these 25 cases. Complications occurred in five patients. These included a transient hemiparesis, twelfth nerve palsy, unilateral nasal field loss, a pseudoaneurysm causing a third-nerve paresis, and temporary cavernous sinus thrombosis. Conservative therapy in mild cases and embolization in cases with visual disability or progressive signs are warranted.

Arteriovenous Fistula↗
PubMed1988

Visual system toxicity following intra-arterial chemotherapy.

We studied the effects of intra-arterial chemotherapy on the visual system of 29 consecutive patients with gliomas. As expected, infra-ophthalmic carotid infusion of cisplatin or carmustine (BCNU) was associated with clinically apparent anterior visual pathway lesions. Electroretinography revealed retinal dysfunction in patients without clinical abnormalities. Supra-ophthalmic carotid infusion of cisplatin or BCNU caused no retinal or optic nerve lesions. Electroretinography was abnormal in only one of these patients. Our results indicated that BCNU and cisplatin cause ischemic damage and are toxic to both retinal and neural tissue in patients with gliomas.

Brain Neoplasms↗
PubMed1988

Dural arteriovenous malformations and papilledema.

We examined and managed two patients with posterior fossa dural arteriovenous malformations (DAVMs) and papilledema. Both DAVMs had venous drainage into the transverse, straight, and sigmoid dural venous sinuses. The mechanism of papilledema in the first case was presumed venous hypertension resulting in impaired cerebrospinal fluid absorption, as the malformation drained into the single transverse sinus. This was cured by selective arterial embolization of the causative DAVM. The second patient had venous sinus thrombosis that impaired venous drainage despite embolization. A lumboperitoneal shunt was necessary to treat the elevated intracranial pressure.

Cerebrospinal Fluid Shunts↗
PubMed1988

Surgical neuroangiography of the spine and spinal cord.

The SCAVMs are high-flow lesions that present at a younger age, during the second or third decades of life. The most common presenting symptoms are subarachnoid hemorrhage and hematomyelia. Endovascular treatment of these lesions has become an important adjunct to surgical management. Complete occlusion is possible by superselective catheterizations and injection of a liquid embolic material. The SDAVFs are slow-flow AV shunting at the dura, which causes progressive neurologic deficit in older age--the fifth or sixth decades of life. Embolization is now the primary mode of treatment. Preoperative embolization of the hypervascular tumors of the spine and spinal cord has become a necessity to reduce bleeding during surgery, and it even reduces the size of the tumor and relieves spinal block. Thorough knowledge of vascular anatomy and better understanding of hemodynamics of these lesions are essential to perform proper and safe embolization.

Angiography↗
PubMed1988

Surgical neuroangiography of intracranial lesions.

Surgical neuroangiography of intracranial vascular lesions is one of the advances in modern neuroradiology. Improved microcatheters permit safer catheterization of very distal intracranial and intracerebral vessels. With proper embolic materials various cerebrovascular problems can be effectively treated by endovascular embolization.

Arteriovenous Fistula↗
PubMed1987

Intracavernous branches of the internal carotid artery (ICA). Comprehensive review of their variations.

Since we started to work in the lateral sellar region (in 1973), a large volume of angiographic material has provided us with exceptional variations that added to the anatomic facts obtained from our dissections. At present, these anatomic facts remain, but the way we look at them and the way we use them for endovascular treatments, has created a need for a different type of approach and understanding. In this report, we present a flexible anatomical view of the intracavernous branches of the internal carotid artery and a scheme to understand and predict the anatomical variations of these collaterals. Four embryonic vessels play an important role in the variations of the arterial supply to the lateral cavernous region: the dorsal ophthalmic artery, the stapedial artery, the trigeminal artery and the primitive maxillary artery. In general each of them partially regresses leaving behind a remnant. However there is a spectrum from their persistence to incomplete regression, resulting in variations of the supply to their distal territories. The term "meningohypophyseal" should be abandoned because it is misleading and improperly used. Complete agenesis is known for a long time; in case of segmental agenesis of the ICA each of the embryonic vessels presented above may represent an alternate route to bypass the agenesis. The ICA is not a direct feeding artery but a succession of independant segments which can be the site of various anomalies. An embryonic transdural circle can be individualized; it is constituted by the trigeminal arteries posteriorly, the ICA siphon anteriorly, the transsellar anastomosis and internal maxillary artery connections. Although regressions usually occur in this embryonic transdural circle, its derivatives congenital and acquired arterial pathologies. It also constitutes the key system in determining the arterial variations of the perisellar region.

Carotid Artery, Internal↗