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Biomedical subjects

C J Moran

Publications and source records attributed to C J Moran.

At least 37 records · Page 2Linked to original sources
PubMed1999

Sagittal sinus occlusion by intraluminal dural cysts. Report of two cases.

Lesions involving the sagittal sinus typically present as masses compressing the sinus externally. The authors describe two cases of lesions entirely within the lumen of the sagittal sinus. In one of the cases, syncope was the presenting symptom and surgical resection of the cyst was performed. An entirely intraluminal cyst, consistent with a dural cyst, was resected, followed by reconstruction of the sinus and resolution of symptoms. Entirely intraluminal lesions of the sagittal sinus have rarely been reported as incidental findings. This represents the first report of symptomatic occlusion of a venous sinus by an intraluminal cyst.

Adult↗
PubMed1999

Radiation dose to patients and personnel during intraoperative digital subtraction angiography.

BACKGROUND AND PURPOSE: The use of intraoperative angiography to assess the results of neurovascular surgery is increasing. The purpose of this study was to measure the radiation dose to patients and personnel during intraoperative angiography and to determine the effect of experience. METHODS: Fifty consecutive intraoperative angiographic studies were performed during aneurysmal clipping or arteriovenous malformation resection from June 1993 to December 1993 and another 50 from December 1994 to June 1995. Data collected prospectively included fluoroscopy time, digital angiography time, number of views, and amount of time the radiologist spent in the room. Student's t-test was used to assess statistical significance. Effective doses were calculated from radiation exposure measurements using adult thoracic and head phantoms. RESULTS: The overall median examination required 5.2 minutes of fluoroscopy, 55 minutes of operating room use, 40 seconds of digital angiographic series time, and four views and runs. The mean room time and the number of views and runs increased in the second group of patients. A trend toward reduced fluoroscopy time was noted. Calculated effective doses for median values were as follows: patient, 76.7 millirems (mrems); radiologist, 0.028 mrems; radiology technologist, 0.044 mrems; and anesthesiologist, 0.016 mrems. CONCLUSION: Intraoperative angiography is performed with a reasonable radiation dose to the patient and personnel. The number of angiographic views and the radiologist's time in the room increase with experience.

Adolescent↗
PubMed1998

Sickle cell disease: imaging of cerebrovascular complications.

This case is reported because of the unusual blood findings, no duplicate of which I have ever seen described. Whether the blood picture represents merely a freakish poikilocytosis or is dependent on some peculiar physical or chemical condition of the blood, or is characteristic of some particular disease, I cannot at present answer. I report some details that may seem non-essential, thinking that if a similar blood condition is found in some other case a comparison of clinical conditions may help in solving the problem.

Adolescent↗
PubMed1998

Natural history of stenosis from intracranial atherosclerosis by serial angiography.

BACKGROUND AND PURPOSE: Knowledge of the natural history of stenoses due to intracranial atherosclerosis may be useful for evaluating possible treatments such as angioplasty. METHODS: We retrospectively reviewed records over a 7-year period to identify patients with intracranial atherosclerotic stenoses and serial angiograms. Quantitative measurements of stenoses were made in a blinded manner, and clinical outcomes were reviewed. RESULTS: We identified 21 patients with 45 intracranial stenoses who underwent repeat angiography at an average interval of 26.7 months. The average stenosis for all intracranial lesions was 43.9% initially and 51.8% on follow-up (P=.032). The average stenosis in the intracranial internal carotid artery (ICA) was stable (51.2% versus 52.6%). The average stenosis in the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) progressed from 32.4% to 49.7% (P=.037). Based on a minimum 10% change, 20% of intracranial ICA lesions progressed compared with 61% of ACA, MCA, and PCA lesions. Regression occurred in 14% of the intracranial ICA group and 28% of the ACA-MCA-PCA group. Cerebrovascular events were infrequent during this period, with 4 transient ischemic attacks and 1 intracerebral hemorrhage. CONCLUSIONS: Intracranial atherosclerotic stenoses are dynamic lesions demonstrating both progression and regression.

Arterial Occlusive Diseases↗
PubMed1998

Increase in diameters of vasospastic intracranial arteries by intraarterial papaverine administration.

OBJECT: This study was conducted to determine if there is a change in intracranial arterial diameters after papaverine infusion for vasospasm and to determine whether the change occurs in proximal, intermediate, and distal arteries. METHODS: The authors measured arterial diameters retrospectively in all patients who received intraarterial papaverine for treatment of vasospasm between November 1992 and August 1995. Patients who received papaverine in the same session with or following angioplasty were excluded. Measurements were made in a blinded manner with the aid of a magnification loupe at 12 predetermined sites on each angiogram before and after papaverine infusion. Eighty-one treatments in 34 patients were included. Angiograms obtained at the time of presentation with subarachnoid hemorrhage (SAH) were examined in 26 of the 34 patients. Nine carotid territories visualized by repeated angiography on the day after infusion were examined to determine the duration of the papaverine effect. CONCLUSIONS: In all treatment groups an increase was found in the average arterial diameters ranging from 2.8 to 73.9%, with a mean increase of 26.5%. Increases in diameter were observed in proximal, intermediate, and distal arteries. The timing of treatments ranged from Day 3 to Day 19 post-SAH, and there was no relationship between timing and arterial responsiveness (r = -0.06). There was a moderately good correlation between the degree of vasospasm in an artery and its responsiveness to papaverine (r = -0.54, -0.66, and -0.66, for proximal, intermediate, and distal arteries, respectively). The effect of papaverine did not persist until the following day in patients in whom repeated angiography was performed.

Angiography, Digital Subtraction↗
PubMed1998

Intracranial pressure monitoring during intraarterial papaverine infusion for cerebral vasospasm.

PURPOSE: Intraarterial papaverine infusions are performed to reverse cerebral arterial vasospasm resulting from subarachnoid hemorrhage, but such infusions may lead to increases in intracranial pressure (ICP). This study was undertaken to determine when ICP monitoring is indicated during papaverine treatment. METHODS: Seventy-eight vessels were treated in 51 sessions in 28 patients with symptomatic vasospasm. ICP, papaverine doses, and infusion rates were recorded during treatment sessions. The procedural data, Hunt and Hess scores, Fisher grades, Glasgow Coma Scale scores, and ages for all subjects were reviewed and analyzed retrospectively. RESULTS: Baseline ICP ranged from 0 to 34 mm Hg. With typical papaverine doses of 300 mg per territory and infusion times ranging from 5 to 60 minutes per vessel, ICP increases above baseline during papaverine infusion ranged from 0 to 60 mm Hg. Significant (> or = 20 mm Hg) ICP increases during therapy were observed even in patients with low baseline ICP and with papaverine infused at the slowest rate. Patients with a baseline ICP of more than 15 mm Hg were much more likely to have significant ICP increases than were patients with a baseline ICP of 0 to 15 mm Hg. Hunt and Hess scores, Fisher grades, age, and Glasgow Coma Scale scores on admission and immediately before treatment did not correlate with ICP increases during papaverine infusion. Patients with ICP increases of more than 10 mm Hg during therapy were more likely to experience adverse clinical events than were patients with ICP increases of < or = 10 mm Hg. Reduction in the rate of papaverine infusion, or termination of infusion, resulted in reversal of drug-induced ICP elevation. CONCLUSION: ICP monitoring during intraarterial papaverine infusions for cerebral vasospasm is recommended for all patients and is particularly important for patients with elevated baseline ICP. Continuous ICP monitoring facilitates safe and time-efficient drug delivery.

Age Factors↗
PubMed1998

Collateral circulation and outcome after basilar artery thrombolysis.

BACKGROUND AND PURPOSE: This study was undertaken to examine the relationship between collateral flow and outcome after local intraarterial thrombolytic treatment for basilar artery thrombosis. METHODS: Twenty-four patients with symptomatic basilar thrombosis were treated with intraarterial urokinase. Angiograms at the time of treatment were analyzed to characterize collateral flow. The number of posterior communicating arteries (PCoAs) and the degree of collateral filling of the basilar artery were then compared with symptom duration before treatment, with Glasgow Coma Scale (GCS) score at the time of treatment, with 90-day modified Rankin score, and with 90-day survival status. RESULTS: Of the 20 patients who had carotid artery injections at the time of the thrombolytic procedure, two had no PCoA, eight had one PCoA, and 10 had two PCoAs. Nine had no collateral opacification of the basilar artery, six had collateral opacification of the distal basilar artery, and five had collateral opacification of the distal and proximal basilar artery. Ninety-day survival was 38%; 25% of patients had good neurologic outcomes. No correlation was found between the number of PCoAs and symptom duration, pretreatment GCS score, survival, or neurologic outcome. Duration of symptoms before treatment was longer in patients with collateral flow to the basilar artery. Basilar artery collateral flow did not correlate with survival, but it did correlate with neurologic outcome for the 12 patients with middle or distal basilar artery thrombus in whom collateral flow to the basilar artery was assessed (83% with collateral flow had good neurologic outcomes, but only 17% without collateral flow had good outcomes). All six patients with proximal basilar artery thrombus in whom collateral flow was assessed died, independent of the collateral flow observed. CONCLUSION: In symptomatic acute basilar artery thrombosis, neurologic outcome was better after intraarterial thrombolysis in patients who had collateral filling of the basilar artery, except in cases of proximal basilar thrombosis. Patients with collateral filling of the basilar artery also tolerated longer symptom duration.

Basilar Artery↗
PubMed1997

Intracranial aneurysm: anatomic factors that predict the usefulness of intraoperative angiography.

PURPOSE: To correlate the size and location of intracranial aneurysm with the need to reposition the aneurysm clip after intraoperative angiography. MATERIALS AND METHODS: In 199 consecutive patients with 234 clipped intracranial aneurysms, 273 intraoperative angiographic studies were retrospectively reviewed. Aneurysm size and location, determined with preoperative angiographic and surgical reports, were correlated with the frequency of clip repositioning because of parent- or branch-vessel compromise or unexpected residual aneurysm. RESULTS: Findings from intraoperative angiograms resulted in clip repositioning in 46 of 273 (16.8%) studies. Clip repositioning was statistically significantly less frequent with aneurysms of the posterior communicating (three of 52 [5.7%] studies) and anterior choroidal (none of 12 studies) arteries. High rates of clip repositioning were found in aneurysms of the superior hypophyseal artery (seven of 18 [38.9%] studies), superior cerebellar artery (three of five [60.0%] studies), and bifurcation of the internal carotid artery (three of nine [33.3%] aneurysms). In 98 conventional follow-up angiographic studies, seven (7%) false-negative cases with unsuspected aneurysm neck remnant were found. CONCLUSION: The rate of clip repositioning in aneurysms of the posterior communicating or anterior choroidal arteries was less than that at other locations (P < .05). Intraoperative angiography may not be necessary when aneurysms are at these two locations.

Angiography, Digital Subtraction↗
PubMed1997

Intracranial tumor in children: MR imaging findings within 24 hours of craniotomy.

PURPOSE: To evaluate whether very early magnetic resonance (MR) imaging enables distinction of residual tumor from benign postoperative change in children. MATERIALS AND METHODS: Forty-six postoperative MR examinations were performed in 43 children with intracranial tumors within 24 hours of the completion of surgery during a 2-year period. These examinations were categorized according to whether residual tumor could be definitely identified or excluded, or whether the diagnosis was uncertain. RESULTS: Contrast enhancement occurred in 33 of 46 MR examinations performed within 24 hours of surgery. In 18 instances, this was associated with obvious residual tumor. In 15 patients, only small amounts of linear or patchy enhancement were seen. Of these, seven patients (46%) were disease-free for an average of 4.5 years. Assessment for postoperative enhancement was hampered in seven patients because of the presence of methemoglobin in the tumor bed. Contrast enhancement was not observed in two patients before surgery. CONCLUSION: Surgically induced, MR-detectable contrast enhancement and extracellular methemoglobin formation occurs within 24 hours of the completion of intracranial surgery. This can interfere with the detection of small amounts of residual tumor.

Brain↗
PubMed1997

Relationship between clot location and outcome after basilar artery thrombolysis.

PURPOSE: To identify factors that predict survival and good neurologic outcome in patients undergoing basilar artery thrombolysis. METHODS: Over a 42-month period, 20 of 22 consecutive patients with angiographic proof of basilar artery thrombosis were treated with local intraarterial urokinase. Brain CT scans, neurologic examinations, symptom duration, clot location, and degree of recanalization were analyzed retrospectively. RESULTS: Overall survival was 35% at 3 months. Survival in patients with only distal basilar clot was 71%, while survival in patients with proximal or midbasilar clot was only 15%. At 3 months, 29% of patients with distal basilar clot and 15% of patients with proximal or midbasilar clot had good neurologic outcomes (modified Rankin score of 0 to 2 and Barthel index of 95 to 100). Complete recanalization was achieved in 50% of patients; 60% of those survived and 30% had good neurologic outcomes. Of patients with less than complete recanalization, only 10% survived. Neither duration of symptoms before treatment (range, 1 to 79 hours), age (range, 12 to 83 years), nor neurologic status at the initiation of treatment (Glasgow Coma Scale score range, 3 to 15) predicted outcome. Pretreatment CT findings (positive or negative for related ischemic changes) did not predict outcome or hemorrhagic transformation. CONCLUSION: The single best predictor of survival after basilar thrombosis and intraarterial thrombolysis was distal clot location. Complete recanalization favored survival. Radiologically evident related infarctions, advanced age, delayed diagnosis, and poor pretreatment neurologic status did not predict poor outcome and therefore should not be considered absolute contraindications for intraarterial thrombolysis in patients with basilar artery thrombosis.

Adolescent↗
PubMed1996

Intrasellar abscess following transsphenoidal surgery.

BACKGROUND: Intrasellar abscess following transsphenoidal surgery has been described only twice in the English language medical literature. Overall mortality associated with intrasellar abscesses is 51%, while mortality in reported cases not treated surgically is 100%. METHODS: Two cases of intrasellar abscess following uncomplicated transsphenoidal surgery for pituitary pathology are reported. The incidence, radiographic features, clinical presentations, and treatment of intrasellar abscesses are discussed. RESULTS: Both patients described underwent uncomplicated transsphenoidal procedures for treatment of a primary pituitary lesion. Neither developed postoperative CSF rhinorrhea, and initial recovery was uneventful. The first patient presented with new symptoms several weeks after transsphenoidal surgery; the second patient almost two years postoperatively. The first displayed signs of an expanding sellar mass, requiring transsphenoidal drainage and postoperative antibiotics. The second presented with recurrent meningitis without discernible CSF leak, and was treated with transnasal endoscopic drainage in conjunction with antibiotic therapy. CONCLUSIONS: The high mortality associated with intrasellar abscess mandates its inclusion in the differential diagnosis of patients presenting with symptoms of meningitis or an expanding sellar mass after transsphenoidal intervention. Although antibiotic therapy is an important adjunct, surgical drainage is required for definitive treatment.

Brain Abscess↗
PubMed1996

Patterns of facial nerve synkinesis.

Facial nerve synkinesis is an extremely distressing sequela of facial paralysis, and its prevention and treatment are less than adequate. Improved therapeutic interventions await better understanding of its pathogenesis. In this study, 11 patients with synkinesis and 11 normal control subjects were quantitatively assessed using a new computer-assisted, motion-sensitive system. Two additional, informative cases presenting at the completion of the study are also briefly reported. The observed synkinetic patterns appear predictable and nonrandom. In addition, these observations tend to raise doubts that the aberrant fiber regeneration hypothesis is the sole explanation of synkinesis. They further implicate facial nuclear hyperexcitability as an explanation in at least some cases of synkinesis. Understanding these patterns enhances clinical detection and evaluation and may lead to a better knowledge of the fundamental pathophysiology of synkinesis and its prevention.

Adult↗
PubMed1996

Early postoperative magnetic resonance imaging following nonneoplastic cortical resection.

Postcraniotomy residual tumor is often determined by magnetic resonance (MR) imaging. Magnetic resonance changes that occur in the postoperative setting must be defined to ensure both the optimum timing of postoperative image acquisition and the accurate assessment of images for residual tumor. Postoperative changes in nontumor parenchyma have previously been described for computerized tomography but not for MR imaging. In the present study, 11 patients without intracranial neoplastic disease (six females and five males with a median age of 36 years) submitted to MR imaging 17 to 28 hours after undergoing temporal lobectomies for epilepsy. Four of the operations were performed with the patients under general anesthesia and seven under local anesthesia. Postoperative MR images (T1-weighted, T1-weighted gadolinium enhanced, and T2-weighted) were reviewed. Extraaxial fluid, air, or blood was present in all cases. Enhancement of the resection bed parenchyma occurred in seven (64%) of 11 patients. In three of the remaining four patients, assessment of parenchymal enhancement was obscured by extraaxial fluid collections. Dural enhancement occurred adjacent to the resection site in all of the cases and remotely in 73%. Eight (73%) of 11 patients displayed enhancement of the pia-arachnoid of the ipsilateral cerebral convexity, two (18%) of the contralateral convexity, and four (36%) of the pia-arachnoid overlying the cerebellum. Contrary to previous reports, contrast enhancement of nonneoplastic human brain parenchyma can occur postoperatively within 17 hours. Benign parenchymal contrast enhancement is usually linear in appearance; nonneoplastic dural and leptomeningeal enhancement can occur both adjacent to and distant from the surgical site. Extraaxial fluid collections can hinder MR evaluation of the resection bed.

Adolescent↗
PubMed1995

Conductive interstitial hyperthermia in the treatment of intracranial metastatic disease.

BACKGROUND: Intracranial metastases commonly complicate oncologic care affecting 140,000 patients per year in the United States. Treatment of these tumors is difficult and often unsuccessful. Hyperthermia is a treatment alternative that has shown promise in treating cancer in other areas. Therefore it was employed in an attempt to provide increased tumor control in CNS metastases. METHODS: This Phase I and Phase II clinical trial of interstitial hyperthermia with recurrent or progressive intracranial metastatic disease was undertaken to evaluate complications, delivery of heat and patient outcome. RESULTS: Feared complications of clinically significant bleeding, increased mass, or infection from the interstitial implant and treatment did not occur. The seizures which occurred in 4 patients were controlled with additional anticonvulsants. Three venous thromboembolic events were treated medically and with percutaneously placed inferior vena cava filters. The KPS of the majority of patients declined slightly with treatment but rebounded to near baseline within several months. CT scans demonstrated decrease or stabilization of tumor volumes in 7 of the 13 patients. In 4 of these patients, regression or stabilization persisted until death from nonCNS disease. CONCLUSIONS: Interstitial hyperthermia therapy for intracranial metastases is technically feasible and may provide increased tumor control. In this small series, it did not cause unreasonable complications. This therapy has some positive effect, but requires study of more patients before its role is definitively known. Combining hyperthermia with brachytherapy and/or chemotherapy is being evaluated.

Adult↗
PubMed1995

Expanded spectrum of herpes simplex encephalitis in childhood.

We designed a polymerase chain reaction method to detect herpes simplex virus (HSV) DNA in spinal fluid from patients with encephalitis. The polymerase chain reaction amplified a 211 base-pair segment of the HSV DNA polymerase gene. Applying this method, we diagnosed HSV type 1 infection in three young children, aged 7 to 13 months, who had atypical forms of the illness. On the basis of magnetic resonance imaging, their disease was diffuse or multifocal in two cases and, in all three, lacked the temporal lobe involvement considered characteristic of HSV encephalitis beyond the neonatal period. Most of the diffuse or multifocal abnormalities detected by magnetic resonance imaging were not apparent by computed tomography. Restriction enzyme analysis of the polymerase chain reaction products from all three patients indicated that their disease was caused by HSV type 1. We conclude that in preschool-age children beyond the neonatal period, the spectrum of HSV encephalitis includes multifocal or diffuse involvement of the brain, which may be detected most efficiently by magnetic resonance imaging. The polymerase chain reaction method has the potential for providing an early diagnosis, but further studies are required to define the sensitivity and specificity of the polymerase chain reaction before it can be used for routine clinical decision making.

Antibodies, Viral↗