Preoperative balloon occlusion: "the intravascular ligature".
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Adolescent↗
Biomedical subjects
C M Mehringer
Publications and source records attributed to C M Mehringer.
Transaortic occlusion of collateral arteries to the lung by detachable valved balloons in a patient with tetralogy of Fallot.
A 5-year-old boy with tetralogy of Fallot, near-atresia of the right ventricular outflow tract and large collateral arteries to the lungs underwent an infundibulectomy without closure of the ventricular septal defect. Further surgery required preliminary reduction of the collateral circulation. The collateral arteries were successfully occluded by metrizimide-filled balloons. There was no change in arterial oxygen saturation, nor were there any complications. This new technique has significant advantages over existing alternatives.
Aortography↗
Therapeutic renal artery occlusion with a detachable balloon.
The use of a new detachable balloon for renal artery occlusion is described. Successful treatment of renal lesions in 5 patients, including 2 tumors, 2 arteriovenous fistulas and 1 case of malignant hypertension with renal failure, is reported.
Adult↗
Bilateral absence of the internal carotid artery with sellar enlargement due to anomalous vascularity.
A unique case is described in which a patient with a primary cerebral neoplasm was found to have bilateral aplasia of the internal carotid artery that presented with an eroded sella turcica mimicking an intrasellar mass. The embryologic origin of this anomaly is discussed, and the literature is reviewed.
Brain Neoplasms↗
A detachable balloon for therapeutic transcatheter occlusions.
A new, detachable, silastic balloon for occlusion of arteries and fistulae is described. The balloon is filled with water-soluble contrast material, is flow-directed into the desired position, and detached using a set of coaxial catheters.
Arteriovenous Malformations↗
Preliminary report of a hollow-centered balloon for intravascular occlusion of intracranial aneurysms or arteriovenous fistulas. Technical note.
A doughnut-shaped balloon has been designed that can be inserted intravascularly by catheter to occlude the orifice of an intracranial berry or giant aneurysm or arteriovenous fistula. The blood in the parent artery can continue to flow uninterrupted through the hole in the balloon. In a preliminary study, an arteriovenous fistula was successfully obliterated in a dog. The technique for placing the ballon is described.
Animals↗
Arterial catheter embolization followed by surgery for large chemodectoma.
We report on the first successful preoperative arterial catheter embolization of a large neck chemodectoma followed by its surgical removal. A 21-year-old man presented with a large mass in the right neck diagnosed 5 years previously by biopsy as a chemodectoma. The patient previously had refused therapy. Because of concern over the large size of the mass and increasing difficulty in swallowing, he agreed to undergo therapy. The patient underwent selective occlusion of the occipital and posterior auricular arteries and the thyrocervical trunk using Ivalon sponge emboli injected through a No. 5 Fr Hanafee catheter. A postembolization arteriogram showed 90% occlusion of tumor vascularity and 30% decrease in size of the tumor. This was followed by removal of the tumor surgically. A review of the difficult management of the patient is presented, and implications for future use of the combined procedures are discussed.
Adult↗
Preoperative embolization of meningiomas.
Embolization of very vascular meningiomas prior to operation will reduce the loss of blood during operation. The technique of preoperative embolization is discussed, and 11 cases are presented.
Adult↗
Recurrent intracerebral blastomycotic granuloma: diagnosis and treatment.
We present a patient with a recurrent intracerebral blastomycotic granuloma. The computerized tomographic scan appearance of this lesion is illustrated. Of the 81 reported cases of intracranial blastomycosis, only 35 have represented solid intracerebral lesions; the other patients have had spinal lesions or meningitis. This patient represents the first reported recurrence of an intracerebral blastomycotic granuloma. The treatment utilized, surgical resection combined with intravenous and intraventricular amphotericin B, represents a unique approach to this problem. The diagnosis and currently advocated treatment of intracranial blastomycosis is reviewed, particularly in regard to the potential for recurrence of blastomycosis.
Adult↗
Emergency occlusive techniques.
Emergency occlusive therapy may be indicated in the management of acute arterial injury or expanding arteriovenous fistula. Intra-arterial occlusion may be performed at the time of diagnostic angiography. Selective placement of catheters permits percise diagnosis and management. We wish to report eight cases to demonstrate the efficacy of different occlusive agents. No adverse reactions were noted in this series of patients. We feel that emergency occlusive therapy is rapid and safe. It may facilitate and occasionally obviate surgical management.
Adolescent↗
Computed tomographic evaluation of ocular trauma.
The CT scans of 10 traumatized patients with demonstrable ocular injuries were reviewed. The CT findings were correlated with the clinical findings in each case. CT manifestations of a variety of ocular and orbital injuries are reported and a systematic approach to the CT evaluation of ocular trauma is presented.
Adult↗
Transarterial embolization of vertebral hemangioma.
PURPOSE: The authors retrospectively reviewed their 4-year clinical experience to determine the role of transarterial embolization in the treatment of symptomatic vertebral hemangioma. PATIENTS AND METHODS: Eight patients (age range, 12-56 years) underwent a total of 10 embolization procedures; one patient underwent three procedures. The lesions were located between T-5 and L-5, and all patients presented with pain and symptoms referable to the lower extremities. RESULTS: Embolization was technically successful in all patients, and no complications were encountered. Six of eight patients underwent surgery within 48 hours of embolization; four of the six showed significant clinical improvement immediately after surgery and on follow-up (average, 34 months). Two patients did not improve postoperatively. Two patients initially underwent embolization as the sole therapy. The first refused surgery and did not improve clinically; the second underwent two embolization procedures without clinical improvement and eventually underwent a third followed by surgery, which resulted in clinical improvement. All patients were hemodynamically stable during surgery, and blood loss was not problematic in any patient. CONCLUSIONS: Overall, surgery was an effective treatment for symptomatic vertebral hemangioma and the authors conclude that transarterial embolization of vertebral hemangioma is a safe and efficacious adjunctive procedure to such surgery. However, embolization was not as promising as a sole therapeutic modality in this small group of patients.
Adolescent↗
Neuroimaging findings in twins discordant for Alzheimer's disease.
Data from computed tomography (CT) scans of 12 twin pairs in which one partner had Azheimer's disease (AD) and the other partner is cognitively intact were analyzed to study structural brain features associated with AD while controlling for familial factors. Visual ratings and analysis of quantified areas and volumes indicated that AD twins showed more dilation of temporal horns, lateral ventricles and third ventricle, and more atrophy of temporal lobes, particularly in the anterior temporal/perisylvian area, than their healthy cotwins. Demented twins did not have smaller intracranial areas or overall brain volumes than their intact partners. The apolipoprotein sigma-4 allele was associated with greater dilation of lateral ventricles and ventricular volume. Significant intrapair correlations were found for total intracranial area and volume, cerebellar area and white matter lesions.
Aged↗
Thalamic extrapontine lesions in central pontine myelinolysis.
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Adult↗
Transvenous embolization of dural fistulas involving the transverse and sigmoid sinuses.
Eleven patients with dural fistulas involving the transverse and sigmoid sinuses were treated by transvenous embolization with coils or liquid adhesives. Seven patients underwent preoperative embolization of the external supply followed by direct surgical exposure of the sinus: liquid adhesives were used in four patients and coils in the remaining three. Four of these patients had complete obliteration of their fistulas and there was 95% reduction in the remaining three. Four patients had transvenous placement of coils from a transfemoral approach. In three, the ipsilateral sigmoid sinus was thrombosed and a contralateral approach across the torcular herophili was used. Coils were used in all four patients; one patient also had liquid adhesives placed within the sinus. Complete cure was achieved in one patient, 95% reduction in another, and 50% and 40%, reductions in the remaining two. Two transient complications occurred, one related to venous occlusion secondary to liquid adhesives and another related to transient occlusion of the vestibular aqueduct. Obliteration of dural fistulas involving the transverse and sigmoid sinuses can be achieved by placement of embolic material within the involved sinus from a transvenous approach; both coils and liquid adhesives can achieve this goal.
Adult↗
Percutaneous transluminal angioplasty of the carotid artery.
Percutaneous transluminal angioplasty (PTA) is being extensively applied to treat arteriosclerotic lesions. However, this application has not been widely accepted for the treatment of carotid artery stenosis. Successful attempts to relieve cerebral ischemia from extracranial carotid arterial stenosis by PTA are reported. Twenty-seven patients with arteriosclerotic stenosis, fibromuscular disease, and Takayasu carotid arterial stenosis were treated by PTA. All anatomic carotid stenotic lesions were corrected without any neurologic complication. Follow-ups ranged from 3 months to 4 years without recurrent symptoms in any patient. These results may suggest that some patients with cerebral ischemia secondary to extracranial carotid artery stenosis may be treated safely and effectively by PTA.
Adult↗
CT of subinsular infarction and ischemia.
A number of CT head scans, covering a 2-year period and showing a variety of distinct curvilinear subinsular lucent lesions, were collected and reviewed. Variations in extent of involvement, tendency toward bilateral symmetry, and clinical background allowed the lesions to be grouped into four general patterns, most of which, to our knowledge, have not been specifically described in the radiologic literature. This project was undertaken first to bring to the attention of those involved in interpretation of cranial CT images several patterns of injury they may not heretofore have been aware of and second to attempt to derive a specific etiology for each of the patterns described. Pattern 1, which appears as a distinct curvilinear lesion (sometimes cystic) apparently limited to the lateral aspect of the putamen, is thought to represent the residua of previous lateral striatal hemorrhage. Pattern 2, occurring in a markedly younger age group appears as relatively symmetrical bilateral subinsular lucencies, which in one case completely resolved. A specific etiology for this pattern remains uncertain. Acute demyelination, either secondary to a variant of anoxic leukoencephalopathy or to a limited form of diffuse encephalomyelitis, is postulated. A third pattern, which extends from generalized deep frontal white-matter lucency across the anterior limb of the internal capsule and tapering posteriorly in the subinsular area is thought to be on the basis of chronic ischemia similar to subcortical arteriosclerotic encephalopathy. The fourth pattern, occurring as a broad band of lucency extending from the frontal horn of the lateral ventricle and also tapering posteriorly is due to relatively proximal occlusion of the lateral lenticulostriate arteries.
Adolescent↗
Giant cavernous aneurysm associated with trigeminal artery: treatment by detachable balloon.
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Aged↗