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Biomedical subjects

F Viñuela

Publications and source records attributed to F Viñuela.

At least 109 records · Page 6Linked to original sources
PubMed1990

Persistent primitive trigeminal artery-cavernous sinus fistulas: report of two cases.

Two cases of persistent primitive trigeminal artery-cavernous sinus fistulas are presented. In one case, the fistula was treated by using a two-balloon tandem technique. This method was accomplished by introducing, inflating, and detaching a silicone balloon into the trigeminal artery, thus preserving the carotid and basilar blood flow. An unusual case of a similar fistula with only contralateral exophthalmos is also reported. The relationship between this type of fistula and the presence of aneurysms on the persistent primitive trigeminal artery and the relationship with traumatic events are discussed.

Adult↗
PubMed1990

Intraoperative digital subtraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations.

Intraoperative digital subtraction angiography using commercially available equipment was employed to confirm the precision of the surgical result in 105 procedures for intracranial aneurysms or arteriovenous malformations (AVM's). Transfemoral selective arterial catheterization was performed in most of these cases. A radiolucent operating table was used in all cases, and a radiolucent head-holder in most. In five of the 57 aneurysm procedures, clip repositioning was required after intraoperative angiography demonstrated an inadequate result. In five of the 48 AVM procedures, intraoperative angiography demonstrated residual AVM nidus which was then located and resected. In two cases intraoperative angiography failed to identify residual filling of an aneurysm which was seen later on postoperative angiography, and in one case the intraoperative study failed to demonstrate a tiny residual fragment of AVM which was seen on conventional postoperative angiography. Two complications resulted from intraoperative angiography: one patient developed aphasia from cerebral embolization and one patient developed leg ischemia from femoral artery thrombosis. This technique appears to be of particular value in the treatment of complex intracranial aneurysms and vascular malformations.

Angiography, Digital Subtraction↗
PubMed1989

Management of vein of Galen aneurysms. Combined surgical and endovascular approach.

The extremely high morbidity and mortality associated with all forms of management of aneurysms of the vein of Galen continues to pose a tremendous challenge. Recent advances in neuroradiologic endovascular embolization techniques have offered some encouraging early results in the treatment of these vascular lesions. Our experience in managing two neonates and a 10-year-old boy with vein of Galen aneurysms is presented. The neonates underwent transtorcular embolization, while the boy was treated by standard transarterial balloon embolization. All patients had satisfactory outcomes. The combined surgical and radiologic approaches are simple when compared to previous surgical techniques, and early results suggest that they are preferable alternatives. The natural history of vein of Galen aneurysms and the various therapeutic modalities available are discussed.

Cerebral Angiography↗
PubMed1989

Neurovascular lesions and endovascular therapy: the role of MR.

Magnetic resonance imaging (MRI) studies were performed on 27 patients with vascular lesions of the central nervous system before and after embolization with either IBCA, polyvinyl alcohol foam particles, Avitene (microfibrillar collagen) or balloons. Thirteen pial brain arteriovenous malformations (AVMs), 3 brain AV fistulas, 2 giant aneurysms, 5 dural AVMs, 1 vertebro-vertebral fistula and 3 meningiomas were studied. The pre-embolization MR demonstrated the nidus and venous drainage of all pial AVMs. MR failed to detect 3 out of 5 dural AVMs using only spin echo sequences. A draining vein alone was seen in the remaining two cases. MR was superior to CT in detecting contiguous parenchymal changes such as atrophy, reversible ischemia, and mass effect in the pre-embolization studies. Following embolization, MR demonstrated partial or complete obliteration of the vascular nidus in all 13 pial AVMs. The embolized area was seen as an area of increased signal consistent with thrombus where previously there had been signal void. Ischemic or edematous changes in the brain parenchyma following embolization were seen on MR more easily than on CT scans. MR was accurate in the assessment of aneurysm patency, degree of thrombosis and balloon position in both giant aneurysms, and AV fistulae. These MR findings had an impact on patient management. MR will be an increasingly useful tool in the diagnosis and management of a number of neurovascular diseases requiring endovascular intervention.

Arteriovenous Malformations↗
PubMed1989

Head and neck lesions: MR-guided aspiration biopsy.

Aspiration biopsy guided with computed tomography (CT) has long been a valuable tool in the evaluation of head and neck disease. The ability to obtain diagnoses without the need for surgery has had a significant effect on patient treatment. Magnetic resonance (MR) imaging is now rapidly replacing CT as the primary imaging study for many head and neck diseases. The standard stainless steel needles used for CT-guided biopsy are unsuitable for MR-guided biopsy because significant ferromagnetic artifacts obscure the underlying anatomy. A new needle has recently been designed specifically for use with MR imaging. This needle has far less magnetic susceptibility and therefore does not cause significant image distortion. The authors describe the use of this needle in MR-guided aspiration biopsy of a variety of lesions in the head and neck.

Adult↗
PubMed1989

Cranial arteriovenous malformations in neonates: color Doppler imaging with angiographic correlation.

Five neonates with cranial arteriovenous malformations were studied with color Doppler sonography. Excellent correlation was found between sonography and subsequent angiography. In three patients with vein of Galen aneurysms, sonography showed a cystic structure with rapid or swirling flow. Careful adjustment of the color Doppler system was required to demonstrate flow in another patient with a dural arteriovenous malformation. An arteriovenous fistula in a fifth patient appeared as an area of increased flow. Arterial feeders and major draining veins were visualized in all five patients. Color Doppler imaging also was used to assess the effect of embolic or operative therapy in three of the patients. We conclude that color Doppler sonography is able reliably to characterize flow patterns in neonatal cranial arteriovenous malformations. Color Doppler imaging also is helpful in assessing flow after embolic or surgical therapy.

Cerebral Angiography↗
PubMed1988

Indications for treatment and classification of 132 carotid-cavernous fistulas.

Classification of carotid-cavernous fistulas (CCFs) into the four types described by Barrow allows the surgeon to choose the optimal therapy for each patient. Type A patients have fast flow fistulas that are manifest by a direct connection between the internal carotid arterial siphon and the cavernous sinus through a single tear in the arterial wall. The best therapy is obliteration of the connection by a detachable balloon. Ninety-two of 95 traumatic CCFs were treated in this fashion. Direct surgical exposure of the cervical or cavernous internal carotid artery (ICA) was necessary in the remaining 3 patients, who had undergone unsuccessful surgical trapping. Three ruptured cavernous aneurysms and 2 spontaneous CCFs also had Type A connections. Other carotid-cavernous fistulas are slow flow, spontaneous dural arteriovenous malformations (AVMs) that have been classified into B, C, and D types on the basis of arterial supply. Occlusion of the ICA is not a logical choice in the treatment of dural AVMs that occur in the elderly, are relatively benign, and are often bilateral. Type B are rare and are fed by meningeal branches of the ICA only. We have not seen this type of dural fistula in our series. Type C are supplied by feeders from the external carotid only and can almost always be obliterated successfully by embolizing the external carotid artery (ECA) branches. There are 4 Type C cases in this series of 37 spontaneous CCFs. All occurred in patients less than 30 years of age and were shunts between the middle meningeal artery and the cavernous sinus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms.

Of 68 patients with unclippable aneurysms treated by proximal artery occlusion with detachable balloons, permanent occlusion was achieved in 65; of these patients, 37 had carotid artery aneurysms below the origin of the ophthalmic artery, 21 had aneurysms arising from the supraclinoid portion of the carotid artery, six had basilar trunk aneurysms, and one had a distal vertebral aneurysm. Examination for treatment selection included assessment of the circle of Willis by compression angiography and xenon blood flow studies, with the ultimate evaluation being test occlusion under systemic heparinization with the balloon temporarily placed in the desired position. Of 67 patients who underwent a formal occlusion test, eight with carotid artery aneurysms did not initially tolerate the occlusion test, and ischemic signs disappeared instantaneously with deflation and removal of the balloon. During test occlusion, two additional patients had ischemic events that proved to be embolic; these reversed immediately upon balloon deflation. Of the 65 patients in whom permanent occlusion was effected by detachable balloon, there were nine instances of delayed cerebral events. One of these was a seizure leading to respiratory arrest and resuscitation 3 days following occlusion in a patient who had presented with seizures. The other eight cases were delayed ischemic events; seven were completely reversed and one patient had residual weakness in one leg (1.5% permanent morbidity). Extracranial-intracranial bypass procedures were performed in 25 of the 65 cases. All aneurysms of the carotid artery below the level of the ophthalmic artery presented angiographic proof of complete thrombosis. Ten of 21 aneurysms arising from the supraclinoid portion of the carotid artery were completely thrombosed by proximal occlusion alone, without additional trapping procedures. Similarly, in three of six basilar trunk aneurysms, proximal occlusion alone initiated complete aneurysm thrombosis without trapping. The conclusion is that proximal balloon occlusion for unclippable cerebral aneurysms is a convenient, safe, and effective way of producing arterial occlusion in these cases.

Carotid Artery Diseases↗
PubMed1987

Giant intracranial varices secondary to high-flow arteriovenous fistulae.

An intracranial varix is rare and has been associated mostly with vein of Galen fistulae or arteriovenous (AV) malformations. The authors present eight cases of intracranial, pial or subpial AV fistulae with concomitant giant varices. Six were supratentorial and two were infratentorial. Only one case involved the vein of Galen. In six cases successful surgical and/or endovascular occlusion of the intracranial AV fistula was obtained, and one case was treated conservatively. Staging of surgery and postoperative hypotension were considered to be important in avoiding edema and hemorrhage following obliteration of a large AV shunt. One patient died from delayed postoperative intracerebral bleeding.

Adolescent↗
PubMed1986

Cardiac and arterial lesions in carotid transient ischemic attacks.

Two hundred fifty consecutive patients with carotid transient ischemic attacks (TIAs) and no previous stroke were assessed with cerebral angiography (95%), two-dimensional echocardiography (86%), electrocardiography (100%), and Holter monitoring (99 selected patients). Angiography disclosed a lesion appropriate to the TIAs in 84%. Lesions also occurred in the asymptomatic carotid artery, but stenosis of more than 75% of the lumen diameter and ulcers were significantly more frequent on the symptomatic side. Twenty-three percent of the patients had a potential source of emboli from the heart, usually in the context of symptomatic heart disease. Among the 205 patients who underwent full angiographic and cardiac investigations, 6% had an isolated potential cardiac source of emboli and 19% had a potential cardiac source of emboli associated with appropriate carotid disease. The search for a potential cardiac source of emboli is strongly indicated in patients with carotid TIAs and known heart disease. In the patients with no history of heart disease, the yield of this search is low, but our results suggest that at least 14 of such patients have an undetected potential cardiac source of emboli. Cardiac and arterial lesions commonly coexist in carotid TIAs.

Adult↗
PubMed1986

Clinical predictors of cardiac and arterial lesions in carotid transient ischemic attacks.

In 205 patients with carotid transient ischemic attacks (TIAs) who underwent full angiographic and cardiac investigations, we found that ipsilateral carotid bruit and triggering of TIA by exertion or standing up suggested a carotid lesion. Angina pectoris or palpitations at onset of TIA suggested a cardiac source of emboli. Patients with only one TIA, multiple identical attacks, progression of symptoms over minutes, and appropriate infarct on computed tomograms (28%) were likely to show a potential arterial or cardiac cause for the TIAs in subsequent investigations. Transient monocular blindness correlated with carotid occlusion, but the severity of the carotid lesion did not influence the duration and repetition of attacks. Transient ischemic attacks in multiple territories, identical attacks, and multiple or silent infarcts on computed tomograms occurred equally in the patients with arterial lesions and those with cardiac lesions. These findings suggest that only a few, albeit important, conclusions regarding etiology can be drawn from the clinical characteristics of TIAs.

Adult↗
PubMed1986

Magnetic resonance imaging in Down's syndrome.

100% of brains of Down's adults over age 40 will show Alzheimer-type neuropathologic changes in the frontal and temporal lobes. In an attempt to image these lesions, magnetic resonance imaging (MRI) was performed in seven patients with Down's syndrome, ranging in age from 17 to 45 years, using a resistive unit operating at 0.15 Tesla. All scans were within normal limits except for one 45 year-old patient with severe left temporal lobe atrophy. No areas of abnormal signal were seen in the frontal or temporal lobes and the white matter lesions commonly seen in elderly demented subjects were not visualized in this group. We conclude that these white matter lesions are likely coincidental and not causally related to Alzheimer's changes. The pathologic process leading to the formation and development of Alzheimer's changes in the brains of Down's adults may not be visible on magnetic resonance images.

Adolescent↗
PubMed1986

Dextran microsphere embolization: experimental and clinical experience with radiologic-pathologic correlation. Work in progress.

The radiologic and pathologic effects of canine renal embolization with dextran microspheres of two size ranges (40-150 micron and 100-300 micron) were studied 30 minutes and 1, 2, 4, and 6 weeks after embolization. Dramatic occlusions occurred with very small quantities of these particles, which reached more distally and were suspended and embolized more easily than other solid embolic agents. Because of these qualities, however, they should be used with more caution. They can be injected through 2-F catheters, calibrated-leak balloons, and open-ended guide wires. Embolization with dextran microspheres was also used for epistaxis, meningioma, dural arteriovenous malformation, renal tumors, bone metastasis, multiple myeloma, or peripheral angioma in ten patients. The technique was safe and effective, but special attention should be directed to proper dilution and gentle embolization with careful monitoring to avoid excessive embolization or reflux.

Animals↗
PubMed1986

Unusual clinical manifestations of dural arteriovenous malformations.

Fourteen patients had classical angiographic findings of intracranial dural arteriovenous malformations (AVM's). They presented with unusual central neurological signs and symptoms, including visual disturbances, hemiparesis, speech disturbances, gait ataxia, diffuse increased intracranial pressure, and intracranial hemorrhage. In 12 of the 14 patients there was a direct correlation between the clinical presentation and the venous drainage characteristics of the AVM's. The symptoms were probably related to a regional steal phenomenon in two patients. Six patients had direct surgical excision of the dural AVM. Five patients underwent endovascular embolization of the malformation and, in one case, the AVM was removed surgically after embolization. In one patient, the external carotid artery in the neck was ligated. Ten of the 14 patients had substantial clinical improvement or cure. A complete anatomical obliteration of the malformation was obtained in seven cases. None of the patients deteriorated clinically after therapy.

Adult↗
PubMed1986

Diagnosis and endovascular therapy of vascular lesions in the cavernous sinus.

One hundred and twenty-eight lesions of the cavernous sinus were diagnosed and treated by endovascular embolization alone or combined with postembolization surgery. All patients presented with acute or subacute cavernous sinus syndrome. A complete angiographic evaluation included bilateral internal and external carotid and vertebral angiography. A total of 88 carotid-cavernous (c-c) fistulae (68 traumatic and 20 spontaneous) and 40 giant aneurysms were demonstrated. A complete anatomic cure or satisfactory clinical improvement was seen in 67 of 68 traumatic fistulae, in 14 of 20 spontaneous c-c fistulae and in 38 of 40 giant intracavernous aneurysms. An overall 15 per cent immediate and 2.7 per cent long-term morbidity with one death was observed. The technical and clinical complications involving endovascular therapy of each specific intracavernous vascular lesion are analyzed.

Adult↗
PubMed1986

Results of the international extracranial/intracranial bypass study. Implications for neuroradiologists.

A randomized trial to determine whether bypass surgery would benefit patients with appropriate atherosclerotic lesions followed 1377 patients for almost five years, and found no benefit from surgery. This negative result has a number of potential implications for neuroradiologists including the expectation for other randomized trials to be carried out, such as for carotid endarterectomy, and the need for neuroradiologists to carry out trials for embolization of cerebral arteriovenous malformations and angioplasty of stenotic cervical or cranial vessels. We are reminded that, ultimately, the clinical outcome is the real measure of procedures, not pretty pictures.

Cerebral Revascularization↗