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Biomedical subjects

G Duckwiler

Publications and source records attributed to G Duckwiler.

At least 19 recordsLinked to original sources

High-flow, small-hole arteriovenous fistulas: treatment with electrodetachable coils.

We present one case of carotid-cavernous fistula caused by percutaneous treatment of trigeminal neuralgia and one case of vertebrovertebral fistula caused by percutaneous internal jugular vein cannulation. Each fistula had a small arteriovenous communication that prevented the use of detachable balloons. Endovascular transarterial treatment of these two iatrogenic fistulas with electrically detachable platinum coils was performed. Both fistulas were occluded with preservation of the parent artery, and the patients have fully recovered.

Aged

Epilepsy associated with cerebral arteriovenous malformations: a multivariate analysis of angioarchitectural characteristics.

PURPOSE: To identify the morphological vascular characteristics of cerebral arteriovenous malformations (AVMs) that predict a clinical presentation of epilepsy. METHOD: Fifteen angioarchitectural characteristics of brain AVMs were selected for assessment in 100 consecutive patients referred to our institution for endovascular treatment. In this population, 47% of the AVMs were diagnosed as a consequence of epilepsy. The angioarchitectural characteristics and population demographics were statistically analyzed by means of multivariate analysis. RESULTS: The following six parameters were found to be the most predictive of epilepsy: cortical location of the AVM, feeding by the middle cerebral artery, cortical location of the feeder, absence of aneurysms, presence of varix/varices in the venous drainage, and association of varix and absence of intranidal aneurysms. Three factors were not among the most predictive factors of epilepsy but were significantly associated with the onset of seizures: AVM feeding by the external carotid artery, a temporal cortical location, and a parietal cortical location. CONCLUSION: Detailed analysis of the angioarchitecture of intracranial AVMs has helped us identify features that strongly correlate with epilepsy. This may aid in future understanding of the physiopathologic mechanisms in epilepsy associated with AVMs, and in identifying goals of treatment for epileptogenic AVMs.

Adolescent

A nonlinear mathematical model for the development and rupture of intracranial fusiform aneurysms.

Laplace's law, which describes a linear relation between the tension and the radius, is often used to characterize the mechanical response of the aneurysm wall to distending pressures. However, histopathological studies have confirmed that the wall of the fully developed aneurysm consists primarily of collagen and is subject to large increases in tension for small increases in the radius, i.e., a nonlinear relationship exists between the tension within the aneurysm wall and the radius. Thus, a nonlinear version of Laplace's law is proposed to accurately describe the development and rupture of a fusiform saccular aneurysm. The fusiform aneurysm was modelled as a thin-walled ellipsoidal shell with a major axis radius, Ra, minor axis radius, Rb, circumferential tension, S0, and meridional tension, S phi, with phi defining the angle from the surface normal. Using both linear and nonlinear models, differential expressions of the volume distensibility evaluated at 90 degrees were used to determine the critical radius of the aneurysm along the minor axis from S0 and S phi in terms of the following geometric and biophysical variables; A, elastic modulus of collagen; E, elastic modulus of the aneurysm (elastin and collagen); t, wall thickness; P, systolic pressure; and Ra. For typical physiological values of A = 2.8 MPa, E = 1.0 MPa, T = 40 microns, P = 150 mmHg, and Ra = 4Rb, the linear model yielded critical radii of 4.0 mm from S phi and 2.2 mm from S0. The resultant critical radius was 4.56 mm. Using the same values, the critical radii from the tension components of the nonlinear model were 3.5 mm from S phi and 1.9 mm from S0.(ABSTRACT TRUNCATED AT 250 WORDS)

Aneurysm, Ruptured

Carotid-cavernous fistula caused by a ruptured intracavernous aneurysm: endovascular treatment by electrothrombosis with detachable coils.

A case of carotid-cavernous fistula caused by a ruptured intracavernous aneurysm is reported. The fistula was treated with electrothrombosis by the detachment of two platinum coils into the aneurysm via an endovascular transvenous approach; the fistula was closed, and the patient has recovered completely. The advantages of using electrodetachable platinum coils include thrombogenicity, controllable deposit, radiopacity, and biocompatibility.

Adult

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

Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience.

Fifteen patients with high-risk intracranial saccular aneurysms were treated using electrolytically detachable coils introduced via an endovascular approach. The patients ranged in age from 21 to 69 years. The most frequent clinical presentation was subarachnoid hemorrhage (eight cases). Considerable thrombosis of the aneurysm (70% to 100%) was achieved in all 15 patients, and preservation of the parent artery was obtained in 14. Although temporary neurological deterioration due to the technique was recorded in one patient, no permanent neurological deficit was observed in this series and there were no deaths. It is believed that this new technology is a viable alternative in the management of patients with high-risk intracranial saccular aneurysms. It may also play an important role in the occlusion of aneurysms in the acute phase of subarachnoid hemorrhage.

Adult

Combined endovascular embolization and surgery in the management of cerebral arteriovenous malformations: experience with 101 cases.

The authors describe their experience with 101 cerebral arteriovenous malformations (AVM's) treated by endovascular embolization followed by surgical removal. Fifty-three patients presented with intracranial hemorrhage and 35 had seizures. Based on the classification of Spetzler and Martin, two AVM's were Grade I, 13 were Grade II, 26 were Grade III, 43 were Grade IV, and 17 were Grade V. Fifty-six AVM's were in the right hemisphere, 28 were in the left hemisphere, 12 were in the corpus callosum, and five involved the cerebellum. In 50 cases, presurgical obliteration of 50% to 75% of the AVM nidus was achieved by embolization, and in 31 cases this percentage increased to between 75% and 90%. In 97 (96%) patients, complete surgical removal of the AVM was obtained. Morbidity resulting from preoperative endovascular embolization was classified as mild in 3.9% of the cases, moderate in 6.9%, and severe in 1.98%. The death rate related to embolization was 0.9%. The immediate postsurgical morbidity was classified as mild in 5.9% of the cases, moderate in 10.8%, and severe in 5.9%. The overall long-term morbidity was mild in 5.9% of the cases, moderate in 6.9%, and severe in 1.98%. Two patients (1.98%) died due to intractable intraoperative hemorrhage and two (1.98%) as a result of postsurgical pulmonary complications.

Adolescent

Use of a new mixture for embolization of intracranial vascular malformations. Preliminary experimental experience.

The internal carotid artery system in swine has a special anatomic configuration similar to a brain "arterial-arterial malformation." The internal carotid artery breaks up into a multitude of fine channels (rete mirabile) situated at the base of the skull on the side of the hypophysis. This anatomic arterial model was used to analyze acute and chronic angiographic and histological changes after occlusion of the rete mirabile with I) avitene, II) avitene, and 50% ethanol, III) avitene, 30% ethanol and Polyvinyl alcohol, IV) avitene 50% ethanol and Polyvinyl alcohol, V) IBCA and VI) silk. Histopathological changes observed in the rete mirabile six weeks following occlusion demonstrated that a mixture of avitene, 30% ethanol and Polyvinyl alcohol and IBCA produced the best anatomic results. Embolization with avitene, PVA and ethanol induced a more bland histological reaction than the one observed with IBCA. Preliminary clinical experience with this mixture is reassuring in those cases in which the AVM was surgically resected. The partially thrombosed AVM was easily depressed and compressed by the neurosurgeon allowing for satisfactory hemostasis in and around the nidus of the AVM.

Animals

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

Interventional magnetic resonance imaging in the head and neck.

Interventional MRI is clearly in its early stages of development. While the value of MR-guided aspiration cytology and MR evaluation of deep electrode implantation in the brain has already been confirmed with human clinical studies, the future of MR-guided interstitial laser therapy remains to be proven. Despite this, as we look ahead into the 1990s and the millennium, it is possible to imagine dedicated MR laser therapy units for combined radiological and surgical outpatient approaches in what may become the operating rooms of the 21st century.

Biopsy, Needle

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

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

MR-directed needle biopsies.

New generation stainless steel alloys have enabled the development of needles which can be used for MR-guided biopsies. Biopsy under MR guidance has the advantages of greater tissue contrast resolution, lack of ionizing radiation, and variable angle oblique imaging planes. The biopsy approaches and imaging techniques are described.

Adult

MR imaging of the knee. Part I. Traumatic disorders.

One hundred thirty patients with a diversity of knee joint injuries were evaluated with a high-resolution magnetic resonance (MR) imaging technique. The authors report the accuracy of this technique in the evaluation of 105 patients with suspected meniscal tears, 26 patients with suspected cruciate ligament tears, and eight patients with suspected patellar tendon injuries. Of those menisci rated as definitely or probably torn on MR imaging, 80% were found to be torn at subsequent arthroscopy. The predictive value of negative MR imaging results was 100%. MR imaging was 92% accurate in predicting the clinical outcome in patients with suspected meniscal tears who did not undergo surgery. MR permitted complete disruption of the patellar tendon to be differentiated from partial tears, ligamentous inflammation, and localized effusion of the infrapatellar bursa. Injuries to the anterior and posterior cruciate ligaments were identified on MR images, and the status of synthetic grafts of the anterior cruciate ligament was ascertained.

Humans

The MR appearance of endovascular embolic agents in vitro with clinical correlation.

A spectrum of embolic agents including PVA, avitene, gelfoam, ethanol, IBCA, silicone microspheres, metal and platinum coils, and balloons containing contrast of HEMA were imaged in vitro at 0.3 Tesla using spin echo, gradient echo, and inversion recovery sequences. Signal intensities associated with these agents and changes created by addition of blood are presented. The in vitro model is also correlated with clinical MR material. Recognition of embolic materials is important to avoid confusion with persistent flow void, hemorrhage, or thrombus.

Adult

Preembolization functional evaluation in brain arteriovenous malformations: the superselective Amytal test.

PURPOSE: To describe our experience with the use of Amytal injected through a superselective catheter prior to planned embolization of cerebral arteriovenous malformations. MATERIALS AND METHODS: 109 superselective tests were performed with 30-mg injections of Amytal. All patients were evaluated by both clinical examination and EEG. RESULTS: Twenty-three of these tests were positive. There were no prolonged neurologic complications of the Amytal test. We also examined the value of EEG monitoring compared to clinical monitoring during the Amytal test. Of the 23 positive Amytal tests, only 12 showed a change on clinical exam (52%). This meant that almost half of the positive Amytal tests would have been falsely called negative (false negative rate of 10%). There were also three positive Amytal tests with changes on clinical examination without any change on EEG. CONCLUSION: The superselective Amytal test can be done safely as part of the interventional neuroradiologic procedure. Clinical and EEG monitoring of the patient are essential.

Adolescent