Biomedical subjects

G Lanzino

Publications and source records attributed to G Lanzino.

At least 19 recordsLinked to original sources

PubMed2006

Differential interhemispheric cooling and ICP compartmentalization in a patient with left ICA occlusion.

We report a case of a 69-year-old white female who presented with a large left internal carotid artery occlusive stroke from a cardiogenic embolus. She was enrolled in an institutional study using a specially designed cooling helmet. Bilateral intracranial pressure (ICP) and temperature probes were placed to determine if there was any differential cooling and ICP compartmentalization between the two hemispheres. We demonstrated a significant temperature gradient between the infarcted and the non-infarcted hemisphere. A significant inter-hemispheric ICP gradient was also observed. We believe that this is the first demonstration of preferential cooling of the infarcted hemisphere over the non-infarcted hemisphere with regional surface hypothermia.

Aged↗

PubMed2006

Cold as a therapeutic agent.

The use of cold as a therapeutic agent has a long and colorful history. The Edwin Smith Papyrus, the most ancient medical text known, dated 3500 B.C., made numerous references to the use of cold as therapy. Baron de Larrey, a French army surgeon during Napoleon's Russian campaign, packed the limbs in ice prior to amputations to render the procedures painless. In the early twentieth century, a neurosurgeon, Temple Fay, pioneered "human refrigeration" as a treatment for malignancies and head injuries. In 1961, Irving Cooper developed the first closed cryoprobe system and ushered in the modern era of cryogenic surgery with his imperturbable convictions. Fay's early work fell victim to the disruptive sequel of the World War II. The Nazis confiscated his data (presented before the Third International Cancer Congress in 1939) forwarded to Belgium for publication and brutally applied his refrigeration techniques experimentally without any benefit of anesthesia in the concentration camps, especially Dachau. Hypothermia became associated in the public mind with the atrocities exposed at the war trials in Nürnberg. After lying dormant for decades, the interest was rekindled in the late 80s when mild hypothermia was shown to confer dramatic neuroprotection in a number of experimental models of brain injury. With several large multi-center clinical studies currently under way, hypothermia is receiving unprecedented attention from the medical and scientific communities.

Cryosurgery↗

PubMed2005

Cerebral vasospasm in patients with unruptured intracranial aneurysms.

Intracranial arterial vasospasm is a typical sequela of subarachnoid haemorrhage. The association between symptomatic vasospasm and unruptured aneurysms has been sporadically presented in the literature. The pathogenesis of this unusual entity is unclear. The published cases were collected in this review and analysed with regard to timing, clinical presentation and possible relationship with surgical factors. We also added an illustrative case which was recently observed in our department.

Cerebral Angiography↗

PubMed2005

Thrombosed giant intracavernous aneurysm with subsequent spontaneous ipsilateral carotid artery occlusion.

We report a case of a 47-year-old man with a giant thrombosed aneurysm of the right cavernous internal carotid artery who initially presented with headache, double vision and trigeminal numbness. He experienced subsequent asymtomatic proximal occlusion of the parent vessel, revealed by follow-up angiography. This case illustrates the possibility that a giant thrombosed aneurysm may exert enough compression upon the parent vessel to induce flow stasis with resultant intraluminal thrombosis progressing to occlude the entire parent artery.

Anticoagulants↗

PubMed2001

An introductory overview of orbital tumors.

The term "orbital tumors" comprises a wide variety of lesions that often share the same cardinal clinical finding (exophthalmos) and clinical history. Age at presentation, associated ophthalmological findings, and radiological features, however, provide invaluable information as to the possible histological type of tumor. The present article serves as an introductory overview regarding the pathological characteristics, clinical features, radiological characteristics, and principles of treatment of orbital tumors.

Exophthalmos↗

PubMed2001

Skull base chordomas: overview of disease, management options, and outcome.

Cranial base chordomas are locally invasive tumors that, from a midline, clival location, extend in different directions and display various patterns of skull base invasion. Although histologically benign, their invasive nature makes true "oncological" resection virtually impossible to achieve in most cases, despite modern skull base surgical techniques. Moreover, because of the tumor's location and proximity to critical neural and vascular structures, surgery-related morbidity can be significant when an aggressive resection is undertaken. Cytoreductive surgery assumes a critical role in the management of these lesions. The choice of surgical approach and the extent of resection are dependent on several factors: location and extension of the tumor, the surgeon's philosophy and familiarity with a specific approach, and the patient's preexisting clinical status. Proton-beam radiotherapy seems to be effective as an adjunct to surgery in achieving local tumor control. The timing of radiation therapy, however, remains controversial. Gamma knife surgery has been proposed as an adjunctive therapy, but the limited experience and short follow-up periods do not permit formulation of meaningful conclusions at this time. Recurrences are common, although in a subset of patients prolonged disease-free survival is demonstrated.

Brachytherapy↗

PubMed2001

Treating complex nervous system vascular disorders through a "needle stick": origins, evolution, and future of neuroendovascular therapy.

In the past few decades, dramatic improvements have occurred in the field of neuroendovascular surgery. Endovascular therapy today is a well-established treatment modality for a variety of cerebrovascular and nonvascular central nervous system diseases. The foundation of this spectacular evolution was laid by the efforts of pioneering visionaries who often worked alone and under difficult, almost impossible, conditions. Ongoing device development and refinement have revolutionized the field at a dizzying, exhilarating pace. With a better understanding of the molecular basis of diseases and further advancements in gene therapy, neuroendovascular techniques have an enormous potential for application to the entire spectrum of central nervous system diseases as a minimally invasive vehicle for the delivery of biological factors.

Angioscopy↗

PubMed2001

Carotid endarterectomy: can we select surgical candidates at high risk for stroke and low risk for perioperative complications?

DESPITE EVIDENCE OF the efficacy of carotid endarterectomy from the large randomized multicenter trials completed in the 1990s, the physician who treats patients with carotid artery stenosis still is faced with a difficult management decision. More recently, subgroup analyses have been conducted of asymptomatic and symptomatic patients enrolled in these trials to identify clinical and radiological factors that increase the rates of morbidity and mortality associated with surgery, as well as those that increase the risk of stroke without surgery. Knowledge of these factors is important to recommend the best course of action for the individual patient. In this article, we summarize the conclusions of some of the subgroup analyses from the major carotid endarterectomy trials.

Carotid Stenosis↗

PubMed2001

Pioneers in the development of transsphenoidal surgery: Theodor Kocher, Oskar Hirsch, and Norman Dott.

The development of new scientific concepts and techniques is usually the result of a progressive evolution. The transsphenoidal approach to pituitary lesions is no exception. Several pioneers contributed to its development and its eventual and nearly unconditional acceptance. In this historical vignette, the contributions of three master surgeons. Theodor Kocher, Oskar Hirsch, and Norman Dott, are reviewed.

History, 19th Century↗

PubMed2000

Decompressive craniectomy for space-occupying supratentorial infarction: rationale, indications, and outcome.

A subset of patients with ischemic cerebrovascular stroke suffer a progressive deterioration secondary to massive cerebral ischemia, edema, and increased intracranial pressure (ICP). The evolution is often fatal. In these patients, a decompressive craniectomy converts the closed, rigid cranial vault into an "open box." The result is a dramatic decrease in ICP and a reversal of the clinical and radiological signs of herniation. For these reasons, decompressive craniectomy has been increasingly proposed as a life-saving measure in patients with large, space-occupying hemispheric infarction. The authors review the rationale, indications, and clinical experience with this procedure, which has been performed in patients who have had supratentorial ischemic stroke.

Cerebral Infarction↗

PubMed2000

Adjuvant use of epsilon-aminocaproic acid (Amicar) in the endovascular treatment of cranial arteriovenous fistulae.

We report our experience with the use of the antifibrinolytic agent epsilon-aminocaproic acid (EACA), Amicar, as an adjuvant to endovascular treatment of cranial arteriovenous fistulae. We also review applications of antifibrinolytic agents to neurovascular disorders and discuss the mechanism of action, dosing strategy, contraindications, and possible complications associated with the use of EACA. We identified 13 patients with cranial arteriovenous fistulae (five direct carotid cavernous fistulae [CCF], seven dural arteriovenous fistulae [DAVF], and one vein of Galen malformation) who received EACA as an adjunct to endovascular treatment. In all cases embolic coils were the primary embolic agent. We reviewed the modes of initial endovascular therapy and angiographic findings immediately thereafter and the response to EACA. Two direct CCF and two DAVF were completely thrombosed on follow-up angiography, and two DAVF demonstrated diminished flow after EACA therapy. Seven fistulae did not respond to EACA. Four of eight tightly coiled fistulae thrombosed, while none of five loosely coiled fistulae thrombosed. None of four cases with a residual fistula separate from the coil mass underwent thrombosis with EACA, while four of nine cases without a separate fistula thrombosed. There was no morbidity related to EACA therapy. EACA may thus be useful as an adjunct to endovascular treatment of cranial arteriovenous fistulae. Loose or incomplete coil packing of the fistula predicts a poor response to EACA therapy.

Adolescent↗

PubMed2000

New developments in cerebrovascular surgery.

Major changes in the treatment of various cerebrovascular disorders have occurred with improvement and maturation of endovascular techniques. Embolization of intracranial aneurysms, angioplasty and stenting of extracranial and intracranial stenosis, as well as local intra-arterial delivery of thrombolytic agents in patients with acute stroke, are therapeutic modalities that are now widely available, with encouraging preliminary results. Pooling and analysis of the immense amount of data generated by the major carotid endarterectomy trials are defining particular subgroups of patients with carotid stenosis who are at higher risk of stroke who might particularly benefit from the operation. Unfortunately, no significant improvements have occurred in the treatment of some other conditions, such as parenchymal arteriovenous malformations and intracerebral hemorrhage.

Journal Article↗

PubMed2000

Transradial approach for vertebral artery stenting: technical case report.

OBJECTIVE: We report the technique of transradial vertebral artery stenting for two patients in whom severe supra-aortic ectasia prevented ready access to the right vertebral artery origin. METHODS: An Allen test was performed to verify ulnar artery collateral flow in the hand. After the administration of local anesthesia, a 6-French sheath was introduced into the radial artery. To allay induced spasm, a mixture of heparin (5000 IU/ml), verapamil (2.5 mg), nitroglycerine (400 microg/ml, 0.25 ml), and lidocaine (2%, 1.0 ml) was infused through the introducer sheath. A microguidewire was positioned across the vertebral artery lesion, followed by placement of a balloon-expandable stent. RESULTS: Postdeployment angiography revealed improved vertebrobasilar system flow. There were no complications related to the radial artery. The patients tolerated the procedure without difficulty and were immediately ambulatory. CONCLUSION: This novel approach should be considered for endovascular procedures for which access to the vertebral artery origin via the femoral approach is limited.

Aged↗

PubMed2000

Identification of patients at risk for periprocedural neurological deficits associated with carotid angioplasty and stenting.

BACKGROUND AND PURPOSE: Transient or permanent neurological deficits can occur in the periprocedural period following carotid angioplasty and stenting (CAS), presumably due to distal embolization and/or hemodynamic compromise. We performed this study to identify predictors of neurological deficits associated with carotid angioplasty and stent placement. METHODS: We reviewed medical records and angiograms in a consecutive series of patients who underwent CAS for symptomatic or asymptomatic cervical internal carotid artery stenosis from June 1996 through December 1998. Using logistic regression analysis, we evaluated the effect of demographic, clinical, intraprocedural, and angiographic risk factors on subsequent development of periprocedural neurological deficits. Periprocedural neurological deficits were defined as new or worsening transient or permanent neurological deficits that occurred during or within 48 hours of the procedure. RESULTS: A total of 111 patients (mean age 68.2+/-9.1 years) who underwent CAS for asymptomatic (n=54) or symptomatic (n=57) stenoses were included in this study. A total of 14 periprocedural neurological deficits (13%) were observed either during (n=4) or after (n=10) the procedure. Three identified variables were independently associated with periprocedural neurological deficits: symptomatic lesion (OR 8.3, 95% CI 1.6 to 42.6), length of stenotic segment >/=11.2 mm (OR 5.2, 95% CI 1.2 to 22.5), and absence of hypercholesterolemia (OR 5.4, 95% CI 1.4 to 20.9). Other variables, including age and degree of stenosis (defined by NASCET criteria), were not associated with periprocedural neurological deficits. CONCLUSIONS: A combination of clinical and angiographic variables can be used to identify patients at risk for periprocedural neurological deficits after CAS. Such identification may help in selection of patients who may benefit from novel pharmacological and mechanical preventive approaches.

Aged↗

PubMed2000

Subarachnoid haemorrhage: epidemiology, risk factors, and treatment options.

The present review focuses on subarachnoid haemorrhage (SAH) secondary to the rupture of an intracranial aneurysm, a condition with a high case fatality rate. Additionally, many of the surviving patients are left with significant disabilities. Risk factors for aneurysmal SAH include both genetic and acquired conditions. The most common presenting symptom is sudden onset of severe headache. Since headache is very common in the general population, it is not unusual that SAH is misdiagnosed at its onset with often catastrophic consequences. Unlike other acute neurological disorders such as brain injury, in which patient outcome is closely related to the extent of the injury occurring at the time of the trauma, patients with aneurysmal SAH are at risk of subsequent deterioration from 'avoidable' complications such as rebleed, vasospasm, hydrocephalus, and several other non-neurological general medical complications. Thus, the critical care management of the patient with SAH is of utmost importance in order to maximise the chances of satisfactory recovery. Although surgical clipping of the ruptured aneurysm remains the gold standard therapy, with the continuing refinement of endovascular techniques, a new, 'less invasive' option is now available, especially for patients considered poor surgical candidates.

Animals↗

PubMed1999

Solitary sarcoid granuloma of the cerebellopontine angle: a case report.

BACKGROUND: Sarcoidosis involves the nervous system about 5% of the time and usually manifests as a granulomatous inflammation of the basal meninges and hypothalamus. Cases which are strictly isolated to the central nervous system occur infrequently; rarely, they may present as an intracranial mass. METHODS: We present the case of a solitary sarcoid granuloma at the cerebellopontine angle in a 42-year-old female who presented with headache, facial numbness, and hearing loss. RESULTS: A suboccipital craniectomy was performed and the lesion was noted to be grossly adherent to the lower cranial nerves and skull base. The lesion was misdiagnosed as a meningioma with preoperative magnetic resonance imaging and intraoperative histology, and perhaps additional morbidity resulted. CONCLUSION: We present this case in order to demonstrate the importance of differentiating these dural-based lesions and propose that cases of neurosarcoidosis presenting as a solitary granuloma be treated with surgical debulking and immunosuppression.

Adult↗

PubMed1999

Posterior inferior cerebellar artery aneurysms associated with posterior fossa arteriovenous malformation: report of five cases and literature review.

BACKGROUND: The association of posterior inferior cerebellar artery (PICA) aneurysms with posterior fossa arteriovenous malformation (AVM) is uncommon. Over the past 3 years, five patients with this condition were treated at this institution. A review of the clinical history of these and other reported cases has illuminated common threads in the presentation, treatment, and outcome of these lesions. METHODS: The findings of 27 patients (5 from our institution and 22 from the medical literature) with PICA aneurysms associated with AVMs were reviewed. RESULTS: Eighty-four percent of individuals presented with sub-arachnoid hemorrhage (SAH); 89% of these episodes resulted from aneurysm rupture documented by either intraoperative inspection or autopsy. All aneurysms were located on a feeding artery to the AVM, and 81% originated from distal portions of PICA. The majority of patients presented with Hunt & Hess grade I SAH; all patients who presented with hemorrhage were treated surgically. Surgical strategy was directed both to secure the aneurysm and to resect the AVM during the course of a single procedure. Although four individuals either died on admission or in the perioperative period, overall outcome was excellent or good in 82% of patients. CONCLUSIONS: PICA aneurysms associated with AVMs most often involve the distal segments of the artery. Patients usually present with SAH secondary to aneurysmal rupture. Surgical clipping of the aneurysm and excision of the AVM is possible in a single procedure with minimal morbidity. Overall prognosis is favorable in 80% of the cases.

Adult↗

PubMed1999

Invasion of the internal carotid artery by cavernous sinus meningiomas.

BACKGROUND: Meningiomas are the most common tumor involving the cavernous sinus. Although these tumors have been known to invade adjacent structures such as bone, soft tissue, and brain, invasion of the internal carotid artery (ICA) by meningiomas has only been recognized recently. The authors evaluate the extent of carotid wall involvement in nine patients with cavernous sinus meningiomas encasing the ICA who underwent en bloc resection of the cavernous sinus. METHODS: The en bloc tumor-ICA specimens were fixed in formalin, embedded in paraffin, and sectioned on a rotary microtome. Hematoxylin and eosin, EVG, and HVG stains were performed and evaluated by light microscopy. RESULTS: There were four males and five females with a mean age of 47 years. Eight patients had not undergone previous surgery, whereas one patient had been operated on before. In this latter case, however, the cavernous sinus was not entered during the first operation. In all patients, stenosis of the ICA was confirmed by preoperative angiography and/or magnetic resonance imaging (MRI). In seven cases, the tumors were excised en bloc along with the stenotic ICA segment. A petrous-to-supraclinoid ICA bypass was performed in these seven patients. In two cases, the tumor was excised with the stenotic artery, but no bypass was performed. The final pathological diagnosis was meningothelial meningioma. In all cases tumor cells were found in the adventitia of the cavernous carotid with stenosis of the arterial lumen. Compression and/or obliteration of the vasa vasorum within the adventia was noted in all specimens. In four cases, the tumor was found to have invaded the external elastic lamina. In two instances the external elastic lamina was disrupted and the tumor focally extended into the media. CONCLUSIONS: These findings suggest that in the case of cavernous sinus meningiomas with encasement and stenosis of the intracavernous ICA, invasion of the vessel wall has occurred. The effect of these findings on the management of cavernous sinus meningiomas and the involved ICA is discussed.

Adult↗