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Biomedical subjects

G N Beute

Publications and source records attributed to G N Beute.

11 recordsLinked to original sources
PubMed2007

Brain AVM embolization with Onyx.

BACKGROUND AND PURPOSE: To report the initial experience by using a new liquid embolic agent (Onyx) for embolization of brain arteriovenous malformations (AVMs). METHODS: Between May 2000 and December 2005, 44 patients with brain AVMs were embolized with Onyx. There were 18 women and 26 men with a mean age of 42.4 years (median 44, range 14-71 years). Clinical presentation included seizures in 26 patients (59%), hemorrhage from the AVM in 13 patients (30%), subarachnoid hemorrhage from a concomitant aneurysm in 3 patients (7%), visual disturbances in 1 patient (2.3%), and in 1 patient (2.3%) the AVM was an incidental finding. Mean estimated size of the AVM was 3.9 cm (median 4, range 2-7 cm). RESULTS: In 44 patients, 52 embolization procedures were performed with 138 feeding pedicles embolized, ranging from 1 to 7 per patient. Average estimated size reduction was 75% (median 80%, range 40%-100%). Total obliteration was achieved in 7 AVMs (16%), and partial embolization was followed by surgery in 10 patients and by radiosurgery in 20 patients. Complications occurred in 6 patients, leading to death in 1 patient (mortality 2.3%) and to permanent disability in 2 patients (morbidity 4.6%). CONCLUSION: Onyx is feasible and safe in the embolization of brain AVMs. Complete obliteration can be achieved in small AVMs. Large AVMs can be adequately reduced in size for additional surgical or radiosurgical treatment.

Adolescent↗
PubMed2006

Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in Parkinson's disease: one year follow-up of a randomised observer-blind multi centre trial.

BACKGROUND: To investigate whether STN stimulation is more efficacious than unilateral pallidotomy in advanced Parkinson's disease (PD) one year after surgery. METHOD: Thirty-four patients with advanced PD were randomly assigned to unilateral pallidotomy or bilateral STN stimulation. Outcome measures were parkinsonian symptoms in off and on phases (UPDRS 3), dyskinesias, functional status, Parkinson's disease quality of life questionnaire, the effects on separate symptoms, timed tests, patient diaries, dopaminergic drugs changes, adverse effects, and global outcome scale. Patients were assessed before surgery, six months and one year after surgery. The primary outcome measure was the off phase UPDRS 3 at six months follow-up. FINDINGS: The off phase UPDRS 3 score improved from 46.5 to 32 points in the pallidotomy patients and from 51.5 to 24 in the STN stimulation patients (p = 0.002). On phase UPDRS 3 and off phase Schwab and England functional scale improved significantly in favour of the STN stimulation patients. Dopaminergic drugs reduction was larger in the STN group although the difference between the treatment groups was not significant. One patient in each group had a major adverse effect. CONCLUSIONS: Bilateral STN stimulation is more efficacious than unilateral pallidotomy in advanced PD up to one year after surgery.

Activities of Daily Living↗
PubMed2006

Ruptured cavernous sinus aneurysms causing carotid cavernous fistula: incidence, clinical presentation, treatment, and outcome.

BACKGROUND AND PURPOSE: In this study, we present our experience with 11 patients with ruptured cavernous sinus aneurysms causing carotid cavernous fistulas (CCFs), to assess the incidence of ruptured cavernous sinus aneurysms causing CCFs and evaluate clinical presentations, treatments, and outcomes. PATIENTS AND METHODS: During a 10-year period, 10 of 689 (1.5%) endovascular-treated ruptured aneurysms were ruptured cavernous sinus aneurysms causing CCF. One additional patient with a CCF died shortly before treatment of intracranial hemorrhage. All patients had audible pulsatile bruit. Exophthalmus, ocular motor palsy, and decreased vision correlated with venous drainage to the superior ophthalmic veins and intracerebral hemorrhage was associated with major cortical venous drainage in 2 patients. RESULTS: Two low-flow CCFs closed spontaneously before treatment with resolution of symptoms; the aneurysms were subsequently treated. Eight CCFs were successfully occluded, 5 by coil occlusion of the aneurysm, one by occlusion of the aneurysm with a balloon, and 2 by simultaneous coil occlusion of the aneurysm and internal carotid artery. There were no complications of treatment. Visual acuity returned to normal in all but one patient, and ophthalmoplegia was cured in 6 of 8 patients. In 2 patients, a remaining abducens palsy was surgically corrected. CONCLUSION: The incidence of CCF by a ruptured cavernous sinus aneurysm was 1.5%. CCF was the presenting symptom in 24.4% of treated symptomatic cavernous sinus aneurysms. Clinical symptoms correlate with venous drainage. Drainage to cortical veins may lead to intracranial hemorrhage. Endovascular treatment with coils is effective in occluding the fistula.

Adult↗
PubMed2006

Coiling of truly incidental intracranial aneurysms.

BACKGROUND AND PURPOSE: The purpose of this study is to report the morbidity, mortality, and angiographic results of coiling of asymptomatic incidental aneurysms and compare the characteristics of these aneurysms with other asymptomatic incidental aneurysms that were not treated. PATIENTS AND METHODS: During a 10-year period, 97 patients without previous subarachnoid hemorrhage, presented with incidentally found intracranial aneurysms. In 48 patients, 58 aneurysms were coiled. The mean size of the 58 coiled incidental aneurysms was 10.9 mm (median, 9 mm; range, 3-40 mm). Twenty-six of 58 coiled aneurysms (44.8%) were > or = 10 mm. RESULTS: Permanent morbidity of coiling was 2.1% (1 of 48), mortality was 0%. Compared with untreated patients with incidental aneurysms, coiled patients were younger and more often had multiple aneurysms. Aneurysms of coiled patients more often had a small neck, were more often located on the carotid artery, and were less often located on the middle cerebral artery. Of 46 aneurysms with angiographic follow up, 45 were completely or near completely occluded. To obtain these results, 3 aneurysms were coiled more than once. Coiled incidental aneurysms did not rupture during a median follow-up period of 28.5 months. Mean hospital stay per patient was 2.5 days. CONCLUSION: Coiling of incidental intracranial aneurysms has a low complication rate in selected aneurysms and patients. Coiling should be the first treatment option in incidental aneurysms suitable for this technique.

Adult↗
PubMed2006

Endovascular treatment of posterior cerebral artery aneurysms.

BACKGROUND AND PURPOSE: The purpose of this study was to report the incidence, clinical presentation, endovascular treatment, and outcome of aneurysms of the posterior cerebral artery (PCA). PATIENTS AND METHODS: Among 1880 aneurysms treated between January 1995 and January 2005, 22 aneurysms (1.2%) in 22 patients were located on the PCA. Ten patients presented with subarachnoid hemorrhage (SAH) from the PCA aneurysm: 2 of these patients had additional visual field deficits and 2 had additional occulomotor palsy. One patient presented with acute occulomotor palsy only. Eleven PCA aneurysms were unruptured: 9 were additional to another ruptured aneurysm and 2 were incidentally discovered. Three aneurysms were >15 mm and the other 19 aneurysms were < or = 8 mm. Eighteen aneurysms were saccular, 2 were fusiform, one was dissecting, and one was mycotic. RESULTS: All aneurysms were successfully treated, 17 with selective occlusion of the aneurysm with coils and 5 with simultaneous occlusion of the aneurysm and parent PCA with coils. There were no complications of treatment. Two patients died of sequelae of SAH shortly after treatment. One patient died 2 months after coiling of an unruptured P1 aneurysm with intramural thrombus of SAH from the same aneurysm. One patient had persistent hemianopsia. In 2 patients with intact visual field in which the parent PCA was occluded, no hemianopsia developed due to sufficient leptomeningeal collateral circulation. CONCLUSION: Aneurysms of the PCA are rare with an incidence in our practice of 1.2% of all types of aneurysms. Clinical presentation is variable with SAH, occulomotor palsy, visual field deficit or a combination. Endovascular treatment with either selective occlusion of the aneurysm or occlusion of the aneurysm together with the parent artery with coils is safe and effective with good clinical results.

Adult↗
PubMed2006

Procedural complications of coiling of ruptured intracranial aneurysms: incidence and risk factors in a consecutive series of 681 patients.

BACKGROUND AND PURPOSE: To report the incidence of procedural complications of coiling of ruptured intracranial aneurysms leading to permanent disability or death in a consecutive series of 681 patients and to identify risk factors for these events. PATIENTS AND METHODS: Between January 1995 and July 2005, 681 consecutive patients with ruptured intracranial aneurysms were treated with detachable coils. Procedural complications (aneurysm rupture or thromboembolic) of coiling leading to death or neurologic disability at the time of hospital discharge were recorded. For patients with procedural complications, odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated for the following patient and aneurysm characteristics: patient age and sex, use of a supporting balloon, aneurysm location, timing of treatment, clinical condition at the time of treatment, and aneurysm size. RESULTS: Procedural complications occurred in 40 of 681 patients (5.87%; 95% CI, 4.2% to 7.9%), leading to death in 18 patients (procedural mortality, 2.6%; 95% CI, 1.6% to 4.2%) and to disability in 22 patients (procedural morbidity, 3.2%; 95% CI, 2.0% to 4.9%). There were 8 procedural ruptures and 32 thromboembolic complications. The use of a temporary supporting balloon was the only significant risk factor (OR, 5.1; 95% CI, 2.3 to 15.3%) for the occurrence of procedural complications. CONCLUSION: Procedural complication rate of coiling of ruptured aneurysms leading to disability or death is 5.9%. In this series, the use of a temporary supporting balloon in the treatment of wide-necked aneurysms was the only risk factor for the occurrence of complications.

Adult↗
PubMed2002

Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study.

BACKGROUND: Because survival benefits of treatment with radiotherapy are questionable and such treatment can cause substantial damage to the brain over time, the optimum management strategy for low-grade gliomas remains controversial. We aimed to identify the specific effects of radiotherapy on objective and self-reported cognitive function, and on cognitive deterioration over time, in patients with low-grade gliomas treated with early radiotherapy. METHODS: 195 patients with low-grade glioma (of whom 104 had received radiotherapy 1-22 years previously) were compared with 100 low-grade haematological patients and 195 healthy controls. Our analyses aimed to differentiate between the effects of the tumour (eg, disease duration, lateralisation) and treatment effects (neurosurgery, radiotherapy, antiepileptic drugs) on cognitive function and on relative risk of cognitive disability. FINDINGS: Low-grade glioma patients had lower ability in all cognitive domains than did low-grade haematological patients, and did even less well by comparison with healthy controls. Use of radiotherapy was associated with poorer cognitive function; however, cognitive disability in the memory domain was found only in radiotherapy patients who received fraction doses exceeding 2 Gy. Antiepileptic drug use was strongly associated with disability in attentional and executive function. INTERPRETATION: Our findings suggest that the tumour itself has the most deleterious effect on cognitive function and that radiotherapy mainly results in additional long-term cognitive disability when high fraction doses are used. Additionally, the effects of other medical factors, especially antiepileptic drug use, on cognitive function in glioma patients deserve attention.

Adult↗
PubMed1999

Unilateral pallidotomy in Parkinson's disease: a randomised, single-blind, multicentre trial.

BACKGROUND: The results of several cohort studies suggest that patients with advanced Parkinson's disease would benefit from unilateral pallidotomy. We have assessed the efficacy of unilateral pallidotomy in a randomised, single-blind, multicentre trial. METHODS: We enrolled 37 patients with advanced Parkinson's disease who had, despite optimum pharmacological treatment, at least one of the following symptoms: severe response fluctuations, dyskinesias, painful dystonias, or bradykinesia. Patients were randomly assigned to unilateral pallidotomy within 1 month or to pallidotomy after the primary outcome assessment (6 months later). The primary outcome was the difference between the groups in median changes on the motor examination section of the unified Parkinson's disease rating scale (UPDRS 3) score done in the off phase. Secondary outcome measures included levodopa-induced dyskinesias (dyskinesia rating scale [DRS]) and extent of disability (UPDRS 2). FINDINGS: The median UPDRS 3 off score of the pallidotomy patients improved from 47 to 32.5, whereas that of control patients slightly worsened from 52.5 to 56.5 (p<0.001). In the on phase the median DRS score improved 50% in pallidotomy patients compared with no change in controls. The UPDRS 2 off score improved with a median of 7 in the pallidotomy group. Two treated patients had major adverse effects. INTERPRETATION: Unilateral pallidotomy is an effective treatment in patients with advanced Parkinson's disease, who have an unsatisfactory response to pharmacological treatment.

Aged↗
PubMed1985

Successful stereotaxic evacuation of an acute pontomedullary hematoma. Case report.

A healthy young woman developed a rapidly progressive pontomedullary lesion 24 hours after delivery of her first child. The lesion was shown on computerized tomography (CT) to be a primary hematoma. Stereotaxic aspiration was carried out, and the patient recovered. Angiography and CT scanning demonstrated a vascular lesion compatible with an arteriovenous malformation.

Adult↗