PubMed Health⌕ Search

Biomedical subjects

G Wikholm

Publications and source records attributed to G Wikholm.

At least 19 recordsLinked to original sources
PubMed2003

Internal carotid artery aneurysms, cranial nerve dysfunction and headache: the role of deformation and pulsation.

Cranial nerve dysfunction and headache may occur with unruptured aneurysms of the cavernous and supraclinoid portions of the internal carotid artery. Nerve deformation (mass effect) and transmitted pulsations have been suggested as pathogenetic mechanisms. Differentiation may be possible by studying effects of endovascular treatment with Guglielmi detachable coils. Symptoms and signs of cranial neuropathy were retrospectively contrasted with angiographic aneurysm volumes before and after treatment in 10 patients. Mean follow-up was 36 months. Symptoms improved in three of four patients with cranial nerve dysfunction and in all patients with headache. None of the other patients, one with cranial nerve dysfunction, and three who were asymptomatic, developed any new symptoms after treatment. Aneurysm volume ranged from 0.1 to 2.7 cm(3 )before and 0.2 to 5.7 cm(3) after treatment; the size thus increased by 15 to 110%, a change which was statistically significant (P=0.004). The consistent increase in aneurysm volume with treatment is not associated with clinical deterioration, suggesting that deformation and displacement play a minor role in cranial neuropathy and that transmitted pulsations may be more important.

Adult↗
PubMed2001

The Göteborg cohort of embolized cerebral arteriovenous malformations: a 6-year follow-up.

OBJECTIVE: To present a follow-up of the results after endovascular treatment of cerebral arteriovenous malformations (AVMs) with acrylic glue. An initial follow-up was published in 1996. METHODS: A cohort of 150 patients with cerebral AVMs underwent embolization between 1987 and 1993. Fifty-seven patients had supplemental stereotactic irradiation, and 13 had subsequent surgery. The follow-up was carried out clinically and radiologically. RESULTS: The mean follow-up time was 6.2 years. Only four patients were lost to follow-up. If at least 90% of the AVM had been obliterated, the clinical course was stable and there were no new manifestations from the AVM. No recanalization occurred in any AVM that had been totally obliterated with glue. For patients in whom it was not possible to totally obliterate the AVM either with glue alone or glue supplemented with stereotactic irradiation or surgery, the long-term outcome was discouraging. CONCLUSION: Obliteration of an AVM with acrylic glue seems to offer stability. If the AVM is totally obliterated, the patient had a stable clinical course. Patients with large AVMs with minor occlusion after embolization may have a worse clinical outcome than expected.

Adolescent↗
PubMed2000

Embolisation with Guglielmi detachable coils during the period of increased risk for cerebral vasospasm: early outcome.

In a retrospective study, we investigated whether embolisation of intracranial aneurysms during the spasm period (days 3-14) after subarachnoid haemorrhage carries an increased risk. A comparison was made with patients embolised during the same period but in the first 2 days after the haemorrhage. The two groups compared well except for a higher incidence of posterior circulation aneurysm in the group with delayed treatment. There seems to be no difference in the short-term outcome between the two.

Embolization, Therapeutic↗
PubMed1998

Transarterial embolization of the uterine arteries: patient reactions and effects on uterine vasculature.

BACKGROUND: Therapeutic embolization of the uterine arteries has been successfully used to manage profuse gynecological hemorrhage. In the present study we aimed to investigate whether embolization of uterine arteries may serve as a safe and effective alternative treatment in cases of menorrhagia in fertile and perimenopausal women. As a first step, we have evaluated the methodology, patient reactions and effects on the uterine vasculature. METHODS: The distal part of the uterine artery was embolized with polyvinyl alcohol particles via catheterization of the right femoral artery. Total abdominal hysterectomy was performed the next day. RESULTS: Bilateral embolization in two patients resulted in considerable pain that required morphine analgesic medication and epidural analgesia. One patient was embolized unilaterally and experienced only slight discomfort with no need for analgesic medication at all, indicating that unilateral embolization is a well-tolerated method. After embolization, angiography showed stagnant flow in embolized vessels without contrast filling of distal branches. Angiography of the specimen showed normal vascular architecture in non-treated vessels. In treated vessels the main arterial trunks were patent but all smaller branches were occluded. Histology showed that most of the particles lodged in small arteries and that arterioles never showed injected material. CONCLUSION: The study indicates that the procedure involves an efficient occlusion of uterine vessels and that unilateral embolization of uterine arteries is well tolerated.

Adult↗
PubMed1997

Hidden compartments in AVMs--a new concept.

PURPOSE: The concept of hidden compartments in cerebral arteriovenous malformations (AVMs), which is hereby launched, offers a new explanation for the neurosurgical and neuroradiological controversies concerning patients with AVMs. MATERIAL AND METHODS: Three patients who were considered completely cured of their AVMs, subsequently developed new areas of malformed vessels as revealed by later angiograms. RESULTS: These 3 cases support our hidden compartment hypothesis and are reported on here, illustrated with relevant angiograms. The clinical implications of the hidden compartment concept refer to phenomena such as AVM growth, AVM recurrence after surgical excision, irradiation or embolization as well as per- or postoperative hemorrhage and swelling. CONCLUSION: The incidence of hidden compartments in the AVM population is unknown but further studies, particularly in the realm of superselective embolization, could reveal their presence.

Adult↗
PubMed1997

Transarterial embolization of a direct carotid cavernous fistula with Guglielmi detachable coils.

Four patients underwent transarterial embolization of a carotid-cavernous fistula with Guglielmi detachable coils; in three cases as the initial form of treatment and in one case after treatment via transarterial balloon embolization failed. The fistulas were 2 to 3 mm in diameter on pretreatment angiograms. Complete obliteration was achieved in two patients; in the other two, minimal residual flow remained immediately after embolization but disappeared by follow-up angiography. One to four coils were used to occlude the fistulas. The internal carotid artery remained patent in all patients, and there were no complications.

Arteriovenous Fistula↗
PubMed1996

Embolization of cerebral arteriovenous malformations: Part I--Technique, morphology, and complications.

OBJECTIVE: The aim of this two-part study is to give a full account of all patients referred for embolization of arteriovenous malformations (AVMs) from 1987 to 1993. This article (Part I of II) presents the patient study, including angiographic features and their relation to the immediate outcome of embolization. METHODS: Of the 192 patients referred, 150 were subsequently treated. Most patients were referred by neurosurgeons, and 85% of the AVMs were Spetzler-Martin Grade > or = 3. We have accounted for the 42 patients who did not undergo embolization. RESULTS: Occlusion from embolization alone (total embolization) was obtained in 13% of patients. Full treatment (total embolization or embolization and then stereotactic radiation or surgery) was achieved in two-thirds of all patients (n = 100, 66%), and combined treatment with stereotactic gamma radiation was the most important part of the treatment strategy. The procedural mortality was 1.3%. The total incidence of complications after embolization was high (40%), but only 6.7% of cases were labeled severe. Of all angiographic features that were considered, large size and the presence of deep feeders were predictors of failure to achieve full treatment. Thirty-four patients with AVMs < 8 cc were included in the study. These could have been irradiated as the sole treatment. In this group of small AVMs, the results of embolization were far better than in the whole group. Fourteen of the AVMs had volumes of < 4 cc, and 10 of these (71%) were totally embolized. One patient had a hemianopsia. Among AVMs 4 to 8 cc in volume (n = 20), the total embolization rate was 15%, the full treatment rate in combination with gamma treatment was 75%, and 10% of the patients were operated on after embolization. Severe complications occurred in 15% of patients, but no complications occurred after November 1990. CONCLUSION: In a series of AVMs, most of which were regarded as unsuitable for surgical excision, two-thirds were reduced to a size suitable for gamma knife treatment or totally occluded by embolization alone. The total complication rate was high, but the combined rate of death and complications affecting lifestyle was 8.0%, equal to approximately 3.2 years of natural history.

Adolescent↗
PubMed1996

Embolization of cerebral arteriovenous malformations: Part II--Aspects of complications and late outcome.

OBJECTIVE: From 1987 through 1993, we performed embolizations on 150 patients with cerebral arteriovenous malformations (AVMs) at Sahlgrenska University Hospital. The patients ranged in age from 5 to 70 years (35.5 +/- 14.8 yr, mean +/- standard deviation) and were selected by neurosurgeons in Scandinavia. We analyzed the risk of complications and late outcome to have a better basis for the decision to perform embolization. METHODS: The follow-up was a personal clinical examination of all surviving patients by a neurologist. Files for all patients were also studied. RESULTS: In 34 patients, the AVMs were eliminated by embolization alone (20 patients) or by supplementary surgery (14 patients). In 66 patients, the AVMs were embolized to a size suitable for supplementary stereotactic radiation. The clinical course was stable for those 100 patients. Another group of 50 patients who had undergone embolization was only partially treated, and as a group, those patients had less favorable outcomes. The manifestations or symptoms leading to diagnosis were in concordance with other studies. Headache and epilepsy showed a positive response to treatment in patients whose AVMs had been eliminated as well as in those who received only partial treatment. A history of cerebral bleeding did not influence the prognosis of recurrent bleeding. Conversely, AVMs with feeder or nidus aneurysms were related to an increased risk of bleeding. If there was a history of bleeding in a patient with large, partially treated AVMs, the prognosis for survival was diminished. CONCLUSION: The indication for treatment increases with the occurrence of AVMs with associated aneurysms. For patients with large AVMs, a history of bleeding justifies a more aggressive approach to treatment. The reduced risk of complications during the last years of the study also increases the indication for embolization.

Adolescent↗
PubMed1996

Stabilization of the nipple base with titanium rings when reoperating patients with continent urostomies for nipple dysfunction.

Nipple dysfunction in Kock reservoirs used for continent urinary diversion is usually caused by a flattening out of the intestinal nipple due to a lateral tore at the base of the nipple when the reservoir expands. This study describes a new method to repair dysfunctioning nipples based on the use of titanium rings applied outside the reservoir around the base of the nipple. Experiments on dogs and rats have shown that rings and plates of titanium rapidly attach to the serosal surface of ileum exposed to urine with only minor signs of inflammation. Ten patients with Kock reservoirs for urinary diversion have been reoperated for nipple dysfunction due to nipple sliding with elongation of the nipple and fixation of the nipple base with titanium rings. The functional result is excellent in 9 out of the 10 patients. No signs of erosion of the rings into the reservoirs have been noted. With this new method for nipple repair the need for using more intestine to construct a new nipple is eliminated.

Adult↗
PubMed1995

Occlusion of cerebral arteriovenous malformations with N-butyl cyano-acrylate is permanent.

PURPOSE: To verify the permanence of total occlusion of cerebral arteriovenous malformations after embolization with N-butyl cyano-acrylate and to evaluate the occlusion rate. METHODS: One hundred thirty-four patients were treated for cerebral arteriovenous malformations with N-butyl cyano-acrylate embolization after superselective catheterization. Those initially totally occluded have been followed with angiography. RESULTS: In 15 instances (11.2%) the arteriovenous malformations were totally occluded by embolization alone. Follow-up angiograms have been performed in 12 cases (80%) after 4 to 78 (mean, 27) months after embolization. In all instances the arteriovenous malformations have remained occluded, and there have been no clinical signs of activity. CONCLUSION: After total occlusion of a cerebral arteriovenous malformation with N-butyl cyano-acrylate, the lesion stays occluded, and the clinical course seems stable.

Cerebral Angiography↗
PubMed1995

Transarterial embolization of cerebral arteriovenous malformations: improvement of results with experience.

PURPOSE: To present the treatment outcome after embolization of arteriovenous malformations. METHODS: All patients with cerebral arteriovenous malformations treated in 1987 and 1988 (27 patients, group I) and in 1992 and 1993 (35 patients, group II) were compared regarding treatment results and clinical outcome. RESULTS: Complications of the treatment occurred in 52% of group I and 22% of group II patients. Severe complications occurred in 11 % and 0%, respectively. There were no treatment deaths. Thirty percent of the arteriovenous malformations in the first group were totally occluded or made accessible for gamma knife treatment, compared with 69% of the arteriovenous malformations in the second group. The clinical outcome improved from 56% with an excellent or good outcome in group I, to 89% in group II. The follow-up time is much shorter in group II, 1.5 versus 5.5 years in group I. CONCLUSION: A definite improvement in treatment outcome has been achieved. The clinical outcome seems to have improved as well, although the shorter follow-up time makes this conclusion less certain.

Adolescent↗
PubMed1994

Superselective transarterial embolization of renal arteriovenous malformations of cryptogenic origin.

Renal arteriovenous (AV) shunts of unknown origin are rare clinical findings. When symptomatic they can as other renal AV shunts and malformations cause hypertension, congestive heart failure and hematuria. During the last few years the treatment has tended to go from surgery to the more gentle and renal parenchyma sparing but yet effective endovacular embolization techniques. Two cases of renal vascular malformations with severe clinical symptoms necessitating treatment are presented. Treatment was successfully performed with tissue adhesive and coils.

Adult↗
PubMed1994

Instillation of alcohol into venous malformations of the head and neck.

Vascular malformations are errors of vascular morphogenesis, and must be differentiated from vascular tumours such as haemangiomas, because the natural history and treatment are different. Vascular malformations may be arteriovenous with high blood flow, or venous with low blood flow. Venous vascular malformations grow among soft tissues and are difficult to delineate at operation. Direct puncture under fluoroscopy with injection of contrast medium is one method of visualising the cavities of a venous malformation. Instillation of concentrated alcohol directly into such cavities is a possible treatment. Forty-four patients with venous malformations of the head or neck have been treated since 1984, of whom 31 responded to a follow up questionnaire. Twenty-three responded to injection of ethanol alone, and eight also required reconstructive surgery; 26 of the 31 described the result as "good" or "excellent" (84%).

Adolescent↗
PubMed1994

Direct puncture of large arteriovenous malformations in head and neck for embolisation and subsequent reconstructive surgery.

Five patients with large arteriovenous malformations (AVM) of the head and neck, which were too large or inconveniently placed for operation alone, were treated by embolisation after direct puncture; two of them were subsequently operated upon. They all recovered without complications. Embolisation of the nidus and subsequent operation is a good alternative for the treatment of large AVM. Ligating the supplying arteries is not a treatment. If the arterial routes to the nidus have previously been closed by ligatures selective catheterisation is impossible, though direct puncture of the nidus is a possibility. The nidus of the AVM can then be obliterated by embolisation either as a treatment, or as a preoperative procedure.

Adult↗