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Biomedical subjects

H Batjer

Publications and source records attributed to H Batjer.

At least 19 recordsLinked to original sources
PubMed2000

Incidental asymptomatic cerebral aneurysms in patients with extracranial cerebrovascular disease: is this a case against carotid endarterectomy without arteriography?

As less arteriography is performed before carotid surgery, concern arises about missing occult cerebral aneurysms and possible adverse outcomes. A study was conducted by the divisions of vascular surgery and neurosurgery of Northwestern University Medical School to evaluate the frequency of incidental cerebral aneurysms and outcomes of patients with extracranial cerebrovascular disease and asymptomatic cerebral aneurysms. From October 1995, through March 1997, 200 patients underwent intracranial and extracranial cerebrovascular angiography for evaluation of extracranial disease. Demographic data, symptoms, data of vascular lesions, surgical treatment and outcomes of stroke and death were recorded prospectively. Two patients (1%) had asymptomatic cerebral aneurysms found on angiography. Six more patients were referred with a known asymptomatic cerebral aneurysm with extracranial disease during this same period. Of these eight patients, five underwent extracranial vascular reconstruction surgery and seven received treatment for their aneurysms. There were two stroke complications, both occurred after treatment of a basilar artery aneurysm. One of these patients died. No aneurysms ruptured following 203 extracranial revascularizations during this same period. On the basis of the low prevalence of diagnosing coincidental cerebral aneurysms during work-up of extracranial disease, as well as the lack of evidence that carotid surgery predisposes to aneurysm rupture in these patients in both our study and the literature review, it is concluded that coexisting extracranial disease and asymptomatic cerebral aneurysms do not pose a case against carotid surgery without routine arteriography. However, arteriography should be considered in selected groups of patients where the yield of intracranial aneurysms is high; these include patients with a familial history of cerebral aneurysms, autosomal dominant polycystic kidney disease, extracranial internal carotid artery medial fibrodysplasia, Takayasu's arteritis, alpha1-antitripsin deficiency and atypical clinical presentations, including headache.

Cerebral Angiography↗
PubMed1995

Treatment of dural sinus thrombosis using selective catheterization and urokinase.

Thrombosis of the cerebral dural venous sinuses, cortical draining veins, and deep cerebral veins is a rare clinical finding. Because of its low incidence and multiple etiologies, the optimum therapy for this condition will only be elucidated by a multicenter, randomized prospective study. At our institution, we favor early and aggressive management of cerebral venous sinus thrombosis with transfemoral, venous intradural infusions of the fibrinolytic agent urokinase. To date, treatment of only 13 patients using this technique has been reported in the English literature. This report adds 12 more such treated patients. Despite the presence of preinfusion infarcts in 5 patients, four of which were hemorrhagic, we incurred no major therapeutic morbidity. Functional sinus patency was achieved in 11 of 12 patients, with our only true failure occurring in an individual with symptoms of at least 2 months' duration. Good to excellent clinical outcome was achieved in 10 of 11 patients (one newborn had inadequate follow-up).

Adult↗
PubMed1994

Lower brain-stem origin of the median nerve N18 potential.

A patient undergoing intraoperative median nerve somatosensory evoked potential (MSEP) and brain-stem auditory evoked response (BAER) monitoring showed changes during basilar artery aneurysm clipping. There was loss of the BAER wave V, with preservation of waves I and III. Simultaneously, there also was loss of the MSEP N20 potential, with preservation of the N18, N13 and Erb's point potentials. The patient died and autopsy showed an infarct involving the whole rostro-caudal extent of the pontine tegmentum. This combination of electrophysiologic and pathologic findings may help answer questions regarding the exact generators of different MSEP potentials. In particular, it implies that medullary structures can generate the N18 potential.

Brain Stem↗
PubMed1994

Detection of cerebral hypoperfusion during trial carotid occlusion with reversal following extracranial-intracranial bypass prior to permanent occlusion.

The authors describe a patient with a large intracavernous aneurysm of the right internal carotid artery and a marked decrease in focal brain blood flow induced by temporary carotid balloon occlusion. The patient subsequently underwent a superficial temporal to middle cerebral artery bypass followed by successful carotid occlusion using detachable balloons placed proximal to the aneurysm. Postoperative rCBF demonstrated normal perfusion in the region of the right internal carotid artery distribution as well as normalization of perfusion to a previous area of baseline perfusion abnormality. Cerebral brain blood flow imaging was useful in the initial evaluation as well as the management of this patient.

Aged↗
PubMed1994

Diagnostic applications of simultaneously acquired dual-isotope single-photon emission CT scans.

PURPOSE: To report the development and validation of a technique of dual tracer single-photon emission CT brain imaging using technetium-99m hexamethylpropyleneamine oxime and iodine-123 iodoamphetamine agents and the application of this technique in patients with a variety of diagnoses. METHODS: Contamination between the two isotopes' energy windows was calculated by opening both energy windows while scanning a group of patients using a single isotope. To compare uniformity of I-123 down-scatter, Tc-99m studies were performed both before and after the administration of I-123 in five of 24 dual studies. The 24 patients studied with the dual-isotope technique were evaluated during acetazolamide testing, trial balloon occlusion, or embolization of an arteriovenous malformation. RESULTS: In a dual acquisition, average count contamination of an I-123 study by Tc-99m was less than 1% of the total I-123 counts, and contamination of a Tc-99m study by I-123 was approximately 12% of the total Tc-99m counts. Tc-99m studies performed both before and after the administration of I-123 demonstrated that contaminating counts do not adversely affect scan interpretation. Dual-tracer scans were completed in all 24 patients, 10 of whom showed changes after intervention. CONCLUSIONS: Dual-tracer single-photon emission CT brain scans of adequate diagnostic quality are possible using Tc-99m and I-123.

Acetazolamide↗
PubMed1993

Brain blood flow SPECT in temporary balloon occlusion of carotid and intracerebral arteries.

It is important to determine preoperatively which patients can tolerate permanent occlusion of a cervical internal carotid or cerebral artery when such a procedure may be necessary to treat cerebrovascular or neoplastic lesions. Here we report our experience in combining temporary intra-arterial balloon occlusion with concomitant cerebral blood flow imaging in preoperative evaluation of such patients. Forty-two patients with a variety of cerebrovascular and neoplastic lesions underwent trial balloon occlusion of an internal carotid or intracerebral artery. Eight patients developed both neurologic symptoms as well as brain perfusion defects during trial occlusion. Nine others developed only perfusion defects. The remainder were asymptomatic and had negative scans. Brain blood flow imaging during intra-arterial balloon occlusion identified 17 patients potentially at risk for developing postsurgical ischemic deficits. Treatment alternatives to acute arterial sacrifice were developed for these patients.

Adolescent↗
PubMed1990

Intracarotid hydroxyethyl methacrylate solution causing stroke in dogs.

Hydroxyethyl methacrylate (HEMA) has been advocated as a polymerizing solution with which to prevent deflation of detachable balloons in interventional neuroradiology. It is pertinent to know if unpolymerized HEMA would have untoward effects if accidentally released into the carotid artery by balloon rupture or deflation. Seven mongrel dogs underwent transfemoral catheterization of the common carotid artery and subsequent injection of HEMA solution in volumes of 1 cc in five dogs, 2 cc in one, and 4 cc in one. Angiography performed at the time of injection revealed evidence of intravascular thrombosis as well as possible spasm. Three surviving animals were sacrificed at 48 hours; the brains were fixed and examined histopathologically. One brain was normal and one was autolyzed and could not be examined. Five of the seven animals had histopathologically documented cerebral infarctions of varying size. No foreign substance was seen within the blood vessels to suggest intravascular polymerization. The animals injected with 2 or 4 cc HEMA solution did not survive 48 hours. Literature review reveals little documentation of the toxicology of intravascular HEMA. With its increasing popularity as a compound for polymerization in detachable balloons introduced into the brain, further investigations are warranted to understand the physical properties of the compound and potential risks of its use.

Animals↗
PubMed1988

Aneurysm recurrence associated with induced hypertension and hypervolemia.

A case of angiographic recurrence of a previously clipped large distal basilar aneurysm associated with prolonged hypervolemic and hypertensive therapy for vasospasm is reported. Currently, the most effective therapy for reversing neurological deficits secondary to vasospasm and for augmenting cerebral blood flow is induced hypertension and hypervolemia. The complication of aneurysm enlargement with this therapeutic modality has been postulated but not previously demonstrated.

Basilar Artery↗
PubMed1987

Enlargement and rupture of distal basilar artery aneurysm after iatrogenic carotid occlusion.

A case of angiographic enlargement and fatal rupture of a previously asymptomatic distal basilar aneurysm in a 12-year-old girl is reported. She had been treated by carotid sacrifice for a giant intracavernous carotid aneurysm. After superficial temporal-middle cerebral artery bypass, this patient underwent a trapping procedure and decompression of her symptomatic giant aneurysm. Despite postoperative patency of her bypass graft, the involved middle cerebral circulation was irrigated substantially by retrograde flow through her posterior communicating artery. An incidental distal basilar aneurysm involving the origin of her superior cerebellar arteries, posterior cerebral arteries, and multiple perforators was treated by a wrapping procedure. Eleven days after carotid ligation, she suffered a fatal subarachnoid hemorrhage from her basilar aneurysm. This catastrophe was undoubtedly produced by our failure to consider the additional hemodynamic stress placed upon the distal basilar artery by carotid sacrifice and may have been preventable by a more aggressive attack on this previously asymptomatic lesion.

Basilar Artery↗
PubMed1987

Surgical approaches to trigonal arteriovenous malformations.

Only about 5% of intracranial arteriovenous malformations (AVM's) are located predominantly within the ventricular system. Between July, 1981, and February, 1986, 15 patients were treated at the authors' institution for AVM's within the ventricular trigone. The mean age of this patient population was 24 years, and two-thirds were female. Intracranial hemorrhage was by far the most frequent presenting symptom and intraventricular hemorrhage occurred in 11 cases, with multiple episodes being documented in five. Arterial supply of the malformations was quite uniform, with the lateral posterior choroidal or posterior temporal branch of the posterior cerebral artery (PCA) being the most frequent source. Venous drainage was similarly stereotypic, with predominant outflow into the galenic system in all but one patient. An interhemispheric surgical approach was used in eight patients, a middle or inferior temporal gyrus incision was performed in six, and a subtemporal route was chosen in a single patient. Operative results suggest that these lesions can be removed with reasonable safety. An interhemispheric approach is recommended if the nidus projects medially from the trigone and is observed medial to the P2-P3 junction of the PCA on angiography. A middle temporal gyrus approach is suggested if the nidus is lateral to the P2-P3 junction, even when the lesion is located in the dominant hemisphere. A subtemporal approach should be reserved for inferiorly projecting AVM's with cortical representation on the fusiform or parahippocampal gyrus in the nondominant hemisphere.

Adolescent↗
PubMed1986

Arteriovenous malformations of the posterior fossa: clinical presentation, diagnostic evaluation and surgical treatment.

Infratentorial arteriovenous malformations represent only some 5-7% of malformations in major series. Since 1977 thirty-two patients with intracranial, intradural malformations of the brain stem or cerebellum have been evaluated by the Division of Neurological Surgery of The University of Texas Health Science Center at Dallas. Thirty of these patients have undergone surgical treatment. Twenty-three patients presented with intracranial hemorrhage which was recurrent in eleven cases. Nine patients were evaluated due to progressive brain stem or cerebellar deficits. A history of progressive deficits was unusual in the group that presented with hemorrhage and a prior or subsequent hemorrhage was rare in the patients initially evaluated due to progressive deficits. Seventeen of these malformations were located in the vermis, seven within the cerebellar hemisphere, two in the tonsil, two in the cerebellar-pontine angle, and four within the brain stem. Operative intervention was directed at primary resection in fifteen cases, staged resection in seven cases, embolization and resection in five cases, and evacuation of hematoma in three patients. Operative mortality in this surgical series was 7% with significant morbidity in 13%. Application of modern microsurgical techniques to the removal of arteriovenous malformations of the posterior fossa may result in improvement over the natural history of the disease process, especially in those patients who present with hemorrhage.

Cerebral Angiography↗
PubMed1986

Intracranial arteriovenous malformations associated with aneurysms.

The presence of intracranial aneurysm in association with arteriovenous malformation has been well documented. Aneurysms have been described in typical proximal sites along the feeding system to the arteriovenous malformation, in abnormal distal locations along feeding vessels, and in sites remote and apparently hemodynamically unrelated to the arteriovenous malformation. Little attention has been focused on the most appropriate medical and surgical care of patients harboring these lesions. Since 1977, 22 patients with this combination of lesions have been evaluated at our institution. Nine patients (41%) presented after intracranial hemorrhage. The remaining 13 patients were investigated because of seizures in 5 patients (23%), headaches in 4 patients (18%), and progressive ischemia in 4 patients (18%). Among the patients suffering intracranial hemorrhage, 78% had bled from an aneurysm, with 22% having hemorrhaged from their arteriovenous malformation. All 7 of the patients who suffered aneurysmal hemorrhage bled from atypical distal aneurysms on major feeding vessels. Our experience and that of others has led us to believe that the safest approach to patients with this combination of lesions is to treat the aneurysm before microsurgical resection of the associated arteriovenous malformation. Hemodynamic changes associated with the abrupt elimination of an arteriovenous malformation may place associated aneurysms at immediate risk.

Adolescent↗
PubMed1986

Potential roles for early revascularization in patients with acute cerebral ischemia.

The risk of carotid endarterectomy in acute cerebral ischemic situations is well documented. By using the superficial temporal or occipital artery, it is possible to provide relatively low flow revascularization conduits, potentially avoiding the risk of postoperative hemorrhage. Eighteen patients at The University of Texas Health Science Center at Dallas, Texas, have been treated recently with extracranial to intracranial bypass in the setting of acute neurological deficit, stroke in evolution, or recent completed infarction. Angiographic causes of these deficits included cervical carotid occlusion in 5 patients, carotid siphon disease in 2 patients, middle cerebral stenosis or occlusion in 3 patients, and delayed cerebral ischemia following subarachnoid hemorrhage in 8 patients. Neurological improvement was demonstrated within 24 hours following revascularization in 15 cases (83%); 3 patients were unchanged following bypass, and no patient's condition was worsened. The only case of postoperative intracerebral hemorrhage occurred 1 week following a long saphenous vein graft from the subclavian to the middle cerebral artery. After an average follow-up of 19 months, 7 patients are neurologically normal, 8 patients have mild to moderate deficits, and 3 patients have died. Low flow revascularization procedures appear to be safe in the setting of acute cerebral ischemia and may in selected patients boost regional cerebral blood flow from levels of symptomatic ischemia into a range compatible with normal neuronal function.

Acute Disease↗
PubMed1986

Intraoperative aneurysmal rupture: incidence, outcome, and suggestions for surgical management.

Intraoperative rupture of an intracranial arterial aneurysm can dramatically interrupt a deliberate microsurgical procedure and jeopardize the patient's chances for a favorable outcome. Intraoperative rupture occurred in 58 of 307 (19%) consecutive aneurysm procedures done at The University of Texas Health Science Center. Rupture occurred during three specific periods: early or predissection in 7%, dissection in 48%, and clip application in 45%. Outcome after rupture during the predissection interval was poor, with only 1 of 4 patients surviving. Aneurysmal rupture during dissection could be attributed to blunt dissection techniques in 75% of the cases and to sharp subarachnoid dissection in 25%. The outcome was favorable in only 50% of the patients sustaining blunt dissection errors, whereas all patients sustaining intraoperative rupture during sharp dissection recovered well. Rupture during clip application was attributed to incomplete dissection in 65%, poor clip application in 31%, and a mechanical clip failure in 1 case. Eighty-eight per cent of the patients who underwent uneventful operative procedures had favorable outcomes, whereas only 62% of the patients suffering intraoperative rupture recovered well. The use of sharp microsurgical techniques with a systematic contingency plan for dealing with sudden hemorrhage and the judicious use of temporary clips should minimize the adverse effect of intraoperative rupture on overall management morbidity and mortality.

Dissection↗
PubMed1986

Use of extracranial-intracranial bypass in the management of symptomatic vasospasm.

Delayed ischemic deficits from vasospasm after subarachnoid hemorrhage remain a major source of death and disability to patients surviving subarachnoid hemorrhage. Ideal treatment for this condition would prevent or reverse spasm in major subarachnoid vessels. This goal remains elusive. Considerable success has been obtained with augmentation of flow in ischemic regions by induced hypertension and hypervolemia. Some patients are not good candidates for this therapy because of underlying cardiovascular disease or the presence of unsecured aneurysms. A total of 11 patients have recently undergone extracranial-intracranial bypass for the treatment of symptomatic vasospasm. Bypass was performed in 4 patients due to failure of medical management and in 7 patients due to our reluctance to induce hypertension in the setting of unsecured aneurysms. Eight of the 11 patients responded neurologically to the bypass procedure within 24 hours. In 6 cases, neurological deficits either improved or resolved. After operation, all 8 patients maintained their preoperative neurological status with lower mean arterial blood pressures than before bypass. Noncomatose patients with focal middle cerebral ischemic deficits and secured aneurysms in whom medical management has failed or in whom these measures are contraindicated may indeed benefit from extracranial-intracranial bypass. Patients with unsecured aneurysms remote from an ischemic middle cerebral territory should probably be revascularized if cautious hypertension fails to improve their conditions.

Adult↗
PubMed1986

Arteriovenous malformations of the posterior fossa. Clinical presentation, diagnostic evaluation, and surgical treatment.

Infratentorial arteriovenous malformations (AVM's) represent only 5% to 7% of all AVM's in major series. Since 1977, 32 patients with intracranial intradural malformations of the brain stem or cerebellum have been evaluated at the University of Texas Health Science Center, 30 of whom underwent surgical treatment. Twenty-three patients presented with intracranial hemorrhage, which was recurrent in 11 cases, and nine patients were evaluated for progressive brain-stem or cerebellar deficits. A history of progressive deficits was unusual in the group that presented with hemorrhage, and a prior or subsequent hemorrhage was rare in the patients initially evaluated for progressive deficits. Seventeen of these AVM's were located in the vermis, seven within the cerebellar hemisphere, two in the tonsil, two in the cerebellopontine angle, and four within the brain stem. Operative intervention was directed at primary resection in 15 cases, staged resection in seven, embolization and resection in five, and evacuation of hematoma in three. Operative mortality in this surgical series was 7%, with significant morbidity in 13%. Use of modern microsurgical techniques in removal of posterior fossa AVM's may offer results better than the natural history of the disease process, especially in patients who present with hemorrhage.

Adult↗