PubMed Health⌕ Search

Biomedical subjects

L Rosta

Publications and source records attributed to L Rosta.

At least 19 recordsLinked to original sources
PubMed1997

Endovascular treatment of pial AVMs: technical options, indications and limits in pediatric age patients.

Our study group consisted of 29 patients who underwent endovascular treatment for the presence of pial AVMs. The patients were treated with various embolization methods including "-free flow" embolization (2 cases); embolization with suture threads (2 mm long micro-emboli: 17 cases) and embolization with acrylic glue (10 cases). There were significant angio-architectural and AVM location differences between the pediatric and the adult patient groups. In pediatric patients, the more frequent AVMs were of the mono or few-pedunculated type, then simple direct fistulas and high-flow fistulous-plexiform AVMs and giant infra-tentorial or deep-seated malformations. In mono or few-pedunculated AVMs, the elected treatment was acrylic glue followed by radio-surgery achieving definitive cure in 3 cases. In direct AVFs and elevated flow AVMs, embolization with suture and acrylic glue offered definitive results. Treatment for infra-tentorial and deep-seated AVMs presented the greatest difficulty in pediatric patients. In two of them, embolization with glue enabled radiosurgery (giant cerebellar AVMs). Our experience did not confirm that current endovascular techniques provide definitive treatment in extensive, deep-seated AVMs. Each treatment, in children more so than in adults, requires a risk/benefit evaluation of the method taking into account the natural history data.

Adhesives↗
PubMed1994

Double-blind comparison of safety and efficacy of iomeprol and iopamidol in carotid digital subtraction angiography.

Iomeprol is a nonionic monomer which provides injectable formulations with the lowest osmolalities and the lowest viscosities among the currently available low-osmolar radiographic contrast agents of the same category. These favourable physico-chemical characteristics, together with high water solubility and low molecular toxicity, make this agent particularly suitable for carotid angiography, a procedure in which contrast-induced blood-brain barrier damage is maximal. This single-centre, randomised, double-blind, parallel-group study aimed at comparing the safety, tolerance and efficacy of 200 mgI/ml solutions of iomeprol and iopamidol in 100 consenting adult inpatients undergoing carotid intra-arterial digital subtraction angiography (IA-DSA). Both agents appeared to be safe and well tolerated. Only minor and transient adverse events occurred throughout the study. Electroencephalographic and neurological examinations performed pre- and post-contrast showed no abnormality induced by the test compounds. Vessel opacification was good or excellent in the vast majority of technically adequate examinations. Information provided by the angiographic examination was useful for subsequent patient management in almost all cases. It is concluded that iomeprol-200 and iopamidol-200 are safe and effective contrast media when used for carotid IA-DSA, an examination which proves useful not only for the diagnosis of vascular lesions, but also to best direct the management of patients scheduled for surgery of intracranial tumors.

Adult↗
PubMed1991

The relevance of anatomic and hemodynamic factors to a classification of cerebral arteriovenous malformations.

Potential prognostic anatomic and hemodynamic factors were evaluated in 248 patients with cerebral arteriovenous malformations (AVMs), all treated by direct microsurgical removal. The size of each AVM was calculated by its volume, obtained by the multiplication of the three AVM diameters by 0.52. A surgical classification of AVM location (in 11 groups) is proposed. Types of feeders and of drainage were classified as superficial or deep; the extent of the drainage system was classified according to a four-degree scale. The mean flow velocity in the main AVM feeder, detected using transcranial Doppler ultrasonography, was used as an indirect measure of AVM shunt flow in a small number of patients (n = 29). AVM volume was a very important prognostic factor: the incidence of hyperemic complications and the morbidity and mortality rate were significantly higher when the volume of the lesion was greater than 20 cm3 (P less than 0.0001 for hyperemic complications; P less than 0.001 for permanent morbidity and mortality). The incidence of hyperemic complications and the morbidity rate were higher in AVMs in rolandic, inferior limbic, and insular locations than in AVMs in other locations. As for other anatomic factors: a) the presence of deep feeders significantly increased the incidence of hyperemic complications, as well as the morbidity and mortality rate; b) the presence of deep drainage significantly increased permanent morbidity only; c) the extension of the venous system was significantly related to the development of hyperemic complications, and to morbidity and mortality. Transcranial Doppler examination showed that mean flow velocities greater than 120 cm/s in the main feeder were associated with a significantly higher rate of postoperative hematomas and transient deficits. A classification of cerebral AVMs that takes into account AVM volume and location, the type of feeders, the extent of the drainage system, and the main feeder flow velocity is suggested.

Adolescent↗
PubMed1989

Craniocerebral epidermoids and dermoids. A review of 44 cases.

We review 40 epidermoids and 4 dermoids of the skull and brain treated surgically in our Department between 1976 and 1987. Fourteen were extradural and 30 intradural. The mean duration of symptoms was 3 years for extradural and 10 years for intradural tumours. Symptoms varied with tumour site, in some sites being helpful in differential diagnosis. Skull X-rays and CT were the key diagnostic investigations in extradural and CT in intradural lesions, the latter, with few exceptions, presenting a characteristic CT scan. In 7 cases MRI supplied important details on the tumour boundaries. All the diploic and orbital lesions were removed totally, with a good outcome. Twelve of the intradural lesions were removed totally, 9 subtotally and 9 partially, with a good outcome in 21 patients and a poor outcome in 4; 5 patients died. Outcome was unrelated to degree of removal.

Adolescent↗
PubMed1988

Italian cooperative study on giant intracranial aneurysms: 2. Radiological data.

240 patients with giant aneurysms admitted to 10 Italian centres were evaluated regarding radiological features and relationships to the outcome. Visualization of the aneurysm without contrast was obtained on CT scan in 49% of patients with aneurysms between 2 and 2.5 cm in diameter (A 1 group) and in 80% of patients with larger aneurysms (A 2 group). Contrast enhancement was homogeneous in 49% of patients, not homogeneous--with central or peripheral hypodensity--in 47% of patients, absent in 4% of patients. Ventricular shift was present in 17% of A 1 patients and in 36% of A 2 patients. Hypodense areas were observed in 12% of cases, and calcifications in 19% of cases; bone erosions were rare. On angiography, the most common aneurysmal locations were the intracavernous carotid (21% of cases) and the middle cerebral artery (23% of cases). A neck could be identified on angiography in only 14% of patients, and stenosis of afferent vessel in 16% of patients. Vasospasm was rarely observed on angiography (17% of A 1 and 10% of A 2 patients). Aneurysmal thrombosis (partial, subtotal or total) was present in 48% of A 1 and 76% of A 2 patients (p less than 0.001); partial peripheral thrombosis was most commonly observed (one half of cases). Round or oval shapes were most commonly observed, while fusiform, irregular, serpentine or doughnut shapes were rare. A few clinical/radiological relations were considered, such as the relation between partial thrombosis and haemorrhage, symptoms of expanding mass lesion, ischaemic episodes, aneurysmal location.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Spontaneous arterio-venous fistulae of the vertebral artery. Diagnostic and therapeutic considerations.

Spontaneous arterio-venous fistulae of the vertebral artery are rare. These lesions mainly affect the upper cervical area, and are usually asymptomatic, or may present as small, often pulsatile, cervical masses with vascular murmurs. The authors report on two cases in which the presumptive diagnosis, suggested by venous digital subtraction angiography, was then confirmed by selective angiography. In both cases an intravascular approach with detachable balloons and particulate substances was carried out, with good anatomical and functional results. Problems related to diagnosis, pathophysiology of symptoms, indications for treatment and embolization techniques are discussed.

Adult↗
PubMed1986

The role of radiation therapy in the management of primary non-Hodgkin lymphomas of the central nervous system: clinical study of 10 cases.

A series of 10 patients with a primary non-Hodgkin lymphoma of the central nervous system were observed and treated by the authors. All were diagnosed after a pathologic examination of the surgical material; the lesions were supratentorial in all cases and unifocal in 9. In every case radiation therapy improved clinical conditions and in most cases even radiologic features of the patients. Four patients were alive and without evidence of disease many months after therapy. Four patients died with a relapse in the central nervous system; 3 of them had disseminated disease at the time of death. Two patients died for an unknown cause. Radiation therapy was performed with 60Co source with 2 opposed portals and the whole brain irradiation technique in all cases but 2. Doses ranged from 35 to 54 Gy. The recent literature on this uncommon disease and the most adequate therapeutic possibilities of radiation therapy and chemotherapy, or both, are discussed.

Adult↗
PubMed1985

Posterior fossa haemangioblastomas: angiography versus computed tomography.

A series of 57 patients harbouring a total of 63 haemangioblastomas of the posterior fossa is reviewed. Some clinical data are pointed out and the findings of vertebral angiography and computed tomography scanning performed in 61 and 38 lesions, respectively, are examined. The results obtained in the last 38 cases, undergoing both examinations, are compared, and some notes on differential diagnosis with other expansive lesions of the posterior fossa are given.

Brain Neoplasms↗
PubMed1985

Spontaneous disappearance of intracranial arterio-venous malformations.

4 cases of spontaneous disappearance of intracranial arteriovenous malformations are reported. All the malformations were in the rolandic-parietal area, and fed in most cases by the MCA. In one case, the malformation was associated with a proximal aneurysm. One malformation was large, one medium-sized, and two small. Venous drainage was towards the longitudinal sinus in all cases. Presenting symptoms consisted of epilepsy in 2 cases, and intracerebral haemorrhage in 2 cases. Disappearance of the AVM was documented by angiography from 1 to 15 years after diagnosis, and was preceded by a new haemorrhage in 2 cases. Acute or gradual thrombosis of the AVM is suggested as the most likely cause of the disappearance of an AVM. Spontaneous thrombosis of an AVM should be considered as an aspect of the pathological entity known as "thrombosed AVM". Guidelines for the management of patients exhibiting spontaneous disappearance of an AVM are briefly discussed.

Adolescent↗
PubMed1984

Role of computed tomography in the management of vasospasm after subarachnoid hemorrhage.

The role of computed tomography (CT) in the management of vasospasm from subarachnoid hemorrhage was evaluated in 242 consecutive cases with CT performed within 7 days after hemorrhage. Only 20% of these cases did not show a detectable subarachnoid hemorrhage on CT. Subsequent angiograms showed vessel narrowing in 56% of the cases; associated clinical deterioration was noted in 34% of the cases. On later CT, clear ischemic areas were detected in 20% of the cases. A strict correlation between the amount of cisternal blood and the subsequent development of vasospasm was observed: although absent or thin cisternal depositions were rarely associated with vasospasm, consistent or thick depositions were frequently linked to vasospasm (72% of the cases) and to ischemic disturbances (51% of the cases), as well as to clear ischemic areas on later CT (30% of the cases). Regarding the morphology of the cisternal blood collection, the risk of developing vasospasm was at its lowest (42%) for depositions only in the frontal interhemispheric fissure and was at its highest (79%) for depositions in multiple cisterns. The site of cisternal deposition corresponded closely to the area of ischemia on later CT. The persistence of subarachnoid blood more than 72 hours after hemorrhage probably increases the risk of vasospasm, although our data are not conclusive. The definition of a CT scan "at risk" for vasospasm--based on the previous findings--gives practical advantages: proper selection of patients in regard to timing of operation, closer observation and the possibility of prophylactic treatment in patients "at risk," and more adequate evaluation of different therapeutic modalities for vasospasm. With regard to the last point, the incidence of vasospasm was not statistically different between two groups of patients uniformly "at risk": the first group submitted to early operation and the second awaiting operation.

Adolescent↗
PubMed1984

Cerebral vasospasm after head injury.

Cerebral vasospasm occurs frequently after head injury. Correlation between neurological deterioration and vasospasm has been reported previously, but delayed neurological deterioration secondary to vasospasm in head injury is a rare occurrence. We report the case of a 57-year-old man who, after a motorcycle accident, developed an acute subdural hematoma and a thick subarachnoid deposition of blood in the left sylvian-insular cistern. After surgical evacuation of the hematoma, the patient improved until the 10th postoperative day, when he developed aphasia and a right hemiparesis. Angiography demonstrated multitapering spasm, and a computed tomographic (CT) scan showed persistence of the cisternal deposition of blood. Despite therapy with hypervolemia, the patient improved only slightly. The association of head injury with substantial subarachnoid hemorrhage producing vasospasm has been considered rarely. Delayed posttraumatic vasospasm secondary to blood degradation products seems to play some role in the vasospasm after head injury. CT scanning may be useful in predicting vasospasm in such patients, and digital subtraction angiography might be useful in demonstrating it.

Brain Injuries↗
PubMedDate not supplied

Preoperative embolization of arteriovenous malformations with polylene threads: techniques with wing microcatheter and pathologic results.

The technique with a wing microcatheter system and the pathologic aspects of 11 cerebral arteriovenous malformations (AVMs) surgically resected after embolization with polylene threads are reported. Embolization was performed once in eight patients and twice in three patients. Resected AVMs were submitted both to routine hematoxylineosin examination and to immunohistochemical workup in order to detect the type of immunologic response to thread emboli. In nine cases, 50% or more of the nidus was obliterated by the embolization. After embolization two patients developed reversible neurologic deficits. Pathologic specimens of resected AVMs demonstrated no vascular necrosis; however, a moderate inflammatory response could be seen, characterized by the presence of both mononuclear cells and foreign-body giant cells, associated with the absence of polymorphonuclear infiltrates. A granulomatous fibrotic process was identified that was present from the first month after embolization. Immunohistochemistry indicated that the immunologic response to thread emboli was cell-mediated, not humoral. Embolization with the wing microcatheter with the use of polylene threads proved to be a safe and efficient system of embolization, as a preoperative procedure. Polylene threads are a nontoxic and biocompatible material that can be used as an embolic agent for brain AVMs.

Adult↗