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Biomedical subjects

M Sluzewski

Publications and source records attributed to M Sluzewski.

At least 37 records · Page 2Linked to original sources
PubMed2001

Bilateral vertebral artery balloon occlusion for giant vertebrobasilar aneurysms.

We describe the clinical presentation, radiological and clinical results in six consecutive patients with a giant vertebrobasilar aneurysm treated by bilateral vertebral artery balloon occlusion. Five patients presented with headache and signs of brain-stem compression and one with subarachnoid haemorrhage. In all patients vertebral artery balloon occlusion was performed. In four, this followed successful test occlusion. In one patient, who did not tolerate the test occlusion, a bypass from the external carotid to the posterior cerebral artery preceded definitive vertebral artery occlusion. One patient underwent bypass surgery prior to test occlusion. At 6-22 months follow-up three patients had a good functional outcome and showed unchanged size or shrinkage of the aneurysm on MRI. Three other patients died; one from recurrent haemorrhage, and two probably from delayed brain-stem ischaemia. The presence of two large posterior communicating arteries predicted good functional outcome, which was also related to the clinical condition at presentation, and the degree of brain-stem compression and oedema on MRI. Bilateral vertebral artery balloon occlusion can be considered in patients with otherwise untreatable giant vertebrobasilar aneurysms. If test occlusion is not tolerated, a surgical bypass to the posterior circulation can be considered.

Adult↗
PubMed2001

Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: incidence, outcome, and risk factors.

OBJECT: The aim of this study was to assess the incidence and outcome of procedure-related rupture of intracranial aneurysms in patients treated with Guglielmi detachable coils (GDCs) and to identify risk factors for this complication. METHODS: Procedure-related rupture occurred in seven of 264 treated aneurysms in 239 consecutive patients. Aneurysm size, history of previous subarachnoid hemorrhage (SAH) caused by the treated aneurysm, timing of treatment after SAH, and the use of a temporary occlusion balloon in the seven procedures in which rupture occurred were compared with the remaining 257 procedures, and these findings were correlated with data from 13 studies in the literature, in which results of 2030 aneurysm treatments were reported. CONCLUSIONS: Procedure-related rupture of intracranial aneurysms during GDC treatment occurs in 2.5% of cases and is responsible for 1% of treatment-related deaths. Risk factors are as follows: small aneurysm size, previous SAH, and probably the use of a temporary occlusion balloon.

Adult↗
PubMed2000

[Neuroradiologic intervention in two patients with cerebral sinus thrombosis].

Two patients with cerebral sinus thrombosis were successfully treated with neuroradiological intervention procedures, one with local thrombolysis and the other with mechanical thrombosuction using a hydrolyser catheter. The first patient, a 20-year-old woman, was treated with asparaginase for acute lymphatic leukaemia. She lapsed into coma with extensor posturing due to superior sagittal and right transverse sinus thrombosis. She recovered completely after local thrombolysis with 2,940,000 units urokinase, administered over a period of 40 hours. The second patient was a 29-year-old man who presented with clinical deterioration after seizures due to superior sagittal, left transverse and straight sinus thrombosis. A CT-scan demonstrated bilateral haemorrhagic cerebral infarctions. Since the risk of haemorrhage during thrombolysis with urokinase was considered to be high, mechanical thrombosuction with a hydrolyser catheter was performed. This procedure took only 4 hours. The patient recovered completely in two weeks. These cases add further evidence to the effectiveness of thrombolysis and thrombosuction in selected patients with severe cerebral sinus thrombosis.

Adult↗
PubMed2000

Carotid balloon occlusion for large and giant aneurysms: evaluation of a new test occlusion protocol.

OBJECTIVE: Validation of a new angiographic test occlusion protocol before carotid balloon occlusion in patients with carotid aneurysms. METHODS: Carotid occlusion was considered for 29 consecutive patients. From 1993 to 1995, test occlusion in four patients consisted of clinical observation for 30 minutes and during electroencephalographic registration. From 1996 onward, test occlusion in 25 patients consisted of clinical observation and angiography of collateral vessels. Permanent balloon occlusion was performed only when the cortical veins in both the occluded and the collateral vascular territories filled synchronously. RESULTS: Two of the four patients with normal clinical and electroencephalographic findings during test occlusion developed delayed hypoperfusion infarction after permanent carotid occlusion. Seventeen of 25 patients (68%) demonstrated both clinical and angiographic tolerance, and no ischemic events occurred after permanent carotid occlusion. In one patient with clinical tolerance but angiographic nontolerance, permanent carotid occlusion had to be performed, which resulted in delayed hypoperfusion infarction. In two patients with angiographic nontolerance, venous filling became synchronous after bypass surgery. Long-term clinical follow-up showed an alleviation of the symptoms of mass effect in 14 of 21 patients (67%). Magnetic resonance imaging follow-up (range, 3-70 mo) revealed a reduction in the size of the aneurysm in 19 of 21 patients (90%). CONCLUSION: Test occlusion with clinical and angiographic control is reliable, safe, and simple to perform.

Adult↗
PubMed1997

[Multidisciplinary treatment of cerebral arteriovenous malformations: preliminary results in 115 consecutive patients].

OBJECTIVE: Preliminary evaluation of the combined treatment (surgery, embolization and stereotactic gamma radiosurgery) of 115 consecutive patients with a cerebral arteriovenous malformation (AVM). DESIGN: Retrospective. SETTING: St. Elisabeth Hospital, Tilburg, the Netherlands. PATIENTS AND METHODS: In a 35-month period 115 consecutive patients presented with an AVM. The mean age was 41.8 years (range: 6-72). The main clinical presentation was haemorrhage in 65 patients (56.5%), seizures in 31 patients (27.0%), neurological deficit in 7 patients (6.1%) and hydrocephalus in 2 patients (1.7%); in 10 patients (8.7%) the AVM was an incidental finding. Treatment consisted of surgery, radiosurgery with the gamma knife and embolization. Embolization was mostly used to reduce the size of an AVM before surgery or radiosurgery. RESULTS: Out of 115 patients 5 were referred for a treatment advice only and treatment was performed elsewhere. Of the remaining 110 patients 84 (76.4%) were treated and 26 (23.6%) were not treated for various reasons. Of the 84 treated patients 17 (20.2%) had surgery only, 17 (20.2%) had radiosurgery only, and 12 (14.3%) were treated with embolization only. Surgery after embolization was performed in 8 patients (9.5%) and radiosurgery after embolization in 26 patients (31.0%). In 4 patients an unusual combination of these treatment methods was used for a variety of reasons. At the time of writing 35 of 84 treated AVMs (41.7%) were completely cured, 39 patients were awaiting the definitive result of radiosurgery. Deliberate partial embolization was performed in 5 patients. In 5 patients (6.0%), the pretreatment objective was not achieved with embolization. Total permanent morbidity was 4.8% (4 patients) and mortality was 1.2% (1 patient). CONCLUSIONS: Given a multidisciplinary combination of treatment methods a treatment is indicated and possible in the majority (76.4%) of patients with an AVM. There is a reasonable chance of a complete cure with an acceptable complication rate.

Adolescent↗
PubMed1997

Thrombosis of the deep cerebral veins: CT and MRI findings with pathologic correlation.

Deep cerebral vein thrombosis can present with acute, severe neurological symptoms and may be rapidly fatal as in the 20-year-old woman reported here. Although MRI is superior for establishing the diagnosis, CT is usually the first examination performed in the clinical setting. It is therefore important to recognise certain indicators such as extensive bithalamic low density. These and certain other less specific signs are correlated with the MRI and autopsy findings.

Adult↗
PubMed1996

[Intravascular treatment of inoperable cerebral aneurysms using Guglielmi's spirals; initial results in The Netherlands].

OBJECTIVE: Evaluation of endovascular treatment of inoperable cerebral aneurysms using electrolytically detachable platinum coils (Gugliemi Detachable Coils, GDC). DESIGN: Retrospective. SETTING: St. Elizabeth Hospital Tilburg, the Netherlands. METHOD: Fifteen aneurysms in 13 patients were treated using GDC; 14 of these aneurysms were inoperable and in three aneurysms surgical clipping had failed. RESULTS: Twelve of the 15 treated aneurysms were completely occluded. In another two, occlusion was 90% and in one, 70%. One patient with an inoperable basilar bifurcation aneurysm died of progressive thrombosis of both posterior cerebral arteries. One patient with an inoperable aneurysm of the anterior communicating artery developed an infarction of the A. centralis longa (recurrent artery of Heubner). CONCLUSION: GDC treatment of inoperable cerebral aneurysms is currently the only available option with a reasonable chance of success and acceptable risks.

Adult↗
PubMed1996

Recurrent transient quadriparesis after minor cervical trauma associated with bilateral partial agenesis of the posterior arch of the atlas. Case report.

The case of a 33-year-old woman with bilateral partial agenesis (type D) of the posterior arch of the atlas and recurrent transient quadriparesis due to contusion of the spinal cord after minor cervical trauma is described. At least some patients with type C or D congenital anomalies of the posterior arch of the atlas are prone to transient quadriparesis; thus a more aggressive management is advocated for them. Radiological and surgical findings showing the possible causative mechanism are presented and a review of the literature is given.

Adult↗
PubMed1995

[Spinal dural arteriovenous fistula: a treatable cause of loss of strength in the legs].

In a 59-year-old male suffering from progressive gait disorder with paraparesis and sensory disturbances in the legs, two spinal dural arteriovenous fistulas on levels Tv and LIII were demonstrated by spinal angiography. Both fistulas were embolised with glue, which resulted in complete relief of his symptoms. Spinal dural arteriovenous fistulas are localized in the dura, extramedullary, and are most often found in males over forty. Signs and symptoms are caused by venous congestion and ischaemia of the spinal cord. Treatment is by means of embolisation or surgical ligation. Early diagnosis and treatment are important, since delay causes development of irreversible myelopathy.

Angiography↗
PubMed1995

Pulmonary embolism: diagnosis in 211 patients with use of selective pulmonary digital subtraction angiography with a flow-directed catheter.

PURPOSE: To evaluate image quality, safety, and clinical validity of selective, intraarterial, pulmonary digital subtraction angiography (DSA) with use of a flow-directed, balloon-tipped catheter in patients with suspected acute pulmonary embolism (PE). MATERIALS AND METHODS: Pulmonary DSA was performed in 211 patients with suspected PE. Subselective magnification series were obtained with nonionic contrast material. Clinical outcome of patients with a negative pulmonary DSA study was assessed by means of retrospective analysis of their medical records, with a minimum follow-up of 3 months. RESULTS: Among the 211 patients, DSA image quality was excellent in 129 (61.1%), adequate in 79 (37.4%), and poor in three (1.4%). Two angiograms (0.9%) were nondiagnostic. No complications occurred. Of 129 patients with negative DSA in whom anticoagulants were withheld, 16 died of disorders other than PE; one (0.9%, 95% confidence interval 0.0%, 4.2%) of 113 patients alive at 3 months returned after 3 weeks with possible PE. CONCLUSION: Pulmonary DSA with the flow-directed catheter is a safe procedure and provides good to excellent image quality. Anticoagulants can be withheld in patients suspected of having PE when pulmonary DSA results are negative.

Adult↗