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S Bien

Publications and source records attributed to S Bien.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Dural carotid-cavernous sinus fistulas: clinical aspects, diagnosis and therapeutic intervention].

BACKGROUND: Carotid cavernous fistulas are cerebral artenovenous shunts which may present with ocular or orbital signs. Direct fistulas are distinguished from dural shunts with respect to the anatomical situation. PATIENTS: We report on two patients with spontaneous dural carotid cavernous fistulas with multiple feeding vessels. Both patients required endovascular embolization. RESULTS: Therapy was successful in both patients. We present an overview of the clinical picture, the diagnostic procedure, the differential diagnosis and the therapeutic possibilities in this clinical entity. CONCLUSION: Both patients prove the importance of an immediate differential diagnostical classification so that a specific neuroradiological diagnostic can be ensured. Today's advanced endovascular technology offers therapeutic options with less risk for the patient than in recent years.

Arteriovenous Fistula↗
PubMed1996

[Estimation of radiation exposure in interventional neuroradiology of the head in children compared to exposure of adult patients].

PURPOSE: We reviewed different dosimetric results in three children investigated for haemangioma, arteriovenous malformation, and angioma of the head in comparison to global results in 11 adults. METHOD: The detailed patient dosimetry was performed using thermoluminescence dosimetry (TLD), area-dose exposure meter (ADE), and Alderson phantom. RESULTS: The patient doses of relevant organs ranged in the milli-Grays (mGy) level. The irradiation-induced risk is on a per mil level in respect of ICRP-60. The risk of cerebral angiographic procedures, radiotherapy, or surgical interventions is on a per cent level. The organ doses for staff are on a micro-Gray (microGy) scale and are higher in examination of children than of adults. A statistical limit of examinations depends on yearly or life-time dose limits with regard to the "Röntgenverordnung" (Germany).

Adult↗
PubMed1996

An intracerebral sonographic catheter as an adjunct to stereotactic guided endoscopic procedures.

To facilitate stereotactic biopsies of intracerebral tumor lesions, to obtain important additional diagnostic information during the procedure and to precisely guide biopsy instrumentation devices to spots of interest, catheter sonography was combined with intracerebral endoscopy intraoperatively in two patients. All catheter instrumentation was performed through the stereotactic puncture channels. A 30 Megahertz ultrasound transducer mounted on the tip of a flexible 5 French catheter is sufficiently penetrating surrounding brain tissue, resulting in high resolution images at a maximum radial penetration depth of 15 mm. Normal brain tissue could be differed from intracerebral tumor tissue in both patients. Smaller tumor lesions within the close surrounding of a solid intracerebral tumor mass clearly appeared in ultrasound. Since diagnostic endoscopy in stereotactic procedures is limited to the surface of a puncture channel, intracerebral ultrasound adds important information about the underlying type of tissue. We found that the combination of both methods facilitates guiding of biopsy instrumentation devices to the spots of interest in stereotactic procedures. In both examined patients all biopsy samples were histologically identified as intracerebral lymphoma. Since ultrasound clearly identified intracerebral blood vessels as tubular hyporeflective structures, the risk of biopsy related hemorrhage could be diminished.

Aged↗
PubMed1996

Catecholamine secreting glomus tumor detected by iodine-123-MIBG scintigraphy.

We report the case of a 41-yr-old woman who presented with arterial hypertension and tinnitus in the right ear synchronous with pulse. She had previously undergone surgery for suspected pheochromocytoma without positive therapeutic effect. CT and MRI revealed a homogenous tumor with contrast enhancement in the right hypotympanon and foramen jugulare, and [123I]metaiodobenzylguanidine (MIBG) scintigraphy demonstrated strong tracer uptake in the same area. Selective venous sampling of catecholamines in the ipsilateral jugular vein confirmed the tumor to have originated from hormone production.

3-Iodobenzylguanidine↗
PubMed1994

Antiphospholipid antibodies in cerebrovascular ischemia and stroke in childhood.

We report on eight children who suffered from cerebrovascular ischemia or stroke at the age of 2 or up to 11 years. Antiphospholipid antibodies (APLA) were detected in two cases during the ischemic event and in six cases during follow-up examinations (after six weeks or within a span of six years). In two patients multiple stenoses of basal cerebral arteries were found; one of them suffered from moyamoya syndrome. The acute hemiplegia in one patient was linked to an asymptomatic mycoplasmal infection and APLA. In three cases, one of the parents was also APLA-positive. Seven patients were treated with acetylsalicylic acid, and in four cases immunoglobulin infusions were given. Transient ischemic attacks subsided after the child with the moyamoya syndrome received immunoglobulins. No effect of medication could be established in the other children. The concept of the antiphospholipid syndrome is still evolving. As none of the common risk factors pertaining to strokes in adults apply to children, pediatric research may offer a suitable platform for specific investigations on the causal, pathogenetic role of APLA. We propose that all children suffering from stroke or transient ischemic attacks should be tested for APLA.

Antibodies, Antiphospholipid↗
PubMed1993

Embolization of a tentorial dural arterio-venous fistula presenting as atypical trigeminal neuralgia.

A patient with a tentorial dural AV fistula causing atypical trigeminal neuralgia (TN) successfully treated by embolization is reported. The patient developed persisting throbbing facial pain in the distribution of the second and third division of the right trigeminal nerve (V2, V3) after a history of typical neuralgia for one year, preceded by a two month spell of TN 6 years previously and accompanied by right-sided pulsatile tinnitus for 10 years. The patient's mother, brother and sister were also said to be affected by typical trigeminal neuralgia. A right-sided dilated vein of Rosenthal due to a dural AV fistula fed by branches of the meningeal, occipital and meningo-hypophyseal trunk of the internal carotid artery was thought to cause trigeminal nerve compression. Complete resolution of symptoms after partial intra-arterial embolization of the main feeding arteries with N-butyroacrylate is described.

Arteriovenous Fistula↗
PubMed1993

[An active endocrine glomus tumor (paraganglioma) as a cause of tinnitus and hypertension].

A glomus jugulare tumor arises from the glomus bodies located in the adventitia of the dome of the jugular bulb. A glomus tumor has the same microscopic appearance as a carotid body tumor. The present report includes the extraordinary clinical and morphological features of a catecholamine-secreting glomus tumor (paraganglioma) in a 41-year-old woman. The patient presented with uncontrollable hypertension und pulsatile tinnitus. The diagnostic and therapeutic management is reported, including MIBG scintigraphy, computed tomography, magnetic resonance imaging, embolization, angiography, selective venous sampling studies and control of hypertension. After cardiovascular stabilization and tumor embolization, the tumor was removed surgically, with subsequent resolution of hypertension. While light microscopical analysis showed a classical glomus tumor, ultrastructural analysis revealed particular details of the tumor cells.

Adult↗
PubMed1991

Endovascular occlusion of vertebral arteries in the treatment of unclippable vertebrobasilar aneurysms.

Twenty-one patients with aneurysms of the vertebrobasilar circulation underwent unilateral or bilateral endovascular occlusion of the vertebral artery. Six patients presented with subarachnoid hemorrhage (SAH), 10 with mass effect, four with mass effect and SAH, and one with ischemic symptoms. Thirteen patients had good outcomes with complete clinical and angiographic cure. Six patients had partial thrombosis of their aneurysms. There was one death and one treatment failure. One patient suffered transient stroke. It is concluded that endovascular occlusion of the vertebral artery following test occlusion is a safe and effective treatment for proximal aneurysms of the vertebrobasilar circulation.

Adolescent↗
PubMed1991

Endovascular occlusion of intracranial vessels for curative treatment of unclippable aneurysms: report of 16 cases.

Among 121 intracerebral aneurysms presenting at one institution between 1984 and 1989, 16 were treated by endovascular means. All 16 lesions were intradural and intracranial, and had failed either surgical or endovascular attempts at selective exclusion with parent vessel preservation. The lesions included four giant middle cerebral artery (MCA) aneurysms, one giant anterior communicating artery aneurysm, six giant posterior cerebral artery aneurysms, one posterior inferior cerebellar artery aneurysm, one giant mid-basilar artery aneurysm, two giant fusiform basilar artery aneurysms, and one dissecting vertebral artery aneurysm. One of the 16 patients failed an MCA test occlusion and was approached surgically after attempted endovascular selective occlusion. Treatment involved pretreatment evaluation of cerebral blood flow followed by a preliminary parent vessel test occlusion under neuroleptic analgesia with vigilant neurological monitoring. If the test occlusion was tolerated, it was immediately followed by permanent occlusion of the parent vessel with either detachable or nondetachable balloon or coils. The follow-up period ranged from 1 to 8 years. Excellent outcomes were obtained in 12 cases with complete angiographic obliteration of the aneurysm and no new neurological deficits and/or improvement of the preembolization symptoms. Four patients died: two related to the procedure, one secondary to rupture of another untreated aneurysm, and the fourth from a postoperative MCA thrombosis after having failed endovascular test occlusion. The angiographic, clinical, and cerebral blood flow criteria for occlusion tolerance are discussed.

Aged↗
PubMed1989

Diskography with iotrolan before chemonucleolysis with chymopapain.

The neuroradiologic changes after chemonucleolysis were studied in animal experiments conducted to establish whether there is any interaction between chymopapain and the contrast medium iotrolan. Twenty canine disks were examined by diskography with iotrolan 300 mg I/ml before nucleolysis with chymopapain. Twenty disks were subjected only to nucleolysis. For control purposes, another 10 disks were examined by diskography without the administration of chymopapain. The neuroradiologic follow-up study with conventional radiography, computed tomography and magnetic resonance imaging of the lumbar vertebral column revealed typical signs of the effect of chymopapain in all nucleolysed disks, regardless of whether diskography had been performed before chemonucleolysis or not. On the basis of our results, there is no need to fear an interaction between the new dimeric, nonionic contrast medium iotrolan and the substance chymopapain used for chemonucleolysis.

Animals↗
PubMed1989

Iotrolan, a nonionic dimeric contrast medium in myelography.

As part of a clinical Phase III study of the nonionic, dimeric contrast medium iotrolan, differences in opacification, tolerance, and effects on the electroencephalogram after myelography were examined in a double-blind comparison with iohexol. Two groups of 25 patients each received either 10 ml iotrolan 240 mg I/ml or 10 ml iohexol 240 mg I/ml for lumbar myelography, and two groups of 50 patients each received either 10 ml iotrolan 300 mg I/ml or 10 ml iohexol 300 mg I/ml for lumbar, thoracic or cervical myelography. The overall assessment of the opacification in the subarachnoid space, which was moderate in only one case of each group and otherwise good, showed no differences between the preparations. The tolerance of both concentrations of iotrolan proved to be significantly better than those of iohexol: at a significance level in the chi-square test of p less than 0.001 in a simple size of 25 patients per preparation with 240 mg I/ml and at a significance level of p +/- 0.05 in a sample size of 50 patients per preparation with 300 mg I/ml.

Adult↗
PubMed1988

Treatment of a recurrent traumatic carotid-cavernous fistula: vertebro-basilar approach after surgical occlusion of the internal carotid artery.

A case of a post-traumatic carotid-cavernous fistula treated by endovascular approach through the vertebrobasilar system is reported. The 16 year old female patient was hurt in a car accident. The instantly-occurring carotid-cavernous fistula was treated with a Fogarty catheter, the internal carotid artery being occluded during this procedure. Ten years later the fistula recurred with a predominantly cortical venous drainage. The fistula was closed with two detachable balloons by an endovascular approach from the vertebrobasilar system via the posterior communicating artery. The small residual fistula, fed by the external artery was occluded by a venous approach via the internal jugular.

Adult↗
PubMed1988

Pre-operative embolization of naso-pharyngeal angiofibromas. Report of 58 cases.

58 patients with a juvenile nasopharyngeal angiofibroma have been treated by a combined neuroradiological-surgical method. In the cases with smaller tumor extension, fed only by the external carotid arteries or with only slight participation of the internal carotid arteries, the external carotid arteries alone have been embolized using particles. In the cases with marked participation of the internal carotid arteries these vessels were also embolized. In the first group there have been no complications and no recurrences. In the latter (31 cases) there have been three temporary minor complications and 11 recurrences.

Adolescent↗
PubMed1988

Motor evoked potentials during interventional neuroradiology.

Following transcranial electrical cortex stimulation motor evoked potentials (MEP) were monitored in 4 patients during 2 angiographic examinations and 4 therapeutic embolization procedures. Changes of MEP were observed in all 4 patients. Temporary decrease of MEP amplitudes as found in two patients was not followed by any additional postoperative neurological deficits. Incomplete recovery of amplitudes in one case associated with a corresponding hemiparesis post-angiographically. In the last patient amplitude reduction was found one week after the second embolization of an av-angioma. Consequently, an angiographic control was performed early, showing a partial revascularisation by newly opened fistulae which needed to be embolized again. In our opinion, monitoring of MEP during interventional neuroradiology is a sensitive method for early detection of impending neurological deficits. The use of MEP monitoring is discussed with respect to the advantages and limitations of conventional SEP monitoring. Because of the discomfort associated with electrical stimulation a magnetic stimulator may be used.

Adult↗
PubMed1988

[EEG study after cervical myelography with iopamidol and metrizamide].

In an open investigation on 100 patients, changes in the electroencephalogram following ascending cervical myelography with iopamidol 250 or metrizamide were studied. In the postmyelographic EEG, there were normal findings in 36 patients after iopamidol and 26 after metrizamide. A comparison of the pathological results after iopamidol and metrizamide yielded a relation of 6:2 for mild, 2:5 for moderate, and 0:6 for severe degree of slowing, 4:6 for basal theta wave activation, and 2:5 for increased cerebral excitability. The results were statistically significant on the 5% level according to the chi-square test.

Brain↗
PubMed1988

Haemodynamic changes in arteriovenous malformations induced by superselective embolization: transcranial Doppler evaluation.

To reduce the intraoperative and postoperative complications in patients who suffer intracerebral arteriovenous malformations (AVM's), the slow reduction of the shunt flow to a brain perfusion flow has been tried by the use of several methods: microsurgical techniques, selective and superselective embolization, intraoperative embolization, staged operation. The risk of re-bleeding and intraoperative oedema increases in AVM's with two or more feeders. Our policy was to exclude such AVM's by primary superselective embolization. If there was only a small residual angioma, we tried to remove this by microsurgical techniques. The haemodynamics in AVM's could be examined by measuring the blood flow velocities in the feeding arteries and in the other parts of the circle of Willis by transcranial Doppler sonography (TCD). Signs of haemodynamic effective embolization could be measured by the reduction of flow velocities. After exclusion of an AVM the velocities in the brain and feeding arteries decreased to below normal values in the first days after the operation. In the feeding arteries this was due to the fact that the arteries were enlarged so that the velocity must be decreased when there was normal volume flow. The combination of superselective angiography and microsurgical resection of the residual angioma seemed to be the best way to treat AVM's which are fed by more than two arteries and which are 3 or more cm in diameter. TCD investigations were used to measure the haemodynamic changes before and after angioma superselective embolization and microsurgical operation.

Cerebral Angiography↗