Biomedical subjects
Publications and source records attributed to Z L Deeb.
We have used a temporal bone middle fossa X-ray template for vestibular nerve localization during surgery. This has proved helpful and it is recommended on all patients undergoing middle fossa approach for vestibular nerve section.
Techniques for uncoiling knots formed in catheters during angiography have been the subject of several previous reports. A new technique for catheter unknotting is presented, based on the use of graded flexibility guidewires. The application of this graded taper method appears particularly pertinent to uncoiling softer, narrow-caliber, adversely looped catheters. Moreover, the mechanisms of knot uncoiling in the previous reports are reassessed and their imprecisions corrected.
The boundaries of a carotid body chemodectoma are sharply defined by use of cranial computed tomography (CT) following the bolus infusion of intravenous iodinated contrast medium. The technique seems valuable in the preoperative staging of tumors in this locale. Enhancement strategies for CT imaging are discussed.
Considerable concern with cranial nerve syndromes has often required detailed information of the relationship between the vertebrobasilar system and the brainstem. The obvious invasiveness of conventional vertebral angiography poses the question of whether computed tomography (CT) might serve as a satisfactory technique or even as a sufficient diagnostic method. During a 12 month period, 12 of 250 patients with cranial nerve syndromes were diagnosed by CT as having vertebrobasilar ectasia. This communication correlates the clinical symptomatology with angiography and CT and presents evidence that CT alone can prove satisfactory.
Opacification of the regional epidural venous plexus is an untoward circumstance of myelography. The following case reports demonstrate the epidural veins and the transient pulmonary symptoms that resulted.
Hemifacial spasm developed in a woman as the only symptom of an aneurysm of the posterior inferior cerebellar artery. Using microdissecting techniques, the aneurysm was clipped and moved from its distorting position at the brain stem exit zone of the seventh nerve. After surgery, she experienced immediate relief of her facial spasm of six years' duration. This case supports the finding that hemifacial spasm may be caused by vascular lesions of the seventh nerve at the brain stem junction. Recent surgical experience indicates that the majority of the hemifacial spasm cases may be due to normal but ectatic blood vessels that cross-compress the most proximal portion of the seventh nerve. Relief may be affected without facial paralysis by a retromastoid microvascular decompressive procedure.
Gas myelography is a useful technique in the evaluation of the spinal canal and its contents. Although it has been greatly simplified and the high-resolution imaging greatly improved, morbidity remains a problem. Removal of the gas at the end of the examination through the lumbar route significantly decreases morbidity. This can be achieved through the same needle if the examination is performed via a lumbar puncture. Insertion of a second needle in the lumbar region may be necessary if the cervical or cisternal puncture is employed for gas introduction.
The radiologic investigation of patients with suspected acoustic neurilemmomas may include specialized plain films, thin-section tomography, CT scanning with intravenous contrast enhancement, Pantopaque cisternography, radionuclide scanning, angiography, and pneumoencephalography. Recently we have used intrathecally enhanced (Amipaque)2 CT cisternography tostudy the cerebellopontine angles and fourth ventricle. An assessment is made of the differential diagnostic value and limitations of radiologic modalities both in tumor detection and in accurate localization. A protocol designed to optimize use of the available radiologic modalities is projected from 30 patients with acoustic neurilemmomas.
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A case of a calcified intramedlllary aneurysm in a spinal angioma is presented. The value of preoperative angiography in the evaluation of intraspinal calcifications is discussed.
Ten suspected suprasellar mass lesions were evaluated by CT cisternography (CTC). In each case the cisterns could be defined. Suprasellar mass lesions were found in six. Precise assessment of the anterior, lateral, posterior, and superior extent, made by metrizamide CTC, was verified at surgery. In two masses the intravenously enhanced scan was not diagnostic, while a lesion was visualized by intrathecal (metrizamide) CT. The major diagnostic entity was an enlarged third ventricle. When a chiasmic lesion is suspected and the conventional scan is negative, metrizamide CTC is the examination of choice.
The methodology and clinical use of metrizamide (Amipaque) computed tomography (CT) cisternography are described as applied in the cases of 22 children with morphologic and physiologic abnormalities affecting the cranial portion portion of the central nervous system. In contrast to pneumoencephalography, CT cisternography affords equivalent or superior visualization of the basal cranal subarachnoid spaces with simpler technique and low morbidity. Intrathecal metrizamide enchancement in children causes a very low incidence of side effects.
Portable sustained graded traction for control of the displaced cervical spine particularly for patients undergoing tomography or gas myelography, is described.
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A total of 65 cases showing asymmetry of the pelvic ureters of greater than 1.4 cm for which no cause could be identified are presented. Only one was a male. The right ureter was situated more medially in 61 of the 64 females. Comparison of the characteristics of these patients with 51 females with symmetrical pelvic ureters revealed no differences except for a significantly more frequent left-sided position of the uterus in the asymmetrical group. Gross medial displacement of the right ureter in a female probably represents a normal variant in a large majority of patients.
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The LGM (Vena Tech) IVC filter is a recently introduced device for caval interruption. The magnetic resonance imaging safety and imaging characteristics of this filter were evaluated. The filter was proven to lack ferromagnetic properties. It was imaged with minimal artifact and no detectable motion in the magnetic field.
One hundred patients with degenerative disease of the lumbar spine on whom both magnetic resonance (MR) and computed tomography (CT)-myelography were performed were reviewed. In one-third of the cases, the CT-myelogram provided additional useful information. This included definition of the extent of large disc herniations, demonstration of focal neural compression by small herniations, and clarifying abnormalities of the facets, including synovial cysts. These results should help to refine the indications for CT-myelography, which continues to be requested extensively.