A. Weill

The “Remodelling Technique” in the Treatment of Wide Neck Intracranial Aneurysms Angiographic Results and Clinical Follow-up in 56 Cases

The main factor limiting endovascular treatment of intracranial aneurysms is the shape of the aneurysmal sac, particularly the width of the neck. In this study we present a new technique to occlude wide neck aneurysms that involve the temporary inflation of a non-detachable balloon in front of the aneurysm neck during each coil placement. The aim of the study is to present the feasibility, efficacy and safety of this “remodelling technique” (RT) compared to that of “normal” GDC treatment. We selected 56 aneurysms in 54 patients for treatment with the RT. Thirty-seven (70%) of the patients presented with subarachnoid haemorrhage. Twenty-five (45%) of the aneurysms were located at the vertebrobasilar artery, 24 (43%) at the internal carotid artery, and seven at the level of smaller arteries. Treatment was achieved in 52 aneurysms in 50 patients. Two aneurysms which were initially not completely occluded underwent a second treatment using the RT. Final results (i.e. the last follow-up angiography or results at the end of the treatment for the cases that have not yet had follow-up) consisted of total occlusion in 40 cases (77%), subtotal occlusion in nine cases (17%), and incomplete occlusion in three cases (6%). Angiographic evidence of clotting was observed during the procedure in three cases, resulting in one permanent deficit (quadranopia). Rupture of the aneurysmal sac occurred during the procedure in three cases, all of which were asymptomatic in the follow-up. Thus, morbidity due to the technique was 1/52 (1%) and mortality was 0/56 patients. The remodelling technique allowed the treatment of 52 wide neck or badly shaped aneurysms that were not treatable without this technique. The results of occlusion with the RT seem better than those in our series of normal GDC treatment, and complications related to the technique are fewer. This technique thereby extends the spectrum of treatable aneurysms without increasing the risk incurred by treatment.

Acrylic vertebroplasty in symptomatic cervical vertebral haemangiomas : report of 2 cases

We report two cases of acrylic vertebroplasty in symptomatic cervical vertebral haemangiomas. In both cases significant improvement of symptoms was rapid. One patient was able to return to work.

Basilar artery occlusion in a child: "clot angioplasty" followed by thrombolysis.

Abstractu2002Basilar artery occlusions are rare but have a very poor prognosis. Intra-arterial thrombolysis may produce recanalization and better clinical outcome. A short delay between the onset of symptoms and thrombolysis is considered essential for successful recanalization and for the smallest possible risk of haemorrhagic complications. We present a case of basilar artery occlusion in an 8-year-old child, which was treated by ”clot angioplasty” followed by intra-arterial thrombolysis. Thirty hours after progressive alteration of consciousness, speech disturbances and left arm paresis, the child became comatose with decerebrate rigidity. A CT scan showed parenchymal ischaemic lesions. Angiography (performed 36 h after the onset of symptoms) showed a total occlusion of the basilar artery. A clot angioplasty was performed by placing a balloon catheter within the thrombus and inflating it several times in the occluded segment of the basilar artery. Thrombolysis was then performed through the balloon catheter. The basilar artery was only partially recanalized at the end of the procedure, but the perforating arteries of the brain stem had reappeared on angiography. Three months later the child had completely recovered to a normal clinical status. In conclusion, the very poor natural prognosis of basilar artery occlusion requires aggressive management. Recanalization of the basilar artery may be performed even late after the onset of symptoms. Clot angioplasty allows partial recanalization, which may increase the efficiency of thrombolysis.

Arteriovenous Malformation of the Mandible: Embolization and Direct Injection Therapy

Arteriovenous malformation (AVM) of the mandible is a rare entity but one that can be potentially fatal as a result of massive hemorrhage. Traditional treatment involved extensive surgical resection of the mandible. With the advent of improved endovascular techniques, interventional radiology is now the best method to control active hemorrhage and ultimately cure these lesions. The authors describe three cases of successfully treated mandibular AVM by percutaneous and/or endovascular techniques.

Letter. "Corrosion" of tungsten spirals. A disturbing finding.

Very long-term (more than 30 months after treatment) skull plain films of patients treated with Mechanical Detachable Spirals “MDS” (tungsten) for intracranial aneurysm or dural fistula by venous approach, showed a decreasing level of radiopacity of the spirals suggesting that this material was resorbing with time. To date, all the aneurysms selectively treated with “MDS” which were followed-up by angiography more than 30 months after treatment (three cases) showed recanalization. The recanalization was proportional to degree of the “corrosion”.

The role of CT in evaluation of the effectiveness of embolisation of spinal dural arteriovenous fistulae with N-butyl cyanoacrylate.

Abstract A failed embolisation of a spinal dural arteriovenous fistula (AVF), because a pedicular injection has not reached the initial venous compartment, must be identified immediately, to allow prompt surgery and thus avoid clinical deterioration. The purpose of our study was to determine the role of CT in confirming a complete cure just after embolisation with N -butyl cyanoacrylate (NBCA). Seven patients embolised for spinal dural AVFs with perimedullary venous drainage had an immediate postembolisation CT scan. In six patients a complete cure was achieved, with a normal postembolisation angiogram in five cases. Just after injection of NBCA, we were unable to determine on plain films whether or not the glue had reached the draining vein in six of seven cases. The postembolisation CT showed various patterns: in two cured patients, the glue was visible in the inner surface of the dura mater and therefore on the venous side. In five cases, the glue was approaching the dura mater around the cord or seemed to reach its surface: in the four patients cured, the glue column was 7–18 mm high, whereas it was less than 2 mm high in the patient with angiographic proof of recurrent fistula. The follow-up angiogram remains the only way to confirm a durable cure. We suggest that immediate postembolisation CT may help in assessing endovascular treatment of spinal dural AVFs.

Posttraumatic spinal subarachnoid cyst

A case of posttraumatic compressive subarachnoid cyst of the thoracic spine studied by MR, myelography, and myelo-CT is reported. This cyst was surgically confirmed and treated by shunting.

Corrosion of Tungsten Spirals

To the Editor: Reul J 1 indicates that detachable coils from MDS are not purely tungsten but also contain iron, in the view of spectroscopy. n nWe analyzed the MDS system2 and found no iron. After dissolution of the coil with acid, we performed ICP-MS (Inductively Coupled Plasma Mass Spectrometry) analysis in scanning mode over the 50-250 m/z range. A skip scan region was set from 75 to 85 m/z to avoid common background polyatomic ion interferences from argon (carrier gas). Tungsten was found in the dissolved coil solution but not in a control sample of 0.65% suprapure nitric acid (figure u200b(figure11). n nFigure 1 n n n n n nSpectrum of the 32 ppb dilution of the dissolved coil (A) and of the blank sample of 0.65 % suprapure nitric acid (B). On each spectrum, a large peak was observed at 56 m/z, corresponding to the polyatomic ion interference from argon with oxygen. n n n nTungsten was strictly identified by its isotopic composition (180 m/z: 0.12%; 182 m/z: 26.31%; 183 m/z: 14.28%; 184 m/z: 30.64% and 186 m/z: 28.64%) in the dissolved coil solution. The estimated amount of tungsten (obtained from the spiral weight) was checked by comparing the signal of the 32 ppb dilution of the dissolved coil solution to those of a 10 ppb tungsten standard solution (tungsten 1 g/L, ref. 1.19805-0500, Merck) (figure u200b(figure22). n nFigure 2 n n n n n nTungsten isotopic distribution and signal of the 32 ppb dilution of the dissolved coil (A) and of a 10 ppb tungsten standard solution (B). n n n nNo iron was found in the dissolved coil solution by electrothermal atomic absorption spectrometry. Despite the interesting observation of Reul J1 in animals, our analysis indicates that the MDS system is purely tungsten.

MR and chemotherapy

To the Editor: We read with great interest the article by Yaffe et al. [1] They described reversible MRI abnormalities after seizures. These MR abnormalities occurred in both gray and white matter, and most patients were under chemotherapy.nnAlthough three patients received intrathecal methotrexate, known to produce radiologic changes in the white matter but not in the gray matter, one of their patients received cyclosporine and another, cisplatinum. …