Bharat Mehta

Dural arteriovenous malformations and intracranial hemorrhage.

Intracranial hemorrhage is seen less frequently with dural than with intraparenchymal arteriovenous malformations (AVMs). We report 6 cases of intracranial hemorrhage among our past 10 patients with dural AVMs. A literature search provided 27 other cases of intracranial hemorrhage from a total of 213 reported dural AVMs. Although hemorrhage was relatively infrequent (7.5%) with dural AVMs located primarily within a major venous sinus, bleeding episodes occurred in 20 of the 39 (51%) cases of malformation outside a major sinus. There was primary leptomeningeal venous drainage in all cases with hemorrhage, and a large variceal dilatation was seen in 14 cases (42%). Dural AVMs located outside a major sinus are uncommon, and they have a propensity for serious intracranial hemorrhage.

Imaging of spinal intradural arachnoid cysts: MRI, myelography and CT

Abstract Imaging studies in eight patients with surgically-confirmed spinal arachnoid cysts were analyzed retrospectively. All patients had preoperative MRI of the spine and seven preoperative myelography with postmyelographic CT. In all cases the correct diagnosis could be made preoperatively on the basis solely of MRI. The diagnosis could also be established from myelography and postmyelographic CT in six of the seven cases. In one case myelography and CT simply demonstrated an intradural extramedullary mass.

Surgical correction of lesions affecting the second portion of the vertebral artery.

Substantial controversy has surrounded the diagnosis and management of vertebrobasilar ischemic events, with no consensus on the value of medical or surgical treatment of patients symptomatic with brain stem ischemia who have angiographically proven vertebral artery lesions. This report presents our experience with the surgical treatment of 12 of 88 patients with angiographically verified lesions in the vertebral artery who were symptomatic for 1 to 12 months before their evaluation. None experienced symptomatic relief with antiplatelet agents, nor did the administration of anticoagulants in 4 of the patients provide any benefit. The lesions included bilateral vertebral artery occlusion with distal reconstitution through muscular collaterals in 6 patients, unilateral vertebral artery hypoplasia with contralateral long-tailed lesions from the vertebral artery origin to C-5 in 3 patients, and severe bilateral vertebral artery origin lesions extending beyond the C-5 level in 3 patients. A vertebral endarterectomy and vertebral-carotid transposition in the second portion of the artery were successfully used to reestablish flow and obtain symptomatic relief in 10 of the 12 cases; 1 of these procedures had to be redone because of a persistent stenosis at C-4. Another patient had a saphenous vein graft from the common carotid to the vertebral artery at C-5. The remaining patient had an anastomosis of the distal external carotid to the vertebral artery at C-3, but this failed and an anastomosis of the occipital artery to the anterior inferior cerebellar artery had to be completed to reestablish flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Early angiographic changes after carotid endarterectomy.

This report reviews the angiographic evaluation of 41 patients who underwent a carotid endarterectomy at Henry Ford Hospital. Postoperative angiograms were performed after 48 endarterectomies. Changes included the development of postoperative intimal flaps, common carotid stenosis, carotid occlusions, areas of corrugation, surface irregularities, and postendarterectomy dilatation. The development of dilatation, or the pantaloon effect, on the endarterectomized segment contributed to the limited use of angioplastic procedures. The benefits derived from a postoperative angiogram include the objective evaluation of the endarterectomized segment, the demonstration of a potentially complicating problem such as intimal flaps that could lead to restenosis, and recognition of the possible development of associated local problems. The procedure can be done with limited risks to the patients and in competent hands has low morbidity and mortality.

Endarterectomy of the vertebral artery from C2 to posterior inferior cerebellar artery intracranially

A new technical approach to endarterectomy of the vertebral artery at the cranial cervical junction is discussed. A patient had symptoms of vertebrobasilar insufficiency on clinical examination. Angiography demonstrated a stenotic plaque in the vertebral artery at the level of C1, and an additional tandem lesion at the origin of the posterior inferior cerebellar artery. He underwent vertebral endarterectomy and was symptomatically improved postoperatively. The surgical approach used and possible alternatives will be discussed in detail.

Absence of the supraclinoid internal carotid artery in association with intracranial aneurysms

Abstract We report a case of absence of the supraclinoid segment of the left internal carotid artery associated with hypoplasia of the ipsilateral internal carotid artery and anterior communicating artery aneurysm formation. We discuss the embryology probably responsible for this anatomical variant and show the imaging findings.

Persistent trigeminal artery detected with standard MRI.

The trigeminal artery is the most common of the primitive carotid-basilar anastomoses to persist into adulthood. Prior to the introduction of MRI, the diagnosis of persistent trigeminal artery (PTA) could only be made at cerebral angiography. This study compares angiography and standard brain MRI in 11 cases of PTA. Nine of the 11 PTAs were identified with MRI. Axial imaging gave the best definition of the course of the PTA.

Intraventricular primary neuronal neoplasms : CT, MR, and angiographic findings

Intraventricular primary cerebral neuroblastoma and the more differentiated intraventricular neurocytoma are primary neuronal tumors that share common radiological characteristics. This article describes the imaging characteristics of these rare tumors using CT, MR, and angiography. We present one case of each neoplasm.

Balloon embolization of nontraumatic vertebral arteriovenous fistulae in children

Two children, aged 4 and 8 years, with nontraumatic extracranial vertebral arteriovenous fistula are described. Under general anesthesia and with fluoroscopic guidance, using a percutaneous endovascular technique, latex detachable balloons were used to successfully occlude the fistulae. The patients were monitored with somatosensory and auditory evoked potentials and kept hypotensive for 24 hours. Immediate and follow-up angiography 1 year later showed obliteration of the fistula in both patients. The management of this rare condition is discussed.

Ultrasonic features of two cases of spinal cord hemangioblastoma

Two patients with proven intramedullary spinal cord hemangioblastomas were examined with intraoperative ultrasound. The ultrasonic features of a hyperechoic intramedullary mass accompanied by nearby cysts and, in one case, by a syrinx correspond with well-known pathological and computed tomographic descriptions of these tumors. Ultrasonic guidance enabled the surgeon to identify the exact location of the tumors and to proceed with the surgery, limiting the dissection to the area detected. The ultrasound also revealed cysts associated with the tumors, thus providing valuable information to guide the progress of surgery.