L E Hendrix

Cirsoid aneurysm treatment by percutaneous injection of sodium tetradecyl sulfate

BACKGROUND Cirsoid aneurysms are uncommon arteriovenous fistulas of the scalp. Surgery for these lesions can be difficult; transarterial embolization is rarely curative, while embolization of the venous pouch with permanent agents usually necessitates subsequent surgical removal of the embolic material. The ideal embolic agent would be one that is safe and effective, commercially available, and would not require subsequent removal. METHODS We treated an arteriovenous fistula of the scalp with direct puncture and injection of sodium tetradecyl sulfate, a commercially available sclerosing agent. RESULTS Control angiography immediately following percutaneous injection of sotradecol into the fistula showed decreased flow but not complete closure of the lesion. However, within several days of the embolization, the patients scalp pain and mass resolved. Four months after embolization, MRA demonstrated no evidence of residual or recurrent fistula. Color doppler flow imaging demonstrated only slightly decreased vascular resistance in the distal superficial temporal artery, possibly indirect evidence of persistent micro-fistulae. Twenty-three months after the procedure, the patient continued to be asymptomatic and had no palpable lesion. CONCLUSIONS Percutaneous injection of sotradecol can be considered as one of the treatment options for arteriovenous fistula of the scalp. Further experience is needed to compare the safety and effectiveness of sotradecol with other agents currently used in the treatment of scalp arteriovenous fistulae.

Gradient recalled echo MR imaging of superior sagittal sinus occlusion

SummaryWith T1-weighted gradient recalled echo (GRE) MR images and flow compensation, we studied the superior sagittal sinus in 3 normal volunteers and 3 patients with sinus occlusion. In these images, sites of patency of the superior sagittal sinus were identified due to the high signal intensity of the normal sinus. Tumor invading the sinus was nearly isointense with cerebral gray matter. T1-weighted GRE imaging proves to be an effective technique to evaluate sinus blood flow.

Selective thrombolysis of central retinal artery occlusion without long- term systemic heparinization

BACKGROUND A central retinal artery occlusion is a potentially blinding retinal vascular event with no effective treatment regimen available. Recently, a few reports have described improved vision in eyes with central retinal artery occlusions after selective fibrinolytic therapy followed by long-term systemic anticoagulation. Acceptance of this treatment, however, has been hampered by a paucity of confirmatory reports and its potential for producing serious hemorrhagic complications. Our report independently confirms the beneficial effects of selective thrombolysis, even with the use of only short-term, post-procedure systemic heparinization. METHODS A case report of selective fibrinolysis of an occluded central retinal artery using urokinase infusion into the ophthalmic artery followed with only 12 h of systemic heparinization is described. RESULTS A 65-year-old man presenting with a central retinal artery occlusion of less than 4-h duration enjoyed an improvement of vision from counting-fingers acuity to 20/20 after selective fibrinolysis with urokinase and only 12 h of systemic heparinization. No hemorrhagic or thrombotic complications occurred. CONCLUSIONS Selective thrombolysis with urokinase followed by short-term systemic heparinization can effectively treat a central retinal artery occlusion. Whereas the authors acknowledge that a single case does not prove that short-term heparinization is better than long-term heparinization, it does show that the latter is not always required.

Surface Coil MR Evaluation of a Lacrimal Gland Carcinoma

Recognition of both bone involvement and extraorbital spread of tumor is essential for the correct diagnosis and treatment of lacrimal fossa masses. We present a case of adenoid cystic carcinoma of the lacrimal gland where bone invasion and extraorbital extension were better defined with magnetic resonance imaging than with CT.

Evaluation of Neurologic Injury Following Regional Anesthesia

Modern anesthesia is a highly predictable undertaking with a very low failure rate. The ability to produce successful anesthesia is a less important characteristic of excellent anesthetic practice than the ability to recognize and treat adverse perioperative events. Recognition of myocardial ischemia or prompt treatment of catastrophic bleeding are examples of the situations requiring careful diagnosis and calm, decisive action. This same approach should prevail when the adverse event is a neurologic complication of regional anesthesia, only there is an added difficulty. At few other times in the practice of anesthesia will a practitioner be so directly confronted with responsibility for an adverse outcome as with a complication from neural blockade, because in a sense the “smoking gun” is clearly in our hands. Additional opprobrium may stem from the common misconceptions that complication rates should be zero in the practice of anesthesiology, and that the complication would not have occurred if only a general anesthetic had been performed.