Lawrence H. A. Gold

Polyvinyl Foam Embolization of Vascular and Neoplastic Lesions of the Head, Neck, and Spine

Embolization of vascular and neoplastic lesions of the head, neck, and spine may be performed either as primary therapy (particularly for lesions which are difficult to approach surgically) or preoperatively to decrease blood loss. Polyvinyl alcohol foam (PAF) offers a number of advantages over other embolic material, including biocompatibility, promotion of progressive thrombosis and fibrosis, permanence, compressibility, and manageability. The clinical cases illustrate the kinds of lesions that are amenable to embolization, including arteriovenous malformations, arteriovenous fistulas, meningiomas, and nasopharyngeal tumors. Techniques and possible complications are discussed.

Combined embolization and operation in the treatment of cervical arteriovenous malformations

The effectiveness of a combined approach of embolization and operation for cervical vascular malformations is stressed. Lesions that seem to be inoperable may have their blood flow sufficiently reduced by preoperative embolization to allow surgical extirpation. Polyvinyl alcohol foam is an ideal embolic agent; not only may it be used preoperatively, but its permanency allows it to be used for primary therapy.

Computed tomographic appearance of methotrexate-induced necrotizing leukoencephalopathy.

A case of methotrexate-induced brain damage is presented. Computed tomography (CT) demonstrated a high-density mass lesion with a low-density area in the white matter which pathologically represented a large area of acute necrotizing cerebritis. CT appearance was indistinguishable from brain abscess.

Periventricular spread of tumor demonstrated by computed tomography.

Spread of intracranial neoplasms through the periventricular tissues of the brain is well known to neuropathologists, but is almost never recognized by the usual neuroradiologic techniques of angiography and pneumoencephalography. Periventricular tumor spread can, however, be readily dmonstrated by contrast-enhanced CT scanning. This report documents 4 cases of periventricular tumor diagnosed by CT scanning.

Multiple Progressive Intracranial Arterial Occlusions

A 30-year-old woman experienced a series of strokes over a period of three months. Radiographical studies showed evidence of occlusive disease of the cerebral arteries and a rich collateral circulation typical of multiple progressive intracranial arterial occlusive disease. At autopsy, the involved cerebral arteries showed marked fibrosis of the intima, media and adventitia, degeneration of the internal elastic lamina, and evidence of old and recent thrombosis. These findings are interpreted as a late stage of the disease and give no indication as to its pathogenesis. It is suggested that the vascular disease may have had its onset in childhood with the terminal strokes related to institution of oral contraceptive therapy.

Intraparenchymal embolization for obliteration of an intramedullary AVM of the spinal cord

A new technique is presented in which expandable compressed Ivalon sponge emboli were used to obliterate an intramedullary arteriovenous malformation of the spinal cord by intraparenchymal embolization. A case is described in which this method was used.

Intraparenchymal embolization for obliteration of an intramedullary AVM of the spinal cord: Technical note

A new technique is presented in which expandable compressed Ivalon sponge emboli were used to obliterate an intramedullary arteriovenous malformation of the spinal cord by intraparenchymal embolization. A case is described in which this method was used.

CT evaluation of intervertebral foramina lesions with normal or non-diagnostic myelograms. Report of ten cases

Ten patients with radicular leg pain are reported in whom good quality myelograms were either normal or non-diagnostic of a disc or tumor. Subsequent CT examination demonstrated herniated discs (eight patients) or tumors (two patients) in the intervertebral foramen, all located too far laterally to be seen with myelography.

Computerized tomography of the orbit in carotid-cavernous sinus fistulae

Abstract Orbital Computerized Tomography was utilized in seven cases of angiographically proven carotid-cavernous sinus fistulae. The findings were as follows: (A) proptosis (in all cases), (B) enlarged superior opthalmic vein (in six cases) and (C) introorbital muscle enlargement (in three cases). Carotid-cavernous sinus fistulae can usually be differentiated from other entities in the clinical differential diagnosis by the use of orbital CT.

Evaluation of Dilute Pantopaque for Large-Volume Myelography

Abstract Fifty patients undergoing routine myelography were examined with dilute forms of Pantopaque and the results compared with those of an additional 50 patients examined using standard 30% Pantopaque. The more dilute forms flowed more slowly, but, based on all parameters evaluated, a 22% concentration of iodinated ethyl-p-phenylundecanoate may be the ideal form of Pantopaque for thoracic and cervical myelography.