Peter J. Yang

Preoperative Balloon Occlusion of Arteriovenous Malformations

Many materials have been utilized to embolize cerebral arteriovenous malformations (AVMs) preoperatively. Specific vascular anatomy with large feeding vessels deep to the nidus or aneurysms within feeding arteries favor the use of detachable balloons over other embolic agents. Detachable balloons allow test occlusion of a vascular pedicle before permanent occlusion and can obliterate aneurysms in feeding arteries. We describe 36 feeder arterial balloon occlusions performed in 31 patients. Twenty-nine patients subsequently had surgical resection. None of the patients developed normal perfusion pressure breakthrough or required blood transfusions. The preoperative balloon occlusion was judged by the neurosurgeon to decrease significantly the difficulty in surgical resection of the malformation. The remaining 2 patients underwent embolization before radiosurgery. One patient had aneurysms in the feeding artery, which was balloon-occluded to diminish the risk of hemorrhage. There were two neurological deficits and three asymptomatic arterial dissections related to the balloon procedure. Balloon occlusion of feeding arterial pedicles in selected cerebral AVMs may be a valuable surgical adjunct.

Cranial metastases from prostate cancer simulating meningioma: report of two cases and review of the literature.

Two cases of prostatic carcinoma metastatic to the cranium that presented with clinical and radiographic features simulating meningioma are described. The literature was reviewed, and 13 similar cases were identified. From the data gathered, we conclude that metastatic prostate cancer should be considered in the differential diagnosis of elderly males who present with characteristic clinical and radiological features of meningioma and that the classical description of meningioma is not specific.

Computed tomography in hematologic malignancies of paranasal sinuses

Hematologic malignancies of the paranasal sinuses are uncommon. Four young patients with ophthalmologic abnormalities as a chief complaint are presented. Lymphoma or leukemia should be considered in the differential diagnosis of destructive lesions in the paranasal sinuses, particularly in children and young adults.

Building And Using A Data Base To Identify Parameters To Further Improve Diagnostic Performance On The Toshiba Computed Radiography System Model 201

The digital imaging group at the University of Arizona Health Sciences Center Radiology Department is vigorously pursuing the development of a total digital radiology department (TDRD). One avenue of research being conducted is to define the needed resolutions and capabilities of TDRD systems. Parts of that effort are described in these proceedings and elsewhere. One of these investigations is to assess the general application of computed r adiography (CR) in clinical imaging. Specifically we are comparing images produced by the Toshiba computed radiography system (Model 201) to those produced by conventional imaging techniques. This paper describes one aspect of that work.

Outpatient dsa in cerebrovascular disease using transbrachial arch injection

Experience with intravenous digital subtraction angiography (DSA) has proven disappointing in the outpatient evaluation of cerebrovascular disease. Vessel superimposition, patient motion, and poor vascular opacification all prevent definitive studies in a significant percentage of patients. These problems were addressed by turning to an intraarterial outpatient DSA technique composed of several elements: (1) right transbrachial catheterization of the ascending aorta using a thin, multiple side-hole, straight catheter; (2) arch injections of relatively small volumes of contrast material; (3) pulsed digital image acquisition with multiple projections; and (4) a limited period of postprocedure observation. A total of 43 outpatients and 16 inpatients was studied in this manner with only two complications, both local. Images of definitive quality and completeness were obtained in 82%-98% of cases, and included the major intracranial as well as the extracranial vessels and their circulatory dynamics. Because the iodine load per injection was relatively low, up to 10 angiograms per case were available for delineating superimposed anatomy and motion degradation. Variations in cardiac output had little impact on image quality, and the average case required less than 60% of the contrast load routinely used for intravenous DSA. The transbrachial approach proved as safe and convenient as intravenous DSA but was more thorough and dependable.