Roushdy S. Boulos

Venous angiomas: An underestimated cause of intracranial hemorrhage

Cerebral venous angiomas are considered by many investigators as infrequent and incidental. Our experience, however, has been different. Since 1975, we have compiled a group of 21 patients with 23 venous angiomas. Nine patients (43%) presented with intracranial hemorrhage, and two in this group had recurrent hemorrhage. Surgical extirpation of the venous angioma was performed in all nine cases. An additional resection of a frontal venous angioma was performed in a woman with intractable seizures and headache. We experienced limited morbidity and no mortality. Although venous angiomas may be uncommon clinically, they have a significant potential for hemorrhage, and particularly, rehemorrhage if left untreated.

Anastomosis of occipital artery to anterior inferior cerebellar artery for vertebrobasilar junction stenosis

A new approach to revascularization of the posterior fossa for vertebrobasilar insufficiency due to vertebrobasilar junction stenosis is reported. The procedure involves anastomosing the occipital artery to a branch of the anterior inferior cerebellar artery. Rationale for the procedure and surgical technique are discussed.

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.

Neurobehavioral deficit and computed tomographic abnormalities in three samples of schizophrenic patients.

Recent reports have suggested that schizophrenics show brain abnormalities as reflected on computed tomography (CT Scan). We present data on three groups of schizophrenic patients which replicate our original report of this phenomenon with associated neuropsychological test results. The over-all evidence for an increased rate of neuropsychological abnormalities and related CT structural anomalies in groups of schizophrenics in several studies is robust. The biological dynamics, cause-effect relationships, and clinical applicability of this phenomenon in the individual case, however, are far from clear. Diagnostic agreements between behavioral and structural abnormalities should simultaneously sound a note of clinical caution and stimulate further study.

Radiologic evaluation of extracranial to sylvian middle cerebral artery bypass

At this institution a new procedure has been developed that involves anastomosing one of the branches of the superficial temporal artery to one of the major trunks of the middle cerebral artery in the Sylvian fissure. This procedure has been performed in 22 cases to date. Clinical indications for this procedure have fallen into four major categories. This new type of anastomosis produces greater bypass flow than conventional cortical middle cerebral artery anastomoses, and may be a better therapeutic alternative in certain clinical situations. The preoperative and postoperative angiographic evaluation of these patients is discussed. The radiologic results in this series of patients are reviewed.

Cerebral angiography and neuropsychological measurement: the twain may meet.

In a sample of 31 cerebral revascularization candidates, severity and dissemination of atherosclerosis on the cerebral angiogram were correlated with two of three global indicators of neurobehavioral impairment. Additionally, the angiographic rating was correlated with age and with an index of medical risk factors, but not with duration of the longest symptomatic episode. It seems likely that several variables, particularly collateral circulation, help to determine whether a given pattern of stenoses results in neuropsychological dysfunction and what type of behavioral deficit occurs. In many cases, the configuration of neuropsychological test scores may not directly mirror the pattern of cerebrovascular stenoses.

Outpatient iohexol lumbar, cervical and total column myelography in 883 patients

Water-soluble non-ionic contrast media have radically changed the practice of myelography. Several reports about outpatient lumbar myelography have already been published. We report our results in 800 lumbar, 66 cervical and 17 complete myelograms performed with iohexol on an outpatient basis. Introduction was by lumbar puncture using a 20- or 22-gauge needle. CT scans were obtained in 2–3 h and the patients were discharged in 5–6 h. Each patient was contacted after 24 h. Reactions lasting 24 h or less were considered mild and were not recorded. Reactions lasting 1–3 days were considered moderate, while reactions lasting more than 3 days or requiring hospitalization were considered severe. In the lumbar group, 52 patients had a total of 91 moderate or severe side effects. In the cervical and complete group, 10 patients suffered a total of 18 reactions. Seven patients had to be hospitalized. Our results compare favorably with those published and demonstrate the safety and utility of this approach provided a well-organized and controlled program is instituted. Tremendous reduction in the cost of work-up of patients can thus be achieved.

Revascularization of the Brain Stem: Anatomical Basis, Clinical Results and Long-Term Angiographic Follow-Up — Ten Years Experience

The first report of vertebral basilar bypass surgery appeared in 1975 with an occipital artery (OA) to posterior inferior cerebellar artery (PICA) bypass procedure (Ausman et al. 1976). Then the OA to anterior inferior cerebellar artery (AICA) (Ausman et al. 1981) and superficial temporal artery (STA) to superior cerebellar artery (SCA) bypass (Ausman et al. 1979) were introduced to provide additional blood flow to presumed hemodynamically compromised areas of the brain stem. The principle followed was to allow the revascularization of the vertebral basilar arterial system distal to a stenotic or an occlusive lesion. Thus, the OA-PICA bypass was used for stenosis or occlusions in the vertebral artery (VA) proximal to PICA. The OA-AICA bypass was utilized for stenotic or occlusive lesions proximal to AICA and the STASCA anastomosis for lesions proximal to SCA. We are reporting the results of 10 years of experience with vertebral basilar revascularization in 50 patients.