S. Joseph

Osteoid Osteoma: CT-Guided Percutaneous Laser Ablation in Spine and Long Bones

or by percutaneous excision . Radio frequency ablation also gives promising results . Interstitial Laser Photocoagulation (ILP) has been developed recently as an alternative less invasive mode of treatment of this condition. In vitro experimental animal studies showed promising results with the production of well-demarcated coagulative necrosis of predictable size in solid tissue, with a low power laser technique . Thin optical fibers are inserted percutaneously into the tumor nidus, which is then heat coagulated and destroyed using the thermal properties of laser energy, including vaporization, coagulation and necrosis . The ability to locate and deliver energy at the target with high degree of precision and excellent dose – response characteristics and the less invasive nature make ILP more acceptable compared to open surgical procedures . The nidus of osteoid osteoma is usually less than 15 mm in diameter and falls well within the range that can be effectively coagulated by low dose laser technique. In vitro experimental study on sheep femur collected from slaughter house showed the mean axial diameter of coagulation by Nd: YAG laser as follows:200J3 Introduction

Coil Embolization for Intracranial Aneurysms: An Indian Experience

Over a period of 4 years. 47 patients with 49 aneurysm were treated via the Endovascular techniques. Those included 24 males and 23 females with ages ranging from 7-72 years. The most common presentation was SAH (24 cases) followed by mass effect on adjacent structures (14 cases) and others were incidental aneurysms. Twenty-eight aneurysms were located in anterior circulation and 21 were in posterior circulation. Following an informed consent, detailed neurological assessment and baseline laboratory investigations were done in all cases. Reassessment of neurological status at discharge and at 3, 6 and 12 months was done.

Cerebral Dural Arteriovenous Fistulae: An Indian Experience

Intracranial dural arteriovenous fistulae are acquired lesions that constitute 10-15% of intracranial malformation. Etiology of dural arteriovenous fistulae being sinus thrombosis, trauma, infection etc. Exact incidence of this lesion is unknown. Females are more affected. Based on venous drainage DAVF are classified by Djinjian and Merland . Symptomatology depends on venous drainage of the lesion. Headache and tinnitus being the Cerebral Dural Arteriovenous Fistulae An Indian Experience

Spinal Arteriovenous Malformations: Role of Interventional Neuroradiology

In the last 14 years, 46 patients were diagnosed as having SAVMs on angiogram. Presenting complaints in these patients included progressive numbness, weakness (quadriparesis or paraparesis), sphincter disturbances or acute pain. Ten patients showed evidence of bleed on imaging. Angiography revealed intramedullary SAVM in 22, intradural perimedullary AVF in 8 Spinal Arteriovenous Malformations Role of Interventional Neuroradiology

Direct Puncture Embolization of Head and Neck Tumors

Embolization is a well-established technique that facilitates the subsequent surgical removal of vascularized tumors such as juvenile angiofibroma and carotid body tumor. However, there is risk of a neurological accident during angiography and tumor embolization from the internal carotid artery. Hence the technique of direct intratumoral injection of permanent liquid polymerizing agent was developed . We present our experience with the technique of direct puncture embolisation to devascularize head and neck tumors.

Vein of Galen Malformations: An Indian Experience

Between October 1983 and July 2002, 22 patients with vein of Galen malformations were referred to our institute for evaluation and management.The clinical presentation of these patients is summarized in Table 1. The most common presentation was with increasing head circumference and headache. Nine children had history of delayed milestones or poor scholastic performance. Seizures and neurological deficits were uncommon in these patients. In one patient, the diagnosis was made before birth by antenatal ultrasound studies, which was confirmed by cerebral angiography after birth. The imaging features in these lesions are summarized in table 2. Hydrocephalus was the most common imaging finding associated with the lesion and was seen in 13 patients. Thrombosis of the venous sac was demonstrable in three patients. In two of these patients, the sac was completely thrombosed. Cerebral parenchymal changes in the form of diffuse cerebral atrophy and parenchymal calcifications were uncommon and were seen in four patients only. Introduction

Percutaneous Vertebroplasty: Initial Experience

Acrylic cements have been used for the augmentation of weakened or partially destroyed bones for decades. In 1984, first percutaneous vertebroplasty was done in France by Deramond and Galibert, for haemangioma of C2 vertebra. Since then the indications for the same have been extended to strengthen the vertebra in benign and malignant collapses. In the present study we are explaining the initial experience of vertebroplasty at our institute.

Carotid Artery Stenting: An Indian Experience

19 patients with symptomatic carotid artery stenosis of more than 70% underwent carotid artery angioplasty and stenting (cervical: 18 and caroticoophthalmic & supraclinoid ICA tandem stenoses: 1). Eight patients constituted a high risk group for revascularization as per NASCET criteria. Pre-procedure work up included detailed neurological examination, colour Doppler, MRI with MRA or CT Angiography and 4 vessel DSA. The procedure was Introduction

Endovascular Treatment of Carotido-cavernous Fistula

1287 male and 20 female), 47 were traumatic in origin, 10 were spontaneous and 1 was iatrogenic. Of the 22 indirect fistulas (13 Carotido-cavernous fistulas are abnormal arteriovenous communications either directly between the internal carotid artery and the cavernous sinus or between the dural branches of the internal and external carotid arteries. Direct fistulas occur most commonly secondary to road traffic accident whereas indirect fistulas occur spontaneously. These fistulas predominantly present with ocular manifestations and they are treated mainly by endovascular techniques in most of the cases.

Preoperative Embolization of Craniofacial Vascular Malformations

1269 duced by the vascular malformation. In three of our earlier patients a history of surgery and ligation of the external carotid artery was obtained. The major arterial feeders embolized were occipital a. in ten, superficial temporal a. in 15, internal maxillary a. in 24, linguo-facial tr. in 24, ophthalmic a. in six, other ICA branches in two, vertebral/ subclavian branches in four. In most patients Bernstein catheter was used which is 7 French catheter tapered to 5 French, which was found useful in entering the tortuous branches of external carotid artery. In some patients the 4 F or 5 F right coronary catheter was used. The technique used for embolization was predominantly of 2 types: