Transcatheter therapeutic arterial embolization

Transcatheter therapeutic arterial embolization was employed in 11 patients with gastrointestinal hemorrhage and 8 patients with bleeding from other sites. Hemorrhage was stopped successfully in all of the patients with gastrointestinal bleeding and 6 of the 7 patients with active bleeding from other sites. There were no significant complications or sequelae, although ischemia msy cause problems in such patients. Embolization is of considerable value when pharmacological therapy fails or is not appropriate due to the site of bleeding. In some cases it may represent the definitive treatment, as in pelvic trauma or renal hemorrhage; in others, embolization may serve to halt bleeding long enough to permit surgery. Therapeutic embolization should be considered whenever active extravasation of contrast material is demonstrated.

Persistent gastrointestinal bleeding due to angiodysplasia of the gut in von Willebrand's disease

Gastronintestinal vascular dysplasia as a cause of persistently recurring melaena is reported in two patients with von Willebrand's disease. Colonic wall vasculature was affected in one patient, the abnormality being demonstrated both radiologically and at operative hemicolectomy undertaken to control bleeding. Abnormalities in the vasculature of the duodenal and jejunal walls were found in the second patient at operation and necropsy, though not demonstrated by angiography.

Spontaneous closure of a dural arteriovenous malformation

A case in which closure of an arteriovenous malformation involving the dura mater occurred spontaneously is presented. The anatomy, pathophysiology and clinical symptomatology of such lesions are reviewed. Possible mechanisms of spontaneous closure of intracranial arteriovenous malformations are discussed.

Cerebral angiotomography

This study was undertaken with two main objectives: (a) to ascertain in the practicability of two simple types of apparatus and (b) to evaluate the clinical situations in which the procedure was most likely to be helpful. Aneurysms, arteriovenous malformations, vascular diseases, tumors, including pituitary tumors, and head injuries were studied. The technique was found to be most useful in aneurysms, arteriovenous malformations and pituitary tumors.

[Origin of the left vertebral artery from the left external carotid artery (author's transl)]

A rare anomaly is described consisting of the left vertebral artery arising from the left external artery. The developmental basis and relationships are discussed.

Rapid arteriovenous shunting in a spinal cord ependymoma. Case report

A case of ependymoma of the conus medullaris and cauda equina is described in which spinal angiography demonstrated rapid arteriovenous shunting, an angiographic sign which is typical of arteriovenous malformations and which has not been previously reported to occur with ependymomas.

[Treatment of spinal cord arteriovenous malformation by surgical excision combined with afferent vessel coagulation-report of a case (author's transl)]

A case of spinal cord arteriovenous malformation was reported, in whom serial selective spinal angiogram and pantopaque myelogram showed a successful demonstration of intramedullary nidus. A 25-year-old male was admitted with paraparesis, impotence, hypesthesia and hypalgesia in his legs in 1974. He was diagnosed to have a spinal cord arteriovenous malformation of so-called "glomus type" with intramedullary nidus by the selective spinal angiogram and pantopaque myelogram. The nidus was fed by the anterior spinal artery through the 8th intercostal artery, from which a major draining vein extended caudally, but there was also some cranial drainage. The arteriovenous malformation was treated by surgical excision combined with afferent vessels coagulation in order to prevent the rupture of the remaining intramedullary nidus. After operation the patient develop a transient analgesia and girdle pain at T9-10 level, but after 42 days he regained full muscle power in his legs and could run by himself, while sensory disturbance remained about the same as before surgery.

Surgical and angiographic localization of spinal arteriovenous malformations

Three cases of spinal arteriovenous malformation are reported which illustrate that localization of intra- and extramedullary components are not always adequately assessed by spinal angiography alone. One large malformation, primarily dorsal to the spinal cord, was not seen on angiography. A second lesion thought to be intramedullary and unresectable as judged by angiography was found at surgery to be primarily dorsolateral and was resected. The third malformation was thought to be extramedullary on angiography, yet had a major intramedullary component at surgery and was not resected. We conclude that surgical exploration of all spinal arteriovenous malformations should be performed despite the angiographic appearance.

[Arteriovenous intracranial and extracranial angiomas in infants and children (author's transl)]

Five patients with arteriovenous angiomas in the head (2 galea angiomas, 1 mixed form with extracranial and intracranial localization of the arteriovenous fistulas and 2 intracranial arteriovenous fistulas) were described. Four patients were examined as newborns or infants. Oximetric data, intracardial pressure and circulation time were ascertained by the cardiac catheter. Selective carotid angiography was performed in the transfemoral pathway. Two infants were successfully operated.

[Causes for vertebrobasilar artery insufficiency and reasons for misinterpretations in angiography (author's transl)]

Different morphological and functional causes of the vertebrobasilar artery insufficiency, which were found in the examination of 128 patients, were analyzed and compared with well known syndromes. Possible misinterpretation in evaluation of angiograms are emphasized.

[Clinical contribution to the study of congenital pulmonary arteriovenous fistulas]

Three cases of congenital a-v fistulas of the lung encountered in some 10,000 patients examined are reported. Emphasis is laid on the possibility that the disease may be misinterpreted for a long time and treated wrongly. It is considered that the most significant examination for diagnostic purposes is angiocardiopneumography because even in the rare cases in which it does not reveal the fistula, it shows up its existence by the early visualization of the left heart.

[Pathophysiological and anatomical prerequisites of hemodynamic disorders in the system of small saphenous vein]

112 patients with varicose small sephenous vein were operated upon. The operation was preceded by a careful clinical investigation, including phlebography. The observed changes were correlated with operative findings. It is shown that varicosity may be conditioned by an obstruction of blood outflow in the popliteal vein or small saphenous vein ostium. A relationship between some structural variants of the small saphenous vein and hemodynamic disturbances was noted.

Communication between the pulmonary and systemic circulations

Communications between the pulmonary and systemic circulation occur normally and also in association with a number of pathological entities. On the basis of recent experience I believe that this phenomenon occurs more frequently than has previously been appreciated and may assume significant clinical importance in many cases. This report reviews the spectrum of the phenomenon of systemic-pulmonary vascular connection, particularly with regard to its occurrence and recognition in the adult age group. A number of illustrative cases are reported and the pertinent literature is reviewed.

Computerised axial tomography. Particular applications and advantages in paediatric neurosurgery

The first year's experience of computerised axial tomography (the EMI scanner) in a department of neurosurgery is described, and those features of particular importance in the younger age group are emphasised.

Multiple arteriovenous malformations of spinal cord and brain in a child. Case report

A case of extensive spinal cord arteriovenous malformation (AVM) associated with a small AVM of the right temporal lobe in a child is presented. Direct surgical approach with successful treatment in several stages was achieved and an excellent result was obtained.

Computerized tomography: abnormal intracerebral collections of blood in children

Three children with unusual abnormal intracerebral collections of blood were examined by computerized tomography. These cases demonstrate the complementary relationship of this technique with other neuroradiological diagnostic methods. An intracerebral aneurysm and an arteriovenous malformation of the vein of Galen are demonstrated on computerized tomograms.

The evaluation of routine selective arteriography in the investigation of renovascular hypertension

A comparison of lesions discovered by selective renal arteriograms with abnormalities observed on abdominal aortograms was made in 100 consecutive hypertensive patients. Twenty-one lesions not seen on aortograms were found by selection. Eight patients with a normal aortogram had lesions. An abnormality was discovered in at least one study in 58 patients. The increased rate of lesion detection by selective studies outweighs the slight risk of complications.

Intra-arterial embolization in the management of arteriovenous malformations

Eighteen patients with arteriovenous malformations (AVM's) involving the extremities, pelvis, or head are reported and their treatment is discussed. Our experience has led us to the following conclusions: (1) careful selective angiography is mandatory to delineate the vascular anatomy, extent, and major afferent vessels supplying the AVM; (2) ligation of afferent vessels to an AVM never is indicated; (3) intra-arterial embolization (IAE) can be used prior to surgical removal of extensive but resectable AVM's; (4) IAE may be employed for symptom control of inoperable AVM's.

[Extracranial angioma with dural participation]

Extracranial congenital arteriovenous malformations are often associated with dural and/or cerebral malformations. One case is presented. The angiography of the common carotid artery revealed no evidence of abnormal vessels into the internal or external carotid territory. The injection of contrast medium into an enlarged epicranial vein showed the extracranial malformation, well opacified; the phlebography revealed also a small dural malformation draining in the superior sagittal sinus. The Authors outline the importance of complete angiographic study in all the cases of extracranial vascular malformations even if the carotid angiography is apparently normal.

[Vascular rings]

Anomalies in the development of aortic arches may cause the formation of a vascular ring around trachea and esophagus, responsible for compression symptoms. The most frequently found vascular rings are the double aortic arch, the right arch with left ligament and the retroesophageal right subclavian artery. The diagnosis is established by means of contrast esophagogram. Surgery is usually done through a left posterolateral thoracotomy to dissect widely the retroesophageal area, after liberating the obstruction by section of a secondary vessel. Three cases are reported to illustrate the most frequent types of vascular rings and their management.

[Compression of trachea and esophagus by abnormal course of the left pulmonary artery (author's transl)]

A three months old infant with abnormal origine and course of the left pulmonary artery is described. The course of the left pulmonary artery between oesophagus and trachea causes narrowing of the distal trachea leading to in- and expiratory stridor. A ventral indentation of the oesophagus, visible on the lateral plane of an oesophageal roentgenogram, is characteristic for the anomaly which can be proven by pulmonary angiography.

[Clinico-roentgenological parallels in congenital hypoplasia of the deep veins of the limbs]

The authors report the results of clinical and phlebographic investigations in 34 patients with congenital hypoplasia of profound veins of the extremities. The specific weight of this lesion among phlebological patients was 2.7%. An extreme degree of aplasia--the total absence of deep crural and femoral veins was diagnosed in 4 cases, arteriovenous fistulas--in 14. The studies performed allowed wider indications to operative treatment employed in 21 cases. It was accomplished with the purpose to unload the lower limb venous system (ligation of arterio-venous fistulas, excision of angiomas and varices, ligation of communicant veins). These interventions improve considerably the patients' state and prevent a progression of the disease. However, they are but of a palliative character.

Complete microsurgical excision of cervical extramedullary and intramedullary vascular malformations

Eleven patients with vascular malformations of the cervical spinal cord have been operated upon at the University of Zürich. Total microsurgical excision was achieved in all. One patient had a lesion which was entirely intramedullary. Nine patients had combined lesions, intramedullary and extramedullary. Only one patient had a lesion which was entirely extramedullary. There was one operative death from meningitis. Another patient improved slightly postoperatively, but eventually died of urological complications. One patient had the operation immediately following his only subarachnoid hemorrhage, and has thus been protected from neurological damage. One patient has had postoperative reversal of his progressive neurological deterioration and severe pain. Six patients severely impaired preoperatively improved dramatically. One patient who was quadriplegic preoperatively has regained function in her upper extremities. The treatment of choice in lesions such as these is complete microsurgical excision.

Concurrent intracranial and spinal cord arteriovenous malformations. Case report

The authors report the case of a patient with subarachnoid hemorrhage in whom an intracranial dural arteriovenous malformation coexisted with a spinal arteriovenous malformation. The latter was considered to be the source of the hemorrhage by clinical and radiographic criteria. It is concluded that patients with subarachnoid hemorrhage who show no suitable intracranial source for their bleed in some instances should be investigated for a spinal origin of hemorrhage.

The Use of Computer Tomography in Ophthalmology

Fifty-three orbital lesions of various types were studied by computer tomography to assess the capabilities and limitations of this technique. Although CT scanning in ophthalmology is in its infancy, results showed that it is useful in the investigation of a number of pathological conditions, including congenital anomalies, arteriovenous malformations, bone lesions, trauma, inflammation, granulomas, pseudotumors, epidermoid cysts, and tumors arising in or near the optic nerve, behind the optic bulb, or in the lacrimal region, as well as changes following eye surgery.