Recanalisation of cerebral artery aneurysms treated endovascularly - a midterm follow-up

Endovascular methods of aneurysm treatment, as an alternative to neurosurgical clipping, have proved a welcome opportunity to treat patients with unruptured aneurysms or those disqualified from neurosurgical intervention. This paper presents our own experience of endovascular treatment of cerebral aneurysms in 107 patients. It includes clinical and technical data from the perioperative period and a 12-month radiological follow-up of 78 patients.

METHOD

Our retrospective evaluation covered patients with intracranial aneurysms treated endovascularly. The following were analysed: age, sex, neurological symptoms, and familial burden of intracranial aneurysm. Multivariate analysis was performed to determine independent factors of recanalisation of the cerebral aneurysm 12 months after embolisation.

RESULTS

The data of 107 patients at a mean age of 61 years [57.09 ± 14.27] treated with embolisation was analysed. The indication for intervention in 16 patients was subarachnoid haemorrhage; in the remaining 91 cases, aneurysms were revealed during diagnostic procedures for different symptoms or during imaging examinations. The intracranial segment of the internal carotid artery and the anterior communicating artery were the most common locations for aneurysms. After embolisation, subarachnoid haemorrhage occurred in one patient, ischaemic stroke in two patients, and one patient died because of acute circulatory insufficiency. The functional status of 94 patients on the day of discharge from the department (on days 4-21) was very good. 78 patients completed a 12-month follow-up period. In 11 of those, a follow-up MR angiography revealed recanalisation 12 months after the intervention. Except for one patient reporting vertigo, aneurysm recanalisation procedures were asymptomatic. The only independent risk factor for recanalisation was the size of aneurysm > 10 mm; OR 3.0; CI [1.15-7.83] p = 0.0255.

CONCLUSIONS

Embolisation of cerebral aneurysms is a safe method with few perioperative complications, and most of these are mild and transient.The size of the aneurysm during qualification for embolisation is a risk factor for recanalisation in the subsequent 12 months. Recanalisation of embolised cerebral aneurysms concerns less than 20% of patients in a one-year follow-up and is most often asymptomatic.

Tumoral calcinosis of the cervical spine in a dialysis patient. Case report and review of the literature

The authors present a case of tumoral calcinosis (TC) in a patient with chronic renal insufficiency. The clinical course, imaging features and microscopic findings are detailed. A 60-year-old woman with a 4-year history of hemodialysis presented with a painful mass in the right posterior cervical triangle. The neuroimaging revealed polycystic mass bulging from the C3-C5 facet joints and lamina on the right. The majority of cystic mass was excised and microscopic features of the specimen were consistent with TC. Tumoral calcinosis is a rare disease characterized by calcium salt deposits in periarticular soft tissue, which enlarge to form tumor-like cystic masses containing chalky calcareous material. TC is typically seen around large joints but rarely in the spine. Review of past publications provided six cases of TC involving the spine in dialyzed patients.

[Embolization of AVM's of thoracic spinal cord with histoacryl glue]

The authors present two cases of inoperable AVM's of thoracic spinal cord successfully treated by embolization with histoacryl glue (B. Brown Melsungen AG). The glue used for embolization is characterized by instant polymerization when comes in contact with blood. A mass of polymer is visible on X-ray thanks to contrast medium Lipiodol and metallic powder Tungsten that are added to glue and injected together with the latter. In the first case, a female who presented with paraparesis and walked only with assistance embolization performed in one session resulted in neurological improvement enabling independent walking at follow-up 2 yrs later. In the second case of a young male not walking for severe paraparesis embolization performed in three sessions resulted in significant neurological recovery. 10 days after the first session the patient became ambulatory. 6 months after treatment he presented with mild paraparesis and was still ambulatory and leading independent life. In each case embolization was performed after balloon occlusion test during which the function of spinal cord was monitored by somatosensory evoked potentials and neurological assessment.

[A case of complete Th7-Th8 fracture-dislocation treated by one-stage posterior and transthoracic approach]

The authors present a case of severe traumatic fracture-dislocation of Th8 with total anterior slippage of Th7 on Th8 without spinal cord injury. The patient underwent one-stage anterior and posterior decompression. Posterior surgery included Th4 to Th9 laminectomy and Th7-Th8 facetectomy and posterior bone graft. Anterior procedure included Th8 vertebrectomy, anterior interbody bone graft and anterior plating with usage of "Zespol" plate and screws anchored in Th6, Th7, Th8 and Th9 vertebral bodies. Postoperative period was uneventful and the patient remained neurologically intact. He was placed in a plaster jacket and mobilized of fifth day after surgery.

[Thoracic outlet syndrome: results of surgical treatment]

21 patients with thoracic outlet syndrome (t.o.s.) were operated on in the Department of Neurosurgery of MMA in Lódź between 1982-1991. Early and long-term results of treatment were analyzed in the group of 13 cases. In early postoperative period 5 patients were free of pain and neurologic or vascular disturbances in the upper limb. In other 6 cases pain disappeared partially and mild neurological or vascular syndromes persisted. Altogether satisfactory results of treatment were obtained in 8 patients (85%). There was some improvement in 2 patients but pain and neurological or vascular disorders were still significant after surgery. Long-term results were assessed at least 1 year after operative treatment. Recurrent pain with or without mild neurological (vascular) syndromes appeared in 6 patients (46%). Recurrent t.o.s. occurred mainly in cases of young women with low position of shoulder girdle and poorly developed musculature of this region. Only 2 patients still remained free of preoperative syndromes. Altogether only 8 patients (61%) had acceptable results of surgical treatment at long-term follow-up. The remaining 5 patients (39%) had unsatisfactory long-term results.

[Diagnosis of the upper thoracic outlet syndrome]

Basing on a review of literature and own experience the authors present the aetiology and various diagnostic methods of thoracic outlet syndrome (t.o.s.), especially electrodiagnostic and Doppler studies. Provocative tests like Wright, Adson or hyperabduction manouvers are discussed and their role in modern diagnosis of t.o.s. is presented.

[The importance of computerized tomography and magnetic resonance imaging in the diagnosis of slowly growing cerebral gliomas]

The authors present diagnostic problem in slowly growing brain gliomas. Two illustrative cases are presented. Both were characterized by scant clinical manifestations and long-term course of the illness before the operation. CT examinations repeated in both patients several times in the preoperative period of a few years disclosed unchanging hypodense areas in cerebral hemispheres. No progress in clinical status of the patients and CT imaging of the lesions were observed throughout years of observation (2 and 5 years, respectively). Rapid deterioration of neurological condition in both patients associated with enlargement of the lesions in CT allowed to establish strong suspicion of brain tumour which was confirmed by examination in each case. Histopathological examination revealed malignant gliomas in both cases. The cases confirmed once again the necessity of early MRI examination in patients with hypodense lesions of the brain found in CT. The authors believe that every hypodense area of the brain should be verified by MRI as soon as possible, regardless their size, progress and neurological status of the patient. Such as approach to the diagnosis of hypodense areas in the CT of the brain may prevent a delay in proper treatment as well as malignant transformation of primarily benign lesion.

[An hourglass-shaped enteric cyst of the cervico-thoracic region with extra- and intramedullary location]

The authors report a case of a hourglass dysontogenetic tumour in a 7-year-old girl (enteric cyst) of the spine at the cervicothoracic region coexistent with a developmental anomaly of the spine and posture anomaly. Atypical symptoms (pains) suggesting a disease of the gastrointestinal tract or heart made the diagnosis very difficult. Contrast examination of the vertebral canal made possible a correct diagnosis and appropriate surgical intervention. Microsurgical technique permitted the tumour to be removed radically.

[Usefulness of computerized tomography in the diagnosis of peripheral nerve tumors]

After an analysis of cases of tumours situated on the peripheral nerves treated in hospital the authors stress the usefulness of computerized tomography in the diagnosis of these tumours. By demonstrating the internal structure of the tumour, its anatomical relationships to the surrounding tissues the investigation provides many important and practical data in the surgery of peripheral nerves.

[Unilateral hyperostosis frontalis interna coexistent with cerebral angioma]

The authors describe a rare case of coexistence of cerebral angioma with hyperostosis frontalis interna in a female patient aged 28 years, suffering from mental disturbances. The coexistence of these two diseases in one person caused considerable diagnostic and therapeutic difficulties. The described case points out that both these conditions may occur concomitantly. Another point of interest is the presence of hyperostosis frontalis interna in a young woman.