Journal of neurointerventional surgery
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Case Reports
Verification of supraselective drug delivery for retinoblastoma using intra-arterial gadolinium.
We present a description of retinoblastoma treated with supraselective intra-arterial chemotherapy, demonstrating selective delivery of the infused chemotherapeutic agent into the tumor bed by MRI. A 7-month-old presented with group E (international classification) unilateral retinoblastoma. ⋯ Intraoperative MRI was obtained within 15 min after treatment and showed increased enhancement of the tumor and subretinal space. We demonstrate here that supraselective administration of chemotherapy into the ophthalmic artery appears to result in drug delivery to the tumor and subretinal space.
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Little is known about how much protection a flow diversion stent provides to a non-thrombosed aneurysm without the adjunctive use of coils. ⋯ The flow diversion effects of both stents were limited to flow velocity reduction. In a non-thrombosed aneurysm or an aneurysm with delayed thrombosis, the intra-aneurysmal pressure remains essentially unchanged regardless of the level of the intra-aneurysmal flow velocity reduction induced by the stents.
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Treatment of dural arteriovenous fistula involving the transverse-sigmoid region with cortical reflux is complex and treatment options may require sacrifice of the fistulous segment of the sinus. ⋯ Fistulas of the transverse-sigmoid sinuses with cortical reflux may require sacrifice of the parent sinus for cure. Defining the fistulous segment and occluding this segment deliberately, completely and precisely is essential for cure. Several modalities and approaches can be used to achieve this. For properly selected patients, cure of the lesions can be achieved with this method with low risk of morbidity.
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Endovascular treatment of ruptured dissecting aneurysms of the posterior inferior cerebellar artery.
Dissecting aneurysms of the posterior inferior cerebellar artery (PICA) are rare, with optimal treatment strategies not well established according to the location of the aneurysm on the PICA. We present our single-center experience of endovascular treatment of ruptured dissecting aneurysms of the PICA. ⋯ Endovascular treatment of ruptured dissecting aneurysms of the PICA is safe and efficient.
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Case Reports
The sea anchor technique: a novel method to aid in stent-assisted embolization of giant cerebral aneurysms.
Endovascular navigation past some large or giant intracranial aneurysms for the purpose of stent deployment can be difficult. Some of these lesions have a morphology which compels the operator to navigate through the aneurysm dome in order to gain distal access, a step which requires straightening of the delivery microcatheter before a stent can be deployed. In most patients this can be achieved by simply retracting the microcatheter and reducing the loop within the aneurysm. ⋯ Instead of retracting and straightening across the aneurysm neck, the microcatheter withdraws leaving the intra-aneurysm loop intact. This challenge can thwart attempts at stent placement and subsequent embolization. The authors describe a simple and safe technique to circumvent this problem, a way of stabilizing the distal tip of the microcatheter which they term the 'sea anchor'.