RESUMO

Dural Arteriovenous Fistulas (dAVFs) of the anterior cranial fossa (ACF) are uncommon but carry a high risk of hemorrhage and pose substantial treatment challenges. Recent advancements in endovascular treatment (EVT), including the introduction of novel liquid embolic agents, have markedly bolstered EVT's role in managing ACF-dAVFs, with notable series published in the last five years. We aimed to assess the feasibility, safety, and efficacy of EVT for ACF-dAVFs. We searched Medline, Scopus, Web of Science, and Cochrane Library databases following PRISMA guidelines. Eligible studies included those with ≥ 5 patients undergoing embolization of ACF-dAVFs, detailing both angiographic and clinical outcomes. We used single proportion analysis with 95% confidence intervals under a random-effects model, I2 to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Publication bias was assessed by funnel-plot analysis and Egger's test. Outcomes included complete occlusion following embolization, unsuccessful endovascular embolization attempts, incomplete occlusion following embolization, symptom resolution or clinical improvement following embolization, recurrence; procedure-related complications, morbidity, and mortality. Additionally, a subanalysis for studies exclusively utilizing Onyx™ embolic system was done. Eighteen studies comprising 231 ACF-dAVF were included. Unsuccessful endovascular embolization attempts rate was 2%. Complete occlusion rate was 85%, with 4% of complications. Incomplete occlusion rate was 10%. Successfully embolized patients experienced either symptom resolution or clinical improvement in 94% of cases. Morbidity and mortality rates were 1% and 0%, respectively. Onyx subanalyses showed an overall rate of 0% for unsuccessful attempts, 95% for complete occlusion, and 5% for incomplete occlusion. Symptom resolution or clinical improvement was 98% and recurrence rate was 0%. EVT for ACF-dAVF is highly feasible, effective, and safe, with a low rate of complications, morbidity, and mortality. The subanalyses focusing on Onyx embolizations revealed superior efficacy and safety outcomes compared to the findings of the primary analyses involving all included studies.

Assuntos

RESUMO

BACKGROUND: Head and Neck Paragangliomas are characterized by having a rich blood supply. Presurgical embolization with Onyx as a neoadjuvant treatment is not a consensus regarding its efficacy and safety. Our study aimed to answer this matter through a single-arm meta-analysis. METHODS: We systematically reviewed 4 databases. Sixteen studies were described and suitable papers were selected for meta-analysis of estimated intraoperative blood loss (EBL), percentage of tumor devascularization, and complications associated with embolization. RESULTS: The study identified 198 patients with 203 tumors, aged between 8 and 70 years. Commonly reported symptoms included neck mass perception and cranial nerve impairment. Carotid Body Tumors were most prevalent (127, 62.5 %), followed by jugular (48, 23.6 %), or vagal (29, 14.2 %) tumors. Eight studies reported estimated intraoperative blood loss (EBL) averaging 261.89 ml (95 %CI: 128.96 to 394.81 ml). In an analysis of 9 studies, 99 % (95 %CI: 96 to 100 %) achieved 70 % or more devascularization, and 79 % (95 %CI: 58 to 100 %) achieved 90 % or more devascularization. Complications from endovascular procedures were observed in 3 % (95 %CI: 0 to 8 %) of 96 patients across 10 studies, including 4 facial nerve deficits. Eighteen postoperative neurological deficits were reported across 15 articles. CONCLUSION: Despite acknowledged limitations, with refined indications, EVOH, especially Onyx embolization may significantly bolster patient safety, decreasing EBL and easing surgical resection. Further research with larger studies will refine criteria, optimize techniques, and improve patient care and treatment outcomes in the management of head and neck paragangliomas.

Assuntos

RESUMO

An ear prosthesis was designed in 3D computer graphics software and fabricated using a 3D printing process of polyvinylidene fluoride (PVDF) for use as a hearing aid. In addition, the prosthesis response to pressure and temperature was observed. Pyroelectric and piezoelectric properties of this ear prosthesis were investigated using an astable multivibrator circuit, as changes in PVDF permittivity were observed according to variations of pressure and temperature. The results show that this prosthesis is reliable for use under different conditions of pressure (0 Pa to 16,350 Pa) and temperature (2 °C to 90 °C). The experimental results show an almost linear and inversely proportional behavior between the stimuli of pressure and temperature with the frequency response. This 3D-printed ear prosthesis is a promising tool and has a great potentiality in the biomedical engineering field because of its ability to generate an electrical potential proportional to pressure and temperature, and it is the first time that such a device has been processed by the additive manufacturing process (3D printing). More work needs to be carried out to improve the performance, such as electrical stimulation of the nervous system, thereby extending the purpose of a prosthesis to the area of sensory perception.

Assuntos

RESUMO

BACKGROUND: Choroid plexus papilloma is a rare intracranial neoplasm derived from choroid plexus epithelium accounting for less than 1 % of all brain tumors. These tumors are highly vascularized, and tumor resection is difficult, especially in small children, due to severe intraoperative bleeding. Preoperative embolization is helpful to reduce intraoperative bleeding, but it may not be possible in small children or if the tumor has no suitable feeding vessels for embolization. METHODS: We present the case of a 2-year-old girl with a giant choroid plexus papilloma. An attempt of tumor resection was previously performed in another clinic, but the surgery was aborted due to massive intraoperative bleeding and only a biopsy was done. Angiography showed no suitable vessels for embolization. A new attempt of tumor removal was carried out, but again, severe intraoperative bleeding occurred and only a partial resection was possible. Intratumoral embolization with onyx through direct percutaneous puncture was performed. RESULTS: Radical tumor removal was possible after two additional surgeries. Intraoperative blood loss was 345 ml (first surgery = only partial removal), 250 ml (second procedure = 1/3 of tumor volume resected), and 250 ml (third surgery = total removal). The patient presented no additional deficits. CONCLUSIONS: Intratumoral percutaneous embolization with onyx was very helpful in reducing intraoperative bleeding in this case. Safe radical tumor resection was possible. This technique may be useful for those surgeons dealing with highly vascularized tumors, especially in small children. No report of intratumoral embolization with onyx in cases of intracerebral tumors could be found in the literature.

Assuntos

RESUMO

BACKGROUND AND PURPOSE: Traumatic intracranial pseudoaneurysms present a challenge for treatment. Traditionally these lesions have required a deconstructive approach consisting of vessel sacrifice since their fragile nature often makes direct microsurgical repair or coil embolization hazardous. As a high-viscosity liquid embolic agent that results in immediate, vessel sparing aneurysm occlusion, Onyx-HD 500 represents a uniquely efficacious tool for this clinical situation. CASE SUMMARY: We report the case of a 56-year-old right-handed gentleman who suffered a vascular injury to the ICA during revision transsphenoidal surgery for a recurrent pituitary macroadenoma. The patient was initially treated with nasal packing, but after recurrent episodes of epistaxis and a CT angiogram demonstrating a large traumatic ICA pseudoaneurysm, the patient was referred for invasive treatment. Given the presumed fragility of the lesion, embolization with Onyx-HD 500 was chosen in order to safely achieve immediate aneurysm occlusion without the need for vessel sacrifice. After an early recurrence due to incomplete initial embolization, the patient went on to complete occlusion without further hemorrhage. CONCLUSION: This case illustrates the utility of a high-viscosity liquid embolic agent in providing immediate protection from rehemorrhage by occluding a large ruptured pseudoaneurysm of the proximal intracranial ICA, while sparing the parent artery.

Assuntos

RESUMO

AIM: To introduce a modification of the reline impression technique (MRIT), and compare the dimensional changes of impressions obtained by MRIT and by conventional reline impression technique (CRIT). METHODS: An acrylic resin tablet was milled by a CAD-CAM system to simulate three abutments (A, B and C) with different distances among them. The abutments were molded using both impression techniques. For MRIT, before completing the putty silicone polymerization, the relieve procedure was made by compression and it was immediately repositioned to complete the polymerization. Impressions were stored dry at room temperature for different periods (immediately, 1 h, 2 days and 7 days). The distances were obtained by scanning. The differences between the impressions and their respective matrix reference measurements were calculated to determine the dimensional changes. Data were subjected to ANOVA and Tukey's test (p<0.05). RESULTS: For AB and BC distances, there was no statistically significant difference between CRIT and MRIT (p=0.0597 and p=0.2167, respectively). For AC, there was statistically significant difference between the techniques for the immediate storage time (p=0.006). In general, for CRIT the material showed expansion, while for MRIT it showed contraction. CONCLUSIONS: It was verified that the addition silicon impressions obtained by both impression techniques showed dimensional stability, except for the immediate time-point...

Assuntos

RESUMO

There exists a small, but growing body of literature that describes electroconvulsive therapy (ECT) performed on patients with intracranial aneurysms. These reports include patients with unrepaired aneurysms and others in which aneurysms have been repaired by clipping or coil embolization methods. To date, these cases have described favorable results and minimal complications. We describe the case of a 34-year-old woman, who received ECT 6 days after balloon-assisted embolization, with Onyx HD-500, of a 7-mm aneurysm of the ophthalmic segment of her left internal carotid artery. The patient experienced a significant reduction in depressive symptoms and tolerated a series of 8 treatments with no aneurysm-related complications. To our knowledge, this represents the earliest administration of ECT after repair of an intracranial aneurysm reported in the literature. Also, this is the only report in the literature of ECT performed after an intracranial aneurysm was repaired using the Onyx Liquid Embolic System.

Assuntos

RESUMO

BACKGROUND AND PURPOSE: Posterior cerebral artery aneurysms are treatment challenge for the neurosurgeon. Parent artery occlusion, trapping and bypass have been the classic treatment options for aneurysms in this location. With the introduction of newer embolic agents such as Onyx®, endovascular intervention is now a viable therapy for these aneurysms. CASE SUMMARY: We report the case of a 60-year-old man who presented with a symptomatic, though unruptured, fusiform left posterior cerebral artery aneurysm. Given the distal location of this dominant sided aneurysm, post-operative visual deficits and aphasia were a concern if parent vessel occlusion were to be performed. Therefore, an endovascular reconstruction using Onyx HD-500 and two closed-cell stents was performed. CONCLUSIONS: This report illustrates the ability of a high-density liquid embolic agent to provide immediate reconstruction of a fusiform aneurysm in a distal location.

Assuntos

RESUMO

Since the introduction of Onyx as a liquid embolic agent for the treatment of brain arteriovenous malformation (AVM), higher endovascular cure rates have been achieved. This may be partially attributed to its non-adhesive property, which allows longer intranidal progression of the embolic agent before solidification. However, Onyx reflux around the microcatheter can form a highly viscous plug, thereby constraining the microcatheter during its retrieval. Also, during the maneuver, arterial stretching can lead to vascular rupture and result in acute bleeding, a potentially fatal complication that demands immediate treatment. This report describes a new treatment strategy for the rapid management of such a complication. The technique consists of the placement of a second microcatheter about 2 cm proximal to the AVM nidus in the same artery containing the intranidal microcatheter. After conclusion of embolization, if rupture occurs during intranidal microcatheter retrieval, the second microcatheter that is already in place can promptly be used to control the bleeding.

Assuntos

RESUMO

O presente trabalho investigou microscopicamente o efeito da equistatina sobre o processo reabsortivo de dentes incisivos superiores de ratos, extraídos e reimplantados. Foram utilizados 42 animais, divididos em grupos com e sem equistatina. Os tempos extra-alveolares dos dentes foram de 30 e 60 minutos e os períodos experimentais pós-cirúrgicos foram 15, 60 e 90 dias. Os espécimes obtidos foram processados e corados em H.E. para observar os processos biológicos presentes. Os eventos microscópicos foram avaliados por dois examinadores, de modo quantitativo histomorfométrico e descritivo, de acordo com o tipo de infiltrado e intensidade da reação inflamatória; com o tipo, extensão e localização de reabsorção dentária; e presença de anquilose alveolodentária. O nível de concordância entre examinadores, determinado pelo índice Kappa, revelou-se quase perfeito para todas as variáveis avaliadas. A comparação entre os grupos testes e controle para as variáveis apresentadas foi feita por meio do teste Mann-Whitney e mostrou não haver diferença estatística entre a administração de equistatina e tempo extra-alveolar em relação à intensidade inflamatória nas diferentes porções radiculares. Quanto ao tipo de reabsorção estabelecida, notou-se que a presença de reabsorção inflamatória foi significativamente maior (p<0,05) no grupo controle nos tempos de 30 e 60 minutos no período pós-cirúrgico de 15 dias. A anquilose alveolodentária também esteve significativamente mais presente no grupo tratado com equistatina com 30 minutos extra-alveolar e 15 dias de período experimental. Houve, ainda, mais anquilose alveolodentária no grupo controle de 60 minutos extra-alveolar, com o período experimental de 60 dias. No período experimental de 90 dias todos os espécimes avaliados apresentaram processos reabsortivos inflamatórios e ausência de anquilose alveolodentária. O teste Kruskall-Wallis avaliou as diferenças significantes entre grupos, em relação à intensidade inflamatória por...

This study aimed to microscopically investigate the effect on the dental resorptive process of subgingival implants of ELVAX polymer with peptide echistatin in reimplantation of upper incisors in rats. For this purpose, 42 animals were used and divided into groups with and without echistatin. Extra alveolar socket period was 30 and 60 minutes and post-surgical experimental periods were 15, 60 and 90 days. Specimens were processed and stained with H.E. to observe the biological processes in the area. The microscopic events were evaluated by two examiners. Quantitative histomorphometric and descriptive evaluation of the events were performed according to the presence, type and location of the inflammatory response, incidence of resorptions or dental ankylosis. The level of agreement between examiners determined by the Kappa index, proved to be almost perfect for all variables. The comparison between the experimental and control groups for the variables presented was performed using the Mann-Whitney test and showed no statistical difference between the administration of echistatin and extra alveolar socket period relative to the inflammatory intensity in different portions of the root. Regarding the type of resorption established, it was noted that the presence of inflammatory resorption was significantly higher (p<0.05) in the control group on days 30 and 60 minutes in the postoperative period of 15 days. Dental ankylosis was also significantly more prevalent in the group treated with echistatin in extra alveolar socket period of 30 minutes and 15-day trial period. There was even more dental ankylosis in control group with 60 minutes of extra alveolar socket, with the trial period of 60 days. In the trial period of 90 days all specimens studied featured inflammatory resorptives processes and absence of dental ankylosis. The Kruskal-Wallis test assessed significant differences between groups in relation to the intensity of...

Assuntos