metrizamide and Intracranial-Aneurysm

Topics: Adult; Biopsy; Brain Neoplasms; Cerebral Infarction; Child, Preschool; Cysts; Diagnosis, Differential; Diagnostic Errors; Hematoma; Humans; Intracranial Aneurysm; Male; Metrizamide; Middle Aged; Neuromuscular Diseases; Paranasal Sinus Neoplasms; Spinal Cord; Spine; Subarachnoid Hemorrhage; Tomography, X-Ray Computed

Two patients with distal basilar aneurysms were treated with intra-aneurysmal balloon occlusion. After apparently successful therapy, follow-up angiograms demonstrated aneurysm enlargement with balloon migration distally in the sac. Geometric mismatch between the base of the balloons and the aneurysm neck together with transmitted pulsation through the 2-hydroxyl-ethylmethacrylate (HEMA)-filled balloon directly contributed to aneurysm enlargement. In this report, the authors discuss the problems of progressive aneurysm enlargement due to a "water-hammer effect" and the possibility of hemorrhage following subtotal occlusion.

Topics: Adult; Basilar Artery; Catheterization; Dilatation, Pathologic; Humans; Intracranial Aneurysm; Male; Metrizamide; Middle Aged; Polyhydroxyethyl Methacrylate; Pulsatile Flow; Radiography

Four carotid-ophthalmic aneurysms were treated through a contralateral pterional approach. Three of these aneurysms were clipped successfully. Because awareness of the size and shape of the optic chiasm is crucial for the success of this approach, we used metrizamide or blood cisternography with a high resolution computed tomographic scanner. With this technique, the shape of the optic chiasm was delineated before operation to make certain that the prechiasmatic space was large enough for the aneurysm to be approached.

Topics: Adult; Blood; Carotid Artery Diseases; Carotid Artery, Internal; Female; Humans; Intracranial Aneurysm; Metrizamide; Middle Aged; Ophthalmic Artery; Optic Chiasm; Subarachnoid Space; Tomography, X-Ray Computed

An analysis of metrizamide computed tomography (CT) cisternographic findings in cases of communicating hydrocephalus has been carried out. Serial observations of the density in the periventricular area in 19 cases with metrizamide ventricular reflux have revealed the following different patterns: (a) precontrast periventricular hypodensity diminishing after CT cisternography and possibly indicating transependymal metrizamide migration (two cases); (b) periventricular hypodensity unchanged (two cases); (c) minimal periventricular hypodensity with slight rise in its attenuation values after ventricular metrizamide reflux (four cases); and (d) no periventricular hypodensity and no change after reflux (six cases). Our preliminary experience indicates that the presence of periventricular hypodensity with an increase in its attenuation values following ventricular reflux of metrizamide is possibly a criterion that may be used in favor of a cerebrospinal fluid shunting operation.

Topics: Adult; Basilar Artery; Cerebral Arteries; Cerebral Ventriculography; Female; Humans; Hydrocephalus; Intracranial Aneurysm; Male; Metrizamide; Middle Aged; Tomography, X-Ray Computed