Surgical Neuroangiography: Vol. 2: Clinical and Endovascular Treatment Aspects in Adults

1320 Pages·2004·69.41 MB·English

by  Alejandro Berenstein M.D.

Surgical Neuroangiography 2.1
Springer
Berlin
Heidelberg
New York
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Milan
Paris
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The complete three-volume set consists of
Volume 1
Clinical Vascular Anatomy and Variations
Volume 2
Clinical and Endovascular Treatment Aspects in Adults
Volume 3
Clinical and Interventional Aspects in Children
A. Berenstein Surgical
P. Lasjaunias
K.G. ter Brugge
Neuroangiography
2.1 Clinical and Endovascular
Treatment Aspects in Adults
• Cerebral Ischemia
• Vascular Tumors of the Head
and Neck
• Traumatic Arteriovenous Fistulae
• Aneurysms
Second Edition
with 734 Figures in 2926 Separate Illustrations,
Some in Color and 155 Tables
Springer
Alejandro Berenstein, M. D.
Professor of Radiology and Neurosurgery
Albert Einstein School of Medicine, NY
Director of the Hyman-Newman Institute of Neurology and Neurosurgery,
and of The Center for Endovascular Surgery
Beth Israel Medical Center New York
170 East End Avenue at 87th Street, New York, NY 10128, USA
Pierre Lasjaunias M. D., Ph. D.
Professeur des Universites en Anatomie
Chef de Service de Neuroradiologie Diagnostique et Therapeutique
Centre Hospitalier Universitaire de Bicetre
78, rue du General Leclerc, 94275 Le Kremlin Bicetre, France
Karel G. ter Brugge, M. D.
Professor of Radiology and Neurosurgery
Head, Division of Neuroradiology University of Toronto /
University Health Network
Department of Medical Imaging, Toronto Western Hospital, FP3-21O
399 Bathurst Street, Toronto, ON M5T 2S8, Canada
The second volume of the second edition of Surgical Neuroangiography
combines the previous volumes 2, 4 and 5 in a two part volume.
ISBN 3-540-41668-4 Springer-Verlag Berlin Heidelberg New York
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Preface
Anatomy is a language and mastery of this language is in our opinion
essential for physicians involved in the management of patients with vas
cular diseases of the central nervous system, head and neck, and spine and
spinal cord. Understanding the clinicopathological aspects of vascular
disease, its natural history, and the various therapeutic options is manda
tory for optimal patient management.
Functional endovascular therapeutic strategies continue to expand and
those that are currently available are discussed within the realm of the
authors' combined experience. Our approach goes beyond today's tech
nological advances and involves a new understanding of how vascular
pathology is expressed, its impact on the structure of the vascular sys
tems, and the possible repair mechanisms of the vascular system in vari
ous environments. The latest techniques that improve such therapeutic
goals are illustrated in the individual chapters on the diseases and high
lighted in the chapter on techniques.
The important field of occlusive vascular disease and our ability to re
open stenotic or even occluded vessels are revolutionizing Endovascular
Neurosurgery. An in-depth study of occlusive vascular disease is a major
addition to this second edition of Surgical Neuroangiography (Vol. 2).
Functional anatomical strategies and protocols are illustrated with the lat
est technological devices. As the rapid technological evolution continues,
our approach and understanding will help guide us to the safest and most
effective revascularization strategy.
Our new concepts with respect to aneurysms as a group of diseases
of different etiologies and pathophysiologies alter the therapeutic indica
tions for their management and therefore the role of specific treatment
techniques.
Our experience in the management of patients with vascular disorders
now extends over many decades and forms the basis for an approach to
cerebral and dural vascular malformations that is both at the leading edge
and well balanced. Management decisions based on a thorough under
standing of these vascular pathologies, their natural history, as well as the
risks associated with their treatment have been outlined in the text. This
work is a reflection of the authors' ongoing commitment to balancing the
exciting technological advances of the tools that have become available
with thorough knowledge of vascular anatomy and an exhaustive under
standing of vascular pathologies. It is this unique approach that facilitates
ongoing progress in the safe management of patients with vascular disor
ders affecting the brain, the spine, and the head and neck.
December 2003 A. Berenstein, P. Lasjaunias, K.G. ter Brugge
Contents of Volumes 2.1 and 2.2
1 Occlusive Vascular Disease 1
1.1 Introduction . . . . . . . . . 2
1.2 Arterial Occlusive Disease . 3
1.2.1 Cerebrovascular Physiology ........ . 3
1.2.1.1 The Blood-Brain Barrier 3
1.2.1.2 Cerebral Blood Flow 4
1.2.1.3 Cerebral Autoregulation 5
1.2.1.4 Cerebral Blood Volume . 7
1.2.1.5 Blood Viscosity ..... . . . . . . . . 8
1.2.1.6 Metabolism in Cerebral Blood Flow . . . . . . 8
1.2.1.7 Carbon Dioxide Reactivity .......... . 9
1.2.1.8 Oxygen Reactivity .............. . 9
1.2.1.9 Nitrous Oxide in Cerebral Circulation ... . 9
1.2.1.1 0 Other Factors ......... ...... . 10
1.2.2 Arterial Ischemic Stroke .......... . 14
1.2.2.1 Definition ................... . 14
1.2.2.2 Neuronal Metabolism and Cerebral Ischemia 17
1.2.2.3 Selective Neuronal Vulnerability . . . . . . . 18
1.2.2.4 Hemodynamic Effects of Ischemia ..... 21
1.2.2.5 Nitrous Oxide and Cerebral Ischemia . . . . 21
1.2.2.6 Window of Opportunity ......... . 22
1.2.2.7 Neutrophil ................ . 23
1.2.3 Atherosclerosis ............. . 23
1.2.3.1 Introduction . . . . . . . . . . . . . . . . 23
1.2.3.2 Epidemiology ............. . 23
1.2.3.3 Pathogenesis . . . . . . . . . . 24
1.2.3.4 Mechanisms of Atherogenesis 24
1.2.3.5 Fatty Streak ...... . 27
1.2.3.6 Fibrous Plaque . . . . . . 28
1.2.3.7 Unstable Fibrous Plaques 28
1.2.3.8 Complicated Plaque . . . 28
1.2.3.9 Carotid Atherosclerosis . . . . . . 29
1.2.3.10 Conclusion . . . . . . . . . . . . . 29
1.2.3.11 Neuroimaging of Ischemic Stroke 30
1.2.4 Ischemic Stroke Treatment . . . . 31
1.2.4.1 Medical Treatment of Acute Stroke ........... . 31
1.2.4.2 Thrombolytic Therapy: Introduction .......... . 32
1.2.4.3 Thrombolytics (IV) . . . . . . . . . . . . . . . . . . . . . 32
1.2.4.4 Recombined Tissue Plasminogen Activator . . . . . . . . 32
VIII Contents of Volumes 2.1 and 2.2
1.2.4.5 Streptokinase ..... . 33
1.2.4.6 Antiplatelets . . . . . . . 34
1.2.4.7 Coumadin Versus Aspirin 39
1.2.4.8 Neuroprotective Agents .. 39
1.2.4.9 Pharmacological Properties of Neuroprotective Drugs 40
1.2.4.10 Binding Properties ............... . 41
1.2.4.11 Angiographic Evaluation . . . . . . . . . . . . . 41
1.2.4.12 Middle Cerebral Artery Stroke: Natural History 44
1.2.4.13 Local Intra-arterial Thrombolysis
in the Anterior Circulation . . . . 45
1.2.4.14 Internal Carotid Artery Occlusion 52
1.2.4.15 Carotid Dissection ....... . 57
1.2.4.16 Central Retinal Artery Occlusion 67
1.2.4.17 Internal Carotid Artery Stenosis Above the Carotid Bulb 68
1.2.4.18 General Organization of a Stroke Emergency Team 70
1.2.4.19 Evolving Treatment Strategies .... 72
1.2.5 Extracranial Carotid Artery Stenosis 73
1.2.5.1 Introduction . . 73
1.2.5.2 Natural History 73
1.2.5.3 Carotid Bruit 75
1.2.5.4 Imaging 75
1.2.5.5 Treatment . 84
1.2.5.6 Symptomatic Carotid Stenosis 86
1.2.5.7 Asymptomatic Carotid Stenosis 86
1.2.5.8 Restenosis After Carotid Endarterectomy 89
1.2.6 Carotid Angioplasty and Stenting .... 90
1.2.6.1 Introduction . . . . . . . . . . . . . . . . 90
1.2.6.2 Techniques of Carotid Angioplasty and Stenting 93
1.2.6.3 Intimal Hyperplasia and Restenosis . . . . . . . 93
1.2.6.4 Follow-up Monitoring ............. . 98
1.2.7 Posterior Circulation Stroke (Stroke Prevention) 98
1.2.7.1 Introduction . . . . . . . . 98
1.2.7.2 Clinical Presentation ...... . 98
1.2.7.3 Pretherapeutic Evaluation
in Cerebral Vascular Insufficiency 99
1.2.7.4 Management of Posterior Circulation Insufficiency 104
1.2.7.5 Basilar Thrombosis . 110
1.2.7.6 Takayasu's Arteritis . 115
1.2.8 Cerebral Angioplasty 116
1.2.8.1 Vasospasm ..... . 117
1.3 Venous Occlusive Disease 135
1.3.1 Etiology ........ . 135
1.3.2 Incidence ........ . 136
1.3.3 Clinical Presentation and Natural History 137
1.3.4 Imaging 138
1.3.5 Treatment 143
Appendix. 147
Contents of Volumes 2.1 and 2.2 IX
2 Dural and Bony Tumors 153
2.1 Introduction . 154
2.2 Meningiomas 154
2.2.1 Epidemiology 154
2.2.1.1 Origin 154
2.2.1.2 Incidence ... 154
2.2.1.3 Association of Meningiomas with Other Tumors 155
2.2.1.4 Sex Hormone Receptors in Meningiomas 156
2.2.1.5 Chromosomal Patterns in Meningiomas 156
2.2.1.6 Meningiomas in Children ....... . 156
2.2.1.7 Familial Occurrence . . . . . . . . . . . . 157
2.2.1.8 Meningioma Incidence, Prevalence, and Mortality 157
2.2.1.9 Etiology of Human Meningiomas 157
2.2.1.10 Oncogenic Viruses 158
2.2.2 Pathology ..... 161
2.2.2.1 Growth and Spread 162
2.2.2.2 Malignant Meningioma 162
2.2.2.3 Angioblastic Meningioma and/or Hemangiopericytoma 165
2.2.2.4 Meningioangiomatosis ... 166
2.2.2.5 Meningeal Meningiomatosis 166
2.2.3 Clinical Presentation . 166
2.2.3.1 Sites ............ . 169
2.2.3.2 Epidural Meningiomas .. 177
2.2.3.3 Meningiomas of the Orbit 177
2.2.3.4 Meningiomas Involving the Cavernous Sinus 178
2.2.3.5 Meningiomas in Other Unusual Sites 179
2.2.3.6 Intracranial Vascular Involvement . . 179
2.2.3.7 Peri tumoral Edema in Meningiomas 181
2.2.4 Pretherapeutic Evaluation .. 181
2.2.4.1 CT Scanning in Meningiomas 181
2.2.4.2 MRI Scanning ....... . 182
2.2.4.3 Angiographic Investigation 184
2.2.4.4 Differential Diagnosis . . . . 187
2.2.5 Therapeutic Strategy and Clinical Objectives 187
2.2.6 Technical Aspects of Embolization ..... 189
2.2.7 Special Considerations in Meningioma Embolization 192
2.2.7.1 Extracranial Tumor Extension . . . . . . . . . . . . 192
2.2.7.2 Recurrent Meningiomas .............. . 192
2.2.7.3 Internal Carotid Supply to Recurrent or Malignant
Meningiomas After Radiation Therapy Has Failed 194
2.2.7.4 Pial Supply . . . . . . . . . . . . . . . . . . . . . . 194
2.2.7.5 Pre- and Postembolization Medical Management 194
2.2.7.6 Time of Operation . . . . . . . . 196
2.2.7.7 Complications of Embolization 196
2.3 Other Bony and Dural Tumors 198
2.3.1 Cerebral Tumors . . . . . 198
2.3.2 Neurinomas ...... . 199
2.3.3 Esthesioneuroblastomas 199
X Contents of Volumes 2.1 and 2.2
3 Nasopharyngeal Tumors 201
3.1 Juvenile Angiofibromas 201
3.1.1 Macroscopic Pathology 201
3.1.2 Microscopic Pathology 204
3.1.3 Epidemiology ........................ 205
3.1.4 Pathophysiology . . . . . . . . . . . . . . . . . . . . . .. 206
3.1.4.1 Juvenile Angiofibromas and Sex Hormones 206
3.1.4.2 Physiology and the Nasal Mucosa ... 206
3.1.4.3 Hormones and the Vascular System . . . . . 207
3.1.4.4 Global Hypothesis for the Development
of Juvenile Angiofibromas 207
3.1.5 Clinical Findings ..... 210
3.1.6 Natural History ...... 211
3.1.7 Pretherapeutic Evaluation 211
3.1.7.1 Computed Tomography. . . . . .. .......... 211
3.1.7.2 Magnetic Resonance Imaging ............... 211
3.1.7.3 Angiography . . . . . . . . . . . . . . . . . . . . . . . .. 211
3.1.8 Therapeutic Goals . . . . . . . . . . . . . . . . . . . . .. 214
3.1.8.1 Radiation Therapy ................ 221
3.1.9 Technical Aspects of Embolization ....... 221
3.1.10 Tumor Recurrence ....... 223
3.2 Other Nasopharyngeal Tumors 224
3.3 Conclusion . . . . . . . . . . . . 226
4 Paragangliomas 227
4.1 Introduction . . . 227
4.2 Embryology ... 228
4.3 Epidemiology .... 230
4.4 Pathology ...... 232
4.4.1 Vascular Architecture 233
4.5 Natural History ... 235
4.6 Clinical Aspects ...... 236
4.6.1 Tympanic Paragangliomas 236
4.6.2 Jugular Paragangliomas 238
4.6.3 Cervical Paragangliomas 238
4.6.4 Paragangliomas in Other Locations ..... . . . . . .. 244
4.6.5 Secretory Paragangliomas 245
4.6.6 Associated Lesions 246
4.7 Differential Diagnosis 246
4.8 Pretherapeutic Evaluation ............. 250
4.8.1 Angiographic Protocol ............... 252
4.8.2 Temporal Paragangliomas: Specific Features ... 252
4.8.3 Cervical Paragangliomas: Specific Features 257
4.9 Therapeutic Strategies ............... 260
4.10 Technical Aspects of Embolization ........ 261
4.11 Complications of Embolization of Paragangliomas 264
Contents of Volumes 2.1 and 2.2 XI
5 Other Head and Neck Tumors 265
5.1 Thyrolaryngeal Tumors 265
5.2 Craniofacial Tumors 270
6 Traumatic Arteriovenous Fistulae 277
6.1 Introduction . . . . . . . . . . . . . . 277
6.2 Traumatic Carotid Cavernous Fistulae 279
6.2.1 Etiology and Epidemiology . . . . . . . 279
6.2.2 Clinical Aspects of Traumatic Carotid Cavernous Fistulae 285
6.2.2.1 Ophthalmological Symptoms ............... 293
6.2.2.2 Corneal Ulcerations and/or Infections
and Secondary Glaucoma . 293
6.2.2.3 Diplopia ................. 298
6.2.2.4 Cranial Nerve Involvement
in Traumatic Carotid Cavernous Fistulae 298
6.2.2.5 Bruit ................. 300
6.2.2.6 Arterial Steal . . . . . . . . . . . . . 300
6.2.2.7 Hemispheric Arterial Insufficiency 300
6.2.2.8 Associated Traumatic Lesions 302
6.2.3 Pretherapeutic Evaluation .. 306
6.2.3.1 Location of the Fistula 308
6.2.3.2 Venous Drainage of the Fistula 314
6.2.4 Therapeutic Objectives and Strategy 321
6.2.4.1 Embolization ............. 321
6.2.4.2 Emergency Treatment ........ 322
6.2.4.3 Surgical Approach to Carotid Cavernous Fistulae 324
6.2.4.4 Conservative Treatment
of Traumatic Carotid Cavernous Fistulae 325
6.2.5 Technical Aspects of Embolization 325
6.2.5.1 Balloon Selection ........... 325
6.2.5.2 Manual Compression . . . . . . . . . 332
6.2.5.3 The Use of NBCA in the Management
of Carotid Cavernous Fistulae .... 332
6.2.6 Postembolization Care ........ 333
6.3 Other Traumatic Arteriovenous Fistulae 334
6.3.1 Extracavernous Arteriovenous Fistulae 334
6.3.2 Vertebral Arteriovenous Fistulae 338
6.3.3 Common Carotid Fistulae 342
6.3.4 External Carotid Fistulae 342
6.3.5 Malignant Fistulae 354
6.3.6 Other Epistaxis 354
6.3.6.1 Coagulopathy ... 357
6.3.6.2 Spontaneous Epistaxis 357
6.3.6.3 Tumoral Epistaxis . 357
6.3.6.4 Biopsy ....... 359
6.3.6.5 Traumatic Epistaxis 362