Journal of neurointerventional surgery
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Review Case Reports
Endovascular embolization of cervical hemangiopericytoma with Onyx-18: case report and review of the literature.
Cervical hemangiopericytoma (HPC) is a rare tumor involving dura and bone. Because HPC shares some imaging features with meningioma, hemangioblastoma, schwannoma and solitary fibrous tumors; histology with appropriate immunohistochemistry is essential for its diagnosis and treatment. HPC is highly vascular and has a high rate of local recurrence following resection. ⋯ Histology confirmed the presumptive diagnosis of HPC. Preoperative embolization with Onyx-18 should be considered for large HPC as it may decrease the risk of intraoperative hemorrhage. In this case, embolization with Onyx-18 did not preclude histopathologic diagnosis of HPC.
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'Artery of Percheron' is a rare variation in blood supply in which a solitary arterial trunk arises from one of the proximal segments of the posterior cerebral arteries and supplies the paramedian thalami bilaterally. A young patient (in their early 30s) who presented with sudden onset of visual disturbance and speech difficulties is reported. A review of literature from 1981 to 2009 and review of the most widely reported clinical signs and symptoms are provided.
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Spinal dural arteriovenous fistulas (SDAVFs) represent the most frequent spinal arteriovenous malformation and have an ominous natural history if left untreated. In the present review, we describe the spinal vascular anatomy, pathophysiology and clinical manifestations of SDAVFs, and the current role of endovascular embolization in this type of lesion.
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The incidence of heparin induced thrombocytopenia (HIT) in neurological patients continues to increase with expansion of indication for neurointerventional procedures. The pathophysiology of HIT is related to a hypersensitivity reaction against complex platelet factor 4. The diagnosis is mostly clinical and is often confirmed by laboratory testing. ⋯ Early diagnosis and heparin cessation are essential in the management of those patients. Both immediate and prolonged alternative anticoagulation are necessary. Understanding of the mechanism of action, indication and drug interaction of the alternative anticoagulants (direct thrombin inhibitors, fondaparinux and danaparoid) and warfarin is essential during management of these patients.
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The pending federal healthcare reform legislation includes Physician Payment Sunshine provisions that would mandate public disclosure of virtually all payments by industry to US physicians on government websites. The requirements reflect a growing trend toward public disclosure of payments following high-profile government investigations of allegedly improper payments and undisclosed conflicts of interests. The pending law world require broad disclosure and will affect most physicians. Industry and physicians groups have offered qualified support to the legislation.