Tips and Tricks for Difficult Prostatic Artery Embolization

Prostatic artery embolization (PAE) is a promising, new, safe, minimally invasive procedure for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. However, it can be a one of the most technically difficult interventional radiology procedures because of the challenging anatomy involved. To help achieve technical success and limit complications, the authors present here a series of tips and tricks that have been proven useful from prior PAE experience

Utility of Pelvic Computed Tomography Angiography Prior to Prostatic Artery Embolization

Pelvic computed tomography angiography (CTA) prior to prostatic artery embolization is a beneficial tool for preprocedural planning to increase the likelihood of success during what can be a challenging procedure. Additionally, the same CTA images can be used for calculating the baseline prostate volume as well as for intraprocedural anatomic guidance, adding to the value of the scan. This article discusses the technique used for pelvic CTA and its role in preprocedural assessment of the pelvic vasculature prior to prostatic artery embolization

Review of Current Literature for Prostatic Artery Embolization

Prostatic artery embolization (PAE) is an emerging, novel interventional technique in the management of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BPH is a common clinical condition in middle-aged and elderly men resulting in LUTS, including nocturia, urinary frequency, urgency, decreased urinary flow rates, hesitancy, and incomplete bladder emptying. Traditionally, LUTSs have been managed by medical or surgical therapies. Since the initial incidental discovery that selective PAE performed for uncontrolled bleeding secondary to BPH resulted in improved LUTS, the technique has continually evolved with a growing body of evidence supporting its safety and efficacy. However, despite the available data, PAE has yet to be established as a standard-of-care treatment option for patients with LUTS/BPH. In this article, the authors review the history and current state of PAE, including published data from case reports, animal studies, retrospective/prospective cohort studies, and prospective randomized controlled trials

Image-guided Percutaneous Drainage for Treatment of Post-Surgical Anastomotic Leak in Patients with Crohn’s Disease

BACKGROUND AND AIMS: Anastomotic leaks with abscess formation are a common complication after bowel surgery in Crohn's disease patients. Image-guided percutaneous drainage is an attractive alternative to reoperation because of decreased morbidity and length of hospital stay. Because data for this specific population are scarce, the purpose of this study is to determine the safety and efficacy of image-guided percutaneous drainage in the management of post-surgical anastomotic leak in patients with Crohn's disease. METHODS: A total of 41 patients who underwent percutaneous drain placement for the treatment of fluid collections due to anastomotic leak from September 2004 to November 2013 were retrospectively identified from the electronic medical record and picture archiving and communication system. Data recorded included number, size, and location of anastomotic leaks, number of drains placed, number of follow-up visits, post-drainage complications, abscess resolution, and subsequent surgeries. RESULTS: In all, 41 patients with 76 fluid collections were identified as having received percutaneous drains. The mean number of targeted fluid collections per patient was 1.5, and the mean duration between surgery and percutaneous drain placement was 18.5 days. The mean number of drains placed was 1.6, and the median drain size was 10 French [range 8-16 French]. One of 41 [2.4%] patients experienced a minor complication from drain placement [injury to a superficial abdominal artery] and no major complications occurred. Two of 41 [4.9%] patients required repeat surgeries. CONCLUSIONS: Image-guided percutaneous drainage for the treatment of post-surgical anastomotic leaks in Crohn's patients is effective and safe, with low rates of complications and reoperations

The Role of PET Imaging Before, During, and After Percutaneous Hepatic and Pulmonary Tumor Ablation

The combination of anatomic and metabolic information provided by positron emission tomography (PET)/computed tomography makes it an important imaging modality to be obtained in conjunction with percutaneous ablation of primary and secondary malignancies of the lungs and liver. Advantages include more accurate preprocedural staging to determine appropriate treatment options, intraprocedural guidance to target difficult-to-see lesions, and postprocedural detection of residual or recurrent disease. Future applications of PET include strategies for intraprocedural guidance with real-time determination of incompletely ablated tumor, and combined PET/magnetic resonance imaging before, during, and after ablation for greater sensitivity to detect disease

Comparison of Type II Endoleak Embolizations: Embolization of Endoleak Nidus Only versus Embolization of Endoleak Nidus and Branch Vessels

AbstractPurposeTo compare outcomes of type II endoleak embolization involving embolization of the endoleak nidus only vs embolization of the endoleak nidus and branch vessels in patients treated with endovascular repair of abdominal aortic aneurysms.Materials and MethodsTwenty-nine consecutive patients (mean age, 77.9 y; range, 63–88 y) with type II endoleak who underwent embolization from 2004 to 2015 were retrospectively reviewed. Patients were divided into 2 groups: embolization of endoleak nidus only (group A) and embolization of endoleak nidus and branch vessels (group B). Mean follow-up intervals were 20.5 months ± 14.7 in group A and 24.3 months ± 18.5 in group B. Outcomes were compared between groups by Mann–Whitney U and Pearson χ2 tests.ResultsMean interval from endovascular aneurysm repair to embolization was 47.6 months ± 42.9, and mean presentation time of endoleak before embolization was 23.1 months ± 25.8. Coils (n = 28) and liquid embolic agents (n = 23) were used for embolization. There were no significant differences in rates of residual endoleak (50% vs 53.8%; P = .96) or sac decrease/stabilization (62.5% vs 61.5%; P = .64). Procedure time and radiation exposure in group B (132.3 min ± 78.1; 232.4 Gy·cm2 ± 130.7) were greater than in group A (63.4 min ± 11.9; 61.5 Gy·cm2 ± 35.5; P < .01). There were no procedure-related complications.ConclusionsEmbolization of the endoleak nidus and branch vessels is not superior to embolization of only the nidus in terms of occlusion of type II endoleak and change in sac size despite requiring longer procedure times and resulting in greater patient radiation exposure

Factors associated with preservation of facial nerve function after surgical resection of vestibular schwannoma

Avoidance of facial nerve palsy is one of the major goals of vestibular schwannoma (VS) microsurgery. In this study, we examined the significance of previously implicated prognostic factors (age, tumor size, the extent of resection and the surgical approach) on post-operative facial nerve function. We selected all VS patients from prospectively collected database (1984–2009) who underwent microsurgical resection as their initial treatment for histopathologically confirmed VS. The effect of variables such as surgical approach, tumor size, patient age and extent of resection on rates facial nerve dysfunction after surgery, were analyzed using multivariate logistic regression. Patients with preoperative facial nerve dysfunction (House-Brackman [HB] score 3 or higher) were excluded, and HB grade of 1 or 2 at the last follow-up visit was defined as “facial nerve preservation.” A total of 624 VS patients were included in this study. Multivariate logistic regression analysis found that only pre-operative tumor size significantly predicted poorer facial nerve outcome for patients followed-up for ≥6 and ≥12 months (OR 1.27, 95% CI 1.09–1.49, p < 0.01; OR 1.35, 95% CI 1.10–1.67, P < 0.01, respectively). We found no significant relationship between facial nerve function and age, extent of resection, surgical approach, or tumor size (when extent of resection and surgical approach were included in the regression analysis). Because facial nerve palsy is a debilitating and psychologically devastating condition for the patient, we suggest altering surgical aggressiveness in patients with unfavorable tumor anatomy, particularly in cases with large tumors where overaggressive resection might subject the patient to unwarranted risk. Residual disease can be followed and controlled with radiosurgery if interval growth is noted

Activity-Induced Remodeling of Olfactory Bulb Microcircuits Revealed by Monosynaptic Tracing

The continued addition of new neurons to mature olfactory circuits represents a remarkable mode of cellular and structural brain plasticity. However, the anatomical configuration of newly established circuits, the types and numbers of neurons that form new synaptic connections, and the effect of sensory experience on synaptic connectivity in the olfactory bulb remain poorly understood. Using in vivo electroporation and monosynaptic tracing, we show that postnatal-born granule cells form synaptic connections with centrifugal inputs and mitral/tufted cells in the mouse olfactory bulb. In addition, newly born granule cells receive extensive input from local inhibitory short axon cells, a poorly understood cell population. The connectivity of short axon cells shows clustered organization, and their synaptic input onto newborn granule cells dramatically and selectively expands with odor stimulation. Our findings suggest that sensory experience promotes the synaptic integration of new neurons into cell type-specific olfactory circuits

Utility of Pelvic Computed Tomography Angiography Prior to Prostatic Artery Embolization

Pelvic computed tomography angiography (CTA) prior to prostatic artery embolization is a beneficial tool for preprocedural planning to increase the likelihood of success during what can be a challenging procedure. Additionally, the same CTA images can be used for calculating the baseline prostate volume as well as for intraprocedural anatomic guidance, adding to the value of the scan. This article discusses the technique used for pelvic CTA and its role in preprocedural assessment of the pelvic vasculature prior to prostatic artery embolization