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Thread: dr. young

  1. #1
    Senior Member
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    dr. young

    dr. young-

    in your entire career, how many cases of young men or women have you seen paralyzed to some degree by a spinal avm? Is it true that a SCI from cord ischemia/infarction is more apt for a recovery than traumatic injuries? Could you fill me in on the cascade of problems which occur when venous congestion ( not a bleed ) disrupts the cord's draining veins? How does a spinal cord look years after such a injury? What have you seen on the spinal cord of freshly dead cadavers who sustained such a SCI?

    sherman brayton

  2. #2
    Sherman,

    I participated in one of the first study of successful embolization of arteriovenous malformations. I am proud of this study because it was the first study to show that AVMs can be embolized with relatively little morbidity. This study changed the way AVMs were treated in the world.

    Recovery is variable in people who have had arteriovenous malformations. No, I have not personally seen the spinal cord of a person who had an arteriovenous malformation although I have seen some presentations of autopsies and there are some published studies. There is

    Venous congestion occurs when venous pressure is high. This slows down blood flow because the pressure gradient between the artery and venous sides of the capillaries determines the rate of blood flow. Obviously, when the venous pressure rises, the pressure difference between the artery and vein decreases. The higher the pressure, the greater the ischemia. Ischemia takes time to damage the spinal cord. Generally, if all blood flow is stopped to the spinal cord for 30 minutes, the spinal cord is damaged, particularly gray matter.

    Wise.



    • Berenstein A, Young W, Ransohoff J, Benjamin V and Merkin H (1984). Somatosensory evoked potentials during spinal angiography and therapeutic transvascular embolization. J Neurosurg. 60: 777-85. Somatosensory evoked potentials (SEP's) were monitored during 42 angiographic examinations and 33 therapeutic embolization procedures in 41 patients. The SEP amplitude decreased in 36 of the 42 angiographic techniques, but recovered to baseline within 2 to 4 minutes in all but one case. Angiographic opacification of the anterior spinal artery reduced SEP amplitude in all but two patients, who had lost their proprioceptive sense and had no recognizable SEP prior to the procedure. No neurological complications resulted from any of the angiography procedures. Of the 33 embolizations, 15 were performed in 12 patients with arteriovenous malformations (AVM's) and 18 in 17 patients with spinal canal tumors. There was only one complication associated with embolization: that occurred in a patient with an intramedullary spinal cord AVM. Monitoring SEP amplitude in this series of patients provided a means of rapidly and reliably identifying the anterior spinal artery, served to assess the potential risk of contemplated steps in embolization, and aided in the execution of the angiographic procedures.

  3. #3
    Please, can you explain with easier words?

    TH 12 incomplete 12-12-69. I am still a walker but I do not know for how long time.

  4. #4
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    This is a very interesting topic. i have a friend with same condition. You don't hear much on this topic thank you Dr. Young.
    I also have a question for you. Is there a specific name for the surgery Dr. Huang is doing. I am very familiar with the procedure but was wondering what the surgical term was?
    Thanks Jai

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