St. Elisabeth Ziekenhuis

Tilburg, Netherlands

St. Elisabeth Ziekenhuis

Tilburg, Netherlands
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Van Rooij W.J.,St. Elisabeth Ziekenhuis | Van Rooij S.B.T.,St. Elisabeth Ziekenhuis
Interventional Neuroradiology | Year: 2013

Traumatic pericallosal artery aneurysms are rare complications of blunt head trauma. The pericallosal artery is torn under the sharp edge of the rigid falx. CT shows a typical hematoma in the corpus callosum. Endovascular treatment with occlusion of the aneurysm including the parent vessel with coils or glue is the best treatment option.


Venmans A.,St. Elisabeth Ziekenhuis | Lohle P.N.M.,St. Elisabeth Ziekenhuis | Van Rooij W.J.,St. Elisabeth Ziekenhuis
Skeletal Radiology | Year: 2014

Objective: Little is known about the natural course of pain from vertebral compression fractures (VCF). In this study we evaluated the pain course in conservatively treated patients with back pain and a VCF on the spine radiograph. Materials and methods: Between May 2007 and November 2008, 169 patients with back pain referred by the general practitioner for spine radiographs and with a VCF were requested to participate in this follow-up study. Base line questionnaires about visual analogue scale (VAS) score, type of treatment and use of osteoporosis medication were filled in by 82 patients. Questionnaires were repeated at 6 weeks, and at 3, 6 and 12 months. Significant pain relief was defined as a decrease in VAS score of 50 % or more from baseline. Results: At baseline, mean VAS score in 82 patients was 6.9 (SD 2.0). Significant pain relief at 12 months was reported by 44 patients (54 %) while in 38 patients (46 %) pain relief was insufficient. No predictors for pain relief could be identified. Patients with insufficient pain relief at 12 months used significantly more analgesics and in these patients physiotherapy did better than other types of therapy. Conclusion: More than half of conservatively treated patients with back pain and VCF had sufficient pain relief at 12 months with most pain decrease in the first 3 months. However, a substantial proportion of patients still reported disabling pain. There were no predictors for the development of chronic pain. Patients with continuing pain ≥3 months after diagnosis of VCF may be candidates for vertebroplasty. © 2013 ISS.


Van Rooij W.J.,St. Elisabeth Ziekenhuis | Sluzewski M.,St. Elisabeth Ziekenhuis
American Journal of Neuroradiology | Year: 2010

BACKGROUND AND PURPOSE: Dural fistulas with cortical venous drainage often present with hemorrhage or neurologic deficit, and prompt treatment is indicated. Occlusion of the draining vein by endovascular techniques or surgical disconnection is considered curative. We present our first endovascular experience with use of Onyx via the arterial route in these aggressive fistulas. MATERIALS AND METHODS: Between October 2008 and October 2009, 8 consecutive patients with a dural fistula with exclusive cortical venous drainage were treated with Onyx. Three patients presented with hemorrhage; 3, with hemianopsia; 1 with bruit; and 1 after incomplete coil occlusion of a benign sigmoid sinus dural fistula. Fistula location was the sigmoid sinus segment in 4, the occipital area in 2, the cavernous sinus in 1, and the torcula in 1. RESULTS: In all 8 patients, it was possible to occlude the proximal venous site of the fistula with Onyx via arterial feeders, resulting in complete cure in all. In 6 patients, a prolonged (17- to 29-minute) single middle meningeal artery injection was sufficient to occlude the venous site of the fistula with retrograde occlusion of other arterial feeders; in the other 2 patients, 2 injections in supplying arteries were needed. Follow-up angiograms after 6-12 weeks confirmed lasting complete occlusion of the fistulas. All patients were clinically cured, there were no complications. CONCLUSIONS: In this small series, curative embolization of dural fistulas with exclusive cortical venous drainage by using Onyx via the arterial route was possible in all patients.


Lee H.,St. Elisabeth Ziekenhuis | Brekelmans G.J.F.,St. Elisabeth Ziekenhuis | Roks G.,St. Elisabeth Ziekenhuis
Clinical Neurophysiology | Year: 2015

Objective: Current diagnostic criteria for dementia with Lewy bodies (DLB) regard electroencephalogram (EEG) abnormalities as a supportive feature. It has also been suggested that EEG abnormalities in DLB are more extensive than in Alzheimer's disease (AD). Still, the use of qualitative EEG analysis as a diagnostic tool to distinguish between DLB and AD remains rare in daily clinical practice because of conflicting studies and absence of a reliable scoring method. The Grand Total EEG (GTE) score has been used in one study to differentiate DLB from AD with good sensitivity and specificity (Roks et al., 2008). Methods: EEGs from 29 patients with DLB and 54 with AD were visually rated according to the GTE score. Results: Patients with DLB had significantly higher median scores than patients with AD: 9 vs. 4. Patients with DLB could be distinguished from those with AD at a GTE cut-off score of 6.5 with a sensitivity of 79% and a specificity of 76%. The association between GTE and DLB was independent of age, gender, Mini Mental State Examination and use of medication. Frontal intermittent rhythmic delta activity (FIRDA) was found in 17.2% of patients with DLB compared to 1.8% with AD. Except for the lower cut-off score our results are comparable to the previous study on the GTE score. Conclusion: The GTE score has proven to be a reliable and simple scoring method applicable to daily clinical practice. Qualitative EEG analysis can help to differentiate DLB from AD with good sensitivity and specificity. Significance: EEG should play a more prominent role in daily clinical practice as a diagnostic tool in differentiating DLB from AD. Future revisions of the diagnostic criteria for DLB should consider the other EEG abnormalities as mentioned in the GTE score, especially FIRDA. © 2014 International Federation of Clinical Neurophysiology.


Roukema J.A.,St. Elisabeth Ziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2013

Massive investments are being made for research into the prevention and reduction of risks and diseases. False-positive outcomes from screening investigations result in fear in a substantial number of patients, and are expensive for society as a whole. Screening for breast cancer has little or no impact on breast-cancer mortality; rather, the negative side-effects of false-positive outcomes of breast cancer screening are a serious problem. The incidence of false-positive results of colorectal cancer screening is underestimated. The risks of overdiagnosis and overtreatment as a result of screening are substantial.


van Rooij W.J.,St. Elisabeth Ziekenhuis
AJNR. American journal of neuroradiology | Year: 2012

Patients with ruptured brain AVMs are at considerable risk of repeat hemorrhage, particularly when associated intranidal or flow-related aneurysms are present. There is controversy about the timing of diagnosis and treatment of patients with hemorrhagic stroke. We present our results of endovascular treatment of ruptured AVMs in the acute phase. Between January 2008 and March 2011, 23 patients (16 men, 7 women; mean age 42 years) with AVM-related hemorrhagic stroke were treated with endovascular techniques within 10 days of the ictus. There were 10 micro-AVMs (< 1 cm) and 1 single-hole pial fistula. In 9 patients, an intranidal or flow-related aneurysm was the likely cause of hemorrhage. Complete obliteration of the AVM with Onyx was achieved in 13 of 23 patients (57%). Eight of the 13 AVMs were micro-AVMs and 3 had an intranidal aneurysm. Partial obliteration of the AVM was achieved in 10 of 23 patients (43%). In 6 of these 10 patients, an intranidal (n = 1) or flow-related aneurysm (n = 5) was obliterated with Onyx or coils. There were no complications of treatment. During a mean follow-up of 21 months in 22 surviving patients, no repeat hemorrhage occurred. Endovascular treatment with Onyx in the acute phase cured most ruptured AVMs. All 9 AVM-associated aneurysms that were considered the source of hemorrhage could be excluded from the circulation. In patients with AVM-related hemorrhagic stroke, prompt angiographic diagnosis and treatment may improve prognosis by reducing repeat hemorrhage rate.


Sluzewski M.,St. Elisabeth Ziekenhuis | Van Rooij W.J.,St. Elisabeth Ziekenhuis | Lohle P.N.,St. Elisabeth Ziekenhuis | Beute G.N.,St. Elisabeth Ziekenhuis | Peluso J.P.,St. Elisabeth Ziekenhuis
American Journal of Neuroradiology | Year: 2013

BACKGROUND AND PURPOSE: During embolization of meningiomas, intratumoral hemorrhagic complications may occur, especially with the use of small particle sizes. We compared the rate of hemorrhagic complications in 55 patients embolized with 400-k mcalibrated microspheres (Embozene) with a historical cohort of 198 patients embolized with smaller PVA particles. MATERIALS AND METHODS: Between September 2009 and February 2012, fifty-five patients with 55 meningiomas were embolized with 400-μm calibrated microspheres. Indications for embolization were preoperative in 47 and before radiosurgery in 2 patients; and in 6 patients, embolization was offered as sole therapy. There were 35 women and 20 men with a mean age of 60.3 years. Mean meningioma diameter was 53 mm (range, 23-97 mm). Hemorrhagic complications were recorded. RESULTS: There were no hemorrhagic complications in the 55 embolized patients (0%; 95% CI, 0.0%-7.8%). The difference in complication rates between 400-μmcalibrated microspheres in this study (0 of 55, 0%) and small PVA particles (45-150μm) in the historical cohort (9 of 108, 8.3%) was just short of significance (P=.066). The difference in complication rates between 400-μmcalibrated microspheres (0 of 55, 0%) and larger PVA particles (150 -250 μm) in the historical cohort (1 of 93, 1.1%) was not significant (P = .8). CONCLUSIONS: In this series, embolization of meningiomas by using large (400-μm) calibrated microspheres did not result in any hemorrhagic complications.


Carli D.F.M.,St. Elisabeth Ziekenhuis | Sluzewski M.,St. Elisabeth Ziekenhuis | Beute G.N.,St. Elisabeth Ziekenhuis | Van Rooij W.J.,St. Elisabeth Ziekenhuis
American Journal of Neuroradiology | Year: 2010

BACKGROUND AND PURPOSE: Particle embolization is widely used in the treatment of meningiomas. We assessed the frequency and outcome of complications of embolization of meningiomas and tried to identify risk factors. MATERIALS AND METHODS: Between 1994 and 2009, a total of 198 patients with 201 meningiomas underwent embolization. Indication for embolization was preoperative in 165 meningiomas and adjunctive to radiosurgery in 8. In the remaining 28 meningiomas, embolization was initially offered as a sole therapy. There were 128 women and 70 men with a mean age of 54.4 years (median age, 54 years; range, 15-90 years). Complications were defined as any neurologic deficit or death that occurred during or after embolization. Logistic regression was used to identify the following possible risk factors: age above median, female sex, tumor size above median, meningioma location in 5 categories, use of small particle size (45-150 μm), the presence of major peritumoral edema, and arterial supply in 3 categories. RESULTS: Complications occurred in 11 patients (5.6%; 95% confidence interval [CI], 3.0%-9.8%). Ten complications were hemorrhagic, and 1 was ischemic. Six of 10 patients with hemorrhagic complications underwent emergency surgery with removal of the hematoma and meningioma. Complications of embolization resulted in death in 2 and dependency in 5 patients (7/198, 3.5%; 95% CI, 1.6%-2.0%). The use of small particles (45-150 μm) was the only risk factor for complications (odds ratio [OR], 10.21; CI, 1.3-80.7; P = .028). CONCLUSIONS: In this series, particle embolization of meningiomas had a complication rate of 5.6%. We believe that the use of small polyvinyl alcohol (PVA) particles (45-150 μm) should be discouraged.


van Rooij W.J.,St Elisabeth Ziekenhuis
Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences | Year: 2014

Flow diverter devices became available in our department in 2009. We considered treatment with flow diverters only in patients with aneurysms not suitable for surgery or conventional endovascular techniques. This paper presents our preliminary experience with flow diverters in a consecutive series of 550 endovascular aneurysm treatments. Between January 2009 and July 2013, 550 endovascular treatments for intracranial aneurysms were performed. Of these, 490 were first-time aneurysm treatments in 464 patients and 61 were additional treatments of previously coiled aneurysms in 51 patients. Endovascular treatments consisted of selective coiling in 445 (80.8%), stent-assisted coiling in 68 (12.4%), balloon-assisted coiling in 13 (2.4%), parent vessel occlusion in 12 (2.2%) and flow diverter treatment in 12 (2.2%). Eleven patients with 12 aneurysms were treated with flow diverters. Two patients had ruptured dissecting aneurysms. One patient with a basilar trunk aneurysm died of acute in stent thrombosis and another patient died of brain stem ischaemia at 32 months follow-up. One patient had ischaemia with permanent neurological deficit. Two aneurysms are still open at up to 30 months follow-up. Flow diversion was used in 2% of all endovascular treatments. Both our own poor results and the high complication rates reported in the literature have converted our initial enthusiasm to apprehension and hesitancy. The safety and efficacy profile of flow diversion should discourage the use of these devices in aneurysms that can be treated with other techniques.


Van Rooij W.J.,St. Elisabeth Ziekenhuis
American Journal of Neuroradiology | Year: 2012

BACKGROUND AND PURPOSE: Aneurysms of the cavernous segment of the internal carotid artery generally exhibit a benign clinical course, with mass effect on cranial nerves. Rupture generally leads to carotid cavernous fistula and, rarely, to subarachnoid hemorrhage. In this study we report results of treatment in 85 patients with 86 cavernous sinus aneurysms. MATERIALS AND METHODS: In a 15-year period, 85 patients with 86 cavernous sinus aneurysms were treated. There were 77 women (91%) and 8 men, with a mean age of 55.5 years (range 26-78 years). Presentation was cranial neuropathy in 56, carotid cavernous fistula in 8, and subarachnoid hemorrhage in 1 patient. Twenty-one aneurysms were asymptomatic. Treatment was selective coiling in 31 aneurysms and carotid artery occlusion in 55 aneurysms, 5 after bypass surgery. RESULTS: All 8 cavernous sinus fistulas were closed with coils. There were no complications of coiling and 1 patient had a permanent neurologic complication after carotid artery occlusion (morbidity 1.2%; 95% confidence interval, 0.01 to 6.9%). Clinical and MR imaging follow-up ranged from 3 months to 12 years. In 52 of 56 (93%) patients presenting with symptoms of mass effect, symptoms either were cured (n = 23) or improved (n = 29). All aneurysms were thrombosed after carotid artery occlusion and at latest MR imaging, 34 of 50 aneurysms (68%) were substantially decreased in size or completely obliterated. CONCLUSIONS: In this series, for patients with cavernous sinus aneurysms, a treatment strategy including selective coiling and carotid artery occlusion was safe and effective. Most symptomatic patients (93%) were improved or cured, and most aneurysms (68%) shrank on follow-up.

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