- Equipment
- 7 Fr. 90cm shuttle + short valve (RHV)
- Soft 5Fr. 115cm + Headway27 + FRED 5.5x32mm
- SL10 + coils *5
- Stiff wire
- 7 Fr. shuttle不容易上到CCA，使用stiff wire
- 短的Valve插兩根導管(Sofia + SL10)會漏水
- Special remarks
- 動脈瘤太大，wire先在動脈瘤繞一圈到遠端，catheter跟上後，再拉整個system把導管拉直，導管進入MCA的時候有點卡要小心
- 如果是大動脈瘤放FRED+loose coiling ，過程中Headway有繞進aneurysm 內打轉後到遠端，手術的最後他有考慮給IA aggrastat
2022年12月27日 星期二
20221227 LICA aneurysm FRED + coil
2022年7月20日 星期三
20220721 Right ACA aneurysm (right aortic arch and aberrant left subclavian artery)
- Right ACA aneurysm (right aortic arch and aberrant left subclavian artery)
- CTA
- 導管從右邊上去往左好不習慣
- 診斷看起來有兩個sac，最大徑6.34mm，短徑3.15-3.18mm，預計會自費用到五顆左右coil
- 8Fr. Mach-1 + Navien 072 115cm放到 T zone，Scepter balloon放到A2，再用SL10勾進遠端sac， 依序用4x10, 3.5x6, 3x8, 2.5x8, 2.5x4mm(最後一顆沒放進去，氣球打起來約2分鐘給他thrombosis)
- Wire勾ACA可以修彎一點比較容易進去，一開始很容易loop進MCA，往回拉轉一下可以跳進ACA
- 塞完第三顆打heparin 3000 U
- 雖然看起來塞完線圈還有縫隙，不過術後DSA看起來total occlusion
- 術後稍微勾一下left aberrant subcalvian artery，雖然JB2看起來沒勾到東西，不過大概位置用wire探探看有進去
- 診斷大概半小時，栓塞大概一個小時上下，加準備與解釋兩個多小時搞定！
2022年2月10日 星期四
20220211 Cerebellum
Cerebellum
Danny Walker, torcula elevation, hydrocephalus
Inferior vermian hypoplasia,
Blake Pouch cyst, cyst with hydrocephalus, obstruction Magendie
Mega Cisterna Magna, delayed perforation of blake pouch cyst, axial view septation, no hydrocephalus
Arachnoid cyst
Hypoplastic cerwbellum, RELN, VLDLR
Rhombencephalosynapsis, absence of the vermis, Gomez Lopez Hernandez syndrome, key hole shape 4th ventricle
Macrocerebellum, MPS type I, II, Costello syndrome,
Cerebellar dysplasia, Chudley McCullough syndrome, 惡魔果實?
Cerebellar and brainstem malformation
PCH, pontocerebellar Hyplasia, 10 subtype, type 2 gene TSEN54, dragonfly appearance
Joubert syndrome, AR, molar tooth sign, renal, ocular, hepatic, MSK abnormal, suprasellar decussafion 消失
Congenital muscular dystrophy owing to defective dystroglycan O Glycosylation , Fukuyama type, cyst
Predomint brainstem malformation
Pontine Tegmengal cap dysplasia, pons flaten, Pons前後顛倒
Horizontal Gaze Palsy with progressive Scoliosis, AR, ROBO3 gene, butterfly shape medulla and pontine hypoplasia
Cerebellar disruption
cerebellar agenesis
global cerebellar hypoplasia, CMV infection
Unilateral cerebellar hypoplasia
Cerebellar cleft, due to hemorrhage
2022年1月1日 星期六
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