Pratique du Shadowing: (English) Middle meningeal artery (MMA) embolization in cSDH - Apprendre l'anglais à l'oral avec la vidéo

Hello dear colleagues, my name is Al -Muhammad,

and today we have a chronic subdural hematoma in an 86 years old male patient who came with headaches and seizures.

On the first non -enhanced CT of the brain, we have seen a chronic subdural hematoma on the left side of the brain,

and the upper right CT scan is the first one after the operation.

41 days after the operation, the patient came with a large recurrence of the hemorrhage seen in the lower left CT scan.

And here we have performed an MMA embolization, and the lower right CT scan is at the six -month follow -up.

And for the embolization, we have used a dual -lumen micro -balloon catheter Scepter Mini

2 .2 by 9 millimeters with Onyx 18 as an embolic agent.

And here we go, we push the long sheath Neuromax with the select catheter in the aorta,

and configurate the tip of the select catheter at the aortic arch, and start the navigation of the left common carotid artery,

and now we need a roadmap to see the anatomy and navigate into the left internal carotid artery.

At first we push the teroma wire and then the select catheter,

and here we need an overview of the internal carotid artery to exclude anastomosis to the intracranial branches

and normal variants of the middle meningeal artery.

And as we can see, there is no anastomosis to the internal carotid artery and no normal variants of the middle meningeal artery.

We can zoom a little bit into the orbiter to see whether there is any anastomosis to the..

but even if we don't see the anastomosis, it doesn't mean that it is not there.

And now we turn to the external carotid artery,

we have the intermediate catheter SOFIA 5F with the stiff wire teromo,

and now we start the navigation of the external carotid artery using the teromo stiff and then the intermediate catheter,

and now we need a 2D angiogram, and very important anastomosis are to the ophthalmic artery and to the fascial nerves,

which can cause blindness or fascial palsy.

And now we zoom a little bit to guarantee a smooth navigation of the middle meningeal artery,

and here we see the frontal and parietal branches of the middle meningeal artery.

And now we prepare the Scepter mini balloon catheter attach it to the saline,

and now we flush the hub with contrast agent,

and push the Mirage microwire into the balloon catheter, and shape the tip of the microwire,

and now we remove the air from the balloon as usual,

and after that we push both balloon and microwire into the intermediate catheter SOFIA5F,

and start the navigation of the middle meningial artery.

And now we perform a test, we push the balloon without the microwire, and look which branch it will take,

and it's taking the paretal branch, and now with the microwire it goes to the frontal branch,

and we start the embolization in the branch which needs a microwire and turn to the other branch without the microwire,

and that's how we can embolize both branches with one balloon.

And we place the balloon distally to the anastomosis to the ophthalmic artery.

And now we need a larger overview to see the embolization,

and now we inflate the balloon and perform a 2D angiogram through the balloon,

and this is the way that we need for the onyx embolization.

We let the contrast agent a little bit flow, and as you can see,

this is the typical MMA blush in chronic subdural hematomas.

And now we start the embolization with onyx, and in the coronal projection we have reached the phalx cerebri, which is a good sign of penetration,

and now we deflate the balloon and pull it back and try to navigate into the paretel branch, and as you can see the balloon is a little bit deformed,

that's why it doesn't go easily in this branch.

There is a tip here, we inflate the balloon a little bit with contrast agent, and then it goes in this branch easily.

And now we are in the paretial branch, we inflate the balloon and continue embolization.

And with the balloon occlusion, we can reach a very deep penetration of the middle meningeal artery.

And as you can see, we have reached every distal branch of the middle meningeal artery and now we deflate the balloon,

because we are getting a little bit reflex, we can give a drop of onyx on our way back and remove the balloon,

but without any pressure to not reach the dangerous anastomosis.

And now we need a 2D angiogram of the external carotid artery, and as you can see, the middle meningeal artery is completely occluded.

And as we have seen at the very beginning, there was no anastomosis to the internal carotid artery and the intracranial branches.

That's why we're not expecting any complications.

And this is the last angiogram of the internal carotid artery.

No occlusions, no hemorrhage, no extravasation.

And thus we've reached the end of our intervention.

As always, if you have any questions, please put them down in the comments below.

You can contact us per email.

Two email addresses and further contact options are in the video description below.

Thanks for watching, Dawes Al -Muhammad, see you next time, peace out.

Qu'est-ce que la technique du Shadowing ?

Le Shadowing est une technique d'apprentissage des langues fondée sur la science, développée à l'origine pour la formation des interprètes professionnels. Le principe est simple mais puissant : vous écoutez de l'anglais natif et le répétez immédiatement à voix haute — comme une ombre suivant le locuteur avec un décalage de 1 à 2 secondes. Les recherches montrent une amélioration significative de la précision de la prononciation, de l'intonation, du rythme, des liaisons, de la compréhension orale et de la fluidité.

Pratique du Shadowing: (English) Middle meningeal artery (MMA) embolization in cSDH - Apprendre l'anglais à l'oral avec la vidéo

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Qu'est-ce que la technique du Shadowing ?