シャドーイング練習: Embolization of AV Malformations: Tips and Tricks - YouTubeで英語スピーキングを学ぶ
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Hi.
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I'd like to thank the organizers for inviting me here today.
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So this is going to be a pretty quick review as well because it's kind of a complex topic.
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So I'm going to focus mainly on the technical part of embolization procedures.
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These are disclosures.
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And so the AVM, as we all know,
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are abnormal connections between arteries and veins.
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Typically with the intervening nidus or collection of abnormal vessels with feeding arteries and draining veins.
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They can be divided into different types,
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the top being more fistulist-type connections,
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which are a direct artery into a venous sac
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and then going down to multiple arteries coming into a nidus and then an outflowing vein.
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And these have been related to different genetic diseases,
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such as hemorrhagic hereditary telangiectasia 1 and 2, capillary malformation AVM syndrome.
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Then they—these do have genes associated with them,
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but most AVMs are actually sporadic.
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And then in, I am a neurointerventionalist,
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so we divide our AVMs into many different types.
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I'm not going to go over it very laboriously,
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but depending on where it's located,
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so in the cerebral matter itself,
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peel malformations are ranging from nidal-type malformations to fistulas,
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which occur mainly in pediatrics.
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and galen malformations occur mainly in newborns.
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And then there are malformations that are more fistulas
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and acquired later in life that occur in the dura or lining of the brain.
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And this can be found in the carotid cavernous region where you can also find direct fistulas from trauma.
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And then there's a whole organization for spinal AVMs as well.
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And so how, you know,
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to get to the embolization part,
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how do we close these malformations?
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The focus and the goal really is to treat the nidus in the case of nidal aneurysms
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and close this connection as well as in the fistula's connection,
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the focus is really to get to the proximal part of the vein that's receiving the arteries and close that.
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are sometimes used in these cases,
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but actually less so because you really can only get to these medium-sized arteries or smaller,
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even tinier arteries with coils,
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so you can't really get good penetration into the nidus itself.
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There have been use of sclerosing agents,
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so taking a micro catheter sorry into a feeding artery injecting ethanol 100% ethanol to kind of burn the malformation
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and and destroy it in that way but the more common uses liquid agents
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and that can be there are really two
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that are in use in the US right now there's NBC a which is a cyanoacrylate and then there's onyx
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which is a polymer, and I'll go into those.
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And then there's some neuroagents in development,
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and these can be placed into the nidus or into the vein via a transarterial or a transvenous approach.
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NBCA is closely related to crazy glue.
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It's an adhesive, so it sticks to the arteries.
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And the goals, as with any embolization of AVM,
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is good penetration into the nidus.
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And with NBCA, it is,
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once it contacts the blood, it polymerizes very quickly.
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And so you want to prevent proximal reflux along the catheter,
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as prolonged contact with the catheter will cause adhesion to it.
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And you can have a retained catheter or vessel injury when you try to pull it out.
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Onyx was developed and approved by the FDA in the 1990s and actually in the mid-2000s.
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And this is a copolymer of ethylene vinyl alcohol.
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It's dissolved in a solvent, DMSO.
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And then there's suspended micronized tantalum powder in it to achieve radio radio opacity,
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so it needs to be shaken right before you inject it or else all the tantalum will settle out of it.
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And then the traditional method of injecting onyx is to inject,
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and it looks like this dark color because of the tantalum within it,
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so you inject little bits along the tip of the microcatheter until you fill the proximal artery here,
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refluxing a little bit along the catheter.
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And then as soon as you create,
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the goal of that is to create a plug within the proximal artery at the location of the tip of the catheter.
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And then once you create that plug,
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when you inject, it's going to go forward and penetrate into the nidus.
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So like I said, a proximal plug is used,
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and the catheter needs to be removed from the embolic cast at the end of the embolization.
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So even though Onyx is not adhesive,
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it can be, if you reflux too much along the catheter,
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this can lead to a retained microcatheter as well,
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just because of friction in trying to remove it.
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And if you then pull too hard,
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this can lead to rupture and hemorrhage.
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So the tips and tricks,
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I'm really just going to talk about a few newer techniques that we're using in the last few years.
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And one of them is,
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and it has to do with newer technology that's coming out.
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So one is the use of the detachable tip microcatheter,
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which is called the Apollo microcatheter.
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And it's a single lumen catheter.
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It has a tip that's actually held into a shaft here by pressure, by friction.
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And this allows for a force being required to actually separate the two.
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So it's less than a third of the force that you would need to actually break any other part of the catheter.
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So it's thought that it's a more gentle force of retrieving the catheter.
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And you basically just pull slowly and stretch and stretch until it detaches or the whole thing pulls out of the onyx.
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And this catheter comes with two tips.
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So this is the distal tip,
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the proximal marker here is where the detachment zone is.
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So you can't, if you're injecting and you reflux all the way to this point,
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you have to stop because you're going to then glue that detachment zone in place.
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And this is an example of a vertebral peel fistula.
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So this is an AP view and a lateral view,
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the vertebral artery in the neck,
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and this fistula's connection to posterior fossa vein.
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And this is a navigation of the Apollo catheter to the fistula.
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You could see it in place,
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the distal marker and the proximal marker.
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And there you see an injection of NBCA.
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So this catheter can be used with both NBCA and ONIX.
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And in this case, it looks like the catheter was completely removed without detaching.
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So then in a second injection,
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another Apollo catheter was brought up to a second fistula site.
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And there's some injection of contrast showing the direct connection to the vein.
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And this is a video here.
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And this is high concentration of NBCA.
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So this really, if you were using any standard microcatheter,
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you would not keep it there that long because you'd be afraid of actually polymerizing and gluing the catheter in place.
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But because now that we have the detachable tip,
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we're more comfortable trying to get good penetration with NBCA.
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And so that's the injection.
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You can see more NBCA filling into the venous side of the fistula,
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and then pull and out.
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And then you can see kind of tiny here,
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but that's the distal tip, and that's the catheter.
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So it's actually detached, and the distal tip of it is left in place.
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So the advantages with Onyx,
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you make reflux purposefully to create a plug,
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so you know how much you can reflux.
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And with the NBCA, you have a controlled injection instead of trying to inject quickly and then pull it out.
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So this allows for better penetration.
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And then it requires less pressure to remove the catheter,
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so less chance of injuring.
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The disadvantage, it is a bit stiffer at the detachment zone,
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so the connection between the tip and the proximal microcatheter
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compared with the rest of the microcatheter and with some other softer microcatheters that we may use.
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And then we've had now two cases where on navigating the catheter without attempting to detach the tip,
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it's inadvertently detached in a proximal artery.
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So that's something that that if you're navigating in torturous anatomy, it can happen.
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And that's the tip.
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So the other thing that's come about is the development of DMSO compatible balloon microcatheters.
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So these are the SEPTR balloons.
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And it's just, it's a dual lumen catheter.
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So you have a lumen that you can inject onyx or glue or coils,
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whatever you want, whatever you're doing,
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and then a second port to inflate this balloon.
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And then this is a case,
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so this really allows for a really good penetration without having to worry about reflux or make a plug.
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So So this is a case of a maxillary arteriovenous malformation.
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This is the internal maxillary, the patient's maxilla.
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And you see this abnormal AVM, capillary-type AVM right here.
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And then this is the balloon catheter in place.
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So it's in this branch here.
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And this is the inflation of the balloon.
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So you create a plug just by inflating the balloon.
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It's very quick.
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And then you can achieve great penetration into the entire AVM.
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This required injection into a couple different feeders,
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but by using this technique,
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I was able to completely treat.
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And at the end of this treatment,
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there was no remaining shunting.
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The important thing when you're using Onyx is you have to be able to recognize abnormal and normal and know your,
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especially in the head and neck,
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you have to know where you're located.
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Avoid any abnormal connections to the internal carotid circulation
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or any normal connections that you might not see
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but you know are there because the onyx with this technique can penetrate into small collaterals that are otherwise closed.
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And then just as This is a last example.
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This is a 42-year-old man with headaches and tinnitus,
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and he got this MRA,
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which shows this markedly abnormal enlarged vessels on the left side of his head from external and as well internal circulation,
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and all going into the left transverse sinus.
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This is a typical dural arteriovenous fistula, and usually acquired.
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This is the MRA showing that fistula.
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You see some external carotid artery,
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occipital branches, middle meningeal branches,
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and then on angiography marked dilatation of these branches.
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And really on the CAT scan,
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we can see that they really all come down to this connection right here into the transverse sinus,
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or so we thought.
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However, when we closed that off,
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we realized that the fistulas were coming to multiple locations along that sinus.
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And this is one disadvantage of ONIX.
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So after you have to close such a complex malformation with multiple vessels,
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you're left with this sort of picture in which you can't really see anything afterwards.
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So that leads to my last point,
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which is the development of this new liquid embolic called Phil,
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which is currently approved in Europe.
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And this is going to be,
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it's going to have iodine attached to the copolymer.
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And so therefore that should absorb and it will be less radio-opaque when you come back for later treatments.
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And that's it.
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Thank you for your attention.
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この動画で発音練習をする理由は？
この動画では、動静脈奇形の塞栓術に関する専門的な内容が紹介されています。医療分野の用語を用いることで、英語の理解力やスピーキング能力を向上させることができます。特に、技術的なトピックに関する英会話の練習は、実際の医療現場や学術的な環境で役立つスキルです。このような英語スピーキング練習の一環として、発音や表現を学ぶことが、IELTS スピーキング対策にも大いに効果的です。英語を話すことで、専門用語の理解を深め、自信を持ってコミュニケーションが取れるようになります。
文法と表現の文脈
- 分詞構文: 「burn the malformation」という表現は、動名詞形によって「malformationを燃やす」という意味を持ち、アクションに対する焦点を強調します。
- 受動態: 「are abnormal connections between arteries and veins」という部分は、受動態を用いることで、動脈と静脈の間の異常な接続状況に焦点をあてています。これは、専門用語の使用において適切な表現方法です。
- 条件文: 「if you want to get to the embolization part」という表現は、条件表現を使って、手続きに進む条件を設定しています。これは、医療手技における論理的思考を促進します。
よくある発音のトラップ
この動画では、特に注意が必要な発音がいくつかあります。例えば、「embolization」という単語は、音節が多いため、正しく発音するのが難しいかもしれません。また、「malformation」という単語も同様です。これらの難しい単語の練習は、英語シャドーイングの際に重要です。自分の声で繰り返し発音することで、正しいアクセントやイントネーションを身につけることができます。
シャドーイングとは？英語上達に効果的な理由
シャドーイング（Shadowing）は、もともとプロの通訳者養成プログラムで開発された言語学習法で、多言語習得者として知られるDr. Alexander Arguelles によって広く普及されました。方法はシンプルですが非常に効果的：ネイティブスピーカーの英語を聞きながら、1〜2秒の遅延で声に出してすぐに繰り返す——まるで「影（shadow）」のように話者を追いかけます。文法ドリルや受動的なリスニングと異なり、シャドーイングは脳と口の筋肉が同時にリアルタイムで英語を処理・再現することを強制します。研究により、発音精度、抑揚、リズム、連音、リスニング力、そして会話の流暢さが大幅に向上することが確認されています。IELTSスピーキング対策や自然な英語コミュニケーションを目指す方に特におすすめです。