scholarly journals Petrous Apex Granulomas: CT and MR Imaging

2002 ◽  
Vol 29 (2) ◽  
pp. 169-170 ◽  
Author(s):  
Stephen Hentschel ◽  
Felix Durity
Keyword(s):  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Lateral Wall ◽  
Petrous Apex ◽  
High Signal ◽  
Horizontal Canal ◽  
Computed Tomography Scanning ◽  
History Of ◽  
Tomography Scanning ◽  
Sixth Nerve

A 29-year-old male complained of a four month history of horizontal, spontaneous, and nonprogressive diplopia. On examination he had a mild left sixth nerve palsy. The rest of his general and neurologic examinations were normal.Computed tomography scanning demonstrated a nonenhancing, well-circumscribed, lesion in the left petrous apex (Figure 1). The opposite apex was well pneumatized. The lesion abutted the medial wall of the horizontal canal of the internal carotid artery and pointed towards the lateral wall of the sphenoid sinus. Unfortunately, CT bone windows were not available for this case but would have been helpful in terms of the differential diagnosis. An MRI demonstrated a predominantly high signal mass on T1 and T2 sequences (Figure 2). The diagnosis was a petrous apex granuloma.

Microsurgical Anatomy and Surgical Exposure of the Petrous Segment of the Internal Carotid Artery

2008 ◽  
Vol 63 (suppl_4) ◽  
pp. ONS210-ONS239 ◽  
Author(s):  
Shigeyuki Osawa ◽  
Albert L. Rhoton ◽  
Necmettin Tanriover ◽  
Satoru Shimizu ◽  
Kiyotaka Fujii
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Lateral Wall ◽  
Common Trunk ◽  
Microsurgical Anatomy ◽  
Carotid Canal ◽  
Complex Relationships ◽  
Arteries And Veins

Abstract Objective: The petrous segment of the internal carotid artery has been exposed in the transpetrosal, subtemporal, infratemporal, transnasal, transmaxillary, transfacial, and a variety of transcranial approaches. The objective of the current study was to examine anatomic features of the petrous carotid and its branches as related to the variety of approaches currently being used for its exposure. Methods: Twenty middle fossae from adult cadaveric specimens were examined using magnification of ×3 to ×40 after injection of the arteries and veins with colored silicone. Results: The petrous carotid extends from the entrance into the carotid canal of the petrous part of the temporal bone to its termination at the level of the petrolingual ligament laterally and the lateral wall of the sphenoid sinus medially. The petrous carotid from caudal to rostral was divided into 5 segments: posterior vertical, posterior genu, horizontal, anterior genu, and anterior vertical. Fourteen (70%) of the 20 petrous carotids had branches. The branch that arose from the petrous carotid was either a vidian or periosteal artery or a common trunk that gave rise to both a vidian and 1 or more periosteal arteries. The most frequent branch was a periosteal artery. Conclusion: An understanding of the complex relationships of the petrous carotid provides the basis for surgically accessing any 1 or more of its 5 segments.

Meningovenous Structures of the Petroclival Region: Clinical Importance for Surgery and Intravascular Surgery

Neurosurgery ◽  
2002 ◽  
Vol 50 (4) ◽  
pp. 829-837 ◽  
Author(s):  
Mehmet Faik Ozveren ◽  
Koichi Uchida ◽  
Sadakazu Aiso ◽  
Takeshi Kawase
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Nerve Injury ◽  
Internal Carotid ◽  
Abducens Nerve ◽  
Lateral Wall ◽  
Petrous Apex ◽  
Anatomic Variations ◽  
Arachnoid Membrane ◽  
Petroclival Region

Abstract OBJECTIVE: The goals of this investigation were to perform a detailed analysis of petroclival microanatomic features, to investigate the course of the abducens nerve in the petroclival region, and to identify potential causes of injury to neurovascular structures when anterior transpetrosal or transvenous endovascular approaches are used to treat pathological lesions in the petroclival region. METHODS: Petroclival microanatomic features were studied bilaterally in seven cadaveric head specimens, which were injected with colored silicone before microdissection. Another cadaveric head was used for histological section analyses. RESULTS: A lateral or medial location of the abducens nerve dural entrance porus, relative to the midline, was correlated with the course and angulation of the abducens nerve in the petroclival region. The angulation of the abducens nerve was greater and the nerve was closer to the petrous ridge in the lateral type, compared with the medial type. The abducens nerve exhibited three changes in direction, which represented the angulations in the petroclival region, at the dural entrance porus, the petrous apex, and the lateral wall of the internal carotid artery. The abducens nerve was covered by the dural sleeve and the arachnoid membrane, which became attenuated between the second and third angulation points. The abducens nerve was anastomosed with the sympathetic plexus and fixed by connective tissue extensions to the lateral wall of the internal carotid artery and the medial wall of Meckel's cave at the third angulation point. There were two types of trabeculations inside the sinuses around the petroclival region (tough and delicate). CONCLUSION: The petroclival part of the abducens nerve was protected in a dural sleeve accompanied by the arachnoid membrane. Therefore, the risk of abducens nerve injury during petrous apex resection via the anterior transpetrosal approach, with the use of the transvenous route through the inferior petrosal sinus to the cavernous sinus, should be lower than expected. The presence of two anatomic variations in the course of the abducens nerve, in addition to findings regarding nerve angulation and tethering points, may explain the relationships between adjacent structures and the susceptibility to nerve injury with either surgical or endovascular approaches. Venous anatomic variations may account for previously reported cases of subarachnoid hemorrhage with the endovascular approach.

scholarly journals Contralateral transmaxillary corridor: an augmented endoscopic approach to the petrous apex

2018 ◽  
Vol 129 (1) ◽  
pp. 211-219 ◽  
Author(s):  
Chirag R. Patel ◽  
Eric W. Wang ◽  
Juan C. Fernandez-Miranda ◽  
Paul A. Gardner ◽  
Carl H. Snyderman
Keyword(s):  
Sphenoid Sinus ◽  
Image Guidance ◽  
Internal Carotid ◽  
Effective Means ◽  
Anterior Wall ◽  
Petrous Apex ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Medial Maxillectomy ◽  
Clinical Cases

OBJECTIVEThe endoscopic endonasal approach (EEA) has been shown to be an effective means of accessing lesions of the petrous apex. Lesions that are lateral to the paraclival segment of the internal carotid artery (ICA) require lateralization of the paraclival segment of the ICA or a transpterygoid infrapetrous approach. In this study the authors studied the feasibility of adding a contralateral transmaxillary (CTM) corridor to provide greater access to the petrous apex with decreased need for manipulation of the ICA.METHODSUsing image guidance, EEA and CTM extension were performed bilaterally on 5 cadavers. The anterior wall of the sphenoid sinus and rostrum were removed. The angle of the surgical approach from the axis of the petrous segment of the ICA was measured. Five illustrative clinical cases are presented.RESULTSThe CTM corridor required a partial medial maxillectomy. When measured from the axis of the petrous ICA, the CTM corridor decreased the angle from 44.8° ± 2.78° to 20.1° ± 4.31°, a decrease of 24.7° ± 2.58°. Drilling through the CTM corridor allowed the drill to reach lateral aspects of the petrous apex that would have required lateralization of the ICA or would not have been accessible via EEA. The CTM corridor allowed us to achieve gross-total resection of the petrous apex region in 5 clinical cases with significant paraclival extension.CONCLUSIONSThe CTM corridor is a feasible extension to the standard EEA to the petrous apex that offers a more lateral trajectory with improved access. This approach may reduce the risk and morbidity associated with manipulation of the paraclival ICA.

Aneurysms of the Intracavernous Carotid Artery: Clinical Presentation, Radiographic Features, and Pathogenesis

Neurosurgery ◽  
1990 ◽  
Vol 26 (1) ◽  
pp. 71-79 ◽  
Author(s):  
Mark E. Linskey ◽  
Laligam N. Sekhar ◽  
William Hirsch ◽  
Howard Yonas ◽  
Joseph A. Horton
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Clinical Presentation ◽  
Mass Effect ◽  
Sensory Loss ◽  
Intracavernous Carotid Artery ◽  
History Of ◽  
Nerve Paresis ◽  
Sixth Nerve

Abstract Thirty-seven patients with 44 intracavernous carotid artery aneurysms (ICCAAns) were seen at one institution from 1976 through 1988. Fifteen patients had multiple intracranial aneurysms and 7 had bilateral ICCAAns. Age at diagnosis ranged from 15 to 80 (median 61). Thirty patients were women. Sixteen had a history of hypertension. In 34% of patients the ICCAAns were asymptomatic at diagnosis. 36% were associated with headache, and 57% had associated signs or symptoms of mass effect including sixth nerve paresis (43%). trigeminal pain or sensory loss (32%), third nerve paresis (20%), decreased vision or visual field cut (18%), fourth nerve paresis (16%), and Horner's syndrome (7%). In 4 patients the ICCAAns ruptured, leading to subarachnoid hemorrhage in 3 and epistaxis in 1. Two patients with ICCAAns were seen with spontaneous thrombosis of the ipsilateral internal carotid artery leading to distal ischemic symptoms in 1. More than 90% of the ICCAAns were saccular. Thirty-four percent were small (<1 cm), 48% were large (1 to 2.5 cm), and 16% were giant (>2.5 cm). The majority arose from the anterior genu of the intracavernous internal carotid artery, followed in frequency by the horizontal segment, and then the posterior genu. Magnetic resonance imaging is superior to computed tomography for diagnosing ICCAAns and is the screening procedure of choice. Angiography remains the “gold standard” for diagnosis and determining specific anatomic details necessary to plan therapy. Analyzing the radiographic anatomy of 44 ICCAAns, we conclude that theories attributing the origin of aneurysms to arterial bifurcations may be inadequate to explain the point of origin and direction of take off of up to one-fourth of ICCAAns. (Neurosurgery 26:71-79, 1990)

Congenital Common Cavity Deformity of Frontal, Ethmoid, and Sphenoid Sinuses

2003 ◽  
Vol 40 (6) ◽  
pp. 639-641 ◽  
Author(s):  
Mustafa Tasar ◽  
Sertac Yetiser ◽  
Mutlu Saglam ◽  
Aysın Tasar
Keyword(s):  
Computed Tomography ◽  
Visual Field ◽  
English Literature ◽  
Adolescent Patient ◽  
Computed Tomography Scanning ◽  
History Of ◽  
The Right ◽  
Common Cavity ◽  
Tomography Scanning ◽  
Sphenoid Sinuses

Objective To present a 17-year-old adolescent patient with lost right eye visual field and intermittent headache since the age of 14 years. The cranium was prominent at the right frontal region. The patient had no history of head trauma or infection and his past medical story was unremarkable. His mental status was normal. Computed tomography scanning revealed an abnormal occurrence of a common cavity deformity of the frontal, ethmoid, and sphenoid sinuses. No other lesions or deformities were present. Such common cavity deformity of these paranasal sinuses has not previously been reported in the English literature.

Silicone Oil–Associated Extensive Intraocular Ossification: A case report

2020 ◽  
pp. 112067212092578
Author(s):  
Yinhao Wang ◽  
Wei Cui ◽  
Rongjun Liu ◽  
Yanjie Tian ◽  
Wei Ni ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Silicone Oil ◽  
Deposition Process ◽  
Calcium Deposition ◽  
Histopathological Analysis ◽  
Case Presentation ◽  
Phthisis Bulbi ◽  
Computed Tomography Scanning ◽  
History Of ◽  
Tomography Scanning

Background: Intraocular ossification is an uncommon calcium deposition process associated with trauma, chronic inflammation, tumor, and long-standing retinal detachment. This is the first reported extensive intraocular bone formation associated with silicone oil. Case presentation: A 30-year-old Han Chinese man came to us with complaint of red, painful blind right eye. He had a history of ocular trauma, retinal detachment, and two failed retinal reattachment surgeries with silicone oil left in the eye. On examination, conjunctiva congestion, band keratopathy, silicone oil emulsification, and limbus neovascularization were found. B-scan ultrasound and computed tomography scanning demonstrated retinal detachment and calcification of the eyeball wall. Histopathological analysis indicated ossification overlying the choroid. Evisceration was finally operated to relieve the pain. Conclusion: The retention of silicone oil in the eye probably accelerates the ossification. Timely silicone oil removal and evisceration should be recommended if necessary for phthisis bulbi.

scholarly journals Catastrophic Candida prosthetic valve endocarditis and COVID-19 comorbidity: A rare case

2021 ◽  
Author(s):  
Lotfollah Davoodi ◽  
Leila Faeli ◽  
Rogheye Mirzakhani ◽  
Rozita Jalalian ◽  
Tahereh Shokohi ◽  
...  
Keyword(s):  
Clinical Manifestations ◽  
Prosthetic Valve Endocarditis ◽  
Past Medical History ◽  
Chain Reaction ◽  
Aortic Valves ◽  
Computed Tomography Scanning ◽  
History Of ◽  
Polymerase Chain ◽  
One Year ◽  
Tomography Scanning

Background and Purpose: Coronavirus disease 2019 (COVID-19) and Candida prostatic valve endocarditis present various clinical manifestations which may overlap;hence, discrimination between them is extremely difficult. Case report: The case was a 66-year-old man with a past medical history of mitral and aortic valves replacement one year before COVID-19 co-infection. He was admitted with fever (for 7 days), shortness of breath, cough, seizure, lethargy,headache, and 85% oxygen saturation. Transesophageal echocardiography revealed multiple large-sized, highly mobile masses on both sides of the mechanical mitral valve highly suggestive of vegetation. Chest computed tomography scanning showed simulating scattered COVID-19 peripheral ground-glass opacities confirmed by reverse-transcription polymerase chain reaction. The set of blood cultures yielded yeast colonies that were identified as Candida tropicalis. The patient died of septic shock shortly after receiving antifungal therapy. Conclusion: This case emphasized the importance of early diagnosis and implementation of antifungal treatment, particularly in patients with prosthetic cardiac valves, to reduce their unfavorable outcomes in COVID-19 patients. 

scholarly journals Anatomic Study of Endoscopic Transnasal Approach to Petrous Apex

2020 ◽  
Vol 218 ◽  
pp. 03016
Author(s):  
Wenyuan He ◽  
Qingying Qin ◽  
Guxian Wang
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Lateral Wall ◽  
Anterior Wall ◽  
Surgical Anatomy ◽  
Petrous Apex ◽  
Transnasal Approach ◽  
Long Time ◽  
Endoscopic Transnasal Approach ◽  
Micro Drill

With the development of Neurosurgery technology, there has been a qualitative leap forward with the appearance of microanatomy, which makes the deep brain tumors which were hard to be achieved in the past, and effectively reduces the mortality of patients. Petrous apex is a cone-shaped part of the anteromedial part of the temporal bone, which is deep. It has been a challenging area for surgical anatomy for a long time. In this paper, fresh adult perfused cadaveric head specimens and dry adult cadaveric head specimens were taken as the experimental objects. The anterior wall of sphenoid sinus and the internal septum of sphenoid sinus were excised under neuroendoscope. The structures of the lateral wall of sphenoid sinus were identified and dissected. The lateral wall of sphenoid sinus and the bone of skull base were opened with micro drill, The meninges were exposed and cut open, and the related structures were dissected, observed and photographed. The experimental results show that it is relatively safe to operate in the range of less than 8mm, and the rock tip can be found accurately. The measurement of the bony structure of the skull base is helpful for the surgeon to judge the course of the internal carotid artery and its adjacent structure.

Unruptured intracranial aneurysms in children: 18 years’ experience in a tertiary care pediatric institution

2019 ◽  
Vol 24 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Daniel-Alexandre Bisson ◽  
Peter Dirks ◽  
Afsaneh Amirabadi ◽  
Manohar M. Shroff ◽  
Timo Krings ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Natural History ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Tertiary Care ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Mean Size

OBJECTIVEThere are little data in the literature on the characteristics and natural history of unruptured intracranial aneurysms in children. The authors analyzed their experience with unruptured intracranial aneurysms in the pediatric population at their tertiary care pediatric institution over the last 18 years. The first objective was to assess the imaging characteristics and natural history of these aneurysms in order to help guide management strategies in the future. A second objective was to evaluate the frequency of an underlying condition when an incidental intracranial aneurysm was detected in a child.METHODSThe authors conducted a Research Ethics Board–approved retrospective review of incidental intracranial aneurysms in patients younger than 18 years of age who had been treated at their institution in the period from 1998 to 2016. Clinical (age, sex, syndrome) and radiological (aneurysm location, type, size, thrombus, mass effect) data were recorded. Follow-up imaging was assessed for temporal changes.RESULTSSixty intracranial aneurysms occurred in 51 patients (36 males, 15 females) with a mean age of 10.5 ± 0.5 years (range 9 months–17 years). Forty-five patients (88.2%) had a single aneurysm, while 2 and 3 aneurysms were found in 3 patients each (5.8%). Syndromic association was found in 22 patients (43.1%), most frequently sickle cell disease (10/22 [45.5%]). Aneurysms were saccular in 43 cases (71.7%; mean size 5.0 ± 5.7 mm) and fusiform in the remaining 17 (28.3%; mean size 6.5 ± 2.7 mm). Thirty-one aneurysms (51.7%) arose from the internal carotid artery (right/left 1.4), most commonly in the cavernous segment (10/31 [32.3%]). Mean size change over the entire follow-up of 109 patient-years was a decrease of 0.6 ± 4.2 mm (range −30.0 to +4.0 mm, rate −0.12 ± 9.9 mm/yr). Interval growth (2.0 ± 1.0 mm) was seen in 8 aneurysms (13.3%; 4 saccular, 4 fusiform). An interval decrease in size (8.3 ± 10.7 mm) was seen in 6 aneurysms (10%). There was an inverse relationship between aneurysm size and growth rate (r = −0.82, p < 0.00001). One aneurysm was treated endovascularly with internal carotid artery sacrifice.CONCLUSIONSUnruptured pediatric intracranial aneurysms are most frequently single but can occur in multiples in a syndromic setting. None of the cases from the study period showed clinical or imaging signs of rupture. Growth over time, although unusual and slow, can occur in a proportion of these patients, who should be identified for short-term imaging surveillance.

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