scholarly journals A Rare Complication of Endovascular Embolization: Extruded Onyx on Trigeminal Nerve

2018 ◽  
Vol 79 (S 05) ◽  
pp. S422-S423 ◽  
Author(s):  
Pinar Eser Ocak ◽  
Mustafa Başkaya
Keyword(s):  
Brain Stem ◽  
Trigeminal Nerve ◽  
Rare Complication ◽  
Cranial Nerves ◽  
Endovascular Embolization ◽  
University Hospital ◽  
Preoperative Embolization ◽  
Postoperative Mri ◽  
Surgery Patient ◽  
The Right

Objectives To demonstrate a rare complication of endovascular tumor embolization with onyx. Design Operative video. Setting Department of neurological surgery in a university hospital. Participants A 39-year-old male who was diagnosed with a right sided hemangioblastoma. Main Outcome Measures Surgical resection of the tumor, preservation of the cranial nerves and extruded embolization material on trigeminal nerve. Results The tumor was embolized with onyx the day before surgery. Patient woke up with no sensation in the right side of his face. Diffusion magnetic resonance imaging (MRI) showed a small restricted diffusion area within the right superior cerebellar vermis. Microsurgical resection of the tumor was uneventful and complete resection was achieved (Fig. 1). After the resection was completed, the trigeminal nerve was identified. Some of the capillaries overlying the nerve as well as the cerebellum and brain stem had extruded onyx-embolic material (Fig. 2). Some of the onyx over the cerebellum was removed; however, the ones on the trigeminal nerve and brain stem were not removed due to the risk of injury to the nerve. Postoperative MRI confirmed total resection. Patient made excellent recovery except he continued to have no sensation in the right side of his face. Conclusion Preoperative embolization is an important adjunct to resection of large hemangioblastomas in selected cases because it may facilitate circumferential dissection and debulking of the tumor. Although extrusion of the embolization material is relatively common, immediate extrusion of onyx and its transfixion on a cranial nerve has not been reported before. Judicial selection of preoperative embolization is required in hemangioblastomas.The link to the Video can be found at: https://youtu.be/s0DjD26Xkas.

scholarly journals Extended Anterolateral Infralabyrinthine Transjugular Approach for Microsurgical Resection of Giant Glomus Vagale Tumor: Operative Video and Technical Nuances

2020 ◽  
Author(s):  
James K. Liu ◽  
Kevin Zhao ◽  
Soly Baredes ◽  
Robert W. Jyung
Keyword(s):  
Skull Base ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Neck Mass ◽  
Preoperative Embolization ◽  
Rare Type ◽  
Lower Cranial Nerve ◽  
Microsurgical Resection ◽  
The Right ◽  
Lower Cranial Nerves

AbstractGlomus vagale tumor is a paraganglioma of the vagus nerve. It is a rare type of benign tumor that occupies the head and neck and skull base regions. Patients often present with lower cranial nerve dysfunctions such as difficulty swallowing, tongue weakness, and hoarseness. Surgical treatment can be complex and difficult due to its high vascularity, frequent involvement of lower cranial nerves, and surrounding critical vascular structures. In this operative video, we demonstrate an extended anterolateral infralabyrinthine transjugular approach for microsurgical resection of a giant glomus vagale tumor in a 53-year-old male who presented with an enlarging neck mass, difficulty swallowing, right tongue weakness, and hoarseness. Imaging revealed a giant glomus vagale tumor in the right parapharyngeal space extending into the jugular foramen with occlusion of the internal jugular vein. After preoperative embolization, the patient underwent a near-total resection of the tumor with a small microscopic residual at the pars nervosa. In summary, the extended anterolateral infralabyrinthine transjugular approach is a useful strategy for removal of giant glomus vagale tumors extending into the skull base. The surgical technique and nuances are described in a step-by-step fashion in this illustrative operative video.The link to the video can be found at: https://youtu.be/L0EosQK95LE.

Arterial hypertension and neurovascular compression at the ventrolateral medulla

1992 ◽  
Vol 77 (1) ◽  
pp. 103-112 ◽  
Author(s):  
Ramin Naraghi ◽  
Michael R. Gaab ◽  
Gerhard F. Walter ◽  
Berthold Kleineberg
Keyword(s):  
Essential Hypertension ◽  
Brain Stem ◽  
Renal Hypertension ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Ventrolateral Medulla ◽  
Control Group ◽  
Histopathological Study ◽  
Neurovascular Compression ◽  
The Right

✓ Intraoperative observations and animal experiments suggest that neurovascular compression at the left ventrolateral medulla is a possible etiological factor in essential hypertension. In pursuing this hypothesis, the authors examined the neurovascular relations in the posterior cranial fossa of 24 patients with essential hypertension, of 10 with renal hypertension, and of 21 normotensive control patients. Artificial perfusion of the vessels and microsurgical investigations during autopsy identified the vascular relations at the brain stem and at the root entry zone of the caudal cranial nerves. There was no evidence of neurovascular compression at the ventrolateral medulla on the left side in any patient from the control group or among those with renal hypertension. Two normotensive patients had neurovascular compression at the right ventrolateral medulla by the posterior inferior cerebellar artery. In contrast, all patients with essential hypertension had definite neurovascular compression at the left ventrolateral medulla. Additional compression of the right side was seen in three of these patients. Based on the anatomical appearance, it was possible to define three distinct types of neurovascular compression at the ventrolateral medulla. Common to all three types is the compression of the medulla oblongata at its rostral part just caudal to the pontomedullary junction and lateral to the olive in the retro-olivary sulcus. Comparative histopathological study of the microsurgically examined brain-stem specimens revealed no differences between patients with essential hypertension, those with renal hypertension, and normal controls. There was a structural integrity at the site of neurovascular compression at the ventrolateral medulla. The microanatomical findings of this study show that neurovascular relations at the ventrolateral medulla in essential hypertension give rise to pulsatile compression on the left. This supports Jannetta's hypothesis of neurovascular compression at the left ventrolateral medulla as an etiology of essential hypertension.

scholarly journals Suboccipital Lateral Approach for Resection of Cerebellopontine Angle Meningioma: Operative Video and Technical Nuances

2018 ◽  
Vol 79 (S 05) ◽  
pp. S397-S398
Author(s):  
Mateus Reghin Neto ◽  
Heros Melo Almeida ◽  
João Almeida ◽  
Ygor Alexim ◽  
Matheus de Almeida ◽  
...  
Keyword(s):  
Treatment Options ◽  
Cranial Nerves ◽  
Lateral Approach ◽  
Magnetic Resonance Imaging Scan ◽  
Extensive Resection ◽  
Tumor Margins ◽  
Postoperative Mri ◽  
History Of ◽  
The Right ◽  
Lower Cranial Nerves

We present the case of a 34-year-old woman, who presented to our department with a 4 months history of dizziness, hearing loss, and tinnitus on the right side. MRI (magnetic resonance imaging) scan demonstrated a large extra-axial lesion, suggestive of a meningioma, with dural attachments to the petrosal bone surface and tentorium, closely related with the trigeminal, abducens, facial, vestibulocochlear, and lower cranial nerves in the right side. Treatment options were discussed with the patient, and surgical resection was selected to remove the lesion, and decompress the cranial nerves and brainstem. The surgery was performed with a patient in a semi-seated position with head placed in a flexed, nonrotated position. A right lateral suboccipital approach was performed, exposing the right transverse and sigmoid sinuses. After dura opening, microsurgical dissection was used to open the cisterna magna, and obtain cerebellum relaxation. That was followed by identification of cranial nerves VII–XII and then identification of the tumor itself. Tumor debulking was then performed with use of suction and ultrasonic aspirator. After extensive resection, the tumor margins were dissected away from brainstem, cerebellum, and cranial nerves. Finally, the tumor attachment to the tentorium was coagulated and cut and the tumor was completely removed. Postoperative MRI confirmed complete resection of the tumor. The patient was discharged on the 1st week after surgery, with no additional postoperative deficits or complications.The link to the video can be found at: https://youtu.be/aZ3jhZTAeAA.

scholarly journals Microsurgical Resection of the Epidermoid Tumor in the Cerebellopontine Angle

2019 ◽  
Vol 80 (S 03) ◽  
pp. S327-S328
Author(s):  
Mirza Pojskić ◽  
Kenan I. Arnautović
Keyword(s):  
Brain Stem ◽  
Aseptic Meningitis ◽  
Cranial Nerve ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
Senior Author ◽  
Epidermoid Tumor ◽  
Postoperative Mri ◽  
Suprasellar Region ◽  
Microsurgical Resection

In this video, we demonstrate epidermoid tumor microsurgical resection of the cerebellopontine angle (CPA) performed by the senior author (K.I.A.). Epidermoid tumors arise from ectoderm trapped within/displaced into the central nervous system. They show predilection for CPA Angle (up to 40%), 4th ventricle, suprasellar region, and spinal cord.1 They are the 3rd most common CPA tumor, comprising approximately 7% of CPA pathology. CPA lesions can produce 5th and 7–12th cranial nerve neuropathies.2 3 4 Recurrent episodes of aseptic meningitis caused by cyst content rupture may occur. Symptoms include fever, meningeal irritation, and hydrocephalus. A 26-year-old female presented with headaches. Head magnetic resonance imaging (MRI) revealed right CPA tumor with brain stem compression (Fig. 1, A–C). There was evidence of restricted diffusion in diffusion-weighted imaging, typical of epidermoid tumor. Surgery was performed in prone position with head turned 25 degrees to the ipsilateral side using retrosigmoid craniotomy.5 Tumor was ventral to the 7th and 8th cranial nerve complexes, between the 5th nerve as well as toward the brainstem. The surgical plan was gross total resection with tumor capsule resection to prevent recurrence.6 (Small residuals can be left behind when capsule is adherent to critical structures.) Tumor was adherent to brain stem perforators which were preserved using meticulous dissection. Cranial nerves and vascular structures were also left intact. We irrigated with antibiotic saline and used perioperative treatment to prevent aseptic meningitis. The pathohistological diagnosis revealed epidermoid tumor cyst. Postoperative MRI revealed complete resection (Fig. 1, D–F). The patient recovered fully and was neurologically intact.The link to the video can be found at: https://youtu.be/LyWl-KZUSGY.

Retrieval of an Intracranially Migrated Dental Injection Needle Through the Foramen Ovale: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E168-E168 ◽  
Author(s):  
Salah G Aoun ◽  
Tarek Y El Ahmadieh ◽  
Vin Shen Ban ◽  
Vishal J Patel ◽  
Awais Vance ◽  
...  
Keyword(s):  
Trigeminal Nerve ◽  
Rare Complication ◽  
Middle Cranial Fossa ◽  
Ethical Review ◽  
Foramen Ovale ◽  
University Of Texas ◽  
Injection Needle ◽  
Facial Musculature ◽  
Patient Consent ◽  
The Right

Abstract Dental injection needle migration is a rare complication of orthodontal procedures. When these needles fracture, they typically dislodge into the cervical space or the facial musculature. Migration into the cranial vault is difficult because of the obstacle created by the skull base. We report a rare case of intracranial migration of an anesthetic injection needle through the foramen ovale. A 59-yr-old man underwent the extraction of a right maxillary molar. The distal end of a 25-gauge injection needle broke into his pterygoid musculature, causing him pain while chewing. Vascular imaging obtained after a computed tomography scan of his face showed that the needle had migrated, potentially because of his efforts of mastication, and had traversed the foramen ovale into the middle cranial fossa. The patient started experiencing intermittent right facial numbness, likely due to compression or injury to the right trigeminal nerve. Our oral and maxillofacial colleagues did not believe that the needle could be retrieved from its facial end. The patient elected to undergo the recovery of the needle through a craniotomy given the fact that the object was contaminated and because he was becoming increasingly symptomatic. A right pterional craniotomy was planned. Extradural dissection was performed until the dura going into the foramen ovale was revealed. We could feel the metallic needle under the dural sheath of the trigeminal nerve. The dura was opened sharply directly over the needle. We then proceeded to mobilize the needle into the face, and then pulled it out completely through the craniotomy to avoid injury to the temporal lobe. The patient recovered well and was asymptomatic at the time of discharge. This case report was written in compliance with our institutional ethical review board. Institutional review board (IRB) approval and patient consent were waived in light of the retrospective and deidentified nature of the data presented in accordance with the University of Texas Southwestern (UTSW) IRB.

Successful removal of a huge hypervascular tentorial cavernous angioma after preoperative endovascular embolization

2014 ◽  
Vol 14 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Junichi Yoshimura ◽  
Yoshihiro Tsukamoto ◽  
Masakazu Sano ◽  
Hitoshi Hasegawa ◽  
Kazuhiko Nishino ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Histopathological Examination ◽  
Cavernous Angioma ◽  
Endovascular Embolization ◽  
Preoperative Embolization ◽  
Intraoperative Bleeding ◽  
Left Posterior ◽  
Successful Removal ◽  
The Right ◽  
Posterior Meningeal Artery

The authors report a rare case of a huge hypervascular tentorial cavernous angioma treated with preoperative endovascular embolization, followed by successful gross-total removal. A 15-year-old girl presented with scintillation, diplopia, and papilledema. Computed tomography and MRI studies revealed a huge irregularly shaped tumor located in the right occipital and suboccipital regions. The tumor, which had both intra- and extradural components, showed marked enhancement and invasion of the overlying occipital bone. Angiography revealed marked tumor stain, with blood supply mainly from a large branch of the left posterior meningeal artery. Therefore, this lesion was diagnosed as a tentorium-based extraaxial tumor. For differential diagnosis, meningioma, hemangiopericytoma, and malignant skull tumor were considered. Tumor feeders were endovascularly embolized with particles of polyvinyl alcohol. On the following day, the tumor was safely gross totally removed with minimum blood loss. Histopathological examination confirmed the diagnosis of cavernous angioma. To date, there have been no reports of tentorium-based cavernous angiomas endovascularly embolized preoperatively. A tentorial cavernous angioma is most likely to show massive intraoperative bleeding. Therefore, preoperative embolization appears to be quite useful for safe maximum resection. Hence, the authors assert that the differential diagnosis of tentorium-based tumors should include tentorial cavernous angioma, for which preoperative endovascular embolization should be considered.

Trigeminofacial reflex: a means of detecting proximity to ophthalmic and maxillary divisions of the trigeminal nerve during surgery

2014 ◽  
Vol 121 (5) ◽  
pp. 1271-1274
Author(s):  
Omar A. AlMasri ◽  
Emma E. Brown ◽  
Alan Forster ◽  
Mahmoud H. Kamel
Keyword(s):  
Observational Study ◽  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Cranial Nerves ◽  
University Hospital ◽  
Time Base ◽  
Tumor Surgery ◽  
Facial Electromyography ◽  
A New Technique ◽  
Trigeminofacial Reflex

Object The aim in this paper was to localize and detect incipient damage to the ophthalmic and maxillary branches of the trigeminal nerve during tumor surgery. Methods This was an observational study of patients with skull base, retroorbital, or cavernous sinus tumors warranting dissection toward the cavernous sinus at a university hospital. Stimuli were applied as normal during approach to the cavernous sinus to localize cranial nerves (CNs) III, IV, and VI. Recordings were also obtained from the facial muscles to localize CN VII. The trigeminofacial reflex was sought simply by observing a longer time base routinely. Results Clear facial electromyography responses were reproduced when stimuli were applied to the region of V1, V2, and V3. Response latency was increased compared with direct CN VII stimuli seen in some cases. Responses gave early warning of approach to these sensory trigeminal branches. Conclusions The authors submit this as a new technique, which may improve the chances of preserving trigeminal sensory branches during surgery in this region.

scholarly journals Cerebral Infarction Associated With Thrombosed Developmental Venous Anomaly: A Case Report

2017 ◽  
pp. 14
Author(s):  
Mehdi Karimian ◽  
Afshin Borhani Haghighi
Keyword(s):  
Protein C ◽  
Rare Complication ◽  
Brain Infarction ◽  
Cranial Nerves ◽  
Previous History ◽  
Central Vein ◽  
Developmental Venous Anomaly ◽  
Venous Anomaly ◽  
Mri Findings ◽  
The Right

Introduction:Developmental venous anomaly (DVA, venous angioma) is a congenital vascular variant of cerebral venous drainage, which consists of several radial veins draining into an enlarged central vein (caput medusa appearance). This anatomical variations are usually followed by benign and asymptomatic clinical course, so it is incidentally detected at MRI, MRA, CT, angiography or autopsy performed for unrelated problems. Rarely DVAs become symptomatic and present with headache, seizures, numbness, diplopia, paresthesia, syncope and focal neurologic deficit secondary to thrombosis in drainage veins. Hemorrhagic complications occur more often than isolated ischemic events. Also, non-hemorrhagic brain infarction is a rare complication in these patients. We describe a patient with non-hemorrhagic venous infarction associated with DVA.Case report:A 57-year- old female patient was admitted to Namazi hospital with complaints of acute severe headache in the right temporo-occipital region, vertigo, left sided paresthesia and weakness. She was in good health a week prior to admission when the blurred vision appeared in her right eye. The patient had previous history of recurrent episodes of migraine-like headache that controlled by medical therapy. The family history was unremarkable. Her only medications were various oral contraceptives and propranolol. On examination, she was afebrile and alert with stable vital signs. Her pupils were equal and reactive to light. Neurological examination was normal and the cranial nerves were intact. The deep tendon reflexes were brisk and symmetric and bilateral Babinski and Hoffmann’s signs were present. On admission, her speech, memory, and intellectual performance were normal. She had weakness of the upper and lower extremities (especially on the left side) and her knees were unstable while walking. Hematology and coagulation tests (protein C, activated protein C resistance, protein S, homocysteine, anticardiolipin antibodies, antithrombin III and antinuclear anti body) were normal.The initial CT scan of the brain demonstrated no evidence of abnormal density, hydrocephalus or hemorrhagic process in the cerebral hemispheres, MRI findings revealed several radially arranged veins converging to a small enlarged vein in the right temporo-occipital lobe. Thrombosis of collector veins detected as a hypersignality on contrast enhanced MRI. Also, “caput medusa” configuration was detectable in angiography.

scholarly journals Diagnosis of the Trigeminal Nerve Injury in a Patient with Pontine Hemorrhage

Diagnostics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 74
Author(s):  
Eun Bi Choi ◽  
Jeong Pyo Seo ◽  
Sung Ho Jang
Keyword(s):  
Nerve Injury ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Diffusion Tensor ◽  
University Hospital ◽  
Pontine Hemorrhage ◽  
The Face ◽  
Touch Sensation ◽  
The Right ◽  
Masseter Muscles

Herein, we present a patient who was diagnosed with trigeminal nerve injury following a pontine hemorrhage. A 38-year-old male was diagnosed with a left pontine hemorrhage and underwent conservative management at the neurosurgery department of a university hospital. After hemorrhage onset, he felt facial pain on the right side. After seven years, he visited the rehabilitation department of another hospital for evaluation of his right facial pain. He complained of somatosensory impairment and facial pain (tingling and cold sensation) on the right side as well as difficulty chewing and gait disturbance. On neurological examination, decreased touch sensation (approximately 30%) was observed on the right side of the face, in the oral cavity, and on the tongue (anterior two-thirds) as well as weakness of the right-sided masseter muscles. He also exhibitedallodynia without dysesthesia on the right side of the face. Diffusion tensor tractography showed the right trigeminal nerve to be discontinued at the anterior margin of the pons (arrow) compared to the state of the left trigeminal nerve.

Acute abdomen in pregnancy: a retrospective study of pregnant patients hospitalised for abdominal pain

2020 ◽  
Vol 99 (3) ◽  
pp. 131-135
Keyword(s):  
Abdominal Pain ◽  
Clinical Signs ◽  
University Hospital ◽  
Diagnostic Process ◽  
Abdominal Emergency ◽  
Lower Abdominal Quadrant ◽  
Abdominal Emergencies ◽  
The Right ◽  
Abdominal Quadrant ◽  
In Pregnancy

Introduction: Abdominal emergencies occur in pregnant women with the rate of 1:500−635 pregnancies. Such conditions usually develop from full health and worsen rapidly. Symptoms are often similar to those in physiological pregnancy (abdominal pain, vomiting, constipation). The diagnostic process is thus difficult and both the mother and her child are at risk. Our aim was to evaluate the frequency of abdominal emergencies in the Department of Surgery, University Hospital in Pilsen and to consider their impact on pregnancy and on the newborn. Methods: We acquired a set of patients by retrograde collection of data. We searched for pregnant patients suspected of developing an abdominal emergency admitted to the Department of Surgery, Faculty of Medicine, Pilsen between 2004 and 2015. We evaluated a number of clinical signs to statistically describe the set. Results: The set included 121 patients; 42 of the patients underwent a surgical procedure and 79 received conservative treatment. 38 patients underwent appendectomy; 6 appendixes were with no pathologies. McBurney’s incision was an approach of choice in most cases. The most frequent symptom was pain in the right lower abdominal quadrant. The foetus has been lost in none of the cases. Conclusion: Acute appendicitis was the most frequent abdominal emergency in our set and also the most frequent reason for surgical intervention. The most specific sign was pain in the right lower abdominal quadrant. No impact of appendicitis or appendectomy on the health of the newborn has been observed. Even though abdominal emergencies in pregnancy are relatively rare, the results of the department are very good.

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