Extradural Middle Fossa and Transcavernous Approach for Resection of Trigeminal Neurinoma at Lateral Cavernous Sinus

AbstractWe present a 52-year-old male case of right trigeminal neurinoma at lateral cavernous sinus. The tumor was 40 mm in maximum diameter, obviously compressed temporal lobe and encased internal carotid artery. Extradural middle fossa and transcavernous approach was applied and the tumor was resected via Parkinson's triangle. This approach enabled safe and effective tumor resection, sufficient visualization, and operative field (Figs. 1 and 2). We performed dissection of the tumor from trigeminal nerve, tentorium, and middle fossa and resect the tumor around internal carotid artery sufficiently. Postoperative course was good without any new neurological deficit. This surgical method is considered safe and effective for the resection of the tumor at lateral cavernous sinus.The link to the video can be found at: https://youtu.be/2ekuILIgEuo.

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Rare Clinical Onset of Nontraumatic Intracavernous Aneurysm of the Internal Carotid Artery: A Diagnostic and Therapeutic Challenge

Indian Journal of Neurosurgery ◽

10.1055/s-0040-1718989 ◽

2020 ◽

Author(s):

Enzo Emanuelli ◽

Maria Baldovin ◽

Claudia Zanotti ◽

Sara Munari ◽

Luca Denaro ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Cavernous Sinus ◽

Internal Carotid ◽

Arterial Injury ◽

Sphenoidal Sinus ◽

Therapeutic Challenge ◽

Cavernous Sinus Syndrome ◽

Sellar Lesions ◽

Risk Of Rupture

AbstractWhile the so-called pseudoaneurysms can result from arterial injury during trans-sphenoidal surgery or after a trauma, spontaneous aneurysms of cavernous–internal carotid artery (CICA) are rare. Symptoms vary and the differential diagnosis with other, more frequent, sellar lesions is difficult. We describe three cases of misdiagnosed CICA spontaneous aneurysm. In two cases the onset was with neuro-ophthalmological manifestations, classifiable as “cavernous sinus syndrome.” The emergency computed tomography scan did not show CICA aneurysm and the diagnosis was made by surgical exploration. The third patient came to our attention with a sudden severe unilateral epistaxis; endonasal surgery revealed also in this case a CICA aneurysm, eroding the wall and protruding into the sphenoidal sinus. When the onset was with a cavernous sinus syndrome, misdiagnosis exposed two patients to potential serious risk of bleeding, while the patient with epistaxis was treated with embolization, using coils and two balloons. Intracavernous nontraumatic aneurysms are both a diagnostic and therapeutic challenge, because of their heterogeneous onset and risk of rupture, potentially lethal. Intracavernous aneurysms can be managed with radiological follow-up, if asymptomatic or clinically stable, or can be surgically treated with endovascular or microsurgical techniques.

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Internal Carotid Artery Injury in Transsphenoidal Surgery: Tenets for Its Avoidance and Refit—A Clinical Study

Brain Sciences ◽

10.3390/brainsci11010099 ◽

2021 ◽

Vol 11 (1) ◽

pp. 99

Author(s):

Dmitry Usachev ◽

Oleg Sharipov ◽

Ashraf Abdali ◽

Sergei Yakovlev ◽

Vasiliy Lukshin ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Cavernous Sinus ◽

Transsphenoidal Surgery ◽

Internal Carotid ◽

Treatment Options ◽

Carotid Artery Injury ◽

Anatomical Features ◽

Stent Grafting ◽

Internal Carotid Artery Injury

One of the most serious/potentially fatal complications of transsphenoidal surgery (TSS) is internal carotid artery (ICA) injury. Of 6230 patients who underwent TSS, ICA injury occurred in 8 (0.12%). The etiology, possible treatment options, and avoidance of ICA injury were analyzed. ICA injury occurred at two different stages: (1) during the exposure of the sella floor and dural incision over the sella and cavernous sinus and (2) during the resection of the cavernous sinus extension of the tumor. The angiographic collateral blood supply was categorized as good, sufficient, and nonsufficient to help with the decision making for repairing the injury. ICA occlusion with a balloon was performed at the injury site in two cases, microcoils in two patients, microcoils plus a single barrel extra-intracranial high-flow bypass in one case, stent grafting in one case, and no intervention in two cases. The risk of ICA injury diminishes with better preoperative preparation, intraoperative navigation, and ultrasound dopplerography. Reconstructive surgery for closing the defect and restoring the blood flow to the artery should be assessed depending on the site of the injury and the anatomical features of the ICA.

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Extraintracranial Bypass as a Rescue Therapy for Symptomatic Flow Diverter Thrombosis

Case Reports in Neurological Medicine ◽

10.1155/2015/204387 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5

Author(s):

Luigi A. Lanterna ◽

Alessandro Lunghi ◽

Carlo Brembilla ◽

Paolo Gritti ◽

Claudio Bernucci

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Rescue Therapy ◽

Flow Diverter ◽

Minor Stroke ◽

Transient Ischemic Attacks ◽

Postoperative Course ◽

A Minor ◽

Ischemic Events

A 56-year-old female with a giant partially thrombosed unruptured carotid-ophthalmic aneurysm was treated with a Pipeline flow diverter. Three months after the procedure, in concomitance with the discontinuation of one of the antiplatelet medications, the patient suffered from a minor stroke and relapsing transient ischemic attacks. The angiography demonstrated the occlusion of the internal carotid artery, and a perfusion-weighted CT scan showed a condition of hypoperfusion. The patient underwent a double-barrel extraintracranial bypass. The postoperative course was uneventful and she has experienced no further ischemic events to date.

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The So-Called Cavernous Sinus: A Review of the Controversy and Its Implications for Neurosurgeons

Neurosurgery ◽

10.1227/00006123-198211000-00019 ◽

1982 ◽

Vol 11 (5) ◽

pp. 712-717 ◽

Cited By ~ 118

Author(s):

John N. Taptas

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Cavernous Sinus ◽

Internal Carotid ◽

Cranial Nerves ◽

Sella Turcica ◽

Middle Cranial Fossa ◽

Cranial Fossa ◽

Base Of The Skull ◽

Extradural Space

Abstract The so-called cavernous sinus is a venous pathway, an irregular network of veins that is part of the extradural venous network of the base of the skull, not a trabeculated venous channel. This venous pathway, the internal carotid artery, and the oculomotor cranial nerves cross the medial portion of the middle cranial fossa in an extradural space formed on each side of the sella turcica by the diverging aspects of a dural fold. In this space the venous pathway has only neighborhood relations with the internal carotid artery and the cranial nerves. The space itself must be distinguished from the vascular and nervous elements that it contains. The revision of the anatomy of this region has not only theoretical interest but also important clinical implications.

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Pipeline embolization device treatment of internal carotid artery terminus aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014312 ◽

2018 ◽

Vol 11 (5) ◽

pp. 485-488 ◽

Cited By ~ 5

Author(s):

Amit Pujari ◽

Brian Matthew Howard ◽

Thomas P Madaelil ◽

Susana Libhaber Skukalek ◽

Anil K Roy ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Treatment Strategies ◽

Maximum Diameter ◽

Class Iii ◽

Pipeline Embolization Device ◽

Proximal Internal Carotid Artery ◽

The Mean

BackgroundThe pipeline embolization device (PED) is approved for the treatment of large aneurysms of the proximal internal carotid artery (ICA). Its off-label application in treating aneurysms located specifically at the ICA terminus (ICA-T) has not been studied.MethodsWe conducted a retrospective chart review of patients from 2011 to 7 treated with PEDs. Out of 365 patients, 10 patients with ICA-T aneurysms were included. Patient demographics, procedural information, follow-up imaging, and clinical assessments were recorded.ResultsMean age was 46.9 years (± 8.8), and 6 (60%) patients were women. The mean maximum diameter of the aneurysms treated was 14.7 mm (± 10.7) and the mean neck diameter was 9.3 mm (± 6.6). Reasons for presentation included six incidental findings, one acute subarachnoid hemorrhage (SAH), and three patients with prior SAH. Kamran–Byrne Occlusion Scale scores for the treated aneurysms were as follows: three class IV (complete obliteration), four class III (<50% filling in both height and width for fusiform aneurysms or residual neck for saccular aneurysms), one class II fusiform aneurysm, 1 class 0 saccular aneurysm (residual aneurysm body), and one not classified due to pipeline thrombosis. Two clinically asymptomatic complications were noted: one patient who had a small distal cortical SAH post PED and one patient whose stent was found to be thrombosed on follow-up angiogram. All patients were seen in follow-up, and no patients were found to have worsening of their pre-procedure modified Rankin Scale score.ConclusionThe PED has potential for treating ICA-T aneurysms not amenable to conventional treatment strategies. Further studies are warranted to confirm the long term outcomes.

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Preoperative Embolization of Brain Tumor with Pial Artery or Dural Branch of Internal Carotid Artery as Feeding Artery

Interventional Neuroradiology ◽

10.1177/15910199060120s145 ◽

2006 ◽

Vol 12 (1_suppl) ◽

pp. 246-251 ◽

Cited By ~ 3

Author(s):

M Hirohata ◽

T Abe ◽

N Fujimura ◽

Y Takeuchi ◽

M Shigemori

Keyword(s):

Brain Tumor ◽

Carotid Artery ◽

Blood Loss ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Tumor Resection ◽

Preoperative Embolization ◽

Digital Subtraction ◽

Feeding Artery ◽

Pial Artery

This study evaluated the clinical usefulness of preoperative embolization of the pial artery or dural branch of the internal carotid artery (ICA) for brain tumor. Subjects comprised 17 patients with large hypervascular brain tumors who underwent preoperative selective embolization. Micro-catheters (2- or 1.7-F) and shapeable hydrophilic micro-guide wires were used for pial artery (branching from the posterior or anterior cerebral artery) or ICA dural branch embolization. Embolization was performed under digital subtraction fluoroscopy with Polyvinyl alcohol (PVA) particles (150–250 mm) and/or liquid coil. Tumor resection was performed immediately or the day after embolization. Digital subtraction angiography (DSA) before and after endovascular devascularization, blood loss during tumor resection, and clinical outcome were evaluated. All endovascular procedures were technically successful. Post-embolization DSA revealed either a disappearance or a marked decrease of the tumor stain in all cases. Control of intraoperative bleeding was easily accomplished, and intraoperative blood loss was low. Preoperative particle embolization of the feeding artery from the cortical artery or ICA dural branch is safe and effective as adjuvant therapy before tumor resection.

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Embolic stroke after carotid artery ligation during carotid body tumor resection

Vascular ◽

10.1258/vasc.2011.cr0274 ◽

2011 ◽

Vol 21 (1) ◽

pp. 23-26

Author(s):

Hyangkyoung Kim ◽

Yong-Pil Cho ◽

Ki-Myung Moon ◽

Tae-Won Kwon

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Body ◽

Internal Carotid ◽

Tumor Resection ◽

Antiplatelet Agents ◽

Carotid Body Tumor ◽

Tumor Surgery ◽

Artery Ligation ◽

Carotid Artery Ligation

This report describes a case of a delayed cerebral embolic infarction, after internal carotid artery (ICA) ligation secondary to carotid body tumor resection. We describe a 34-year-old woman who underwent left ICA ligation during a large carotid body tumor surgery. Immediately after surgery, the patient was neurologically asymptomatic; however, she subsequently developed a cerebral embolic infarction nine hours postoperatively. After beginning antiplatelet therapy, all symptoms ultimately resolved, although over a gradual course. Since the ligation of the ICA can cause thromboembolic infarctions of the cerebrum, we contend that antiplatelet agents be administered to prevent and/or treat embolic strokes.

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