“Craniotomy Within Craniotomy” Technique for Safe Resection of an Intracranial Arteriovenous Malformation With Frontal Bony Erosion: 2-Dimensional Operative Video

Acute Onset ◽

Bone Flap ◽

Intracranial Arteriovenous Malformation ◽

Excessive Bleeding ◽

Left Hand ◽

The Right ◽

Venous Varix

Abstract Surgical resection is one option in the treatment of large high-grade brain arteriovenous malformations (AVMs). Resection of AVMs with skull-eroding components can be challenging due to the risk of excessive bleeding from these components during craniotomy and bone flap removal. We present a case of a 25-yr-old woman who presented with an acute onset right-sided frontal headache. She was found to have a large, frontal Spetzler-Martin grade IV AVM with an associated dural AVM. The AVM had caused focal erosions of the right frontal bone by a venous varix traversing the region of the calvarial defect. An elective staged endovascular embolization followed by surgical resection was recommended considering the patient's young age and the large size of the AVM located in a noneloquent area. Given the high risk of intraoperative hemorrhage during the craniotomy portion of the procedure, a “craniotomy within craniotomy” approach was planned. During this approach, a small rectangle of bone, including the portion eroded by the venous varix, was left in place, while the larger bone flap surrounding it was removed for an initial approach to the AVM. The small bony piece was safely removed at later stages of resection once the arterial feeders had been reasonably obliterated. Immediate postoperative catheter angiogram demonstrated good filling of the intracranial vascular territories with no residual AVM. The patient developed mild left facial and left hand weakness postoperatively, which resolved after 2 wk of follow-up. The patient remained neurologically intact on further follow-up.

Advances in the endovascular treatment of intracranial arteriovenous malformations

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2000.2.3/atournade ◽

2000 ◽

Vol 2 (3) ◽

pp. 315-320

Keyword(s):

3D Imaging ◽

Treatment Options ◽

Interventional Neuroradiology ◽

Functional Magnetic Resonance ◽

Intracranial Arteriovenous Malformations ◽

Intracranial Arteriovenous Malformation ◽

Work Up ◽

Valuable Role

The three treatment options for intracranial arteriovenous malformation are resection, endovascular embolization, and stereotactic radioneurosurgery, in rare cases, the malformation can be eradicated using only one of these options; most cases require a combination of the options, even all three. The most recent advances have been in interventional neuroradiology with the introduction of highdefinition 3D imaging and hyperselective intranidal endovascular embolization using rnicrocatheters and microguidewires, giving marked advantages in terms of rapidity, efficacy, and safety, Nidal devascularization is now much improved, as shown by the increased interval between embolization sessions, while high-field functional magnetic resonance imaging plays a valuable role in the preembolization work-up and postembolization follow-up.

Giant intracranial capillary hemangioma associated with enlarged head circumference in a newborn

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/1/6/488 ◽

2008 ◽

Vol 1 (6) ◽

pp. 488-492 ◽

Cited By ~ 18

Author(s):

Thomas Daenekindt ◽

Frank Weyns ◽

Kuan Hua Kho ◽

Dieter Peuskens ◽

Koen Engelborghs ◽

...

Keyword(s):

Recent Literature ◽

Capillary Hemangioma ◽

Neurological Deficits ◽

Conservative Approach ◽

Temporal Fossa ◽

Natural Behavior ◽

Intracranial Lesion ◽

✓ The authors describe the case of a patient with an intracranial capillary hemangioma, and they review the recent literature on intracranial capillary hemangiomas with special attention to their differential diagnosis and management. The only sign in this 7-week-old boy was head enlargement. There were no neurological deficits, and imaging revealed a large intracranial lesion in the right temporal fossa. The results of biopsy confirmed the diagnosis, and, after endovascular embolization, the entire lesion was resected. The incidence of intracranial capillary hemangioma is very low but may be underestimated. In the present case, the size of the tumor prompted surgical treatment. The natural behavior of extracranial capillary hemangiomas, however, suggests that a conservative approach with follow-up and steroid therapy may also be considered.

Case of primary hepatic leiomyosarcoma successfully treated with laparoscopic right hepatectomy

BMJ Case Reports ◽

10.1136/bcr-2019-233567 ◽

2020 ◽

Vol 13 (2) ◽

pp. e233567 ◽

Cited By ~ 1

Author(s):

Stephanie Vella ◽

Kelvin Cortis ◽

David Pisani ◽

James Pocock ◽

Luca Aldrighetti

Keyword(s):

Physical Examination ◽

Surgical Resection ◽

Epigastric Pain ◽

Large Mass ◽

Disease Recurrence ◽

Right Hepatectomy ◽

Liver Lobe ◽

Laparoscopic Right Hepatectomy ◽

We describe the case of a 77-year-old woman, presenting with non-specific epigastric pain. Physical examination and subsequent imaging revealed the presence of a large mass in the right liver lobe. This was shown to be a leiomyosarcoma on biopsy histology. Further investigation confirmed this to be a primary hepatic leiomyosarcoma with no evidence of metastases. The patient underwent successful surgical resection. She is currently under imaging follow-up, with no evidence of disease recurrence.

Clinical Characteristics of Nodular Fasciitis of Ear in Children

10.21203/rs.3.rs-484827/v1 ◽

2021 ◽

Author(s):

Xiaoxu Wang ◽

Wei Liu ◽

Lejian He ◽

Min Chen ◽

Jianbo Shao ◽

...

Keyword(s):

Surgical Resection ◽

Clinical Characteristics ◽

Clinical Manifestations ◽

Neck Surgery ◽

Final Diagnosis ◽

Diagnosis And Treatment ◽

Nodular Fasciitis ◽

Gene Test ◽

Abstract Purpose Summarized the clinical characteristics and diagnosis and treatment process of three cases of nodular fasciitis of ear, to provide a basis for clinical diagnosis and treatment. Methods Reviewed the clinical manifestations, images, pathology, treatment and postoperative follow up results of three cases of pediatric nodular fasciitis in the Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University from 2018 to 2020. Results The average age at diagnosis were 24 months, with two girls and a boy. Two lesions were found in the left ear and one in the right ear. All cases had a history of biopsy before surgery. Two of three cases showed a sign of rapid growth after biopsy and three of which were ineffective in anti-inflammatory treatment. FISH test for USP6 were performed in two of the three cases with positive results. Three lesions show a hypointensity or isointensity on T1-weighted MRI and a heterogeneous hyperintensity on T2-weighted MRI. ‘‘Fascial tail’’ sign was found on image of all three cases. All lesions underwent surgical resection. Follow-up showed no recurrence and had an intact ear appearance. Conclusion The early misdiagnosis rate of nodular fasciitis of the ear is high. Combine clinical features with imaging findings may improve the accuracy of preoperative diagnosis. Besides the appearance of pathology, USP6 gene test is also an important tool in the diagnosis. The final diagnosis should be based on comprehensive assessment. Complete surgical resection can prevent recurrence.

Bilateral Multiple Metacarpal Head Avascular Necrosis: A Case Report

International Surgery ◽

10.9738/intsurg-d-16-00010.1 ◽

2016 ◽

Vol 101 (9-10) ◽

pp. 473-477 ◽

Cited By ~ 2

Author(s):

Wengang Li ◽

Biao Liu ◽

Jun Song ◽

Yan Liu ◽

Haoyu Liu ◽

...

Keyword(s):

Avascular Necrosis ◽

Middle Finger ◽

Left Hand ◽

The Third ◽

Metacarpal Head ◽

Right Hand ◽

Satisfactory Clinical Result ◽

Slight Limitation ◽

Avascular necrosis of the metacarpal head is a rare disease. We herein report a case with varying degrees of lesions in the third and fourth metacarpal heads of the right hand and the third metacarpal head of the left hand. The patient was a 37-year-old male right-handed mechanical worker who presented with persistent dull pain in the right hand after labor work for more than a year. The 3 lesions in this patient were treated differently based on their clinical imaging manifestations. The neurologic function of the right hand recovered by the 18-month follow-up; only a slight limitation remained in the right middle finger. This is the first report of 1 patent who received 2 different treatment methods simultaneously and both provided a satisfactory clinical result.

Detailed Sonographic Anatomy of Dorsal Hand Augmentation With Hyaluronic Acid and Calcium Hydroxyapatite Fillers

Aesthetic Surgery Journal ◽

10.1093/asj/sjy227 ◽

2018 ◽

Vol 39 (10) ◽

pp. 1096-1106 ◽

Cited By ~ 2

Author(s):

Jong Seo Kim

Keyword(s):

Hyaluronic Acid ◽

Calcium Hydroxyapatite ◽

Level Of Evidence ◽

Left Hand ◽

Stratum Corneum Hydration ◽

Dorsal Hand ◽

Hands On ◽

Grading Scale ◽

Abstract Background Volume restoration using filler in the dorsum of the hand is a simple and effective procedure to improve wrinkles and hide veins and tendons. Currently, calcium-hydroxyapatite (CaHA) filler is the only FDA-accepted material to use in the hand dorsum. However, it is not easy to inject due to swelling and redness. In addition, hand anatomy through sonography is wrongly described in Plastic and Reconstructive Surgery® Journal. Through incorrect marking in sonographic hand anatomy, physicians will conduct erroneous procedures and surgeries. Objectives CaHA filler and hyaluronic acid (HA) filler were both injected into the hand to compare intra-individually the effect of each filler. Through this study, the author introduced detailed and refined sonographic anatomy. Overall, the author identified the correct injection method and depth. Methods In this prospective, intra-individual, comparative study, patients were injected 1 cc of CaHA filler to the left hand and 3 cc (36 mg) of microphasic hyaluronic acid to the right. Outcomes were assessed by Merz hand grading scale, skin bio-parameters, dermascopic finding, and Global Aesthetic Improvement Scale (GAIS) with follow-up at 3, 6, 9, and 12 months. Results The average GAIS score improved in both hands and generally maintained over the course of the study. There was significantly more bruising and swelling in the CaHA-injected hands compared with the HA-injected hands. The skin roughness and appearance improved in both sets of hands on dermascope. The average Trans-Epidermal-Water-Loss decreased and the average Stratum Corneum Hydration increased in HA-injected hands. The biopsy study showed that the HA particles lasted for 9 months. Conclusions The author reestablished sonographic anatomy. Veins and tendons became less apparent after injections. Level of Evidence: 2

Lymphocutaneous Sporotrichosis during Treatment with Anti-TNF-Alpha Monotherapy

Case Reports in Rheumatology ◽

10.1155/2015/614504 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 6

Author(s):

Francesco Ursini ◽

Emilio Russo ◽

Christian Leporini ◽

Marilena Calabria ◽

Caterina Bruno ◽

...

Keyword(s):

Sporothrix Schenckii ◽

Direct Consequence ◽

Dimorphic Fungus ◽

Left Hand ◽

Clinical Syndromes ◽

Nodular Lesions ◽

Appropriate Therapy ◽

The Right ◽

First Time

Sporotrichosis is an infectious disease caused bySporothrix schenckii, a dimorphic fungus isolated for the first time in 1896 by Benjamin Schenck from a 36-year-old male patient presenting lesions on the right hand and arm. The infection generally occurs by traumatic inoculation of soil, plants, and organic matter contaminated with the fungus. Different clinical syndromes are described as a direct consequence ofS. schenckiiinfection, including lymphocutaneous and disseminated forms, although extracutaneous presentations are reported most frequently in AIDS patients. Here we describe the case of a 57-year-old Caucasian male diagnosed in 2004 with ankylosing spondylitis under stable treatment with adalimumab monotherapy (40 mg every other week). During a routine follow-up visit in March 2013, he presented with multiple nodular lesions arranged in a linear fashion along the left hand and forearm. After diagnostic aspiration of the lesions, lymphocutaneous sporotrichosis was diagnosed and appropriate therapy started.

Endovascular coil embolization of a spinal epidural arteriovenous fistula with associated cord compression from an enlarging venous varix

Interventional Neuroradiology ◽

10.1177/1591019915609132 ◽

2015 ◽

Vol 21 (6) ◽

pp. 738-741 ◽

Cited By ~ 1

Author(s):

Dale Ding ◽

Robert M Starke ◽

David Manka ◽

R Webster Crowley ◽

Kenneth C Liu

Keyword(s):

Coil Embolization ◽

Venous Drainage ◽

Cord Compression ◽

Technical Note ◽

Arteriovenous Fistulas ◽

Endovascular Coil Embolization ◽

The Right ◽

Spinal Epidural ◽

Venous Varix

Spinal arteriovenous fistulas (AVFs) completely isolated to the epidural compartment are exceedingly rare. As such, the optimal management of these lesions is poorly defined. The aim of this technical note is to describe our endovascular technique for the occlusion of a purely epidural AVF of the thoracic spine associated with cord compression from an associated enlarging venous varix. A 40-year-old male presented with severe right-sided back pain and anterior thigh numbness after a sports-related back injury six months previously. Spinal magnetic resonance imaging (MRI) showed an enhancing, extradural mass lesion at T12. Spinal angiography revealed an epidural AVF supplied by a radicular branch of the right T12 subcostal artery and draining into the paravertebral lumbar veins, as well as an adjacent 20 × 13 mm2 contrast-filling sac, compatible with a dilated venous varix. There was no evidence of intradural venous drainage. We elected to proceed with endovascular treatment of the lesion. At the time of embolization five days later, the venous varix had enlarged to 26 × 16 mm2. The T12 epidural AVF was completely occluded with two coils, without residual or recurrent AVF on follow-up angiography one month later. The patient made a full recovery, and complete resolution of the venous varix and cord compression were noted on MRI at three months follow-up. Endovascular coil embolization can be successfully employed for the treatment of appropriately selected spinal epidural AVFs. Cord compression from an enlarging venous varix can be treated concurrently with endovascular occlusion of an associated spinal epidural AVF.

Rare Case of Young Patient with Intraventricular Angiomatous Meningioma

Global Journal of Medical Research ◽

10.34257/gjmravol21is3pg19 ◽

2021 ◽

pp. 19-25

Author(s):

Gabriel Carvalho Heemann ◽

Vinicius Rosa de Castro ◽

Normando Guedes Pereira Neto ◽

Camila Bocchi ◽

Otavio Garcia Martins ◽

...

Keyword(s):

Surgical Resection ◽

Lateral Ventricle ◽

The Body ◽

Neurological Sequela ◽

Transcallosal Approach ◽

Frontal Horn ◽

Intraventricular Tumors ◽

The Right ◽

Clinical Stability

Pediatric meningiomas are rare and account for only 2.2% of CNS tumors. In this age group, they are more frequently located in atypical sites, such as, mainly, the ventricular system, with a frequency of 8.8 to 13.6%. Adding this to the fact that the angiomatous subtype constitutes only 2.1% of all meningiomas, the rarity of the case reported here i s corroborated. We report a 17-year-old female patient diagnosed with intraventricular angiomatous meningioma; she underwent surgical resection of the tumor in the body and frontal horn of the right lateral ventricle, and there was no neurological sequela. With a follow-up of 4 years, there was no recurrence and the patient had clinical stability. Intraventricular tumors usually have slow growth and reach considerable size until they cause symptoms and then are diagnosed. In addition, the tumor’s deep location and proximity to eloquent areas make such tumors an neurosurgical challenge. The angiomatous subtype, due to the presence of hypervascularization (consisting of more than 50% of vascular components), may, in some cases, hinder surgical resection as well as be erroneously diagnosed. However, surgical treatment aimed at total resection of the lesion remains the conduct of choice in the case reported here, especially in patients in the first two decades of life, in which the use of radiation is avoided. Specifically when it comes to the surgery, we chose a transcallosal approach that allows a good transoperative visualization of the lesion when located in the body and frontal horn of the lateral ventricle.

Embolization of a peripheral cerebral aneurysm associated with intracranial major artery occlusion through a transdural anastomotic artery: Case report

Interventional Neuroradiology ◽

10.1177/1591019918801539 ◽

2018 ◽

Vol 25 (2) ◽

pp. 172-176 ◽

Cited By ~ 1

Author(s):

Norito Fukuda ◽

Kazuya Kanemaru ◽

Koji Hashimoto ◽

Hideyuki Yoshioka ◽

Nobuo Senbokuya ◽

...

Keyword(s):

Cerebral Aneurysm ◽

Artery Occlusion ◽

Acute Onset ◽

Ruptured Aneurysm ◽

Occipital Artery ◽

Collateral Vessel ◽

Pericallosal Artery ◽

Collateral Vessels ◽

A peripheral cerebral aneurysm is known to develop at collateral vessels as a result of hemodynamic stress by the occlusion of the intracranial major arteries. We report a case of successful embolization of a ruptured aneurysm through a transdural anastomotic artery. The aneurysm formed at the developed collateral vessel from the meningeal branch of the occipital artery (OA) to the posterior pericallosal artery. A 59-year-old man presented with acute-onset headache, and computed tomography revealed subarachnoid hemorrhage and intracerebral hemorrhage at the splenium of the corpus callosum with intraventricular hemorrhage. Digital subtraction angiography demonstrated a ruptured aneurysm located at a transdural anastomotic artery from the right OA to the posterior pericallosal artery. The patient underwent endovascular treatment for the aneurysm through the transdural anastomotic artery with a coil and n-butyl-2-cyanoacrylate. Because it was impossible to navigate a microcatheter to the aneurysm through the right anterior cerebral artery because of the occlusion of its proximal portion, it was advanced through the transdural anastomosis from the right OA. The aneurysm was completely occluded without complications. Endovascular embolization is a useful treatment option for a peripheral cerebral aneurysm developed at a collateral vessel with intracranial major artery occlusion.