Complete Removal of Bilateral Clinoidal Meningiomas Through a Pterional Approach: 3-Dimensional Operative Video

2021 ◽  
Author(s):  
Alvaro Campero ◽  
Matías Baldoncini ◽  
Sabino Luzzi ◽  
Juan F Villalonga
Keyword(s):  
Complete Removal ◽  
Neurofibromatosis Type ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Pterional Approach ◽  
3 Dimensional ◽  
Close Proximity ◽  
History Of ◽  
Microsurgical Techniques ◽  
Magnetic Resonance Imaging Mri

Abstract Surgical removal of anterior clinoidal meningiomas remains a challenge because of its complicated relationship with surrounding vascular and neural structures.1-3  This is a 39-yr-old female, with headaches, neurofibromatosis type 2, and history of 3 previous brain surgeries. The patient gave the consent to use the images and surgical video. In the imaging control, the growth of bilateral anterior clinoidal meningiomas was observed.  A right pterional approach and extradural anterior clinoidectomy was performed, and a complete resection of bilateral clinoidal meningiomas was achieved obtaining a Simpson scale resection grade 1.  The patient evolved without neurological deficits after the surgery, and the postoperative magnetic resonance imaging (MRI) evidenced a complete bilateral resection of the clinoidal meningiomas.  Clinoidal meningiomas are the unique subset of tumors because of their close proximity to neurovascular structures and can be safely excised with minimal morbidity and mortality using microsurgical techniques.3-5 In rare cases of bilateral anterior clinoidal meningiomas such as the case presented, we recommend detailed neuroimaging analysis and consider the possibility to resect both in a single approach.

Interhemispheric Contralateral Transfalcine Approach for Subparacentral Arteriovenous Malformation: 3-Dimensional Operative Video

2021 ◽  
Author(s):  
Matías Baldoncini ◽  
Alvaro Campero ◽  
Sabino Luzzi ◽  
Juan F Villalonga
Keyword(s):  
Right Hemisphere ◽  
Vascular Lesion ◽  
Neurological Deficits ◽  
3 Dimensional ◽  
Postoperative Mri ◽  
Drainage Vein ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Superior Longitudinal Sinus ◽  
The Right

Abstract Neurovascular procedures along the interhemispheric fissure harbor unique features differentiating them from those arteriovenous malformations (AVMs) located at the lateral surface of the brain.1-4  The aim of this 3-dimensional operative video is to present a microsurgical resection of an AVM in a subparacentral location, operated through an interhemispheric contralateral transfalcine approach.1,3,5  This is a case of a 29-yr-old female, with headaches and history of seizures. The patient presented an interhemispheric bleeding 6 mo before the surgery. The magnetic resonance imaging (MRI) showed a vascular lesion located on the medial surface of the right hemisphere at the confluence between the cingulate sulcus and its ascending sulcus. In the cerebral angiography, a right medial AVM was observed, receiving afference from the right anterior cerebral artery and draining to the superior longitudinal sinus. The patient signed an informed consent for the procedure and agreed with the use of her images and surgical video for research and academic purposes.  The patient was in a supine position, and a left interhemispheric contralateral transfalcine approach was performed,1-3 a circumferential dissection of the nidus, and, finally, the AVM was resected in one piece.  The patient evolved without neurological deficits after the surgery. The postoperative MRI and angiography showed a complete resection of the AVM.  In the case presented, to avoid exposing the drainage vein first and to use the gravity of the exposure, the contralateral transfalcine interhemispheric approach was used,1,2 which finally accomplished the proposed objectives.

CAVERNOUS HEMANGIOMA OF THE MESENCEPHALON: TONSILLOUVEAL TRANSAQUEDUCTAL APPROACH

2009 ◽  
Vol 64 (suppl_5) ◽  
pp. ons296-ons300
Author(s):  
Ruben Dammers ◽  
Ernst J. Delwel ◽  
Ali F. Krisht
Keyword(s):  
Cavernous Hemangioma ◽  
Functional Anatomy ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Suboccipital Craniotomy ◽  
Tela Choroidea ◽  
History Of ◽  
Microsurgical Techniques ◽  
The Right ◽  
First Time

Abstract OBJECTIVE Recent advances in microsurgical techniques facilitate surgical resection of brainstem lesions that were previously considered inoperable. In this article we present, for the first time, the tonsillouveal transaqueductal approach to access a progressively symptomatic cavernoma within the depth of the tegmentum of the mesencephalon. METHODS A 52-year-old woman presented with a history of slowly progressive right-sided hemiparesis and ataxia. On magnetic resonance imaging, a relatively large cavernoma involving the tegmentum of the mesencephalon was shown. The sylvian aqueduct was patent and there was no secondary ventriculomegaly. The patient underwent surgery via a suboccipital craniotomy and C1 laminectomy. The right tonsillouveal and medullotonsillar spaces were opened to the level of the choroidal point of the posteroinferior cerebellar artery. The tela choroidea was incised from the foramen of Magendie to the telovelar junction. Looking through the aqueduct and at a point 5 mm superior to its inferior inlet, there was a small cherry-like blister protruding into the aqueductal anterior surface. This was used as an entry point to access the cavernoma. The space around the cavernoma was gently dissected and the cavernoma was circumferentially coagulated to shrink it in a concentric manner toward its center. RESULTS The total removal of the lesion was achieved and the histopathological findings were consistent with a cavernoma. As a result of noncommunicating hydrocephalus, the patient needed a ventriculoperitoneal shunt. The 1-year postoperative neurological examination was consistent with preoperative findings. CONCLUSION This report shows, for the first time, direct surgical removal of a cavernous hemangioma in the mesencephalic tegmentum via the aqueduct. This approach adds to contemporary microneurosurgery, respecting functional anatomy and minimizing neurological deficits.

scholarly journals A rare case of cavernous hemangioma accompanied with diffuse hepatic hemangiomatosis

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Takuji Ota ◽  
Toshiya Kamiyama ◽  
Takuya Kato ◽  
Takayuki Hanamoto ◽  
Kunihiro Hirose ◽  
...  
Keyword(s):  
Oral Contraceptives ◽  
Cavernous Hemangioma ◽  
Contraceptive Use ◽  
Careful Examination ◽  
Pathological Examination ◽  
Surgical Removal ◽  
Adjacent Area ◽  
Oral Contraceptive Use ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

Abstract Background Hepatic cavernous hemangioma (CH) is the most common hepatic benign tumor. Most cases are solitary, asymptomatic, and found incidentally. In symptomatic cases with rapidly growing tumors and coagulopathy, surgical treatment is considered. In rare cases, diffuse hepatic hemangiomatosis (DHH) is reported as a comorbidity. The etiology of DHH is unknown. Case presentation A 29-year-old female patient had a history of endometriosis treated with oral contraceptives. Hepatic CH was incidentally detected in the segment IVa of the liver according to the Couinaud classification. Follow-up computed tomography (CT) and ultrasound sonography showed the growth of the lesion and formation of multiple new lesions near the first. Enhanced CT and magnetic resonance imaging (MRI) revealed that the new lesions were different from CH. Although oral contraceptives were stopped, all lesions grew in size. Malignancy and possibility of rupture of these tumors were considered due to the clinical course, and we opted for surgical removal of the tumors. Left liver lobectomy and cholecystectomy were performed. Surgical findings were small red spot spreading and a mass in segment IV of the liver. Pathological examination revealed a circumscribed sponge-like tumor with diffuse irregular extension to the adjacent area. Both of the lesions consisted of blood-filled dilated vascular spaces lined by flat endothelium without atypia. The diagnosis was hepatic CH with DHH. The patient was discharged on postoperative day 12 uneventfully. Conclusion We report the successful resection of CH with DHH. The case findings suggest a relationship between oral contraceptive use and enlargement of CH and DHH. Although DHH has been poorly understood, a few previously published cases reported DHH occurrence in patients using oral contraceptives. In such cases, the decision to perform surgical resection should be made after careful examination.

scholarly journals Multifocal granulocytic sarcoma of the spine mimicking neurofibromatosis Type 2: case report

2016 ◽  
Vol 25 (4) ◽  
pp. 523-527
Author(s):  
Gregory P. Lekovic ◽  
Marc S. Schwartz ◽  
John L. Go
Keyword(s):  
Granulocytic Sarcoma ◽  
Neurofibromatosis Type ◽  
Rapid Onset ◽  
Neurofibromatosis Type 2 ◽  
Neurological Deficits ◽  
Lumbosacral Spine ◽  
Imaging Features ◽  
History Of ◽  
Patient’S History

In this report the authors report on a patient with a very indolent course of granulocytic sarcoma, characterized by steroid-induced remission of spinal and cranial tumors and recurrence over a period of several years. This 24-year-old man with history of leukemia presented with rapid-onset quadriparesis secondary to multiple extraaxial masses of the cervicothoracic spine, from C-5 to T-3, and lumbosacral spine, from L-5 to the coccyx. Although the imaging features were highly suggestive of neurofibromatosis Type 2, the patient's history and clinical course were consistent with granulocytic sarcoma; repeat imaging and, later, needle biopsy definitively established the diagnosis of granulocytic sarcoma. Laminectomy and surgical decompression of the spine were not required and, arguably, could have posed unnecessary risk to the patient. This case illustrates that the successful management of a patient presenting with profound neurological deficits due to intradural spinal cord tumors may sometimes be nonsurgical.

Optic Nerve Glioma in Two Sisters with Family History of Neurofibromatosis Type 1

2018 ◽  
Vol 79 (03) ◽  
pp. 268-272
Author(s):  
Sevdalin Nachev ◽  
Lyudmila Todorova ◽  
Marin Marinov ◽  
Jivko Surchev
Keyword(s):  
Optic Nerve ◽  
Pediatric Patients ◽  
Neurofibromatosis Type ◽  
Treatment Modalities ◽  
Surgical Removal ◽  
Optic Nerve Glioma ◽  
History Of ◽  
Contralateral Eye

AbstractOptic nerve glioma (ONG) is associated in 10% of patients with neurofibromatosis (NF) type 1. To date no consensus has been reached regarding the therapeutic approach and prevention of visual impairment in these patients. Reports in the literature vary from a conservative approach (observation) to the use of single treatment modalities or multimodality protocols of surgical removal, radiotherapy, and/or chemotherapy. We present our experience with two siblings with ONG whose mother carries cutaneous stigmata of NF type 1. The younger sister was diagnosed 3 years after the treatment of the older sibling following recommended imaging for screening. Postoperative follow-up for 11 and 15 years, respectively, demonstrated lack of tumor regrowth and preserved vision in the contralateral eye. We discuss the treatment strategy in pediatric patients with orbital ONG associated with NF type 1.

Microsurgical Resection of Anaplastic Ependymoma of the Cerebellopontine Angle in an Adult: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. E91-E91 ◽  
Author(s):  
Sima Sayyahmelli ◽  
Mustafa K Baskaya
Keyword(s):  
Cerebellopontine Angle ◽  
Recurrent Disease ◽  
Anaplastic Ependymoma ◽  
Total Resection ◽  
3 Dimensional ◽  
History Of ◽  
Microsurgical Techniques ◽  
Microsurgical Resection ◽  
Grade Iii

Abstract Infratentorial ependymomas usually arise in the fourth ventricle and extend into the cerebellopontine angle (CPA) through the foramina of Luschka is well described. A primary CPA location of an ependymoma is distinctly uncommon.  In this 3-dimensional video, we present a 38-yr-old woman with a 1-mo history of vertigo and slow left sided gaze drift. She underwent microsurgical gross total resection of the CPA ependymoma via retrosigmoid approach. The histopathology was grade III anaplastic ependymoma. She tolerated the surgery well and her postoperative course was uneventful. She received radiation therapy and there was no recurrent disease in follow-up studies.  Important steps of the surgical approach and microsurgical techniques in resection of these challenging tumors are demonstrated in this 3-dimensional surgical video. The patient consented to publication of her image.

An analysis of the natural history of cavernous angiomas

1991 ◽  
Vol 75 (5) ◽  
pp. 702-708 ◽  
Author(s):  
O. Del Curling ◽  
David L. Kelly ◽  
Allen D. Elster ◽  
Timothy E. Craven
Keyword(s):  
Natural History ◽  
Mr Imaging ◽  
Vascular Malformations ◽  
Medical Center ◽  
Cavernous Angioma ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Cavernous Angiomas ◽  
History Of ◽  
Estimated Risk

✓ The advent of magnetic resonance (MR) imaging has permitted the recognition of many angiographically occult vascular malformations before the development of complications and subsequent surgical removal. This study reviews all patients at one institution who had radiographically identifiable vascular malformations believed to represent cavernous angiomas in order to obtain information on the natural history of this particular lesion. All 8131 craniospinal MR images performed at our medical center from January 1, 1986, to November 30, 1989, were reviewed, and 32 patients were identified with 76 lesions meeting the MR imaging criteria for cavernous angioma. Medical histories, physical examination records, and other data from these patients were then reviewed to determine the frequency of complications. Their mean age at latest follow-up examination (or at surgical removal of the lesion) was 37.6 years (range 16 to 72 years). Sixteen patients (50%) had a history of seizures, seven (22%) had focal neurological deficits, and three (9%) had clinically significant hemorrhage attributable to the cavernous angioma; six patients (19%) were asymptomatic. The estimated risk of hemorrhage for this population is 0.25%/person-year of exposure; the estimated risk of seizure development is 1.51%/person-year. Eight patients underwent surgical procedures, resulting in improved seizure control and/or lessened neurological deficit. Although these lesions are often excised with relative ease and minimal morbidity, the potential risks and benefits of surgery must be weighed carefully before removal of these relatively benign malformations.

scholarly journals A Human Case of Lumbosacral Canal Sparganosis in China

2021 ◽  
Vol 59 (6) ◽  
pp. 635-638
Author(s):  
Jian-Feng Fan ◽  
Sheng Huang ◽  
Jing Li ◽  
Ren-Jun Peng ◽  
He Huang ◽  
...  
Keyword(s):  
Human Case ◽  
Elisa Test ◽  
Hunan Province ◽  
Surgical Removal ◽  
Lumbosacral Spine ◽  
Serum Samples ◽  
Gadolinium Contrast ◽  
Inferior Margin ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

In this study, we intended to describe a human case of lumbosacral canal sparganosis in People’s Republic of China (China). A 56-year-old man was admitted to Xiangya Hospital Central South University in Changsha, Hunan province, China after having an experience of perianal pain for a week. An enhancing mass, a tumor clinically suggested, was showed at the S1-S2 level of the lumbosacral spine by the examination of magnetic resonance imaging (MRI) with gadolinium contrast. The patient was received the laminectomy from S1 to S2, and an ivory-white living worm was detected in inferior margin of L5. In ELISA-test with cerebrospinal fluid (CSF) and serum samples, anti-sparganum antibodies were detected. He had a ingesting history of undercooked frog meat in his youth. By the present study, a human case of spinal sparganosis invaded in lumbosacral canal at the S1-S2 level was diagnosed in China. Although the surgical removal of larvae is known to be the best way of treatment for sparganosis, we administered the high-dosage of praziquantel, albendazole and dexamethasone to prevent the occurrence of another remain worms in this study.

scholarly journals Neurofibromatosis Type 1 Presenting with Plexiform Neurofibromas in Two Patients: MRI Features

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Ahmet Mesrur Halefoglu
Keyword(s):  
Neurofibromatosis Type 1 ◽  
Autosomal Dominant ◽  
Genetic Disorders ◽  
Neurofibromatosis Type ◽  
Plexiform Neurofibromas ◽  
Mri Features ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Distinguishing Features

Neurofibromatosis type 1 (NF1), also known as peripheral neurofibromatosis or von Recklinghausen’s disease, is one of the most common genetic disorders. It is inherited in an autosomal dominant pattern. Multiple cutaneous neurofibromas are hallmark lesions of NF1. Localized and plexiform neurofibromas of the paraspinal and sacral region are the most common abdominal neoplasms in NF1. Herein, we report two patients with a known history of NF1 presenting with multiple, extensive localized and plexiform neurofibromas. We describe the important distinguishing features of these tumors as seen on magnetic resonance imaging (MRI), including very bright signal intensity and target sign on T2 weighted images.

scholarly journals Diffuse Neurofibroma in a Patient with Unknown History of NF1

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Mahmoud A. K. Ebrahim ◽  
Mishal M. AlMutairi ◽  
Khaled M. Hindi ◽  
Jassem M. Bastaki
Keyword(s):  
Parotid Gland ◽  
Previous History ◽  
Neurofibromatosis Type ◽  
Needle Aspiration ◽  
Nerve Sheath Tumor ◽  
Nerve Sheath ◽  
History Of ◽  
Laboratory Investigations ◽  
Magnetic Resonance Imaging Mri

Malignant peripheral nerve sheath tumor (MPNST) is a rare disease in the parotid gland with a poor prognosis in most cases. The disease most often develops in the setting of neurofibromatosis type 1 (NF1) but can also occur sporadically. Herein, we report a rare case of MPNST in the parotid gland, in a patient with no previous history of NF1. Initial investigations of the patient, which consisted of laboratory investigations, ultrasound imaging of the swelling, fine-needle aspiration (FNA), computed tomography (CT) scan, and magnetic resonance imaging (MRI) of the neck and swelling, were compatible with a benign pleomorphic adenoma of the parotid gland. However, intraoperatively, the dissection was challenging as the tumor was adherent to the neighboring tissue. A diagnosis of MPNST arising from a diffuse neurofibroma was established based on clinicopathologic features of the disease. The patient, who exhibited clinical features compatible with (NF1), proceeded for radiotherapy following surgery to continue his treatment.

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