Microsurgical Resection of a Meningioma at the Entrance of Dorello's Canal Causing VI Cranial Nerve Compression: 2-Dimensional Operative Video

Abstract We describe the case of a 73-yr-old female patient with a 2-yr history of diplopia that has progressively become worse. Physical examination revealed a right VI cranial nerve (CN) palsy. Magnetic resonance imaging and angiography showed a dolichoectatic basilar artery near the VI CN. A suboccipital craniectomy was performed, initially with the intention to perform a microvascular decompression; however, a red mass was encountered at the entrance of the right Dorello's canal that was compressing the VI CN. Complete resection of the lesion was done and decompression of the nerve was accomplished. In the following video illustration, we narrate this operative case and highlight the nuances of this approach. Patient consent was obtained for the submission of the video to this journal.

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Extradural Devascularization for Resection of a Lesser Sphenoid Wing Meningioma: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz290 ◽

2019 ◽

Vol 19 (1) ◽

pp. E49-E49

Author(s):

David Gallardo-Ceja ◽

Thalia E Sanchez-Correa ◽

Diego Mendez-Rosito

Keyword(s):

Magnetic Resonance ◽

Complete Removal ◽

Resonance Imaging ◽

Large Tumor ◽

Anterior Clinoid Process ◽

Operative Case ◽

History Of ◽

Head Clamp ◽

The Right

Abstract We describe the case of a 42-yr-old female patient with a 2-yr history of headache that has progressively worsened. Physical examination revealed no neurological deficit. Magnetic resonance imaging showed a large tumor of the left lesser sphenoid wing that enhanced with gadolinium and produced displacement of the midline and the Sylvian fissure. A thorough analysis of the origin of the tumor was done to establish the surgical strategy. With the patient positioned supine with the head slightly turned to the right side, fixed in a 3-pin head clamp, a pterional craniotomy was performed. Since the origin of the tumor is in the lesser wing an early extradural devascularization of the tumor was done with drilling out all the hyperostotic bone of the lesser sphenoid wing, including the lateral base of the anterior clinoid process. Intradural debulking and resection showed the effect of extradural devascularization with an important decrease in bleeding, allowing the total resection of the tumor. An immediate postop magnetic resonance showed a complete removal of the tumor. The patient presented a paresis of the oculomotor nerve that completely resolved in the 3-mo follow-up. In the following video illustration, we narrate this operative case and highlight the nuances of this approach.1 The patient has given assent and written consent for videos, images, or clinical or genetic information to be published.

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Comorbid Depressive Disorders in Epilepsy

CNS Spectrums ◽

10.1017/s1092852900004223 ◽

2010 ◽

Vol 15 (S4) ◽

pp. 3-6 ◽

Cited By ~ 3

Author(s):

Andres M. Kanner ◽

Andrew J. Cole

Keyword(s):

Emergency Room ◽

Depressive Disorders ◽

Clonic Seizure ◽

Resonance Imaging ◽

Abnormal Signal ◽

The Past ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

History Of Depression

A 27-year-old woman presented to the emergency room after having witnessed generalized tonic clonic seizure while asleep. Birth and development were normal. She had suffered a single febrile seizure at 13 months of age, but had no other seizure risk factors. She was otherwise well except for a history of depression for which she was taking sertraline. Depressive symptoms had been well controlled over the past 3 months, but she had been under increased stress working to finish a doctoral thesis. Neurological examination was normal. Magnetic resonance imaging (MRI) showed modest asymmetry of the hippocampi, slightly smaller on the right, but no abnormal signal and well-preserved laminar anatomy. An electroencephalogram was negative. She was discharged from the emergency room with no treatment. Three weeks later, the patient's boyfriend witnessed an episode of behavioral arrest with lip smacking and swallowing automatisms lasting 45 seconds, after which the patient was confused for 20–30 minutes. The next morning she and her boyfriend kept a previously scheduled appointment with a neurologist.

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Spasmodic Torticollis Due to Neurovascular Compression of the Spinal Accessory Nerve by the Anteroinferior Cerebellar Artery: Case Report

Neurosurgery ◽

10.1097/00006123-200009000-00049 ◽

2000 ◽

Vol 47 (3) ◽

pp. 768-772 ◽

Cited By ~ 1

Author(s):

Concetta Alafaci ◽

Francesco M. Salpietro ◽

Gaspare Montemagno ◽

Giovanni Grasso ◽

Francesco Tomasello

Keyword(s):

Cranial Nerve ◽

Neuromuscular Disorder ◽

Spasmodic Torticollis ◽

Accessory Nerve ◽

Decompression Surgery ◽

Neurovascular Compression ◽

Cerebellar Artery ◽

History Of ◽

Microvascular Decompression Surgery ◽

The Right

ABSTRACT OBJECTIVE AND IMPORTANCE Spasmodic torticollis is a neuromuscular disorder characterized by uncontrollable clonic and intermittently tonic spasm of the neck muscles. We report a case of spasmodic torticollis attributable to neurovascular compression of the right XIth cranial nerve by the right anteroinferior cerebellar artery (AICA). CLINICAL PRESENTATION A 72-year-old man with a 2-year history of right spasmodic torticollis underwent magnetic resonance imaging, which demonstrated compression of the right XIth cranial nerve by an abnormal descending loop of the right AICA. INTERVENTION The patient underwent microvascular decompression surgery. During surgery, it was confirmed that an abnormal loop of the right AICA was compressing the right accessory nerve. Compression was released by the interposition of muscle between the artery and the nerve. CONCLUSION The patient's postoperative course was uneventful, and his symptoms were fully relieved at the 2-year follow-up examination. This is the first reported case of spasmodic torticollis attributable to compression by the AICA; usually, the blood vessels involved are the vertebral artery and the posteroinferior cerebellar artery.

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Progressive Spasticity With a Single Magnetic Resonance Imaging Lesion

10.1093/med/9780197583425.003.0006 ◽

2021 ◽

pp. 20-21

Author(s):

Samantha A. Banks ◽

Eoin P. Flanagan

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Magnetic Resonance ◽

Oligoclonal Bands ◽

Resonance Imaging ◽

Fluid Analysis ◽

Skin Cancers ◽

Clinical Episode ◽

History Of ◽

The Right

A 59-year-old White man with a history of excised basal and squamous cell skin cancers was evaluated for gait difficulties. He had erectile dysfunction but no bowel or bladder dysfunction. He also reported fatigue. He began using a cane for ambulation 2 weeks before evaluation at our facility. His medications included vitamin D and sildenafil. He was a lifelong nonsmoker and had no family history of multiple sclerosis. Neurologic examination at the time of our evaluation 3 years after onset was notable for a positive Hoffman sign on the right and mild weakness of the right triceps but preserved strength elsewhere. He had a spastic gait with moderate spasticity in both lower extremities, hyperreflexic patellar and ankle jerks bilaterally, and bilateral positive Babinski sign. The remainder of the examination was essentially normal. Magnetic resonance imaging of the brain showed a single lesion at the cervicomedullary junction and medullary pyramids, more prominent on the right. There was also some accompanying atrophy that was also visible on cervical spine magnetic resonance imaging. Results of cerebrospinal fluid analysis showed a normal white blood cell count, increased protein concentration (108 mg/dL), and positive oligoclonal bands. The progressive nature of his symptoms, spinal fluid results, and lesion appearance were all consistent with a diagnosis of progressive solitary sclerosis. At the time this patient was seen, no immunomodulatory medications for progressive solitary sclerosis were approved, so no immunomodulatory medication was tried. Ongoing symptomatic management was recommended. Progressive solitary sclerosis is a rare variant of multiple sclerosis in which patients have a single central nervous system demyelinating lesion and development of motor progression attributable to that lesion. Patients can initially have a clinical episode followed by progression or can have a progressive course without an initial relapse.

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Microsurgical Resection of Trigeminal Schwannomas: 3-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz097 ◽

2019 ◽

Vol 18 (1) ◽

pp. E18-E18

Author(s):

Duarte N C Cândido ◽

Marcio S Rassi ◽

Guilherme Henrique Weiler Ceccato ◽

Jean Gonçalves de Oliveira ◽

Luis A B Borba

Keyword(s):

Trigeminal Nerve ◽

Senior Author ◽

Petrous Apex ◽

Middle Fossa ◽

Middle Fossa Approach ◽

3 Dimensional ◽

History Of ◽

Nerve Paresis ◽

Microsurgical Resection ◽

The Right

Abstract Trigeminal schwannomas are benign lesions arising from the Schwann cells of the trigeminal nerve. This is an unusual tumor that accounts for less than 0.4% of intracranial pathologies, even though they are the second most frequent schwannoma after the vestibular schwannoma. The tumor spreads along the natural course of the V nerve at its cisternal portion, along the ganglion inside Meckel's cave or through its peripheral division. Even though the tumor can reach great size and become multicompartmental. We present a 51-yr-old woman, with an history of 3 mo of incapacitating facial pain, that was found on examination to be on the territory of the third division of the trigeminal nerve on the right side. The MRI depicted a large homogeneous enhancing lesion at the base of the right middle fossa with extension through the petrous apex to the most superior and medial part of the posterior fossa. The patient was operated by the senior author, through a middle fossa approach, dissecting between the two layers of the middle fossa dura (the apparent inner and the true outer layer of the cavernous sinus), the so called middle fossa “peeling”. We achieved total resection of the tumor, but the patient presented after surgery with facial nerve paresis. This is thought to be related to geniculate ganglion manipulation, as it was unprotect by bone at the middle fossa and the patient maintained lacrimal function (post-geniculate alteration). It resolved completely after 6 mo. The patient consented to publication of her images.

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Orbital Schwannoma: Case Report and Review

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0039-1693683 ◽

2019 ◽

Vol 38 (03) ◽

pp. 199-202 ◽

Cited By ~ 1

Author(s):

Ricardo Lourenço Caramanti ◽

Mário José Goes ◽

Feres Chaddad ◽

Lucas Crociati Meguins ◽

Dionei Freitas de Moraes ◽

...

Keyword(s):

Clinical Symptoms ◽

Previous History ◽

Mass Effect ◽

Complete Resection ◽

High Signal ◽

Resonance Imaging ◽

History Of Disease ◽

Orbital Pain ◽

History Of ◽

Magnetic Resonance Imaging Mri

AbstractOrbital schwannomas are rare, presenting a rate of incidence between 1 and 5% of all orbital lesions. Their most common clinical symptoms are promoted by mass effect, such as orbital pain and proptosis. The best complementary exam is the magnetic resonance imaging (MRI), which shows low signal in T1, high signal in T2, and heterogeneous contrast enhancement. The treatment of choice is surgical, with adjuvant radiotherapy if complete resection is not possible. We report the case of a 24-year-old male patient with orbital pain and proptosis, without previous history of disease. The MRI showed a superior orbital lesion compatible with schwannoma, which was confirmed by biopsy after complete resection using a fronto-orbital approach.

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NOVEL SURGICAL TREATMENT OF A TRANSVERSE-SIGMOID SINUS ANEURYSM PRESENTING AS PULSATILE TINNITUS

Neurosurgery ◽

10.1227/01.neu.0000338255.93266.00 ◽

2009 ◽

Vol 64 (2) ◽

pp. E393-E394 ◽

Cited By ~ 34

Author(s):

Yakov Gologorsky ◽

Scott A. Meyer ◽

Alexander F. Post ◽

H. Richard Winn ◽

Aman B. Patel ◽

...

Keyword(s):

New York ◽

Surgical Treatment ◽

Sigmoid Sinus ◽

Venous Aneurysm ◽

Pulsatile Tinnitus ◽

Aneurysm Neck ◽

Suboccipital Craniectomy ◽

History Of ◽

Flow Through ◽

The Right

Abstract OBJECTIVE Pulsatile tinnitus is a relatively common, potentially incapacitating condition that is often vascular in origin. We present a case of disabling pulsatile tinnitus caused by a transverse-sigmoid sinus aneurysm that was surgically treated with self-tying U-clips (Medtronic, Inc., Memphis, TN). We also review the literature and discuss other described interventions. CLINICAL PRESENTATION A 48-year-old woman presented with a 5-year history of progressive pulsatile tinnitus involving the right ear. Her physical examination was consistent with a lesion that was venous in origin. Angiography demonstrated a wide-necked venous aneurysm of the transverse-sigmoid sinus that had eroded the mastoid bone. INTERVENTION The patient underwent a retromastoid suboccipital craniectomy to expose the aneurysm and surrounding anatomy. The aneurysm dome was tamponaded and the aneurysm neck was coagulated until the dome had shrunk to a small remnant. The linear defect in the transverse sigmoid junction was then reconstructed with a series of U-clips and covered with Gelfoam hemostatic sponge (Pfizer, Inc., New York, NY). The patient awakened without neurological deficit and with immediate resolution of her tinnitus. A postoperative angiogram demonstrated obliteration of the aneurysm, with minimal stenosis in the region of the repair and good flow through the dominant right transverse-sigmoid junction. CONCLUSION This technical case report describes a novel definitive surgical treatment of venous sinus aneurysms. This technique does not necessitate long-term anticoagulation, has a low likelihood of reintervention, and provides immediate resolution of pulsatile tinnitus.

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Intracranial subdural osteoma

European Journal of Inflammation ◽

10.1177/2058739220926854 ◽

2020 ◽

Vol 18 ◽

pp. 205873922092685

Author(s):

Yunna Yang ◽

Zheng Gu ◽

Yinglun Song

Keyword(s):

Dura Mater ◽

Histopathological Examination ◽

Surgical Excision ◽

Benign Neoplasms ◽

Resonance Imaging ◽

Inner Surface ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

T1 Hyperintensity ◽

The Right

Subdural osteomas are extremely rare benign neoplasms. Here, we report the case of a 35-year-old female patient with a right frontal and parietal subdural osteoma. The patient presented with a 2-year history of intermittent headache and fatigue. Computerized tomography (CT) scan showed a high-density lesion attached to the inner surface of the right frontal and parietal skull. Magnetic resonance imaging (MRI) demonstrated T1 hyperintensity and T2 hypointensity of the lesion. Intraoperatively, the hard mass was located in subdural space and attached to the dura mater. Histopathological examination revealed lamellated bony trabeculae lined by osteoblasts and the intertrabecular marrow spaces occupied by adipose tissue. The patient underwent neurosurgical resection and recovered without complication. Surgical excision is recommended to extract the symptomatic lesions with overlying dura mater.

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Surgical treatment of a cerebral brain abscess in a cat

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-10-02-0018 ◽

2011 ◽

Vol 24 (01) ◽

pp. 72-75 ◽

Cited By ~ 7

Author(s):

M. Beukers ◽

L. F. H. Theyse ◽

E. G. H. Wouters

Keyword(s):

Magnetic Resonance Imaging ◽

Histopathological Examination ◽

Resonance Imaging ◽

Ataxic Gait ◽

Pupillary Light ◽

Small Defect ◽

History Of ◽

The Right ◽

Extensive Necrosis ◽

Temporal Lobe Lesion

SummaryA nine-year-old male castrated European Shorthair cat was presented with a six-day history of progressive depression and ataxic gait. Neurological examination revealed depression, absent menace in the left eye, absent pupillary light reflex in the right eye, anisocoria, circling to the right, and delayed proprioception in all limbs. Magnetic resonance imaging showed a space-occupying right temporal lobe lesion adjacent to a small defect in the temporal bone suggestive of a meningo-encephalitis with concurrent abscess formation. The site was surgically approached by a rostrotentorial craniectomy. A cerebral abscess was found and debrided. Histopathological examination of the removed tissue demonstrated a subacute to chronic purulent encephalitis with extensive necrosis of brain tissue. Neurological symptoms resolved completely within two weeks and full recovery was observed four weeks after surgery.

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Internal Carotid Dissection as the Cause of Stroke in Childhood

Case Reports in Pediatrics ◽

10.1155/2021/5568827 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Giulia Cinelli ◽

Vitaliana Loizzo ◽

Lisa Montanari ◽

Ilaria Filareto ◽

Elisa Caramaschi ◽

...

Keyword(s):

Risk Factors ◽

Magnetic Resonance ◽

Internal Carotid ◽

Clinical Signs ◽

Cervical Pain ◽

Resonance Imaging ◽

Cervical Trauma ◽

History Of ◽

Associated Risk Factors ◽

The Right

Internal carotid artery (ICA) dissection is a cause of stroke, but it is often underdiagnosed in children. ICAs’ risk factors and pathogenic mechanisms are poorly understood, and the treatment is still empirical. We report the case of a previously healthy 9-year-old girl who presented with involuntary hypertonic closure of the right hand associated with transient difficulty for both fine movements of the right arm and speech. She had a history of minor cervical trauma occurring 20 days prior to our observation without other associated risk factors. Magnetic resonance imaging and magnetic resonance angiography showed ischemic lesions due to the left ICA dissection. Treatment with both acetylsalicylic acid and levetiracetam allowed recanalization of the ICA associated with the resolution of clinical signs. Our clinical case suggests that the ICA dissection must be suspected early whenever a child manifests mild neurologic deficits after a cervical trauma, especially if they are associated with headache and/or cervical pain. Moreover, the management of ICA dissection must be improved.

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