Microsurgical Excision of T12-L1 Pial Arteriovenous Malformation: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. E85-E85
Author(s):  
Qazi Zeeshan ◽  
Chun-Yu Cheng ◽  
Basavaraj V Ghodke ◽  
Laligam N Sekhar
Keyword(s):  
Arteriovenous Malformation ◽  
Complete Recovery ◽  
Bowel Dysfunction ◽  
Sensory Loss ◽  
Anterior Spinal Artery ◽  
Magnetic Resonance Imaging Scan ◽  
Large Artery ◽  
Complete Excision ◽  
3 Dimensional ◽  
Bowel And Bladder Dysfunction

Abstract This 29-yr-old man presented with progressive paraparesis, sensory loss, allodynia, bowel, and bladder dysfunction for 9 mo, acutely exacerbated in the preceding 24 h. Magnetic resonance imaging scan showed multiple dilated vessels involving the thoracic cord. Spinal angiogram revealed a T12-L1 pial arteriovenous malformation (AVM)/arteriovenous fistula on the left side. It was fed by an L1 radicular artery that filled the anterior spinal artery, which in turn had multiple feeders to a pial AVM. Because of the supply from the anterior spinal artery with multiple feeders to the AVM, and the danger of infarction of the conus, embolization was not performed. He underwent T11-L1 laminectomy laterally to the pedicles and excision of AVM. There was one large arterialized vein in the midline that had a fistulous connection with an artery coursing up from inferiorly. Despite occlusion of this fistula, the vein was still arterialized. On further exploration, there was a large artery coming in to the subarachnoid space at the T11 level and coursing inferiorly, and entering the intradural pial AVM with a glomus of vessels located at the T12 level in the left anterolateral subpial aspect of the cord. This major artery as well as multiple smaller vessels going into it were cauterized and divided, and the AVM was totally excised. Postoperative angiogram showed complete excision of the nidus. At 1 mo follow-up, he had complete recovery of motor and bladder functions but bowel dysfunction persisted. He was independent for his daily activities. Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

Localization and Microsurgical Resection of Left Postcentral Gyrus Spetzler-Martin Grade 3 Arteriovenous Malformation by Intraoperative Neuronavigation and Tracing of Subcortical Draining Vein: 3-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E185-E186
Author(s):  
Qazi Zeeshan ◽  
Juan P Carrasco Hernandez ◽  
Laligam N Sekhar
Keyword(s):  
Arteriovenous Malformation ◽  
Blood Clot ◽  
Preoperative Embolization ◽  
Facial Weakness ◽  
Cortical Vein ◽  
3 Dimensional ◽  
Postcentral Gyrus ◽  
Microsurgical Resection ◽  
Martin Grade ◽  
Grade 3

Abstract This 42-yr-old man presented with a history of sudden right-sided facial and right arm weakness and dysarthria. Head computed tomography showed a left frontal-parietal blood clot. An intra-arterial digital subtraction angiography demonstrated a left subcortical postcentral, Spetzler-Martin Grade 3 arteriovenous malformation (AVM) with a diffuse nidus, measuring 2.1 × 1.5 cm, supplied by branches of the left MCA, and draining into a cortical vein and a deep vein, which was going toward the ventricle. Preoperative embolization was not possible.  The patient underwent left frontal-parietal craniotomy with intraoperative motor and sensory mapping. No arterialized veins were visible on the cortical surface. Neuronavigation localized the AVM in the subcortical postcentral gyrus. Through an incision in the postcentral sulcus, microdissection led to a yellowish gliotic plane. The large cortical vein was in the gliotic area and traced to the AVM. Circumferential microdissection was performed around the AVM. It had a very diffuse nidus; the arterial feeders were cauterized and divided, and the superior superficial and inferior deep draining veins were finally occluded, and AVM was removed.  Postoperative angiogram showed total removal of the AVM. At discharge, his right arm weakness had improved (power 5/5), and facial weakness and dysarthria were improving (modified Rankin Scale (mRS) 2). At 1-yr follow-up, facial weakness and dysarthria had improved considerably, and patient returned to work (mRS 1).  This video shows microsurgical resection of an AVM by neuronavigation and tracing of the subcortical draining vein. The technique of cauterizing the perforating arteries after temporary clipping with flow arrest is shown in the video. Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

scholarly journals Staphylococcus intermedius Brain Abscess as a Complication of Pulmonary Arteriovenous Malformation in a Patient With Hereditary Hemorrhagic Telangiectasia

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Leon S Moskatel ◽  
Joslyn N Vo ◽  
Keshav R Nayak ◽  
Nancy F Crum-Cianflone
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Abscess ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Clinical Manifestations ◽  
Complete Recovery ◽  
Pulmonary Arteriovenous Malformation ◽  
Staphylococcus Intermedius ◽  
First Case ◽  
Human Infections ◽  
The Brain

Abstract Staphylococcus intermedius is a rare cause of human infections ranging from skin and soft tissue infections to bacteremia. It is particularly known for its association with exposure to dogs. We report an unusual case of a 73-year-old female with a brain abscess caused by S intermedius who was recently diagnosed with hereditary hemorrhagic telangiectasia and a pulmonary arteriovenous malformation. The patient underwent debridement of the brain abscess followed by a 6-week course of vancomycin and rifampin, after which she made a near complete recovery. This is the first case of a brain abscess in an adult due to S intermedius in the published literature, and we provide a comprehensive review of the literature of all human infections caused by this pathogen and summarize its clinical manifestations, treatment recommendations, and outcomes.

Prevalence of bladder, bowel and sexual problems among multiple sclerosis patients two to five years after diagnosis

2007 ◽  
Vol 13 (1) ◽  
pp. 106-112 ◽  
Author(s):  
M W Nortvedt ◽  
T Riise ◽  
J Frugaård ◽  
J Mohn ◽  
A Bakke ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Bowel Dysfunction ◽  
Sexual Problems ◽  
Health Related Quality ◽  
Related Quality ◽  
Bowel And Bladder Dysfunction ◽  
Health Related ◽  
Multiple Sclerosis Patients

Most multiple sclerosis (MS) patients experience some sexual, bladder and/or bowel dysfunction during the course of the disease - one of MS most disabling features. This study estimated the frequency of these problems among patients, two to five years after diagnosis, and investigated how these problems are associated with health-related quality of life (using the Multiple Sclerosis Quality of Life-54 questionnaire). The study population comprised a cohort of patients (n=56), diagnosed in a three-year period, in Hordaland County, Norway. The patients were examined clinically, including scoring of the Expanded Disability Status Scale (EDSS), and completed questionnaires related to bowel and bladder dysfunction, sexual problems and health-related quality of life. More than half the patients had bladder and sexual problems. The frequency of self-reported bladder problems corresponded to the relatively high levels of residual urine found. The presence of these problems was associated with lower scores on the quality of life scales. Further, the bowel problems reported were markedly associated with the quality of life scores. Since treatments and preventive strategies can manage many of these problems, we suggest increasing the focus on these aspects of the disease when consulting patients, including at early stages.

scholarly journals Subcutaneous Zygomycosis Due to Basidiobolus ranarum: A Case Report from Maharastra, India

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Mani Anand ◽  
Sanjay D. Deshmukh ◽  
Dilip P. Pande ◽  
Suresh Naik ◽  
Dhyaneshwari P. Ghadage
Keyword(s):  
Case Report ◽  
Soft Tissue Tumor ◽  
Histopathological Examination ◽  
Inflammatory Lesion ◽  
Complete Recovery ◽  
Rare Entity ◽  
Complete Excision ◽  
Fungal Hyphae ◽  
Microbiological Examination ◽  
Asian Child

Entomophthoromycosis is a rare entity. We hereby report a case of entomophthoromycosis in a three-year-old Asian child who presented with a painless, nontender, rapidly increasing large swelling on the thigh of six months duration, which was initially misdiagnosed as a soft tissue tumor and resected. The cause of misleading diagnosis was rapid growth of the lesion in a short duration of time, indicating the possibility of a tumor. Histopathological examination revealed an inflammatory lesion with aseptate fungal hyphae and the characteristic Splendore-Hoeppli phenomenon. Microbiological examination identified the fungus as Basidiobolus ranarum. Complete excision of the lesion followed by antifungal therapy was associated with complete recovery. Entomophthoromycosis should be considered early when children from endemic areas present with unusual, rapid-growing lesions of the subcutaneous region. In order to emphasize tumor-like presentation of zygomycosis, we are presenting this case.

Anterior Approach for Removal of a Cervical Intradural Tumor

Neurosurgery ◽  
1978 ◽  
Vol 2 (2) ◽  
pp. 128-130 ◽  
Author(s):  
J.-Cartier Giroux ◽  
Chaouky Nohra
Keyword(s):  
Cervical Spine ◽  
Bone Grafting ◽  
Anterior Approach ◽  
Complete Recovery ◽  
Complete Excision ◽  
Intradural Tumor ◽  
Intradural Extramedullary

Abstract A case of an intradural extramedullary meningioma of the cervical spine excised through an anterior approach is reported. This permitted a complete excision without manipulation of the cord followed by a rapid and complete recovery. The technique of excision and bone grafting is described.

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