Burr Hole-Assisted Direct Transsylvian Venous Catheterization for Carotid-Cavernous Fistula Embolization: A Case Report

Abstract BACKGROUND AND IMPORTANCE Carotid-cavernous fistulas (CCF) are pathological connections between carotid artery branches and the cavernous sinus. They can lead to a variety of symptoms, such as chemosis and double vision, or more insidious events, such as vision loss and intracranial hemorrhage. Although these patients are often treated by endovascular means, we describe a case in which the patient's CCF was not able to be accessed by usual methods and required an open surgical approach. CLINICAL PRESENTATION The patient had progressive chemosis, double vision, and periorbital pain. Angiogram showed an indirect type D CCF with cortical venous drainage with a large sylvian vein that was directly draining the fistula. The patient did not have a dilated superior ophthalmic vein, and the petrosal sinuses could not be catheterized. Therefore, because of the patient's increased risk for intracranial hemorrhage, she was taken to the operating room for an image guided burr hole for direct catheterization of the sylvian vein. From this point, the fistulous point could be catheterized, and the CCF was embolized using onyx. Follow-up angiogram showed complete occlusion. CONCLUSION This is the first report in literature of an indirect CCF being treated through a transsylvian approach with onyx. This combined open-surgical-and-endovascular approach was necessary to get full resolution of the lesion, and patient had rapid improvement of symptoms.

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Dural carotid cavernous fistula following hypertensive emergency

BMJ Case Reports ◽

10.1136/bcr-2019-230823 ◽

2019 ◽

Vol 12 (9) ◽

pp. e230823

Author(s):

Geoffrey Law ◽

Gavin Docherty

Keyword(s):

Vision Loss ◽

Venous Drainage ◽

Hypertensive Emergency ◽

Visual Recovery ◽

Superior Ophthalmic Vein ◽

Coil Embolisation ◽

Carotid Cavernous Fistula ◽

Cerebral Angiogram ◽

Cavernous Fistula ◽

Type D

A 58-year-old woman was referred to the outpatient ophthalmology clinic with progressive bilateral eye redness and vision loss. She had presented 2 weeks earlier with an episode of hypertensive emergency. CT angiography revealed bilateral superior ophthalmic vein (SOV) dilation, prompting further workup with a cerebral angiogram. Subsequent imaging revealed an indirect (type D) carotid-cavernous fistula (CCF) with venous drainage into both SOVs and cavernous sinuses. Successful treatment of the CCF with coil embolisation required interdisciplinary teamwork between ophthalmologists and interventional neuroradiologists. The patient made a substantial visual recovery following treatment.

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Case report: isolated lower lip lesion following cavernoma resection in prone position

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-019-0055-6 ◽

2019 ◽

Vol 34 (1) ◽

Author(s):

Mir Ibrahim Sajid ◽

Noor Malik ◽

Rashid Jooma

Keyword(s):

Cervical Spine ◽

Prone Position ◽

Vision Loss ◽

Rare Complication ◽

Lower Lip ◽

Anatomical Structures ◽

Long Duration ◽

Increased Risk ◽

Duration Of Surgery ◽

Spine Mri

Abstract Background Surgery in a prone position is necessary when access to posterior anatomical structures is needed. A procedure in this position is associated with complications such as injuries to the eyes, peripheral nerves, and pressure points and swelling of the tongue. We report a rare complication of isolated lower lip swelling following neck dissection in the prone position. Case presentation A 25-year-old male patient presented to the clinic with complaint of neck pain for the past 2 months. A cervical spine MRI was done which showed the presence of a cavernoma. C2 laminectomy was performed for resection of the tumor in prone position with the head fixed on a three-point Mayfield clamp. Postoperatively, isolated swelling of the lower lip was observed. The patient was managed conservatively. Conclusion Cervical spine surgeries done in prone positions carry an increased risk of postoperative vision loss and swellings including those of the oropharynx and in the periorbital region. Possible risk factors for such conditions include anemia, hypotension, long duration of surgery, and significant intraoperative hydration.

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Mechanical Ventilation in Preterm Infants: Neurosonographic and Developmental Studies

PEDIATRICS ◽

10.1542/peds.90.4.515 ◽

1992 ◽

Vol 90 (4) ◽

pp. 515-522 ◽

Cited By ~ 2

Author(s):

Leonard J. Graziani ◽

Alan R. Spitzer ◽

Donald G. Mitchell ◽

Daniel A. Merton ◽

Christian Stanley ◽

...

Keyword(s):

Mechanical Ventilation ◽

Early Childhood ◽

Cerebral Palsy ◽

Developmental Delay ◽

Preterm Infants ◽

Intracranial Hemorrhage ◽

Apgar Scores ◽

Mechanically Ventilated ◽

Increased Risk ◽

Grade Iii

Surviving preterm infants of less than 34 weeks' gestation who were selected on the basis of serial cranial ultrasonographic findings during their nursery course had repeated neurologic and developmental examinations during late infancy and early childhood that established the presence (n = 46) or absence (n = 205) of spastic forms of cerebral palsy. Of the 205 infants without cerebral palsy, 22 scored abnormally low on standardized developmental testing during early childhood. The need for mechanical ventilation beginning on the first day of life (n = 92) was significantly related to gestational age, birth weight, Apgar scores, patent ductus arteriosus, grade III/IV intracranial hemorrhage, large periventricular cysts, and the development of cerebral palsy. In the 192 mechanically ventilated infants, vaginal bleeding during the third trimester, low Apgar scores, and maximally low Pco2 values during the first 3 days of life were significantly related to large periventricular cysts (n = 41) and cerebral palsy (n = 43), but not to developmental delay in the absence of cerebral palsy (n = 18). The severity of intracranial hemorrhage in mechanically ventilated infants was significantly associated with gestational age and maximally low measurements of Pco2 and pH, but not with Apgar scores or maximally low measurements of Po2. Logistic regression analyses controlling for possible confounding variables disclosed that Pco2 values of less than 17 mm Hg during the first 3 days of life in mechanically ventilated infants were associated with a significantly increased risk of moderate to severe periventricular echodensity, large periventricular cysts, grade III/IV intracranial hemorrhage, and cerebral palsy. Neurosonographic abnormalities were highly predictive of cerebral palsy independent of Pco2 measurements. However, neither hypocarbia nor neurosonographic abnormalities were associated with a significantly increased risk of developmental delay in the absence of cerebral palsy. In this preterm infant population, therefore, the risk factors for developmental delay differed from those predictive of spastic forms of cerebral palsy. Of the 57 ventilated preterm infants who were exposed to a maximally low Pco2 of less than 20 mm Hg at least once during the first 3 days of life, 21 developed large periventricular cysts or cerebral palsy or both. Those results suggest that prenatal and neonatal factors including the need for mechanical ventilation beginning on the first day of life and marked hypocarbia during the first 3 postnatal days are associated with an increased risk of damage to the periventricular white matter of some preterm infants. However, a causal relationship between hypocarbia and brain damage in preterm infants remains unproven.

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Surfactant Therapy and Intracranial Hemorrhage: Review of the Literature and Results of New Analyses

PEDIATRICS ◽

10.1542/peds.92.6.775 ◽

1993 ◽

Vol 92 (6) ◽

pp. 775-786

Author(s):

J. Harry Gunkel ◽

Phillip L.C. Banks

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Birth Weight ◽

Intracranial Hemorrhage ◽

Incidence Rates ◽

Surfactant Therapy ◽

Controlled Study ◽

Hemodynamic Changes ◽

Increased Risk ◽

Risk Of Hemorrhage

Background and objective. Surfactant replacement is a powerful therapy for newborns with respiratory distress syndrome, but limited observations suggest that alterations of cerebral blood flow can accompany the use of several available surfactants. An early European multicenter controlled study with beractant demonstrated an increased rate of intracranial hemorrhage in treated patients. Nine additional controlled studies were subsequently performed and included follow-up evaluations through 2 years adjusted age. This clinical experience provided a database of approximately 1700 infants to examine retrospectively for any relationship between surfactant therapy and intracranial hemorrhage. Methods. Cumulative incidence rates, hazard ratios, and 95% confidence intervals for intracranial hemorrhage were computed for each study and for appropriately pooled studies of similar design. Where an association between surfactant and the risk of intracranial hemorrhage was found, additional analyses were performed to attempt to identify intermediate physiologic events that might link administration of surfactant to the occurrence of intracranial hemorrhage. These analyses were guided by literature reports of hemodynamic changes observed in association with surfactant therapy. Results. During the controlled studies with beractant, treated newborns of 600 to 750 g birth weight were at higher risk for grades I and II intracranial hemorrhage than control newborns. There was no increased risk for grades III and IV hemorrhage among these newborns, nor was there increased risk of hemorrhage among any other patient groups. This finding did not result in increased morbidity for the affected patients; at 2 years adjusted age, they were not different from the control infants of 600 to 750 g birth weight. Retrospective examination of the database could not pinpoint the mechanism behind the finding, but it might have been related to changes in cerebral blood flow after surfactant uncompensated by ventilator management of oxygenation and ventilation. Conclusion. Surfactant therapy may set in motion hemodynamic changes that could predispose to intracranial hemorrhage in certain circumstances, but this can probably be compensated by careful management of oxygenation and ventilation. A relationship between surfactant therapy and intracranial hemorrhage is probably not isolated to any particular surfactant preparation or method of delivery; studies comparing surfactants have shown no differences in rates of intracranial hemorrhage.

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Spontaneous resolution of nontraumatic bilateral Barrow Type D indirect carotid-cavernous fistulas: A case report

Brain Circulation ◽

10.4103/bc.bc_50_21 ◽

2021 ◽

Vol 7 (4) ◽

pp. 289

Author(s):

AdnanH Siddiqui ◽

AmmadA Baig ◽

AudreyL Lazar ◽

Muhammad Waqas ◽

RimalH Dossani ◽

...

Keyword(s):

Case Report ◽

Spontaneous Resolution ◽

Type D ◽

Carotid Cavernous Fistulas

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Venous Drainage Patterns in Carotid Cavernous Fistulas

ISRN Radiology ◽

10.1155/2014/760267 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

Ayse Aralasmak ◽

Kamil Karaali ◽

Can Cevikol ◽

Utku Senol ◽

Timur Sindel ◽

...

Keyword(s):

Treatment Approach ◽

Imaging Techniques ◽

Venous Drainage ◽

High Flow ◽

Digital Subtraction ◽

Carotid Cavernous Fistula ◽

Drainage Patterns ◽

Carotid Cavernous Fistulas ◽

Mixed Types ◽

Anterior Posterior

Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach.

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Sensory loss and suicide ideation in older adults: findings from the Three-City cohort study

International Psychogeriatrics ◽

10.1017/s104161021800056x ◽

2018 ◽

Vol 31 (1) ◽

pp. 139-145 ◽

Cited By ~ 6

Author(s):

S. Cosh ◽

I. Carrière ◽

V. Daien ◽

C. Tzourio ◽

C. Delcourt ◽

...

Keyword(s):

Older Adults ◽

Major Depressive Disorder ◽

Suicidal Ideation ◽

Suicide Ideation ◽

Vision Loss ◽

Community Dwelling ◽

Sensory Loss ◽

Major Depressive ◽

Increased Risk

ABSTRACTObjectives:To examine the longitudinal risk of vision loss (VL) or hearing loss (HL) for experiencing suicidal ideation in older adults.Design:The Three-City study, examining data from three waves of follow-up (2006–2008, 2008–2010, and 2010–2012).Setting:Community-dwelling older French adults.Participants:N = 5,438 adults aged 73 years and over.Measurements:Suicidality was assessed by the Mini-International Neuropsychiatric Interview, Major Depressive Disorder module. Mild VL was defined as Parinaud of 3 or 4 and severe VL as Parinaud >4. Mild HL was self-reported as difficulty understanding a conversation and severe HL as inability to understand a conversation.Results:Severe VL was associated with an increased risk of suicidal ideation at baseline (OR = 1.59, 95% CIs = 1.06–2.38) and over five years (OR = 1.65, 95% CIs = 1.05–2.59). Mild and severe HL were associated with an increased risk of suicidal ideation, both at baseline (OR = 1.29, 95% CIs = 1.03–1.63; OR = 1.78, 95% CIs = 1.32–2.40) and over five years (OR = 1.47, 95% CIs = 1.17–1.85; OR = 1.97, 95% CIs = 1.44–2.70).Conclusion:Sensory losses in late life pose a risk for suicidal ideation. Suicidality requires better assessment and intervention in this population.

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A-158 Case Study: Cognitive Deficits Associated with Postoperative Intracranial Hemorrhage Following Meningioma Resection

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acab062.176 ◽

2021 ◽

Vol 36 (6) ◽

pp. 1212-1212

Author(s):

Khushnoo K Indorewalla ◽

Richard Phenis

Keyword(s):

Intracranial Hemorrhage ◽

Cognitive Deficits ◽

Vision Loss ◽

Tumor Resection ◽

Inpatient Rehabilitation ◽

Neuropsychological Deficits ◽

Resection Cavity ◽

Neurocognitive Profile

Abstract Objective Postoperative intracranial hemorrhages (PIH) are an infrequent complication following cranial tumor resection and associated with prolonged hospitalization as well as long-term neurologic deficits. There is limited research examining the neuropsychological deficits resulting from PIH following meningioma resection, especially with neuropsychological data. Here, we present the neurocognitive profile of a patient who underwent a meningioma resection surgery and subsequently suffered a PIH within the resection cavity. Method Mr. Doe is a bilingual male in his late 40s who developed right-side vision loss and an isolated incidence of disorientation, resulting in discovery of a left anterior clinoid meningioma. He underwent a left frontotemporal craniotomy for gross total resection of the mass a month after discovery. Postoperative neuroimaging the following day revealed the appearance of a hematoma and intracranial hemorrhage within the resection cavity, resulting in right hemiplegia, aphasia, and ophthalmoplegia. He underwent neuropsychological evaluation 15 months post-resection, to assess residual cognitive deficits following his hospitalization and subsequent inpatient rehabilitation. Results In the context of average premorbid intellectual functioning, Mr. Doe’s neurocognitive profile was notable for deficits in processing speed, receptive and expressive language, and executive functioning associated with speed/verbally mediated tasks. Testing revealed lateralized deficits indicative of left (language-dominant) hemisphere dysfunction secondary to meningioma resection and subsequent PIH within the resection cavity. Conclusion The current poster aims to contribute to the limited body of literature examining residual neuropsychological deficits resulting from PIH following intracranial resection of meningioma. This is especially crucial given that long-term cognitive deficits can negatively impact patients’ quality of life over time.

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Abstract 2701: Multicenter Study For Prediction And Validation Of Intracranial Hemorrhage Risk In The Natural History Of Brain Arteriovenous Malformation Patients

Stroke ◽

10.1161/str.43.suppl_1.a2701 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Helen Kim ◽

Tony Pourmohamad ◽

Charles E McCulloch ◽

Michael T Lawton ◽

Jay P Mohr ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Natural History ◽

Prediction Model ◽

Intracranial Hemorrhage ◽

Prediction Models ◽

Statistical Significance ◽

Venous Drainage ◽

Cox Proportional Hazards ◽

Natural Course

Background: BAVM is an important cause of intracranial hemorrhage (ICH) in younger persons. Accurate and reliable prediction models for determining ICH risk in the natural history course of BAVM patients are needed to help guide management. The purpose of this study was to develop a prediction model of ICH risk, and validate the performance independently using the Multicenter AVM Research Study (MARS). Methods: We used 3 BAVM cohorts from MARS: the UCSF Brain AVM Study Project (n=726), Columbia AVM Study (COL, n=640), and Scottish Intracranial Vascular Malformation Study (SIVMS, n=218). Cox proportional hazards analysis of time-to-ICH in the natural course after diagnosis was performed, censoring patients at first treatment, death, or last visit, up to 10 years. UCSF served as the model development cohort. We chose a simple model, including known risk factors that are reliably measured across cohorts (age at diagnosis, gender, initial hemorrhagic presentation, and deep venous drainage); variables were included without regard to statistical significance. Tertiles of predicted probabilities corresponding to low, medium, and high risk were obtained from UCSF and risk thresholds were validated in COL and SIVMS using Kaplan-Meier survival curves and log-rank tests (to assess whether the model discriminated between risk categories). Results: Overall, 82 ICH events occurred during the natural course: 28 in UCSF, 41 in COL, and 13 in SIVMS. Effects in the prediction model (estimated from UCSF data) were: age in decades (HR=1.1, 95% CI=0.9-1.4, P=0.41), initial hemorrhagic presentation (HR=3.6, 95% CI=1.5-8.6, P=0.01), male gender (HR=1.1, 95% CI=0.48-2.6; P=0.81), and deep venous drainage (HR=0.8, 95% CI=0.2-2.8 P=0.72). Tertiles of ICH risk are shown in the Figure , demonstrating good separation of curves into low, medium and high risk after 3 years in UCSF (left, log-rank P=0.05). The model validated well in the COL referral cohort with better discrimination of curves (middle, P<0.001). In SIMVS, a population-based study, the model separated curves in the earlier years but a consistent pattern was not observed (right, P=0.51), possibly due to the small number of ICH events. Conclusion: Our current prediction model for predicting ICH risk in the natural history course validates well in another referral population, but not as well in a population cohort. Inclusion of additional cohorts and risk factors after data harmonization may improve overall prediction and discrimination of ICH risk, and provide a generalizable model for clinical application.

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Influence of Prolonged Visual Display Terminal Use and Exercise on Physical and Mental Conditions of Internet Staff in Hangzhou, China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16101829 ◽

2019 ◽

Vol 16 (10) ◽

pp. 1829

Author(s):

Xiao Cheng ◽

Mengna Song ◽

Jingxia Kong ◽

Xinglin Fang ◽

Yuqing Ji ◽

...

Keyword(s):

Mental Health ◽

Vision Loss ◽

Operation Time ◽

Visual Display ◽

Poor Mental Health ◽

Job Burnout ◽

Physical And Mental Health ◽

Exercise Frequency ◽

Visual Display Terminal ◽

Increased Risk

To examine the effects of prolonged visual display terminal (VDT) working hours and exercise frequency on VDT-related symptoms, we recruited 944 Chinese internet staff for the study. A self-administered questionnaire survey was used to obtain the hours of daily VDT work, exercise frequency, and the physical and mental health of the participants. The daily VDT working time of participants was 8.7 hours. Musculoskeletal pain and eye complaints were prevalent, and the participants had poor mental health status. When daily VDT operation time was more than 11 hours, VDT-related symptoms, including backache (odds ratios (OR) = 3.59), wrist pain (OR = 1.88), hip pain (OR = 2.42), dry eyes (OR = 2.22), and ocular soreness (OR = 2.16) were more likely to occur, and an increased risk of serious occupational stress (OR = 6.75) and job burnout (OR = 2.66) was found in internet workers. Compared with those who never exercised, appropriate exercise frequency (three times per week) was helpful to relieve pain in the shoulders (OR = 0.28), neck (OR = 0.45), back (OR = 0.30), lower back (OR = 0.25), and wrists (OR = 0.38), as well as to prevent vision loss (OR = 0.33) and job burnout (OR = 0.42). Therefore, avoiding excessive VDT exposure and performing moderate exercise could protect the physical and mental health of internet staff from the adverse effects of VDT.

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