scholarly journals Far Lateral Approaches: Dural Arteriovenous Fistulae at the Hypoglossal Canal: 3-Dimensional Operative Video

2021 ◽  
Vol 22 (1) ◽  
pp. e50-e50
Author(s):  
Karol P. Budohoski ◽  
Damiano G. Barone ◽  
Saniya Mediratta ◽  
Matthew Ross ◽  
Ramez W. Kirollos ◽  
...  
Keyword(s):  
Arteriovenous Fistulae ◽  
3 Dimensional ◽  
Hypoglossal Canal ◽  
Far Lateral

Quantitative Analysis of Variants of the Far-Lateral Approach

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons191-ons198 ◽  
Author(s):  
Anhua Wu ◽  
Joseph M. Zabramski ◽  
Pakrit Jittapiromsak ◽  
Robert C. Wallace ◽  
Robert F. Spetzler ◽  
...  
Keyword(s):  
Angle Of Attack ◽  
Lateral Approach ◽  
Occipital Condyle ◽  
3 Dimensional ◽  
Hypoglossal Canal ◽  
Computed Tomographic ◽  
Transcondylar Approach ◽  
Surgical Exposure ◽  
Far Lateral Approach ◽  
Far Lateral

Abstract BACKGROUND The rationale for choosing between the condylar fossa and transcondylar variations of the far-lateral approach requires understanding of the relationships between the occipital condyle, jugular tubercle, and hypoglossal canal. OBJECTIVE We examined the anatomic relationship of these 3 structures and analyzed the effect that changes in these relationships have on the surgical exposure and angle of attack for these 2 approaches. METHODS Anatomic measurements of 5 cadaveric heads from 3-dimensional computed tomographic scans were compared with direct measurements of the same specimens. The condylar fossa and transcondylar approach were performed sequentially in 8 of 10 sides. Surgical exposure and angle of attack were measured after each exposure. RESULTS The jugular tubercle (JT) angle (JTA) measures the angle formed by reference points on the condyle, hypoglossal canal, and JT. When the JT and occipital condyle are not prominent (JTA > 180°), the transcondylar approach does not significantly increase petroclival or brainstem exposure compared with the condylar fossa approach; however, it does significantly increase the angle of attack to the junction of the posterior inferior cerebellar and vertebral arteries and the surgical angle for the medial part of the JT (P < .05). CONCLUSION The condylar fossa and transcondylar approaches provide similar exposures of the petroclivus and brainstem when the JT and occipital condyle are not prominent (JTA > 180° on 3-dimensional computed tomographic). However, for lesions below the hypoglossal canal, the transcondylar approach is preferred because it significantly increases the angle of attack.

scholarly journals Far Lateral Approaches: Far Lateral Approach With Minimal Condylectomy for C2 Schwannoma: 3-Dimensional Operative Video

2021 ◽  
Vol 22 (1) ◽  
pp. e49-e49
Author(s):  
Karol P. Budohoski ◽  
Damiano G. Barone ◽  
Ramez W. Kirollos ◽  
Thomas Santarius ◽  
Rikin A. Trivedi
Keyword(s):  
Lateral Approach ◽  
3 Dimensional ◽  
Far Lateral Approach ◽  
Far Lateral

Delayed Occipitocervical Instability With Cranial Settling After Far-Lateral Transcondylar Surgery for Invasive Skull Base Tumor

2018 ◽  
Vol 16 (2) ◽  
pp. 250-255 ◽  
Author(s):  
Marcus D Mazur ◽  
Andrew T Dailey ◽  
Lubdha Shah ◽  
Jonathan P Scoville ◽  
William T Couldwell
Keyword(s):  
Skull Base ◽  
Lateral Approach ◽  
Occipital Condyle ◽  
Skull Base Tumor ◽  
Pathological Fractures ◽  
Hypoglossal Canal ◽  
Far Lateral Approach ◽  
Tumor Involvement ◽  
Far Lateral ◽  
Clinically Significant

Abstract BACKGROUND Occipitocervical instability is a rare but potentially severe complication of a far-lateral transcondylar surgical approach to the skull base. OBJECTIVE To investigate the incidence of clinically significant occipitocervical instability after transcondylar surgery via a far-lateral approach and to determine whether the extent of occipital condyle resection relative to the hypoglossal canal was associated with the development of occipitocervical instability. METHODS A retrospective review of patients undergoing far-lateral transcondylar surgery was performed at our institution to identify patients who developed postoperative occipitocervical instability. RESULTS Of the 61 far-lateral transcondylar operations performed, the authors identified 2 cases of delayed occipitocervical instability after surgery. In each case, the patient had tumor invading into the occipital condyle and supracondylar region and a resection extending anterior to the hypoglossal canal was performed. Both patients presented with pathological fractures and a severe occipitocervical deformity. CONCLUSION Patients who have tumor involvement of the occipital condyle and supracondylar region and undergo partial unilateral condylar resection are at risk for occipitocervical instability and should be considered for occipitocervical fusion.

Transvenous coil embolization with intra-operative cone beam CT assistance in the treatment of hypoglossal canal dural arteriovenous fistulae

2018 ◽  
Vol 11 (2) ◽  
pp. 179-183 ◽  
Author(s):  
Matthew Thomas Crockett ◽  
Albert Ho Yuen Chiu ◽  
Tejinder P Singh ◽  
William McAuliffe ◽  
Timothy John Phillips
Keyword(s):  
Coil Embolization ◽  
Low Dose ◽  
Cone Beam Ct ◽  
Cone Beam ◽  
Complication Rates ◽  
Effective Treatment Option ◽  
Arteriovenous Fistulae ◽  
Hypoglossal Canal ◽  
Patient Cohort ◽  
Entire Patient Cohort

BackgroundHypoglossal canal dural arteriovenous fistulae (HC-dAVF) are a rare subtype of skull base fistulae involving the anterior condylar confluence or anterior condular vein within the hypoglossal canal. Transvenous coil embolization is a preferred treatment strategy, however delineation of fistula angio-architecture during workup and localization of microcatheter tip during embolization remain challenging on planar DSA. For this reason, our group have utilized intra-operative cone beam CT (CBCT) and selective cone beam CT angiography (sCBCTA) as adjuncts to planar DSA during workup and treatment. The purpose of this article is to present our experience in the treatment of HC-dAVF using transvenous coil embolization (TVCE) with cone beam CT assistance, describing our technique as well as presenting our angiographic and clinical outcomes.MethodsTen patients with symptomatic HC-dAVF were treated using TVCE with intra-operative cone beam CT assistance. Prospectively collected data regarding clinical and angiographic results and complication rates was recorded and reviewed.ResultsComplication-free fistula occlusion was achieved in our entire patient cohort. The dominant symptom of pulsatile tinnitus resolved in all 10 patients.ConclusionsThis study demonstrates that TVCE with CBCT assistance is a highly effective treatment option for HC-dAVF, achieving complication-free fistula occlusion in our entire patient cohort. We have found low-dose sCBCTA and CBCT to be an extremely useful adjunct to planar DSA imaging during both workup and treatment of these rare fistulae.

Superselective Shunt Occlusion for the Treatment of Cavernous Sinus Dural Arteriovenous Fistulae

2013 ◽  
Vol 73 (suppl_1) ◽  
pp. ons100-ons105 ◽  
Author(s):  
Tetsu Satow ◽  
Kenichi Murao ◽  
Toshinori Matsushige ◽  
Kenji Fukuda ◽  
Susumu Miyamoto ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Long Term Results ◽  
Rotational Angiography ◽  
Arteriovenous Fistulae ◽  
3 Dimensional ◽  
Arteriovenous Shunts ◽  
Shunt Occlusion

Abstract BACKGROUND: In treating cavernous sinus dural arteriovenous fistulae (CSdAVFs), transvenous embolization of the whole affected sinus is usually performed, which may result in the disturbance of normal venous drainage or permanent cranial nerve palsy. OBJECTIVE: To describe superselective shunt occlusion of CSdAVFs. METHODS: Between July 2005 and August 2011, we had 20 consecutive cases of CSdAVFs. In 14 cases (70%), we could detect the restricted locus of arteriovenous shunts by 3-dimensional rotational angiography and/or superselective arteriography. After navigating the microcatheter to the shunt segment, consecutive superselective arteriovenography was performed to confirm the location of the microcatheter at the proper position. RESULTS: In 12 of 14 cases (85.7%) in which the shunt was restricted, coiling only in the small venous pouch or compartment, which was just downstream of the shunt point, led to complete disappearance of the shunt without obliterating the entire sinus. No recurrence or permanent cranial nerve palsy was observed during the follow-up period with a mean of 46 months (range, 3-69 months) in 12 cases treated by superselective shunt occlusion. CONCLUSION: This technique, which enables complete extirpation of shunts by small amounts of coils, is a feasible way to treat CSdAVFs with excellent mid- to long-term results. Understanding of the angioarchitecture by 3-dimensional rotational angiography and consecutive superselective arteriovenography was useful. This method should be considered before sinus packing or mere obliteration of dangerous venous outlets.

scholarly journals Dural Arteriovenous Fistulae After Cerebral Venous Thrombosis

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3344-3347
Author(s):  
José M. Ferro ◽  
Jonathan M. Coutinho ◽  
Olav Jansen ◽  
Martin Bendszus ◽  
Francesco Dentali ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Mr Angiography ◽  
Sinus Thrombosis ◽  
Controlled Trial ◽  
Dabigatran Etexilate ◽  
Dural Sinus ◽  
Arteriovenous Fistulae ◽  
3 Dimensional

Background and Purpose: This analysis examined the frequency of dural arteriovenous fistulae (dAVF) after cerebral venous thrombosis (CVT) in patients included in a randomized controlled trial comparing dabigatran etexilate with dose-adjusted warfarin (RE-SPECT CVT [A Clinical Trial Comparing Efficacy and Safety of Dabigatran Etexilate With Warfarin in Patients With Cerebral Venous and Dural Sinus Thrombosis]), who had systematic follow-up magnetic resonance (MR) imaging. Methods: RE-SPECT CVT was a Phase 3, prospective, randomized, parallel-group, open-label, multicenter, exploratory trial with blinded end point adjudication. We allocated patients with acute CVT to dabigatran 150 mg twice daily or dose-adjusted warfarin, for 24 weeks and obtained a standardized MR protocol including time-of-flight MR angiography, 3-dimensional phase-contrast venography, and 3-dimensional contrast-enhanced MR venography at the end of the treatment period. A blinded adjudication committee assessed the presence of dAVF in a predefined substudy of the trial. Results: We analyzed development of dAVF in 112 of 120 randomized patients; 57 allocated to dabigatran and 55 to warfarin. For 3 (2.7%) of these 112 patients, quality of follow-up imaging was insufficient to evaluate dAVF. A dAVF (Borden I) was found in 1 patient (0.9%) allocated to warfarin; however, this dAVF was already present at baseline. The patient did not present with hemorrhage at baseline or during the trial and was asymptomatic at follow-up. Conclusions: Despite systematic imaging, we found no new dAVF 6 months after CVT. Routine follow-up cerebral MR angiography aiming to detect new dAVF 6 months after CVT has a very low yield. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02913326.

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