Concurrent dural and perimedullary arteriovenous fistulas at the craniocervical junction: case series with special reference to angioarchitecture

2013 ◽  
Vol 118 (2) ◽  
pp. 451-459 ◽  
Author(s):  
Kenichi Sato ◽  
Toshiki Endo ◽  
Kuniyasu Niizuma ◽  
Miki Fujimura ◽  
Takashi Inoue ◽  
...  
Keyword(s):  
Case Series ◽  
Vascular Anomaly ◽  
Craniocervical Junction ◽  
Posterolateral Approach ◽  
Pathophysiological Mechanism ◽  
Arterial Aneurysm ◽  
Female Ratio ◽  
Arteriovenous Fistulas ◽  
Male Female Ratio ◽  
The Right

Object Dural arteriovenous fistulas (DAVFs) and perimedullary arteriovenous fistulas (PAVFs) are uncommonly associated in the craniocervical junction. The purpose of this study was to describe the clinical and angiographic characteristics of such concurrent lesions. Methods Authors reviewed 9 cases with a coexistent DAVF and PAVF at the craniocervical junction. Clinical presentation, angiographic characteristics, intraoperative findings, and treatment outcomes were assessed. Results All patients (male/female ratio 5:4; mean age 66.3 years) presented with subarachnoid hemorrhage. Angiography revealed that 8 patients had both a DAVF and PAVF on the same side, whereas 1 patient had 3 arteriovenous fistulas, 1 DAVF, and 1 PAVF on the right side and 1 DAVF on the left side. All of the fistulas shared dilated perimedullary veins (anterior spinal vein, 7 cases; anterolateral spinal vein, 2 cases) as a main drainage route. The shared drainage route was rostrally directed in 8 of 9 cases. Eight patients exhibited an arterial aneurysm on the distal side of the feeding arteries to the PAVF, and the aneurysm in each case was intraoperatively confirmed as a bleeding point. One patient had ruptured venous ectasia at the perimedullary fistulous point. All patients underwent direct surgery via a posterolateral approach. No recurrence was observed in the 4 patients who underwent postoperative angiography, and no rebleeding event was recorded among any of the 9 patients during the follow-up period (mean 38.4 months). Conclusions The similarity of the angioarchitecture and the close anatomical relationship between DAVF and PAVF at the craniocervical junction suggested that these lesions are pathogenetically linked. The pathophysiological mechanism and anatomical features of these lesions represent a unique vascular anomaly that should be recognized angiographically to plan a therapeutic strategy.

Morphoconstitutional analysis of a series of 166 urinary stones in Western Algeria for a period of two years (2015-2017)

2018 ◽  
Vol 7 (3) ◽  
pp. 107-112
Author(s):  
Bouzana Fatima ◽  
Sbahi Khayra ◽  
Kerroumi Slimane ◽  
Attar Abderahmane ◽  
Seghir Madjhouda Omar ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Sequential Analysis ◽  
Left Kidney ◽  
Urinary Stones ◽  
Female Ratio ◽  
Composition And Structure ◽  
Male Female Ratio ◽  
Anatomical Localization ◽  
Western Algeria ◽  
The Right

A stone is not only an obstacle, sometimes painful, on the urinary tract justifying an emergency urological gesture to restore their permeability. It is primarily a symptom of crystallogenic pathologies or urinary imbalances of nu-tritional origin whose recurrence is the rule if the cause has not been correctly identified. It is therefore recommended in the patient's interest; analyze the calcul or its fragments to determine its composition and structure, one and / or the other orienting towards the pathology in question. A series of 166 urinary stones were collected nearby the hospitals of western Algeria after urological intervention or spontaneous expulsion and sequential analysis of the nucleus at the surface by Fourier transform infrared spectrophotometry. The male / female ratio was 1.78. The study of the anatomical localization of the stones showed a predominance of the high urinary tract with a rate of 76.9%. 27.3% of the stones were located in the left kidney compared to 25.7% in the right kidney. Analysis of the crystalline composition showed that calcium oxalate was predominant in 65.8% of the calculs and in 58.5% of the nuclei. In all, whewellite was present in 46.9% of cases and weddellite in 18.9%. uric acid anhydrous was the major component of 12.2% of the calculations analyzed. It was present in 23.3% of cases with predominance in subjects over 60 years. Our results show that the lithiasis of the urinary tree in western Algeria tends to evolve in the same direction as that of the industri-alized countries.

Clinical Manifestations of Cholelithiasis in Quito, Ecuador. A Cohort Study

2021 ◽  
pp. 12
Author(s):  
◽  
◽  
Keyword(s):  
Epigastric Pain ◽  
Medical Center ◽  
Clinical Manifestations ◽  
Abdominal Ultrasound ◽  
Common Symptom ◽  
Low Back ◽  
Female Ratio ◽  
Male Female Ratio ◽  
The Right ◽  
A Prospective Study

Introduction: A prospective study was carried out, with the aim of establishing the clinical manifestations of cholelithiasis in the population of Quito, Ecuador. Methods: During the period from January 2012 to October 2017, 534 patients were referred from different outpatient clinics of the Ecuadorian Institute of Social Security to the Batan Medical Center with the diagnosis of cholelithiasis after a clinical assessment and abdominal ultrasound, to be treated surgically. Results: Sixty-nine percent of patients were female with a male-female ratio of 1:2.21. Mean age was 44.9 years. Pain was the most common symptom in our study: 95.7%. Among these patients, pain was located in the epigastrium in 49.8%, in the right hypochondrium in 45.1% and only 0.8% had low back pain. Pain ranged from moderate and even severe. The remaining 4.3% of patients had dyspepsia or were asymptomatic. Conclusions: This finding highlights the fact that epigastric pain must be always considered as a clinical manifestation on cholelithiasis.

Endoscope-assisted far-lateral transcondylar approach for craniocervical junction chordomas: a retrospective case series and cadaveric dissection

2021 ◽  
pp. 1-12
Author(s):  
Arianna Fava ◽  
Paolo di Russo ◽  
Valentina Tardivo ◽  
Thibault Passeri ◽  
Breno Câmara ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Tumor Resection ◽  
Case Series ◽  
Craniocervical Junction ◽  
Anatomical Landmarks ◽  
Total Resection ◽  
Female Ratio ◽  
Cadaveric Dissection ◽  
Transcondylar Approach ◽  
Far Lateral

OBJECTIVE Craniocervical junction (CCJ) chordomas are a neurosurgical challenge because of their deep localization, lateral extension, bone destruction, and tight relationship with the vertebral artery and lower cranial nerves. In this study, the authors present their surgical experience with the endoscope-assisted far-lateral transcondylar approach (EA-FLTA) for the treatment of CCJ chordomas, highlighting the advantages of this corridor and the integration of the endoscope to reach the anterior aspect and contralateral side of the CCJ and the possibility of performing occipitocervical fusion (OCF) during the same stage of surgery. METHODS Nine consecutive cases of CCJ chordomas treated with the EA-FLTA between 2013 and 2020 were retrospectively reviewed. Preoperative characteristics, surgical technique, postoperative results, and clinical outcome were analyzed. A cadaveric dissection was also performed to clarify the anatomical landmarks. RESULTS The male/female ratio was 1.25, and the median age was 36 years (range 14–53 years). In 6 patients (66.7%), the lesion showed a bilateral extension, and 7 patients (77.8%) had an intradural extension. The vertebral artery was encased in 5 patients. Gross-total resection was achieved in 5 patients (55.6%), near-total resection in 3 (33.3%), and subtotal resection 1 (11.1%). In 5 cases, the OCF was performed in the same stage after tumor removal. Neither approach-related complications nor complications related to tumor resection occurred. During follow-up (median 18 months, range 5–48 months), 1 patient, who had already undergone treatment and radiotherapy at another institution and had an aggressive tumor (Ki-67 index of 20%), showed tumor recurrence at 12 months. CONCLUSIONS The EA-FLTA provides a safe and effective corridor to resect extensive and complex CCJ chordomas, allowing the surgeon to reach the anterior, lateral, and posterior portions of the tumor, and to treat CCJ instability in a single stage.

Adult Hemophagocytic Lymphohistiocytosis: Clinical Presentation and Follow-Up in a Consecutive Series of Ten Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3845-3845
Author(s):  
Keisuke Shirai ◽  
Alberto Montero ◽  
Jesse Powell ◽  
Lydia Christiansen ◽  
John Lazarchick
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Case Reports ◽  
Case Series ◽  
Hematologic Malignancies ◽  
Neurological Involvement ◽  
Consecutive Series ◽  
Female Ratio ◽  
Etoposide Treatment ◽  
Male Female Ratio ◽  
Underlying Causes

Abstract Hemophagocytic Lymphohistiocytosis (HLH) is very rare in adults but can be fatal without treatment. Reports in adults are limited to case reports and very small case series. Clinically it is characterized by fever, hepatosplenomegaly, lymphadenopathy, severe cytopenias, hepatic dysfunction, coagulopathy, as well as neurological involvement. This syndrome is associated with diverse processes including: infection, rheumatologic, and hematologic malignancies. Presently, the underlying cause of HLH is unknown. We present a cosecutive series of 10 adults with HLH diagnosed at our institution between 2004–2006. All diagnoses were confirmed by pathology. The median age was 59 years (range: 18–73 years), and a male: female ratio of 4:1. All patients uniformly presented with fever. Half of the patients presented with evidence of hepatomegaly or splenomegaly. The most predominant laboratory abnormalities included: leukopenia or thrombocytopenia (100%), and elevation of liver enzymes (50%). EBV IgG was positive in 8 of 10 patients. The underline illnesses associated with HLH were diverse. The underlying causes were as follows; acute leukemia (n=2), infection (n=2), rheumatologic (n=2), post transplant (n=2) sickle cell disease (n=2), unknown (n=2). Mortality rate was 60% with a median survival time since diagnosis of 58 days. One patient is still on maintenance cyclosporin after etoposide treatment. One patient is on steroid and cytoxan. One patient recovered just with supportive care. In conclusion, due to the high morality rate associated with HLH, early treatment with immunosuppressant is warranted and attempts to identify underlying cause.

scholarly journals Clinical features and outcomes of adrenal schwannoma: a study of 13 cases from a single center

2021 ◽  
Author(s):  
Henghai Huang ◽  
Qijian Ding ◽  
XiaoCao Lin ◽  
DeLin Li ◽  
Jingjing Zeng ◽  
...  
Keyword(s):  
Operative Management ◽  
Pathological Examination ◽  
Computed Tomography Imaging ◽  
Tertiary Referral Hospital ◽  
Female Ratio ◽  
Tomography Imaging ◽  
Male Female Ratio ◽  
The Mean ◽  
The Right

Background: Adrenal schwannomas (AS) are extremely rare neoplasms. This study shares our experience regarding the diagnosis and operative management of AS. Methods: Clinical details, radiologic, laboratory, and pathologic findings as well as follow-up data were analyzed retrospectively for 13 AS patients who accepted surgery at a tertiary referral hospital in China between January 1, 1996, and December 31, 2017. Results: The mean age of the patients at diagnosis was 44.7 ± 13.7 years (range 19–62 years; male: female ratio, 1:1.16), of whom 7 patients had unilateral AS on the right side, and the remaining 6 on the left side. None of the cases were hormonally active. None of the 13 cases were diagnosed as AS by computed tomography imaging before the operation. Among the patients, 10 were asymptomatic. The mean preoperative size was 7.1 ± 3.2 cm (range 1.6–12.6 cm). All patients underwent surgery, with open adrenalectomy in 5 patients and laparoscopy in 8 patients. The mean tumor size on pathologic examination was 6.8 ± 3.0 cm (range 3.0–11.7 cm). The surgical specimens were confirmed by pathological examination. During a median follow-up of 60.8 ± 17.7 months, no patients showed recurrence or metastasis. Conclusion: The preoperative diagnosis of AS remains difficult despite the advances in imaging examinations. After complete resection, the prognosis of AS is excellent.

Foreign Bodies in the Larynx and Tracheobronchial Tree in Children

1980 ◽  
Vol 89 (5) ◽  
pp. 434-436 ◽  
Author(s):  
Bruce F. Rothmann ◽  
Clifford R. Boeckman
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
Tracheobronchial Tree ◽  
Female Ratio ◽  
Foreign Objects ◽  
Left Bronchus ◽  
Male Female Ratio ◽  
Opaque Object ◽  
The Right ◽  
Trachea And Bronchi

In a study of 225 patients with foreign bodies in the larynx, trachea and bronchi, 77 % were 36 months of age or less. The male-female ratio was 2:1. Food or food derivatives were the causative agent in 70% of the cases, with 38% due to a portion of nut. The foreign body involved the right and left bronchus with equal frequency. A choking episode followed by an audible wheeze (55 %) was the most common presenting complaint. Obstructive emphysema was demonstrated in 60 % and was best demonstrated by inspiration-expiration chest roentgenograms or fluoroscopy. A radio-opaque object was seen in 13 %. Two hundred ten foreign objects (93 %) were removed by endoscopy. Four patients required pulmonary resection for bronchiectasis and in three patients bronchotomy was performed. Five patients expelled the foreign body spontaneously, two patients were transferred to another hospital, and one foreign body was not recovered. There was no mortality.

Motion-related vascular abnormalities at the craniocervical junction: illustrative case series and literature review

2015 ◽  
Vol 38 (4) ◽  
pp. E6 ◽  
Author(s):  
Vijay M. Ravindra ◽  
Jayson A. Neil ◽  
Marcus D. Mazur ◽  
Min S. Park ◽  
William T. Couldwell ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Case Series ◽  
Vascular Anomaly ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Dissecting Aneurysm ◽  
Vascular Pathology ◽  
Illustrative Case ◽  
Vascular Compression ◽  
Elective Resection

The craniocervical junction (CCJ) functions within a complicated regional anatomy necessary to protect and support vital neurovascular structures. In select instances, vascular pathology can be attributed to this complicated interplay of motion and structure found within this narrow space. The authors report 3 cases of complex vascular pathology related to motion at the CCJ and detail the management of these cases. Two cases involved posterior circulation vascular compression syndromes, and one case involved a vascular anomaly and its relation to aneurysm formation and rupture. The patient in Case 1 was a 66-year-old man with a history of syncopal episodes resulting from the bilateral vertebral artery becoming occluded when he rotated his head. Successful microsurgical decompression at the skull base resulted in patent bilateral vertebral artery V3 segments upon head movement in all directions. The patient in Case 2 was a 53-year-old woman who underwent elective resection of a right temporal meningioma and who experienced postoperative drowsiness, dysphagia, and mild right-arm ataxia. Subsequent MRI demonstrated bilateral posterior inferior cerebel-lar artery (PICA) strokes. Cerebral angiography showed a single PICA, of extradural origin, supplying both cerebellar hemispheres. The PICA exhibited dynamic extradural compression when the patient rotated her head; the bilateral PICA strokes were due to head rotation during surgical positioning. In Case 3, a 37-year-old woman found unconscious in her home had diffuse subarachnoid hemorrhage and evidence of a right PICA aneurysm. A right far-lateral craniectomy was performed for aneurysm clipping, and she was found to have a dissecting aneurysm with an associated PICA originating extradurally. There was a shearing phenomenon of the extradural PICA along the dura of the foramen magnum, and this microtraumatic stress imposed on the vessel resulted in a dissecting aneurysm. This series of complex and unusual cases highlights the authors’ understanding of vascular pathology of the CCJ and its management.

scholarly journals Aggressive angiomyxoma of the vulva: a case report in a Brazilian patient

2019 ◽  
Vol 5 (2) ◽  
pp. 54-57
Author(s):  
Antonio Chambo Filho ◽  
◽  
Emmanuel Nasser Vargas Araujo de Assis ◽  
Flávia de Sousa Freitas Scherre ◽  
Luciene Lage da Motta ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Surgical Excision ◽  
Aggressive Angiomyxoma ◽  
Female Ratio ◽  
Brazilian Patient ◽  
Male Female Ratio ◽  
Aggressive Tumor ◽  
The Right

Aggressive angiomyxoma is a locally aggressive tumor of mesenchymal origin. The condition predominantly affects females, with a male/female ratio of 6:1. Most cases occur during the reproductive years, with a peak between the third and fourth decades of life. The symptoms are non-specific, and the principal differential diagnosis is with Bartholin’s cysts or abscesses. The treatment of choice is surgical excision of the lesion, including evaluation of the margins. This case report refers to a 41-year old patient with an insidiously growing lesion on the right vestibular area measuring approximately 9 x 5 x 5 cm, associated with dyspareunia. Surgical excision was successful, and there have been no signs of tumor recurrence in the six months of follow-up. Differential diagnosis in cases of vulvar lesions is of the utmost importance. A detailed vulvar examination is essential to ensure early diagnosis and to reduce the rate of underdiagnosed cases of aggressive angiomyxoma

Congenital absence of the left circumflex artery: Case series and review

2021 ◽  
pp. 021849232199737
Author(s):  
Pankaj Jariwala ◽  
Kartik Jadhav ◽  
Satya Sridhar Kale
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Case Series ◽  
Lateral Wall ◽  
Congenital Absence ◽  
Circumflex Artery ◽  
Female Ratio ◽  
Left Circumflex Artery ◽  
Coronary Syndrome ◽  
The Right

Congenital absence of the left circumflex artery (CALCx) or an anomalous origin of the left circumflex artery from the right coronary artery is a unique anomaly in the literature that has been incidentally diagnosed with coronary angiography. CALCx is characterized by an angiographical absence of the left circumflex artery, with a super-dominant right coronary artery that provides the postero-lateral wall of the left ventricle. We present a review of the literature of a total of 52 CALCx cases reported so far including our case. In our study, the average age of patients was 52.83 years (median – 55 years; standard deviation – 13.05 years; range 12–76 years) with a male to female ratio of 1.93:1. The chronic coronary syndrome was the most common clinical presentation followed by the acute coronary syndrome. In 45.5% of cases, the associated coronary artery disease was documented. A comprehensive anatomical and functional assessment is required for the appropriate management strategy.

Dural arteriovenous fistulas at the craniocervical junction: a systematic review

2015 ◽  
Vol 8 (6) ◽  
pp. 648-653 ◽  
Author(s):  
Jingjing Zhao ◽  
Feng Xu ◽  
Jinma Ren ◽  
Sunil Manjila ◽  
Nicholas C Bambakidis
Keyword(s):  
English Language ◽  
Venous Drainage ◽  
Craniocervical Junction ◽  
Female Ratio ◽  
Arteriovenous Fistulas ◽  
Increased Risk ◽  
Significant Difference ◽  
Dural Arteriovenous Fistulas ◽  
Complete Obliteration ◽  
Feasible Alternative

BackgroundDural arteriovenous fistulas (DAVFs) at the craniocervical junction are uncommon but clinically important abnormalities.ObjectiveTo investigate the clinical characteristics of patients with DAVFs at the craniocervical junction and assess angiographic features associated with bleeding at presentation.MethodsWe systematically reviewed the literature and searched PubMed and EMBASE for all relevant English language articles published between 1980 and 2014. The clinical presentation, angiographic characteristics, and treatment were assessed. The clinical differences between a subarachnoid hemorrhage (SAH) group and a non-SAH group were statistically examined.ResultsFifty-six patients were identified after a review of the literature (mean age 55.6 years; male to female ratio=3:1). Twenty-one patients (37.5%) presented with hemorrhage including SAH and posterior fossa hemorrhage. There was no significant difference in patient age, sex, or location of the DAVF between the SAH group and the non-SAH group. Intracranial venous drainage was significantly associated with SAH (p<0.001). The presence of a varix was significantly associated with SAH (p=0.001). Open surgery had a significantly higher efficacy of initial complete obliteration than embolization (100% vs 71.4%, p<0.01).ConclusionsDAVFs at the craniocervical junction are rare lesions, which often present with hemorrhage. Intracranial venous drainage and a venous varix are associated with increased risk of SAH. Surgical interruption of the feeding arteries or draining veins is an effective and reliable method for treating DAVFs at the craniocervical junction. Embolization is a feasible alternative to surgery in the treatment of selective DAVFs.

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