scholarly journals Emergency resection of brainstem cavernous malformations

2018 ◽  
Vol 128 (5) ◽  
pp. 1289-1296 ◽  
Author(s):  
Abdulfettah Tumturk ◽  
Yiping Li ◽  
Yahya Turan ◽  
Ulas Cikla ◽  
Bermans J. Iskandar ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Cranial Nerve ◽  
Surgical Intervention ◽  
Sudden Onset ◽  
Timing Of Surgery ◽  
Acute Hemorrhage ◽  
Cavernous Malformations ◽  
Small Series ◽  
Controversial Topic ◽  
Emergency Resection

Brainstem cavernous malformations (CMs) pose significant challenges to neurosurgeons because of their deep locations and high surgical risks. Most patients with brainstem CMs present with sudden-onset cranial nerve deficits or ataxia, but uncommonly patients can present in extremis from an acute hemorrhage, requiring surgical intervention. However, the timing of surgery for brainstem CMs has been a controversial topic. Although many authors propose delaying surgery into the subacute phase, some patients may not tolerate waiting until surgery. To the best of the authors’ knowledge, emergency surgery after a brainstem CM hemorrhage has not been described. In cases of rapidly progressive neurological deterioration, emergency resection may often be the only option. In this retrospectively reviewed small series of patients, the authors report favorable outcomes after emergency surgery for resection of brainstem CMs.

Clinical outcomes and prognostic factors for cavernous hemangiomas of the spinal cord: a retrospective cohort study

2019 ◽  
Vol 31 (2) ◽  
pp. 271-278 ◽  
Author(s):  
Narihito Nagoshi ◽  
Osahiko Tsuji ◽  
Daisuke Nakashima ◽  
Ayano Takeuchi ◽  
Kaori Kameyama ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Surgical Intervention ◽  
Lesion Size ◽  
Sudden Onset ◽  
Neurological Function ◽  
Neurological Injury ◽  
Prognostic Indicators ◽  
Asymptomatic Patients ◽  
Surgical Data ◽  
Unstable Gait

OBJECTIVEIntramedullary cavernous hemangioma (CH) is a rare vascular lesion that is mainly characterized by the sudden onset of hemorrhage in young, asymptomatic patients, who then experience serious neurological deterioration. Despite the severity of this condition, the therapeutic approach and timing of intervention for CH remain matters of debate. The aim of this study was to evaluate the clinical characteristics of CH patients before and after surgery and to identify prognostic indicators that affect neurological function in these patients.METHODSThis single-center retrospective study included 66 patients who were treated for intramedullary CH. Among them, 57 underwent surgery and 9 patients received conservative treatment. The authors collected demographic, symptomology, imaging, neurological, and surgical data. Univariate and multivariate logistic regression analyses were performed to identify the prognostic indicators for neurological function.RESULTSWhen comparing patients with stable and unstable gait prior to surgery, patients with unstable gait had a higher frequency of hemorrhagic episodes (52.4% vs 19.4%, p = 0.010), as assessed by the modified McCormick Scale. The lesion was significantly smaller in patients who underwent conservative treatment compared with surgery (2.5 ± 1.5 mm vs 5.9 ± 4.1 mm, respectively; p = 0.024). Overall, the patients experienced significant neurological recovery after surgery, but a worse preoperative neurological status was identified as an indicator affecting surgical outcomes by multivariate analysis (OR 10.77, 95% CI 2.88–40.36, p < 0.001). In addition, a larger lesion size was significantly associated with poor functional recovery in patients who had an unstable gait prior to surgery (8.6 ± 4.5 mm vs 3.5 ± 1.6 mm, p = 0.011).CONCLUSIONSOnce a hemorrhage occurs, surgical intervention should be considered to avoid recurrence of the bleeding and further neurological injury. In contrast, if the patients with larger lesion presented with worse preoperative functional status, surgical intervention could have a risk for aggravating the functional deficiencies by damaging the thinning cord parenchyma. Conservative treatment may be selected if the lesion is small, but regular neurological examination by MRI is needed for assessment of a change in lesion size and for detection of functional deterioration.

scholarly journals Magnetic Resonance Thermometry-Guided Stereotactic Laser Ablation of Cavernous Malformations in Drug-Resistant Epilepsy: Imaging and Clinical Results

2015 ◽  
Vol 12 (1) ◽  
pp. 39-48 ◽  
Author(s):  
D Jay McCracken ◽  
Jon T Willie ◽  
Brad A Fernald ◽  
Amit M Saindane ◽  
Daniel L Drane ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Magnetic Resonance ◽  
Minimally Invasive ◽  
Real Time ◽  
Refractory Epilepsy ◽  
Acute Hemorrhage ◽  
Cavernous Malformations ◽  
Remote Imaging ◽  
Medically Refractory Epilepsy

Abstract BACKGROUND Surgery is indicated for cerebral cavernous malformations (CCMs) that cause medically refractory epilepsy. Real-time magnetic resonance thermography (MRT)-guided stereotactic laser ablation (SLA) is a minimally invasive approach to treating focal brain lesions. SLA of CCM has not previously been described. OBJECTIVE To describe MRT-guided SLA, a novel approach to treating CCM-related epilepsy, with respect to feasibility, safety, imaging, and seizure control in 5 consecutive patients. METHODS Five patients with medically refractory epilepsy undergoing standard presurgical evaluation were found to have corresponding lesions fulfilling imaging characteristics of CCM and were prospectively enrolled. Each underwent stereotactic placement of a saline-cooled cannula containing an optical fiber to deliver 980-nm diode laser energy via twist drill craniostomy. MR anatomic imaging was used to evaluate targeting before ablation. MR imaging provided evaluation of targeting and near real-time feedback regarding the extent of tissue thermocoagulation. Patients maintained seizure diaries, and remote imaging (6-21 months postablation) was obtained in all patients. RESULTS Imaging revealed no evidence of acute hemorrhage following fiber placement within presumed CCM. MRT during treatment and immediate postprocedure imaging confirmed the desired extent of ablation. We identified no adverse events or neurological deficits. Four of 5 (80%) patients achieved freedom from disabling seizures after SLA alone (Engel class 1 outcome), with follow-up ranging 12 to 28 months. Reimaging of all subjects (6-21 months) indicated lesion diminution with surrounding liquefactive necrosis, consistent with the surgical goal of extended lesionotomy. CONCLUSION Minimally invasive MRT-guided SLA of epileptogenic CCM is a potentially safe and effective alternative to open resection. Additional experience and longer follow-up are needed.

Brachial Plexitis—Parsonage-Turner Syndrome

2018 ◽  
Author(s):  
Sandra Hearn
Keyword(s):  
Turner Syndrome ◽  
Impression Management ◽  
Peripheral Nerves ◽  
Surgical Intervention ◽  
Sudden Onset ◽  
Accurate Diagnosis ◽  
Advanced Imaging ◽  
Neuralgic Amyotrophy ◽  
Arm Pain ◽  
Immune Mediated

The chapter provides a case-based review of Parsonage-Turner syndrome. Parsonage-Turner syndrome, also known as neuralgic amyotrophy and idiopathic brachial plexitis, represents immune-mediated inflammation of neural structures within the brachial plexus and peripheral nerves of the upper limb. Classic features include sudden-onset shoulder or upper arm pain, followed by weakness in the forequarter or limb. This pattern, in addition to nonmechanical and nonradicular clinical features, should prompt consideration of Parsonage-Turner syndrome diagnosis. The diagnosis is established on clinical grounds, although electrodiagnostic data and advanced imaging can support the impression. Management is conservative. For neurosurgeons, accurate diagnosis of Parsonage-Turner syndrome can avoid unnecessary and inappropriate surgical intervention when symptoms are erroneously ascribed to another cause.

Resection of a Pontine Cavernous Malformation via an Endoscopic Endonasal Approach

2012 ◽  
Vol 71 (suppl_1) ◽  
pp. onsE186-onsE194 ◽  
Author(s):  
Matthew M. Kimball ◽  
Stephen B. Lewis ◽  
John W. Werning ◽  
J D. Mocco
Keyword(s):  
Skull Base ◽  
Surgical Resection ◽  
Conservative Management ◽  
Cavernous Malformation ◽  
Gross Total Resection ◽  
Total Resection ◽  
Transnasal Approach ◽  
Acute Hemorrhage ◽  
Cavernous Malformations ◽  
Endoscopic Transnasal Approach

Abstract BACKGROUND AND IMPORTANCE: Cavernous malformations of the brainstem are a dilemma in terms of deciding when to operate, and they remain difficult to access surgically. We present a novel approach for the resection of a brainstem cavernous malformation CLINICAL PRESENTATION: A 59-year-old woman presented with a 1-month history of intermittent dysarthria, right facial weakness, and left arm and leg weakness. A magnetic resonance image revealed a 2-cm mass in the pons with blood products of differing ages, consistent with a cavernous malformation. We discussed with her the risks of surgical resection and conservative management. She decided to pursue conservative management. Two weeks later, she returned to the emergency room with diplopia and left-sided hemiplegia. Acute hemorrhage within the right pons was seen. She then chose to undergo surgical resection. CONCLUSION: The patient underwent an endoscopic transnasal approach for resection of a pontine cavernous malformation. Image guidance was used to identify key anatomic landmarks. A gross total resection was achieved without new neurological deficits. With physical and occupational therapy, the patient developed antigravity strength in her left upper and lower extremities before discharge. At her 4-week follow-up, she was ambulating independently with the assistance of a cane. We report the successful gross total resection of a pontine cavernous malformation via an endoscopic transnasal approach. This patient had improvement in neurological symptoms after surgical resection with minimal surgical morbidity. Technologic advances in endoscopic skull base approaches have provided access to lesions of the skull base previously requiring more invasive approaches.

scholarly journals Recomendaciones para la realización de procedimientos quirúrgicos de urgencia, emergencia, trauma y cuidados críticos ante la situación de pandemia por COVID-19

2020 ◽  
Vol 112 (3) ◽  
pp. 234-238
Author(s):  
Rubén D. Algieri ◽  
◽  
Ernesto Donelly
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Trauma Care ◽  
Emergency Surgery ◽  
Surgical Intervention ◽  
Trauma Systems ◽  
Raising Awareness ◽  
Adequate Care ◽  
Care Workers ◽  
Emergency Systems

Conditions requiring emergency surgery and trauma care are still common in emergency systems and require immediate evaluation and timely resolution even during a pandemic as is currently happening with COVID-19, a scenario that threatens to affect their capacity to provide care5,8. In these cases, certain measures must be taken for the special care of health care workers and their patients, who are often admitted in critical condition and require an immediate surgical intervention that does not allow for any delay. For this purpose, an algorithm should be developed with recommendations which include a checklist to guide surgeons working in emergency and trauma systems about the issues to consider for the appropriate management and treatment of these conditions and for preparation of perioperative environments during the COVID-19 pandemic. The ultimate goal is to maintain adequate care with the necessary and required protection in each case5,8,11, raising awareness of the importance of preserving capacity to respond to these conditions that routinely occur in our community.

scholarly journals An Occipital Headache as the First Presentation of Multiple Third, Fourth, and Lateral Ventricular Cavernous Malformations: A Case Report and Review of Literature

2017 ◽  
Vol 6 (1) ◽  
pp. 61-65
Author(s):  
Alireza Vakilian ◽  
Amir Moghadam Ahmadi ◽  
Habib Farahmand
Keyword(s):  
Surgical Intervention ◽  
Cavernous Malformation ◽  
Vascular Malformations ◽  
Case Reports ◽  
Review Of Literature ◽  
Rare Presentation ◽  
Cavernous Malformations ◽  
Cavernous Hemangiomas ◽  
Occipital Headache ◽  
Tomography Scan

Background: Cavernous hemangiomas are common benign vascular malformations. Their existence in the intraventricular region is very rare. Case Reports: A 43-year old woman with an occipital headache was admitted to the emergency ward. Brain computed tomography scan showed mild hydrocephalus and multiple intraventricular isodense lesions. Imaging findings, especially of Gradient Resonance Echo imaging, were in favor of multiple intraventricular cavernous malformations. Conclusion: This is a rare presentation of multiple cavernous malformation as occipital headache without needing surgical intervention in this phase. Coexistence of periventricular plaques like Radiologically isolated syndrome of Multiple sclerosis is another unique aspect in this report. [GMJ.2017;6(1):61-65]

scholarly journals Evidence-based management of central cord syndrome

2013 ◽  
Vol 35 (1) ◽  
pp. E6 ◽  
Author(s):  
Nader S. Dahdaleh ◽  
Cort D. Lawton ◽  
Tarek Y. El Ahmadieh ◽  
Alexander T. Nixon ◽  
Najib E. El Tecle ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Current Treatment ◽  
Timing Of Surgery ◽  
Evidence Based ◽  
Class Iii ◽  
Medical Subject Headings ◽  
Central Cord Syndrome

Object Evidence-based medicine is used to examine the current treatment options, timing of surgical intervention, and prognostic factors in the management of patients with traumatic central cord syndrome (TCCS). Methods A computerized literature search of the National Library of Medicine database, Cochrane database, and Google Scholar was performed for published material between January 1966 and February 2013 using key words and Medical Subject Headings. Abstracts were reviewed and selected, with the articles segregated into 3 main categories: surgical versus conservative management, timing of surgery, and prognostic factors. Evidentiary tables were then assembled, summarizing data and quality of evidence (Classes I–III) for papers included in this review. Results The authors compiled 3 evidentiary tables summarizing 16 studies, all of which were retrospective in design. Regarding surgical intervention versus conservative management, there was Class III evidence to support the superiority of surgery for patients presenting with TCCS. In regards to timing of surgery, most Class III evidence demonstrated no difference in early versus late surgical management. Most Class III studies agreed that older age, especially age greater than 60–70 years, correlated with worse outcomes. Conclusions No Class I or Class II evidence was available to determine the efficacy of surgery, timing of surgical intervention, or prognostic factors in patients managed for TCCS. Hence, there is a need to perform well-controlled prospective studies and randomized controlled clinical trials to further investigate the optimal management (surgical vs conservative) and timing of surgical intervention in patients suffering from TCCS.

scholarly journals Silent Arteriovenous Malformation Hemorrhage and the Recognition of “Unruptured” Arteriovenous Malformation Patients Who Benefit From Surgical Intervention

Neurosurgery ◽  
2015 ◽  
Vol 76 (5) ◽  
pp. 592-600 ◽  
Author(s):  
Adib A. Abla ◽  
Jeffrey Nelson ◽  
Helen Kim ◽  
Christopher P. Hess ◽  
Tarik Tihan ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Surgical Intervention ◽  
Deep Drainage ◽  
Radiographic Evidence ◽  
Acute Hemorrhage ◽  
Acute Bleeding ◽  
Group 3 ◽  
Group 2 ◽  
Bleeding History ◽  
Group 1

Abstract BACKGROUND: Arteriovenous malformation (AVM) patients present in 4 ways relative to hemorrhage: (1) unruptured, without a history or radiographic evidence of old hemorrhage (EOOH); (2) silent hemorrhage, without a bleeding history but with EOOH; (3) ruptured, with acute bleeding but without EOOH; and (4) reruptured, with acute bleeding and EOOH. OBJECTIVE: We hypothesized that characteristics and outcomes in the unrecognized group of silent hemorrhage patients may differ from those of unruptured patients. METHODS: Two hundred forty-two patients operated-on since 1997 were categorized by hemorrhage status and hemosiderin positivity in this cohort study: unruptured (group 1), silent hemorrhage (group 2), and ruptured/reruptured (group 3/4). Group 3/4 was combined because hemosiderin cannot distinguish acute hemorrhage from older silent hemorrhage. RESULTS: Hemosiderin was found in 45% of specimens. Seventy-five patients (31.0%) had unruptured AVMs, 30 (12.4%) had silent hemorrhage, and 137 (56.6%) had ruptured/reruptured AVMs. Deep drainage, posterior fossa location, preoperative modified Rankin Scale (mRS) score, outcome, and macrophage score were different across groups. Only the macrophage score was different between the groups without clinical hemorrhage. Outcomes were better in silent hemorrhage patients than in those with frank rupture (mean mRS scores of 1.2 and 1.7, respectively). CONCLUSION: One-third of patients present with silent AVM hemorrhage. No clinical or anatomic features differentiate these patients from unruptured patients, except the presence of hemosiderin and macrophages. Silent hemorrhage can be diagnosed using magnetic resonance imaging with iron-sensitive imaging. Silent hemorrhage portends an aggressive natural history, and surgery halts progression to rerupture. Good final mRS outcomes and better outcomes than in those with frank rupture support surgery for silent hemorrhage patients, despite the findings of ARUBA.

Cavernous Malformation of the Oculomotor Nerve Mimicking a Partially Thrombosed Posterior Communicating Artery Aneurysm: Report of Two Cases

Neurosurgery ◽  
2011 ◽  
Vol 69 (2) ◽  
pp. E470-E474 ◽  
Author(s):  
Stacey Quintero Wolfe ◽  
Glen Manzano ◽  
David J. Langer ◽  
Jacques J. Morcos
Keyword(s):  
Magnetic Resonance ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Artery Aneurysm ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Radiographic Appearance ◽  
Cavernous Malformations ◽  
Cranial Nerve Function ◽  
Posterior Communicating Artery Aneurysm

Abstract BACKGROUND AND IMPORTANCE: Cavernous malformations of the cranial nerves are exceedingly rare. The classic radiographic appearance of cavernous malformations may not be obvious when located in a cranial nerve. CLINICAL PRESENTATION: We present 2 cases of acute oculomotor paresis caused by cavernous malformations of the oculomotor nerve that were mistaken for a thrombosed posterior communicating artery aneurysm on magnetic resonance imaging, magnetic resonance angiography, and digital subtraction angiography. Both patients underwent a craniotomy with exploration of the lesion. Both cavernous malformations were completely resected while the integrity of the third cranial nerve was maintained. One patient experienced complete resolution of the oculomotor palsy. CONCLUSION: Although rare, cavernous malformations should be included in the differential diagnosis of a partially thrombosed posterior communicating artery aneurysm. Exploration and complete lesional resection are possible with improvement of the cranial nerve function.

scholarly journals Association between trauma and acute hemorrhage of cavernous malformations in children: report of 3 cases

2016 ◽  
Vol 18 (3) ◽  
pp. 263-268 ◽  
Author(s):  
Andrew A. Fanous ◽  
Patrick K. Jowdy ◽  
Lindsay J. Lipinski ◽  
Lucia L. Balos ◽  
Veetai Li
Keyword(s):  
Risk Factor ◽  
Head Trauma ◽  
Cavernous Hemangioma ◽  
Case Series ◽  
Vascular Lesions ◽  
Acute Hemorrhage ◽  
Cavernous Malformations ◽  
Vascular Abnormalities ◽  
Cavernous Hemangiomas ◽  
History Of

OBJECTIVE Cavernous hemangiomas are benign congenital vascular abnormalities. Intracerebral cavernous hemangiomas have an appreciable risk of spontaneous hemorrhage. Little is known as to whether head trauma increases the risk of bleeding for these lesions. In this study, the authors present a case series of 3 patients with posttraumatic nonspontaneous hemorrhage of intracerebral cavernous malformations (CMs). For the first time, to the authors' knowledge, they propose that trauma might constitute a risk factor for acute hemorrhage in intracerebral cavernomas. METHODS The authors reviewed the charts of all patients with a new diagnosis of intracerebral cavernoma at their pediatric hospital between 2010 and 2014. Patients with a history of head trauma prior to presentation were subsequently studied to identify features common to these posttraumatic, hemorrhage-prone lesions. RESULTS A history of head trauma was identified in 3 of 19 cases. These 3 patients presented with seizures and/or headaches and were found to have acute hemorrhage within a cavernous hemangioma. None of these patients had any history of abnormal neurological symptoms. All 3 abnormal vascular lesions had associated developmental venous anomalies (DVAs). The 3 patients underwent resection of their respective vascular abnormalities, and the diagnosis of cavernous hemangioma was confirmed with postsurgical tissue pathology. All 3 patients had complete resolution of symptoms following complete excision of their lesions. CONCLUSIONS Trauma may represent a risk factor for acute hemorrhage in patients with CMs. The presence of associated DVAs may represent a risk factor for posttraumatic hemorrhage of cavernomas. Excision should be considered in such cases, if feasible.

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