scholarly journals Extracranial arteriovenous malformation and subsequent contralateral cavernous sinus dural arteriovenous fistula showing abducens nerve palsy: illustrative case

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Atsushi Tsukada ◽  
Kiyoyuki Yanaka ◽  
Kazuhiro Nakamura ◽  
Nobuyuki Takahashi ◽  
Kuniyuki Onuma ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Spontaneous Regression ◽  
Dural Arteriovenous Fistula ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Illustrative Case ◽  
Vascular Structure ◽  
The Right

BACKGROUND Extracranial arteriovenous malformations (AVMs) are rare clinical entities and on rare occasions cause neurological symptoms. The authors report a case of an extracranial pterygoid AVM and a subsequent contralateral cavernous sinus dural arteriovenous fistula (dAVF) presenting with abducens nerve palsy. OBSERVATIONS An 80-year-old woman was referred to the authors’ hospital with left abducens nerve palsy followed by right ophthalmalgia. Magnetic resonance imaging (MRI) showed abnormal vessel staining in the left pterygoid and the right inferior petrosal sinus (IPS). Cerebral angiography revealed a left pterygoid AVM draining into the right IPS via the cavernous sinus (CS). A dAVF in the right CS was also revealed. The right ophthalmalgia disappeared spontaneously, and, 4 months later, the left abducens nerve palsy also disappeared after conservative management. Follow-up MRI showed spontaneous regression of the AVM and dAVF. The disappearance of the dAVF was considered to be due to spontaneous regression of the left pterygoid AVM and the consequent decrease in venous pressure of the CS, and the symptoms eventually disappeared. LESSONS The authors treated an extremely rare case of extracranial AVM with dramatic changes in vascular structure and symptoms. Understanding of the pathophysiology between symptoms and dynamic changes in the vascular structure is essential for providing the appropriate treatment.

Pitfalls in Endovascular Treatment of Dural Arteriovenous Fistulas Involving the Cavernous Sinus

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 88-92
Author(s):  
N. Kuwayama ◽  
S. Endo ◽  
M. Kubo ◽  
T. Akai ◽  
A. Takaku
Keyword(s):  
Endovascular Treatment ◽  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Transarterial Embolization ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Arteriovenous Fistulas ◽  
Type D ◽  
Dural Arteriovenous Fistulas ◽  
The Right

Angiographic changes of the sylvian veins, superior ophthalmic vein (SOV), and superior petrosal sinus (SPS) before and after endovascular treatment were determined for 18 patients with dural arteriovenous fistulas (AVFs) involving the cavernous sinus, and pitfalls of endovascular treatment, especially regarding venous drainage routes, for 3 of the patients were reported. Case 1: 57-year-old woman who presented with right abducens nerve palsy had a Barrow type D fistula in the right cavernous sinus draining into the bilateral inferior petrosal sinuses (IPS). One of the ipsilateral sylvian veins that had drained antegradely before treatment was occluded, and a small lacunar infarction in the corona radiata developed after transvenous embolization (TVE) of the right cavernous sinus. Case 2: 72-year-old woman who presented with symptoms of right ocular hypertension had a type D fistula in the right cavernous sinus draining into only the ipsilateral SOV. Conjunctival hyperemia persisted and was aggravated after angioanatomical obliteration of the fistula by transarterial embolization. Case 3: 55-year-old man who presented with left abducens nerve palsy had a type D fistula in the left cavernous sinus draining into the ipsilateral IPS and sylvian vein. The dural AVF was obliterated once with TVE, but recurred 1 week later with retrograde drainage into the ipsilateral SPS and mesencephalic veins. A second TVE resulted in complete obliteration of the fistula. In conclusion, detailed analysis of drainage routes is necessary for planning of treatment of patients with dural AVF, and prompt treatment is needed when redistribution of drainage routes develops during or after TVE.

scholarly journals Cavernous sinus dural arteriovenous fistula accessed through a straightened superficial temporal vein

2021 ◽  
Vol 12 ◽  
pp. 634
Author(s):  
Teishiki Shibata ◽  
Yusuke Nishikawa ◽  
Takumi Kitamura ◽  
Mitsuhito Mase
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Chronic Total Occlusion ◽  
Nerve Palsy ◽  
Dural Arteriovenous Fistula ◽  
Abducens Nerve ◽  
Transvenous Embolization ◽  
Access Route ◽  
Treatment Procedure ◽  
Total Occlusion

Background: Transvenous embolization through the inferior petrosal sinus (IPS) is the most common treatment procedure for cavernous sinus dural arteriovenous fistula (CSDAVF). When the IPS is inaccessible or the CSDAVF cannot be treated with transvenous embolization through the IPS, the superficial temporal vein (STV) is used as an alternative access route. However, the approach through the STV is often challenging because of its tortuous and abruptly angulated course. We report a case of recurrent CSDAVF which was successfully treated using a chronic total occlusion (CTO)-dedicated guidewire and by straightening the STV. Case Description: A 63-year-old woman was diagnosed with CSDAVF on examination for oculomotor and abducens nerve palsy. She was initially treated with transvenous embolization through the IPS. However, CSDAVF recurred, and transvenous embolization was performed through the STV. A microcatheter could not be navigated because of the highly meandering access route through the STV. By inserting a CTO-dedicated guidewire into the microcatheter, the STV was straightened and the microcatheter could be navigated into a shunted pouch of the CS. Finally, complete occlusion of the CSDAVF was achieved. Conclusion: If an access route is highly meandering, the approach can be facilitated by straightening the access route with a CTO-dedicated guidewire.

CELLULAR SCHWANNOMA OF THE GREATER SUPERFICIAL PETROSAL NERVE PRESENTING WITH ABDUCENS NERVE PALSY AND XEROPHTHALMIA

Neurosurgery ◽  
2008 ◽  
Vol 63 (4) ◽  
pp. E813-E814 ◽  
Author(s):  
Giyas Ayberk ◽  
Mehmet F. Ozveren ◽  
Nuket Uzum ◽  
Ozgur Tosun ◽  
Emine K. Akcay
Keyword(s):  
Nerve Palsy ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Petrous Apex ◽  
Clinical Prognosis ◽  
Tear Secretion ◽  
Pathological Evaluation ◽  
Greater Superficial Petrosal Nerve ◽  
Extradural Approach ◽  
The Right

ABSTRACT OBJECTIVE Cellular schwannomas (CS) are rare in the cranial space. This report is the first of a patient with a greater superficial petrosal nerve CS presenting with abducens nerve palsy and xerophthalmia. CLINICAL PRESENTATION A 16-year-old female patient presented with a 1-month history of diplopia. Neurological examination was normal except for the presence of right abducens nerve palsy. Schirmer's test revealed decreased tear secretion in the right eye. Computed tomography and magnetic resonance imaging showed a mass in the right petrous apex. It was thought that the schwannoma in our patient originated from the greater superficial petrosal nerve, based on the location of the tumor in addition to the absence of partial Horner's syndrome and a persistent decrease in tear secretion. INTERVENTION: The tumor was exposed with the use of a right subtemporal extradural approach and removed entirely. Pathological evaluation of the tumor revealed a CS. CONCLUSION The abducens nerve palsy improved completely in the follow-up period, but the decreased tear secretion did not resolve. CS is one of the subtypes of ordinary schwannomas and exhibits malignant features on microscopic examination, although it has a good clinical prognosis. No adjuvant treatment was applied because of the tumor's benign character. The greater superficial petrosal nerve schwannoma should be considered in the differential diagnosis of the abducens nerve palsy and petrous apex mass.

scholarly journals The right eye abducens nerve palsy as a cranial neuropathy of dengue fever: The benefit of corticosteroids in an unusual dengue sequela

2019 ◽  
Vol 1 (2) ◽  
pp. 145-151
Author(s):  
Mohd Khairul Bin Abd Majid
Keyword(s):  
Dengue Fever ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Acute Onset ◽  
Favourable Outcome ◽  
Abducens Nerve Palsy ◽  
Oral Steroid ◽  
Cranial Neuropathy ◽  
Systemic Corticosteroids ◽  
The Right

Dengue fever is very common in tropical climate countries and the number of reported cases in Malaysia shows an increasing trend recently, according to the Malaysian Clinical Practice Guidelines. Although dengue fever is common, cranial nerve mononeuropathy is a very rare manifestation in relation to other neurological-associated syndromes. We report a rare case of cranial mononeuropathy of dengue fever in Malaysia and highlight the option of steroid usage as an alternative treatment to hasten the neurological recovery. The patient, a 25-year-old healthy policeman, presented with symptomatic viral fever, which was serologically confirmed as dengue fever. He developed acute-onset binocular diplopia, which was secondary to right eye isolated abducens nerve palsy during the critical phase of dengue fever. His visual acuity was 6/6 in both eyes with slightly restricted abduction of the right eye, consistent with right abducens nerve palsy, which was confirmed with a Hess test. There was corresponding diplopia over the right paracentral visual field. Urgent contrasted brain imaging was done, which ruled out the life-threatening intracranial pathology; therefore, a diagnosis of possible subclinical inflammatory changes causing sixth nerve palsy was made. Subsequently, he was treated with intravenous methylprednisolone 500 mg daily for 3 days and regained full extraocular muscle movement after 1 week. Oral steroid was not initiated. In conclusion, although the isolated unilateral cranial mononeuropathy may improve spontaneously within a certain period of time, a short course of systemic corticosteroids may be considered to hasten the recovery, as it has a favourable outcome.

scholarly journals A case of recurrent cavernous sinus dural arteriovenous fistula arising after superselective shunt occlusion and detected by venous arterial spin labeling

2021 ◽  
Vol 12 ◽  
pp. 594
Author(s):  
Hiromu Sunada ◽  
Ryosuke Maeoka ◽  
Ichiro Nakagawa ◽  
Hiroyuki Nakase ◽  
Hideyuki Ohnishi
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Arterial Spin Labeling ◽  
Dural Arteriovenous Fistula ◽  
Spin Labeling ◽  
Digital Subtraction ◽  
Resonance Imaging ◽  
Shunt Occlusion ◽  
Paradoxical Worsening ◽  
The Right

Background: Superselective shunt occlusion (SSSO) for cavernous sinus dural arteriovenous fistula (CSDAVF) avoids the risk of cranial nerve palsy, unlike entire sinus packing, but requires paying attention to recurrence. Distinguishing between true and paradoxical worsening of postoperative ophthalmic symptoms using a less-invasive modality is often difficult. Here, we report a case of true worsening of neuro-ophthalmic symptom by recurrent CSDAVF detected by venous-arterial spin labeling (ASL) on magnetic resonance imaging. Case Description: A 55-year-old woman with neither contributory medical history nor previous head trauma presented with neuro-ophthalmic symptoms and pulsatile tinnitus. Digital subtraction angiography (DSA) revealed CSDAVF with multiple shunted pouches. She underwent successful transvenous SSSO, but neuroophthalmic symptom worsened after SSSO and venous-ASL revealed increased signal intensity in the right superior orbital vein (SOV). DSA confirmed recurrent CSDAVF and additional transvenous embolization was performed. Neuro-ophthalmic symptoms and venous-ASL hyperintensity on SOV improved postoperatively. Conclusion: Venous-ASL is noninvasive and seems useful for detecting true worsening of neuro-ophthalmic symptoms of recurrent CSDAVF.

scholarly journals Abducens nerve palsy on a patient with sphenoid fungal rhinosinusitis and cavernous sinus meningioma – Case report

2018 ◽  
Vol 8 (31) ◽  
pp. 193-196
Author(s):  
Andreea Marza ◽  
Claudiu Manea
Keyword(s):  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Complete Removal ◽  
Abducens Nerve Palsy ◽  
Cavernous Sinus Meningioma ◽  
Fungal Rhinosinusitis ◽  
Wait And See ◽  
The Brain

Abstract We report a case of a 47-year-old patient recently diagnosed with left abducens nerve palsy, who was admitted in our clinic with diplopia. The cranio-facial CT scan revealed left sphenoid fungal rhinosinusitis and the patient underwent endoscopic surgery with complete removal of the fungal material. The immediate postoperative evolution of the patient was favourable, with partial improvement of diplopia. The first month follow-up visit revealed the recurrence of the diplopia, so the patient performed an MRI scan of the brain that showed a cavernous sinus meningioma. The patient was referred to a neurosurgeon who choose a “wait-and-see” strategy instead of surgery. The paper presents the limits of computed tomography versus magnetic resonance imaging in the radiologic diagnosis of intracranial tumors.

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