Extrasellar extension of a pituitary adenoma in a patient with a normal-sized sella turcica and impaired vision from an atheromatous carotid artery

1973 ◽  
Vol 39 (3) ◽  
pp. 398-401 ◽  
Author(s):  
John R. Clifford ◽  
Dean H. Echols
Keyword(s):  
Carotid Artery ◽  
Surgical Intervention ◽  
Sella Turcica ◽  
Complete Recovery ◽  
The Other ◽  
Surgical Removal ◽  
Impaired Vision ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ Chromophobe adenomas rarely invade the brain without causing enlargement of the sella turcica and without compressing the optic nerves or chiasm. Such a case is reported, in which the patient made a complete recovery after surgical removal of the tumor. Five years later impaired vision in the other eye suggested recurrence of the adenoma. This time surgical intervention disclosed compression of the optic nerve by an atheromatous carotid artery.

Relief of facial pain after combined removal of precentral and postcentral cortex

1971 ◽  
Vol 34 (4) ◽  
pp. 537-543 ◽  
Author(s):  
Richard A. Lende ◽  
Wolff M. Kirsch ◽  
Ralph Druckman
Keyword(s):  
Facial Pain ◽  
The Other ◽  
Precentral Gyrus ◽  
Nerve Section ◽  
Content Type ◽  
Burning Pain ◽  
Cortical Localization ◽  
The Brain ◽  
Fine Print ◽  
Frontal Lobotomy

✓ Cortical removals which included precentral and postcentral facial representations resulted in relief of facial pain in two patients. Because of known failures following only postcentral (SmI) ablations, these operations were designed to eliminate also the cutaneous afferent projection to the precentral gyrus (MsI) and the second somatic sensory area (SmII). In one case burning pain developed after a stroke involving the brain stem and was not improved by total fifth nerve section; prompt relief followed corticectomy and lasted until death from heart disease 20 months later. In the other case persistent steady pain that developed after fifth rhizotomy for trigeminal neuralgia proved refractory to frontal lobotomy; relief after corticectomy was immediate and has lasted 14 months. Cortical localization was established by stimulation under local anesthesia. Each removal extended up to the border of the arm representation and down to the upper border of the insula. Such a resection necessarily included SmII, and in one case responses presumably from SmII were obtained before removal. The suggestions of Biemond (1956) and Poggio and Mountcastle (1960) that SmII might be concerned with pain sensibility may be pertinent in these cases.

Vascular malformations of the brain stem

1989 ◽  
Vol 70 (6) ◽  
pp. 847-852 ◽  
Author(s):  
Douglas Chyatte
Keyword(s):  
Brain Stem ◽  
Vascular Malformation ◽  
Vascular Malformations ◽  
Surgical Removal ◽  
Content Type ◽  
Appropriate Treatment ◽  
Complete Obliteration ◽  
Time Of Presentation ◽  
The Brain ◽  
Fine Print

✓ Vascular malformations of the brain stem are unusual lesions that may pose a diagnostic and therapeutic challenge. Seven patients with vascular malformations involving the brain stem were evaluated; six were treated surgically, with complete obliteration of the lesion in five patients. In five patients symptoms developed only after a hemorrhage had occurred, and three of these suffered a rebleed before appropriate treatment was given. Angiography failed to demonstrate lesions in three cases, which did not appear to protect from repeat hemorrhage since two of the three rebled. There were no operative deaths, and no patients were made permanently worse after surgery. Useful recovery occurred commonly after appropriate treatment and appeared to be possible even in patients who had suffered a catastrophic neurological deficit at the time of presentation. These data indicate that surgical removal of the lesion may be warranted in some patients with symptomatic brain-stem vascular malformation.

Spasm of the extracranial internal carotid artery resulting from blunt trauma demonstrated by angiography

1971 ◽  
Vol 35 (6) ◽  
pp. 742-747 ◽  
Author(s):  
Elisha S. Gurdjian ◽  
Blaise Audet ◽  
Renato W. Sibayan ◽  
Llywellyn M. Thomas
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Blunt Trauma ◽  
Internal Carotid ◽  
Clinical Symptoms ◽  
The Other ◽  
Extracranial Internal Carotid Artery ◽  
Content Type ◽  
Fine Print

✓ Two cases of spasm of the extracranial portion of the internal carotid artery following trauma are described. In one case, the spasm did not cause lasting clinical symptoms, while in the other the spasm caused clinical symptoms with probable infarction.

Experimental induction of cerebral aneurysms in monkeys

1987 ◽  
Vol 67 (6) ◽  
pp. 903-905 ◽  
Author(s):  
Nobuo Hashimoto ◽  
Choegon Kim ◽  
Haruhiko Kikuchi ◽  
Masayuki Kojima ◽  
Yoo Kang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Anterior Communicating Artery ◽  
Experimental Hypertension ◽  
Content Type ◽  
Experimental Induction ◽  
The Common ◽  
The Brain ◽  
Fine Print

✓ Saccular cerebral aneurysms were successfully induced in two monkeys treated with ligation of the common carotid artery, experimental hypertension, and β-aminopropionitrile feeding. The cerebral aneurysms developed on the large arteries at the base of the brain, such as the anterior communicating artery and the internal carotid artery at the origin of the posterior communicating artery. Because of the similarity of the monkey to man as a species, the present results strongly suggest the significance of postnatal aggravating factors in the development of cerebral aneurysms in man.

A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernous sinus

1989 ◽  
Vol 71 (5) ◽  
pp. 699-704 ◽  
Author(s):  
Akira Hakuba ◽  
Kiyoaki Tanaka ◽  
Toshihisa Suzuki ◽  
Shuro Nishimura
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
The Other ◽  
Vascular Lesions ◽  
Content Type ◽  
Fine Print

✓ The authors present four cases of vascular lesions and 10 cases of tumors involving the cavernous sinus. They were operated on via a combined orbitozygomatic infratemporal epidural and subdural approach. With this approach, multisided exposure of the cavernous sinus can be achieved via the shortest possible distance with minimal retraction of the neural structures in and around the cavernous sinus. In one patient the carotid artery had been occluded previously, but in the other 13 patients it was preserved. There was no mortality, and all patients except one returned to work within 6 months after surgery.

Outcome of aggressive removal of cavernous sinus meningiomas

1994 ◽  
Vol 81 (2) ◽  
pp. 245-251 ◽  
Author(s):  
Franco DeMonte ◽  
Harold K. Smith ◽  
Ossama Al-Mefty
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
The Other ◽  
Surgical Removal ◽  
Content Type ◽  
Formidable Challenge ◽  
Acute Hypothyroidism ◽  
Total Tumor Removal ◽  
Subtotal Removal ◽  
Fine Print

✓ Despite recent advances in surgery of the cavernous sinus, meningiomas in that area offer a formidable challenge. The rationale for aggressive surgical removal of cavernous sinus meningiomas is based on the presumption that the extent of removal is inversely related to the rate of recurrence. Over the past 10 years, 41 patients with histologically benign meningiomas involving the cavernous sinus underwent aggressive surgery. Total removal, as confirmed by intraoperative inspection and postoperative radiological studies, was achieved in 31 patients (76%). Twelve patients have been followed for more than 5 years; 10 underwent total tumor removal and only one of these experienced recurrence (5 years after surgery). The other two patients underwent subtotal removal and had symptomatic and radiological evidence of regrowth 3 and 4 years after surgery. Pre-existing cranial nerve deficits improved in only 14% of the patients, remained unchanged in 80%, and worsened permanently in 6%. Seven patients experienced a total of 10 new cranial nerve deficits, four of which involved the nerves subserving ocular motor function. Extraocular muscle function did not worsen in the 25 patients with a seeing eye ipsilateral to the tumor, and no instance of visual worsening occurred. Two patients died 4 months after surgery, one from severe delayed vasospasm and hypothalamic infarction and the other because of a myocardial infarction. Another patient died from a pulmonary embolus on the 9th postoperative day. There were three instances of cerebral ischemia; one was transient, lasting less than 24 hours, while two were related to injury of the middle cerebral artery and resulted in residual hemiplegia. Other complications included three cases of nonfatal pulmonary emboli, two cerebrospinal fluid leaks, and one instance each of exposure keratitis, acute hypothyroidism, and cerebral edema.

Surgical considerations regarding giant dilations of the perivascular spaces

2004 ◽  
Vol 100 (5) ◽  
pp. 820-824 ◽  
Author(s):  
Paul House ◽  
Karen L. Salzman ◽  
Anne G. Osborn ◽  
Joel D. MacDonald ◽  
Randy L. Jensen ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Mass Effect ◽  
Perivascular Spaces ◽  
Resonance Imaging ◽  
Imaging Studies ◽  
Content Type ◽  
Relationship Of ◽  
The Relationship ◽  
The Brain ◽  
Fine Print

Object. Dilations of brain perivascular spaces (PVSs), also known as Virchow—Robin spaces, are routinely identified on magnetic resonance imaging studies of the brain and recognized as benign normal variants. Giant dilations occur only rarely and can be easily misdiagnosed as central nervous system tumors. The relevant surgical literature was reviewed to help establish indications for surgical intervention in these typically benign lesions. Methods. Giant dilations of the PVSs in 12 patients who had undergone surgery for several different indications were identified. Both clinical and radiographic presentations of these patients were reviewed along with the surgical procedures. Conclusions. Dilations of the PVSs can become giant lesions that may necessitate surgical intervention to relieve mass effect or hydrocephalus. The relationship of these lesions to neurological symptoms such as tremor and seizures remains unclear.

Nasal glioma

1977 ◽  
Vol 46 (1) ◽  
pp. 85-91 ◽  
Author(s):  
Leonard F. Hirsh ◽  
Sylvan E. Stool ◽  
Thomas W. Langfitt ◽  
Luis Schut
Keyword(s):  
Surgical Approach ◽  
Clinical Characteristics ◽  
Neural Tissue ◽  
Surgical Removal ◽  
Content Type ◽  
Nasal Tumors ◽  
Mass Lesions ◽  
The Brain ◽  
Selection Of ◽  
Fine Print

✓ Six cases of nasal gliomas, which are rare ectopic rests of neural tissue found at the root of the nose, are presented. It is important to distinguish nasal tumors from basofrontal encephaloceles to avoid inadvertent exposure of the brain during the surgical removal of mass lesions. Because of their related embryologic origins, the distinction between nasal gliomas and basofrontal encephaloceles may not be clear clinically. Nasal gliomas may be treated by several surgical specialties, and only a proper awareness of their relationship to encephaloceles can assure the selection of a flexible and adequate surgical approach. This paper emphasizes the salient clinical characteristics of nasal gliomas, their clinical distinction from and embryologic relationship to encephaloceles, and the options for treatment.

Radiosurgery for venous angiomas

1993 ◽  
Vol 78 (4) ◽  
pp. 531-536 ◽  
Author(s):  
Christer Lindquist ◽  
Wan-Yio Guo ◽  
Bengt Karlsson ◽  
Ladislau Steiner
Keyword(s):  
Venous Drainage ◽  
The Other ◽  
Minimal Risk ◽  
Venous Angioma ◽  
Content Type ◽  
Complete Obliteration ◽  
Effects Of Radiation ◽  
Venous Angiomas ◽  
The Brain ◽  
Fine Print

✓ Radiosurgical treatment with the gamma knife for venous angiomas was used as an alternative to microsurgical removal in order to avoid abrupt cessation of venous drainage, which may be shared by the venous angioma and important parts of the brain. Thirteen cases of venous angioma were treated between 1977 and 1991. In two cases cavernous angiomas were also present and in one case a distant arteriovenous malformation (AVM) was also found. In two cases the angioma shared the venous drainage with an adjoining AVM; this is the first description of such pathology. For venous angiomas irradiation was prescribed to cover at least the convergence of the medullary veins. For AVM's close to a venous angioma the treatment was exclusively prescribed to the AVM nidus. After treatment, complete obliteration of the venous angioma was observed in one case, partial obliteration was observed in three cases, and five venous angiomas were unaffected by the treatment. Undue effects of radiation occurred in four cases: one focal edema and three radionecroses. Extirpation of the radionecrotic tissue 6 months after radiosurgery was necessary in one case. In the other three cases, the venous angioma was observed to be completely or partially obliterated, or unaffected by the treatment (one case each). In two cases of combined AVM and venous angioma, complete obliteration of the treatment AVM nidus was obtained. It is concluded that radiosurgery for venous angioma, although conceptually attractive, still does not fulfill the rigid criteria of minimal risk which must be set for the treatment of a lesion with a benign natural history.

Stereotaxic thrombosis of inaccessible intracranial aneurysms

1977 ◽  
Vol 47 (6) ◽  
pp. 833-839 ◽  
Author(s):  
Randall W. Smith ◽  
John F. Alksne
Keyword(s):  
Brain Stem ◽  
Cavernous Sinus ◽  
Intracranial Aneurysms ◽  
Sphenoid Sinus ◽  
Ophthalmic Artery ◽  
Sella Turcica ◽  
Content Type ◽  
The Brain ◽  
Stereotaxic Technique ◽  
Fine Print

✓ Some intracranial aneurysms that might be considered inoperable by open craniotomy are readily treatable by stereotaxic thrombosis. This is possible because the stereotaxic technique requires only that some point on the fundus of the aneurysm can be punctured with a needle. Illustrative cases are given describing the successful treatment of aneurysms arising at the origin of the ophthalmic artery, within the cavernous sinus, within the sella turcica, and from the vertebrobasilar and the posterior inferior cerebellar arteries ventral to the brain stem. The aneurysms within the sella or cavernous sinus can be approached through the sphenoid sinus, and the aneurysms ventral to the brain stem can be approached through the clivus without opening the dura.

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