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.

Carotid-cavernous sinus thrombosis caused by Aspergillus fumigatus

1980 ◽  
Vol 52 (1) ◽  
pp. 120-125 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Manuel Dujovny ◽  
Gutti R. Rao
Keyword(s):  
Aspergillus Fumigatus ◽  
Cavernous Sinus ◽  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Sinus Thrombosis ◽  
Sella Turcica ◽  
Cavernous Sinus Thrombosis ◽  
Content Type ◽  
The Central Nervous System ◽  
Fine Print

✓ A case is presented of Aspergillus fumigatus granuloma involving the sphenoid sinus, sella turcica, cavernous sinus, and the internal carotid artery. The diagnosis was established by a transsphenoidal biopsy. The infection proved difficult to treat and finally remitted after chemotherapy with a combination of amphotericin B, rifampin (rifampicin), and flucytosine (5-fluorocytosine). The spectrum of aspergillosis of the central nervous system is reviewed, and difficulties in treating this infection are considered.

Arteriovenous malformations in the posterior fossa

1977 ◽  
Vol 47 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Hiroshi Matsumura ◽  
Yasumasa Makita ◽  
Kuniyuki Someda ◽  
Akinori Kondo
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Anterior Part ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were directly related to the brain stem. The AVM's in the anterior part of the cerebellum were operated on through a transtentorial occipital approach.

Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms

1993 ◽  
Vol 79 (2) ◽  
pp. 161-173 ◽  
Author(s):  
Gary K. Steinberg ◽  
Charles G. Drake ◽  
Sydney J. Peerless
Keyword(s):  
Clinical Outcome ◽  
Vertebral Artery ◽  
Brain Stem ◽  
Intracranial Aneurysms ◽  
Artery Occlusion ◽  
Neurological Deterioration ◽  
Content Type ◽  
Vertebrobasilar Junction ◽  
Aneurysm Thrombosis ◽  
Fine Print

✓ Deliberate occlusion of the basilar or vertebral arteries was performed in 201 patients with intracranial aneurysms, where the aneurysmal neck could not be clipped directly. The aneurysms arose from the basilar apex in 83 cases, the basilar trunk in 46, the vertebrobasilar junction in 35, and the vertebral artery in 37; 87% of the aneurysms were classified as giant lesions (> 2.5 cm). There were 85 upper basilar occlusions, 41 lower basilar occlusions, 29 bilateral vertebral occlusions, and 48 unilateral vertebral artery occlusions. The clinical follow-up period varied from 1 to 23 years, with a mean of 9.5 years. Overall long-term results were excellent in 68% of the patients, good in 5%, and poor in 3%; 24% died. Clinical outcome varied according to aneurysm site; excellent or good results were achieved in 64% of the patients with basilar apex, 76% with basilar trunk, 74% with vertebrobasilar junction, and 87% with vertebral artery aneurysms. Clinical outcome also varied depending on preoperative grade: 86% of the patients with an excellent presenting grade achieved excellent results. The size of the posterior communicating arteries was a good predictor of tolerance to basilar artery occlusion (p < 0.05). Successful aneurysm thrombosis was achieved in 78% of the patients. The neurological status in 26 patients (13%) deteriorated due to vertebrobasilar ischemia occurring within the 1st postoperative week, and thrombosis or embolism was implicated much more frequently than hemodynamic insufficiency. Subarachnoid hemorrhage (SAH) in 14 patients, vasospasm in five patients, and surgical trauma in seven patients accounted for additional morbidity in the 1st month following operation; however, many of these patients ultimately made an excellent recovery. Late vertebrobasilar ischemic complications or neurological deterioration from persistent mass effect occurred in 4% of patients with successful aneurysm thrombosis 6 weeks to 18 months after arterial ligation. Among the 43 patients with incompletely thrombosed aneurysms, 67% developed early or late neurological deterioration from SAH, progressive brain-stem compression, or brain-stem stroke, with 86% of the complications proving fatal.

Cervical spinal cord in experimental hydrocephalus

1972 ◽  
Vol 37 (5) ◽  
pp. 538-542 ◽  
Author(s):  
George J. Dohrmann
Keyword(s):  
Spinal Cord ◽  
Brain Stem ◽  
Cervical Spinal Cord ◽  
Central Canal ◽  
Content Type ◽  
Experimental Hydrocephalus ◽  
Physiological Pressure ◽  
The Brain ◽  
Shunting Procedure ◽  
Fine Print

✓ Adult dogs were rendered hydrocephalic by the injection of kaolin into the cisterna magna. One group of dogs was sacrificed 1 month after kaolin administration, and ventriculojugular shunts were performed on the other group. Hydrocephalic dogs with shunts were sacrificed 1 day or 1 week after the shunting procedure. All dogs were perfused with formalin at physiological pressure, and the brain stem and cervical spinal cord were examined by light microscopy. Subarachnoid granulomata encompassed the superior cervical spinal cord and dependent surface of the brain stem. Rarefaction of the posterior white columns and clefts or cavities involving the gray matter posterior to the central canal and/or posterior white columns were present in the spinal cords of both hydrocephalic and shunted hydrocephalic dogs. Predominantly in the dogs with shunts, hemorrhages were noted in the spinal cord in association with the clefts or cavities. A mechanism of ischemia followed by reflow of blood is postulated to explain the hemorrhages in the spinal cords of hydrocephalic dogs with shunts.

Cerebral cysticercosis with aqueductal obstruction

1980 ◽  
Vol 53 (2) ◽  
pp. 252-255 ◽  
Author(s):  
Tung Pui Poon ◽  
Edward J. Arida ◽  
Wolodymyr P. Tyschenko
Keyword(s):  
Intracranial Hypertension ◽  
Brain Stem ◽  
Normal Pressure Hydrocephalus ◽  
Signs And Symptoms ◽  
Normal Pressure ◽  
Content Type ◽  
Neurological Signs ◽  
Cerebral Cysticercosis ◽  
The Brain ◽  
Fine Print

✓ The authors report a case of cerebral cysticercosis which presented with generalized nonspecific neurological signs and symptoms attributed to acute aqueductal obstruction, with concomitant intracranial hypertension. These were characteristic intracranial calcifications along with angiographically demonstrated signs of hydrocephalus. Contrast encephalography clearly demonstrated aqueductal obstruction. Pathologically, the aqueductal obstruction was shown to be due to parasitic invasion of the brain stem with compression of the aqueduct. The presence of typical intracranial calcification in conjunction with either obstructive or normal-pressure hydrocephalus should alert the observer to the possibility of cerebral cysticercosis.

Odontoid compression of the brain stem in a patient with rheumatoid arthritis

1980 ◽  
Vol 53 (6) ◽  
pp. 841-845 ◽  
Author(s):  
Harold P. Smith ◽  
Venkata R. Challa ◽  
Eben Alexander
Keyword(s):  
Rheumatoid Arthritis ◽  
Brain Stem ◽  
Neurological Deficit ◽  
Neurological Symptoms ◽  
Direct Compression ◽  
Content Type ◽  
Vertical Subluxation ◽  
Progressive Neurological Deficit ◽  
The Brain ◽  
Fine Print

✓ Cervical spine involvement by rheumatoid arthritis is common; brain-stem compression secondary to vertical subluxation of the odontoid in patients with rheumatoid arthritis is rare. Vertical subluxation results from 1) destruction of the transverse atlantal, apical, and alar ligaments of the atlas and odontoid, and 2) bone resorption in the occipital condyles, lateral masses of the atlas, and basilar processes of the skull. Neurological symptoms result from direct compression of the brain stem or from ischemia secondary to compression of vertebral arteries, anterior spinal arteries, or small perforating arteries of the brain stem and spinal cord. A case is reported in which a slowly progressive neurological deficit developed in a woman with rheumatoid arthritis following a fall from a stretcher. Neurological symptoms represented direct compression of the medulla by the dens, a mechanism confirmed at operation and autopsy. Recognition of progressive neurological deficit is often difficult in patients with rheumatoid arthritis because of their inactivity and their atrophic and immobile joints, but is essential if appropriate decompressive or stabilizing procedures are to be done. In patients with vertical subluxation of the dens, the transoral approach with removal of the odontoid is recommended. Decompression should be extensive, including the fibrous capsule around the odontoid and overlying synovial tissue as well as the odontoid itself.

Thickening of sphenoid sinus mucosa during the acute stage of pituitary apoplexy

2001 ◽  
Vol 95 (5) ◽  
pp. 897-901 ◽  
Author(s):  
Kazunori Arita ◽  
Kaoru Kurisu ◽  
Atushi Tominaga ◽  
Kazuhiko Sugiyama ◽  
Fusao Ikawa ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Sphenoid Sinus ◽  
Pituitary Apoplexy ◽  
Sella Turcica ◽  
Acute Stage ◽  
Mr Images ◽  
Content Type ◽  
Subepithelial Layer ◽  
Sinus Mucosa ◽  
Fine Print

✓ The authors treated two patients with pituitary apoplexy in whom magnetic resonance (MR) images were obtained before and after the episode. Two days after the apoplectic episodes, MR imaging demonstrated marked thickening of the mucosa of the sphenoid sinus that was absent in the previous studies. The relevance of this change in the sphenoid sinus was investigated. Retrospective evaluations were performed using MR images obtained in 14 consecutive patients with classic pituitary apoplexy characterized by acute onset of severe headache. The mucosa of the sphenoid sinus had thickened predominantly in the compartment just beneath the sella turcica, in nine of 11 patients, as ascertained on MR images obtained within 7 days after the onset of apoplectic symptoms. This condition improved spontaneously in all four patients who did not undergo transsphenoidal surgery. The sphenoid sinus mucosa appeared to be normal on MR images obtained from three patients at the chronic stage (> 3 months after onset). The incidence of sphenoid sinus mucosal thickening during the acute stage was significantly higher in the patients with apoplexy than that in the 100 patients without apoplexy. A histological study conducted in four patients who underwent transsphenoidal surgery during the early stage showed that the subepithelial layer of the sphenoid sinus mucous membrane was obviously swollen. The sphenoid sinus mucosa thickens during the acute stage of pituitary apoplexy. This thickening neither indicates infectious sinusitis nor rules out the choice of the transsphenoidal route for surgery.

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.

Primary carcinoma of the pituitary with metastasis to the brain stem

1972 ◽  
Vol 36 (6) ◽  
pp. 781-784 ◽  
Author(s):  
Alan S. Fleischer ◽  
Thomas Reagan ◽  
Joseph Ransohoff
Keyword(s):  
Brain Stem ◽  
Primary Carcinoma ◽  
Microscopic Appearance ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ A case of primary carcinoma of the pituitary with metastasis to the brain stem is presented. Although both tumors had the microscopic appearance of benign adenomas, the infiltrative characteristics necessitated the diagnosis of carcinoma.

Noninvasive localization of brain-stem lesions in the cat with multimodality evoked potentials

1981 ◽  
Vol 54 (6) ◽  
pp. 740-750 ◽  
Author(s):  
Richard P. Greenberg ◽  
Donald M. Stablein ◽  
Donald P. Becker
Keyword(s):  
Evoked Potentials ◽  
Brain Stem ◽  
Evoked Potential ◽  
Animal Experiments ◽  
Content Type ◽  
Central Nervous System Dysfunction ◽  
Multimodality Evoked Potentials ◽  
Stem Lesions ◽  
The Brain ◽  
Fine Print

✓ Multimodality evoked potential (MEP) data from over 300 comatose head-injured patients suggest that central nervous system dysfunction of the brain stem and/or hemispheres can be localized with this noninvasive neuroelectric technique. Based on this work, decerebrate motor posturing and prolonged coma are not associated with brain-stem dysfunction but rather with dysfunction of the hemispheres, while absent pupillary and oculocephalic responses are correlated with brain-stem dysfunction alone. However, the accuracy with which MEP data localized human brain-stem or hemispheric dysfunction could not be confirmed by pathological correlation because of low mortality and the small number of autopsies obtained in the patients who died. Therefore, this study was undertaken in an animal model of brain-stem lesion. Complete brain-stem transections were made at the cervicomedullary junction, the medulla just caudal to the eighth nerve, and at the intercollicular region. All cortical visual evoked potential (VEP) peaks were reduced in amplitude and delayed by each of the brain-stem transections, but none of the peaks was abolished. In spite of brain-stem transection, VEP's can be used to gain information about hemispheric function. Somatosensory (SEP) and auditory cortically generated evoked potentials (AEP) were abolished by these brain-stem transections, but early-latency brain-stem SEP and AEP data could accurately localize specific areas of brain-stem dysfunction caused by the lesions. Observations made on human MEP data seem to be confirmed by these animal experiments. Correlations between human and cat MEP data are discussed.

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