Management of the unresectable cystic craniopharyngioma by aspiration through an Ommaya reservoir drainage system

1980 ◽  
Vol 52 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Philip H. Gutin ◽  
William M. Klemme ◽  
Raymond L. Lagger ◽  
Alexander R. MacKay ◽  
Lawrence H. Pitts ◽  
...  
Keyword(s):  
Drainage System ◽  
Signs And Symptoms ◽  
Ommaya Reservoir ◽  
Content Type ◽  
Cystic Craniopharyngioma ◽  
Reasonable Alternative ◽  
Fine Print

✓ Four patients with primary and recurrent craniopharyngiomas that were grossly cystic were managed by intermittent aspiration through an indwelling Ommaya reservoir apparatus. The technique is safe and provides a reasonable alternative for the amelioration of signs and symptoms when total extirpation of the tumor is impossible.

Use of bleomycin in intratumoral chemotherapy for cystic craniopharyngioma

1996 ◽  
Vol 84 (1) ◽  
pp. 124-126 ◽  
Author(s):  
Sergio Cavalheiro ◽  
Fábio Veiga de Castro Sparapani ◽  
José Orlando Bidó Franco ◽  
Marcia Cristina da Silva ◽  
Fernando Menezes Braga
Keyword(s):  
Skull Base ◽  
Ommaya Reservoir ◽  
Sphenoid Bone ◽  
Complete Regression ◽  
Content Type ◽  
Intratumoral Chemotherapy ◽  
Cystic Craniopharyngioma ◽  
Fine Print ◽  
Intratumoral Injections

✓ The authors present a case of a gigantic cystic craniopharyngioma that was treated with intratumoral injections of bleomycin. The mass had eroded the skull base and extended to the sphenoid bone. A total of eight intratumoral injections through an Ommaya reservoir were given. Six months after treatment, there was complete regression of the lesion and improvement in both visual and endocrinological symptomatology.

Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: an initial experience

2000 ◽  
Vol 92 (5) ◽  
pp. 771-778 ◽  
Author(s):  
Peter A. Rasmussen ◽  
John Perl ◽  
John D. Barr ◽  
Georges Z. Markarian ◽  
Irene Katzan ◽  
...  
Keyword(s):  
Alternative Therapy ◽  
Signs And Symptoms ◽  
Antiplatelet Agents ◽  
Posterior Circulation ◽  
Occlusive Disease ◽  
Stent Insertion ◽  
Initial Experience ◽  
Content Type ◽  
Vertebrobasilar Artery ◽  
Fine Print

Object. Patients with intracranial vertebrobasilar artery (VBA) atherosclerotic occlusive disease have few therapeutic options. Unfortunately, VBA transient ischemic attacks (TIAs) herald a lethal or devastating event within 5 years in 25 to 30% of patients. The authors report their initial experience with eight patients in whom medically refractory TIAs secondary to intracranial posterior circulation atherosclerotic occlusive lesions were treated with stent-assisted angioplasty.Methods. Eight patients (six men), ranging in age from 43 to 77 years, experienced signs and symptoms of VBA insufficiency despite combination therapy with warfarin and antiplatelet agents. Angiographic studies revealed severe distal vertebral (four patients), proximal basilar (one patient), or proximal and midbasilar stenoses (three patients). Aspirin and clopidogrel were administered for 3 days before primary angioplasty and stent placement, and this regimen was maintained by the patients on discharge. Patients underwent heparinization during the procedure and were given a bolus and 12-hour infusion of abciximab. A neurologist specializing in stroke evaluated all patients before and after the procedure.The VBAs in all patients were successfully revascularized with 7 to 28% residual stenosis. Six patients experienced no neurological complications. One patient died the evening of the procedure due to a massive subarachnoid hemorrhage. Two patients had groin hematomas, one developed congestive heart failure, and one had transient encephalopathy. All surviving patients are asymptomatic up to 8 months postoperatively.Conclusions. Although primary intracranial VBA angioplasty with stent insertion is technically feasible, complications associated with the procedure can be life threatening. As experience is gained with this procedure, it may be offered routinely as an alternative therapy to patients with medically refractory posterior circulation occlusive disease that may develop into catastrophic VBA insufficiency.

Diagnosis and management of pituitary abscess: a review of twenty-four cases

2001 ◽  
Vol 95 (2) ◽  
pp. 233-241 ◽  
Author(s):  
G. Edward Vates ◽  
Mitchel S. Berger ◽  
Charles B. Wilson
Keyword(s):  
San Francisco ◽  
Hormone Replacement ◽  
Sella Turcica ◽  
Signs And Symptoms ◽  
Cystic Mass ◽  
Pituitary Abscess ◽  
Pituitary Mass ◽  
Content Type ◽  
Visual Changes ◽  
Fine Print

Object. Pituitary abscess is a rare but serious intrasellar infection. To better determine the salient signs and symptoms that help in making the diagnosis, and to determine the most appropriate treatment, the authors reviewed their experience in a series of 24 patients treated at the University of California at San Francisco. Methods. Nine of the patients were female and 15 were male, and their mean age was 41.2 years (range 12–71 years). Surprisingly, most patients in our series presented with complaints and physical findings consistent with a pituitary mass, but rarely with evidence of a serious infection. Headache, endocrine abnormalities, and visual changes were the most common clinical indicators; fever, peripheral leukocytosis, and meningismus were present in 33% or fewer of the patients. Imaging tests demonstrated a pituitary mass in all patients, but the features evident on computerized tomography and magnetic resonance studies did not distinguish pituitary abscesses from other, more common intrasellar lesions. Because of the ambiguous clinical features and imaging findings, most abscesses were not diagnosed before treatment; rather, the diagnosis was made during surgical exploration of the sella turcica, when the surgeon encountered a cystic mass containing pus. There were only two deaths in this series (8.3%). Patients presenting with headache and visual changes noted improvement in almost all cases; patients with endocrine dysfunction generally did not recover normal pituitary function, but were easily treated with hormone replacement therapy. Conclusions. Antibiotic therapy is suggested for patients who have symptoms of sepsis, or for patients in whom specific organisms are identified from cultures obtained during surgery. The transsphenoidal approach is recommended over open craniotomy for surgical drainage.

Management of proximal shunt obstruction

1988 ◽  
Vol 68 (5) ◽  
pp. 817-819 ◽  
Author(s):  
Charles C. Duncan
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Intracranial Pressure ◽  
Signs And Symptoms ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Content Type ◽  
Cerebrospinal Fluid Flow ◽  
Shunt Obstruction ◽  
Fine Print

✓ Proximal shunt obstruction or obstruction of the ventricular catheter may present with signs and symptoms of shunt failure with either no cerebrospinal fluid flow or a falsely low intracranial pressure (ICP) upon shunt tap. The author reports a technique for lowering the ICP and for measuring the pressure in patients with such obstruction by cannulation of the reservoir and ventricular catheter to penetrate into the ventricle with a 3½-in. No. 22 spinal needle. The findings in 20 cases in which this approach was utilized are summarized.

Abdominal pseudocysts and ascites formation after ventriculoperitoneal shunt procedures

1975 ◽  
Vol 43 (4) ◽  
pp. 476-480 ◽  
Author(s):  
S. Walton Parry ◽  
John F. Schuhmacher ◽  
Raeburn C. Llewellyn
Keyword(s):  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Signs And Symptoms ◽  
Late Complications ◽  
Neurological Symptoms ◽  
Shunt Malfunction ◽  
Content Type ◽  
Ventriculoperitoneal Shunts ◽  
Ascites Formation ◽  
Fine Print

✓The authors report three patients with abdominal pseudocysts and one with cerebrospinal fluid ascites as late complications of ventriculoperitoneal shunts. The presenting signs and symptoms were those of an intraabdominal abnormality, with no neurological symptoms suggestive of shunt malfunction.

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.

Long-term control of recurrent cyst of the conus medullaris

1977 ◽  
Vol 47 (6) ◽  
pp. 953-954 ◽  
Author(s):  
Harold J. Hoffman ◽  
Renn O. Holness ◽  
Norman R. Flett
Keyword(s):  
Epidermoid Cyst ◽  
Conus Medullaris ◽  
Ommaya Reservoir ◽  
Content Type ◽  
Recurrent Cyst ◽  
Intermittent Drainage ◽  
Fine Print

✓ The authors report a case in which decompression of an intramedullary epidermoid cyst was maintained by intermittent drainage via an implanted subcutaneous Ommaya reservoir.

Transfemoral embolization of an external carotid-cavernous fistula

1975 ◽  
Vol 42 (1) ◽  
pp. 94-97 ◽  
Author(s):  
Robert D. Pugatch ◽  
Samuel M. Wolpert
Keyword(s):  
Arterial Embolization ◽  
Signs And Symptoms ◽  
External Carotid ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Fluoroscopic Control ◽  
Fine Print

✓ The authors report a case of spontaneous carotid-cavernous fistula in which transfemoral arterial embolization under fluoroscopic control resulted in immediate occlusion of the fistula and dramatic resolution of the patient's signs and symptoms.

Spinal intramedullary cavernoma: clinical presentation and surgical outcome

2000 ◽  
Vol 93 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Harel Deutsch ◽  
George I. Jallo ◽  
Alina Faktorovich ◽  
Fred Epstein
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Signs And Symptoms ◽  
Acute Onset ◽  
Surgical Removal ◽  
Resonance Imaging ◽  
Content Type ◽  
Posterior Laminectomy ◽  
Fine Print

Object. Improved neuroimaging techniques have led to an increase in the reported cases of intramedullary cavernomas. The purpose of this study was to define the spectrum of presenting signs and symptoms in patients with spinal intramedullary cavernomas and to analyze the role of surgery as a treatment for these lesions. Methods. The authors reviewed the charts of 16 patients who underwent surgery for spinal intramedullary cavernomas. All patients underwent preoperative magnetic resonance imaging studies. Cavernomas represented 14 (5.0%) of 280 intramedullary lesions found in adults and two (1.1%) of 181 intramedullary lesions found in pediatric cases. A posterior laminectomy and surgical resection of the malformation were performed in all 16 patients. Conclusions. Magnetic resonance imaging is virtually diagnostic for spinal cavernoma lesions. Patients with spinal intramedullary cavernomas presented with either an acute onset of neurological compromise or a slowly progressive neurological decline. Acute neurological decline occurs secondary to hemorrhage within the spinal cord. Chronic progressive myelopathy occurs due to microhemorrhages and the resulting gliotic reaction to hemorrhagic products. There is no evidence that cavernomas increase in size. The rate of rebleeding is unknown, but spinal cavernomas appear to be clinically more aggressive than cranial cavernomas, probably because the spinal cord is less tolerant of mass lesions. Complete surgical removal of the cavernoma was possible in 15 of 16 of the authors' cases.

Pontine cyst presenting as trigeminal pain

1974 ◽  
Vol 41 (5) ◽  
pp. 636-639 ◽  
Author(s):  
Richard H. Mortara ◽  
William R. Markesbery ◽  
William H. Brooks
Keyword(s):  
Cranial Nerve ◽  
Signs And Symptoms ◽  
Content Type ◽  
Autopsy Findings ◽  
Developmental Origin ◽  
Trigeminal Pain ◽  
Cerebellar Peduncles ◽  
Fine Print

✓ The clinical, operative, and autopsy findings associated with a large, solitary, benign cyst of the pons and cerebellar peduncles that simulated a neoplasm of the fifth cranial nerve are described. The cyst manifested itself clinically by fifth cranial nerve signs and symptoms alone. A developmental origin is suggested for this nonneoplastic cyst.

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