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.

Angiographically cryptic AVM presenting as a pontine tumor

1980 ◽  
Vol 53 (6) ◽  
pp. 846-848 ◽  
Author(s):  
A. Leland Albright ◽  
Ryland P. Byrd ◽  
Mary Lee Harrison
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Clinical Course ◽  
Vascular Malformations ◽  
Content Type ◽  
Booster Injection ◽  
The Brain ◽  
Fine Print

✓ A 19-month-old child became disoriented and ataxic 6 days after a diphtheria-pertussis-tetanus (DPT) booster injection. Computerized tomographic scan revealed a hyperdense mesencephalic-pontine mass, and angiography demonstrated an avascular mass. Pontine biopsy revealed no abnormality. Her clinical course fluctuated until her death 15 months later. At autopsy, an angiographically cryptic arteriovenous malformation (AVM) was present in the mesencephalon and pons. Vascular malformations of the brain stem, producing prolonged clinical courses, are reviewed.

Surgical treatment of vascular lesions in the brain stem

1975 ◽  
Vol 42 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Shelley N. Chou ◽  
Donald L. Erickson ◽  
Humberto J. Ortiz-Suarez
Keyword(s):  
Surgical Treatment ◽  
Brain Stem ◽  
Arteriovenous Malformations ◽  
Vascular Lesions ◽  
Surgical Removal ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ The authors report the total surgical removal of five vascular lesions of the brain stem, three hemangioblastomas and two arteriovenous malformations. One patient died; among the others, the quality of survival is excellent. Factors favoring surgical removal of such lesions are discussed.

Management of arteriovenous malformations of the brain stem

1986 ◽  
Vol 64 (6) ◽  
pp. 857-864 ◽  
Author(s):  
Robert A. Solomon ◽  
Bennett M. Stein
Keyword(s):  
Radiation Therapy ◽  
Brain Stem ◽  
Arteriovenous Malformations ◽  
Treated Group ◽  
Intracranial Arteriovenous Malformations ◽  
Content Type ◽  
Embolization Therapy ◽  
Complete Obliteration ◽  
The Brain ◽  
Fine Print

✓ In a series of 250 intracranial arteriovenous malformations (AVM's), 12 malformations involved the brain stem. Nine of these lesions were treated surgically, with complete obliteration in eight. There were no operative deaths, and only two patients were made worse by surgery. In the nonsurgically treated group, one patient had embolization therapy and two patients underwent radiation therapy. Results in these three patients have not been satisfactory. These data indicate that brain-stem AVM's can be surgically removed with acceptable morbidity.

Surgical removal of arteriovenous malformations from the brain stem and cerebellopontine angle

1975 ◽  
Vol 43 (6) ◽  
pp. 661-670 ◽  
Author(s):  
Charles G. Drake
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Surgical Experience ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ The author reports his surgical experience with five cases of arteriovenous malformation of the brain stem and cerebellopontine angle causing multiple hemorrhages and severe neurological deficits. Surgical removal of the lesions had good results in four cases; there was one death.

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.

Successful evacuation of a pontine hematoma secondary to rupture of a pathologically diagnosed “cryptic” vascular malformation

1973 ◽  
Vol 39 (1) ◽  
pp. 104-108 ◽  
Author(s):  
Ben B. Scott ◽  
Joachim F. Seeger ◽  
Richard C. Schneider
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Posterior Fossa ◽  
Vascular Malformation ◽  
Nerve Palsy ◽  
Neurological Deficits ◽  
Content Type ◽  
Brain Stem Lesion ◽  
Seventh Nerve ◽  
Fine Print

✓ A posterior fossa exploration was performed on a child thought initially to have an inoperable brain stem lesion. A pontine hematoma was discovered and evacuated. The pathological specimen was designated as a “cryptic” arteriovenous malformation. All preoperative neurological deficits disappeared except for a minimal left seventh nerve palsy.

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.

Intraoperative monitoring of brain-stem auditory evoked potentials

1982 ◽  
Vol 57 (5) ◽  
pp. 674-681 ◽  
Author(s):  
Betty L. Grundy ◽  
Peter J. Jannetta ◽  
Phyllis T. Procopio ◽  
Agnes Lina ◽  
J. Robert Boston ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Brain Stem ◽  
Auditory Nerve ◽  
Intraoperative Monitoring ◽  
Cerebellopontine Angle ◽  
Auditory Evoked Potentials ◽  
Irreversible Loss ◽  
Content Type ◽  
Complete Obliteration ◽  
Fine Print

✓ Brain-stem auditory evoked potentials (BAEP) were monitored during 54 neurosurgical operations in the cerebellopontine angle. The BAEP were irreversibly obliterated in five patients who required deliberate section of the auditory nerve. Technical difficulties interfered with monitoring in three cases, and three patients had deafness and absent BAEP preoperatively. Reversible alterations in BAEP were seen during 32 operations, with recovery after as long as 177 minutes of virtually complete obliteration. Changes in BAEP were associated with surgical retraction, operative manipulation, positioning of the head and neck for retromastoid craniectomy, and the combination of hypocarbia and moderate hypotension. In 19 cases, waveforms improved after specific interventions made by the surgeon or anesthesiologist because of deteriorating BAEP. In 13 other cases, BAEP recovered after maneuvers not specifically related to the electrophysiological monitoring, most often completion of operative manipulation. Whenever BAEP returned toward normal by the end of anesthesia, even after transient obliteration, hearing was preserved. Irreversible loss of BAEP occurred only when the auditory nerve was deliberately sacrificed. The authors conclude that monitoring of BAEP may help prevent injury to the auditory nerve and brain stem during operations in the cerebellopontine angle.

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.

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