Retrograde intraventricular hemorrhage caused by a traumatic sacral pseudomeningocele in the presence of spina bifida occulta

2005 ◽  
Vol 3 (5) ◽  
pp. 390-392 ◽  
Author(s):  
Christopher Uff ◽  
Robert Bradford
Keyword(s):  
Spina Bifida ◽  
Spinal Dysraphism ◽  
Artery Aneurysm ◽  
Spina Bifida Occulta ◽  
Oculomotor Nerve Palsy ◽  
Communicating Hydrocephalus ◽  
Content Type ◽  
Sacral Region ◽  
Cranial Nerve Palsies ◽  
Fine Print

✓ The authors present the case of a large, posttraumatic sacral pseudomeningocele in the presence of spina bifida occulta. A pseudomeningocele in the sacral region is associated with trauma and with Marfan syndrome, but only one occurrence has been reported in association with spinal dysraphism. Trauma resulted in bleeding into the pseudomeningocele and retrograde passage of blood and fat into the ventricles. An oculomotor nerve palsy subsequently developed in the patient. The authors suspected a subarachnoid hemorrhage caused by a posterior communicating artery aneurysm, although this hypothesis was refuted on further investigation. The pseudomeningocele was drained by direct exposure of the neck and opening of the sac. Postoperatively, communicating hydrocephalus developed and the patient underwent ventriculoperitoneal shunt placement, resulting in resolution of the cranial nerve palsies. This first report of intradural bleeding from direct trauma to a pseudomeningocele illustrates the rare phenomenon of retrograde passage of blood from the sacral region to the brain. It also illustrates a possible but unlikely differential diagnosis of intraventricular blood and fat.

Upper basilar artery aneurysms: oculomotor outcomes in 163 cases

2005 ◽  
Vol 102 (3) ◽  
pp. 482-488 ◽  
Author(s):  
Hisham Al-Khayat ◽  
Haitham Al-Khayat ◽  
Jonathan White ◽  
David Manner ◽  
Duke Samson
Keyword(s):  
Basilar Artery ◽  
Nerve Palsy ◽  
Arterial Occlusion ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Stepwise Logistic Regression ◽  
Categorical Data Analysis ◽  
Content Type ◽  
History Of ◽  
Fine Print

Object. The purpose of this study was to identify factors predictive of postoperative oculomotor nerve palsy among patients who undergo surgery for distal basilar artery (BA) aneurysms. The data can be used to estimate preoperative risk in this population. The natural history of oculomotor nerve palsy in patients with good outcomes is also defined. Methods. The cases of 163 patients with distal BA aneurysms, who were treated surgically between 1996 and 2002, were retrospectively studied to identify factors contributing to oculomotor nerve palsy. After the data had been collected, stepwise logistic regression procedures were used to determine the predictive effects of each variable on the development of oculomotor nerve palsy and to create a scoring system. Factors that interfered with resolution of oculomotor dysfunction in patients with good outcomes were also studied. Postoperative oculomotor nerve palsy occurred in 86 patients (52.8%) with distal BA aneurysms. The following factors were associated with postoperative oculomotor dysfunction, as determined by a categorical data analysis: 1) younger patient age (p < 0.001); 2) poor admission Hunt and Hess grade (p < 0.001); 3) use of temporary arterial occlusion (p < 0.001); 4) poor Glasgow Outcome Scale score (p < 0.001); and 5) the presence of a BA apex aneurysm that projected posteriorly (p < 0.001). For patients with good outcomes, postoperative oculomotor nerve palsy resolved completely within 3 months in 31 patients (52%) and within 6 months in 47 patients (80%). The projection of the BA aneurysm was associated with incomplete oculomotor recovery at 6 months postoperatively (p = 0.019). Conclusions. The results of this study can help identify patients with a high risk for the development of oculomotor nerve palsy. This may help neurosurgeons in preoperative planning and discussions.

Automobile accidents caused by unsuspected neurological disease

1973 ◽  
Vol 38 (5) ◽  
pp. 581-583 ◽  
Author(s):  
James R. Keane
Keyword(s):  
Neurological Disease ◽  
Neurological Diseases ◽  
Artery Aneurysm ◽  
The Other ◽  
Automobile Accidents ◽  
Content Type ◽  
Cerebral Trauma ◽  
Left Posterior ◽  
Posterior Communicating Artery Aneurysm ◽  
Fine Print

✓ Two patients admitted as cerebral trauma cases following single-car automobile accidents were found to have previously-unsuspected, surgically-treatable neurological diseases that undoubtedly caused the accidents. A left posterior communicating artery aneurysm was clipped in one patient and a right frontal lobe abscess aspirated in the other, with excellent results in both patients.

Evaluation of the central canal of the spinal cord in experimentally induced hydrocephalus

1978 ◽  
Vol 48 (6) ◽  
pp. 970-974 ◽  
Author(s):  
A. Everette James ◽  
William J. Flor ◽  
Gary R. Novak ◽  
Ernst-Peter Strecker ◽  
Barry Burns
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Experimental Model ◽  
Alternative Pathway ◽  
Central Canal ◽  
Communicating Hydrocephalus ◽  
Csf Flow ◽  
Content Type ◽  
Histological Appearance ◽  
Fine Print

✓ The central canal of the spinal cord has been proposed as a significant compensatory alternative pathway of cerebrospinal fluid (CSF) flow in hydrocephalus. Ten dogs were made hydrocephalic by a relatively atraumatic experimental model that simulates the human circumstance of chronic communicating hydrocephalus. The central canal was studied by histopathology and compared with 10 normal control dogs. In both groups the central canal of the spinal cord was normal in size, configuration, and histological appearance. In this experimental model dilatation of the canal and increased movement of CSF does not appear to be a compensatory alternative pathway.

Distal anterior inferior cerebellar artery aneurysms

2002 ◽  
Vol 97 (3) ◽  
pp. 692-696 ◽  
Author(s):  
Eric L. Zager ◽  
Ellen G. Shaver ◽  
Robert W. Hurst ◽  
Eugene S. Flamm
Keyword(s):  
Artery Aneurysm ◽  
Distal Segment ◽  
Anterior Inferior Cerebellar Artery ◽  
Management Options ◽  
Content Type ◽  
Von Hippel Lindau ◽  
Cerebellar Artery ◽  
Distal Branch ◽  
Acute Subarachnoid Hemorrhage ◽  
Fine Print

✓ Aneurysms of the distal anterior inferior cerebellar artery (AICA) are rare; fewer than 100 cases have been reported. The authors detail their experience with four cases and present endovascular as well as microsurgical management options. The medical records and neuroimaging studies obtained in four patients who were treated at a single institution were reviewed. Clinical presentations, neuroimaging and intraoperative findings, and clinical outcomes were analyzed. There were three men and one woman; their mean age was 43 years. Two patients presented with acute subarachnoid hemorrhage (SAH), and two presented with ataxia and vertigo (one with tinnitus, the other with hearing loss). Angiographic studies demonstrated aneurysms of the distal segment of the AICA. In one patient with von Hippel—Lindau syndrome and multiple cerebellar hemangioblastomas, a feeding artery aneurysm was found on a distal branch of the AICA. Three of the patients underwent successful surgical obliteration of their aneurysms, one by clipping, one by trapping, and one by resection along with the tumor. The fourth patient underwent coil embolization of the distal AICA and the aneurysm. All patients made an excellent neurological recovery. Patients with aneurysms in this location may present with typical features of an acute SAH or with symptoms referable to the cerebellopontine angle. Evaluation with computerized tomography, magnetic resonance (MR) imaging, MR angiography, and digital subtraction angiography should be performed. For lesions distal to branches coursing to the brainstem, trapping and aneurysm resection are viable options that do not require bypass. Endovascular obliteration is also a reasonable option, although the possibility of retrograde thrombosis of the AICA is a concern.

Trigeminal schwannoma

1988 ◽  
Vol 69 (6) ◽  
pp. 850-860 ◽  
Author(s):  
Paul C. McCormick ◽  
Jacqueline A. Bello ◽  
Kalmon D. Post
Keyword(s):  
Trigeminal Nerve ◽  
Surgical Approach ◽  
Csf Leak ◽  
Symptom Duration ◽  
Consecutive Series ◽  
Nerve Function ◽  
Content Type ◽  
Trigeminal Schwannoma ◽  
Cranial Nerve Palsies ◽  
Fine Print

✓ A consecutive series of 14 patients with trigeminal schwannoma managed surgically at the Neurological Institute of New York since 1970 is reported. Nine women and five men (mean age 40 years) were diagnosed following a mean symptom duration of 33 months. Abnormalities of trigeminal nerve function were present in 11 patients on admission examination. Facial pain was a prominent feature in eight patients. Two patients, both with schwannomas arising from the trigeminal root, presented initially with typical trigeminal neuralgia. Additional cranial nerve palsies or cerebellar or pyramidal tract signs were noted in eight patients. The surgical approach to these tumors depends on their anatomical location. Four patients had tumors confined to the middle fossa, three patients had tumors limited to the posterior fossa, and seven patients had both supratentorial and infratentorial components of their tumors. Twenty operative procedures were performed on these patients, resulting in complete extirpation in six patients, nearly complete removal in seven patients, and partial removal in one patient. Adherence of the tumor to the lateral wall of the cavernous sinus or the brain stem precluded total removal. There was one postoperative death. In the immediate postoperative period, abnormalities of cranial nerves controlling the extraocular muscles were common. In general, these deficits were transient; however, some permanent loss of trigeminal nerve function occurred in nine patients. Two patients required tarsorrhaphy for neurotropic keratitis, and two patients underwent cerebrospinal fluid (CSF) shunting procedures for hydrocephalus or for a persistent CSF leak. The follow-up period ranged from 4 to 177 months (mean 47 months). The clinical features, anatomical considerations, and surgical approach to these rare tumors are discussed. A clinical review of 106 additional cases of trigeminal schwannoma, reported in the English literature since 1935, is also presented.

A multidisciplinary team approach to skull base chondrosarcomas

2001 ◽  
Vol 95 (2) ◽  
pp. 184-189 ◽  
Author(s):  
H. Alan Crockard ◽  
Anthony Cheeseman ◽  
Timothy Steel ◽  
Tamas Revesz ◽  
Janice L. Holton ◽  
...  
Keyword(s):  
Skull Base ◽  
Team Approach ◽  
Content Type ◽  
Mean Survival Time ◽  
Cranial Nerve Palsies ◽  
Slow Progression ◽  
The Mean ◽  
Skull Base Chordomas ◽  
Skull Base Chordoma ◽  
Fine Print

Object. The authors review their experience with treating skull base chondrosarcomas, which are much rarer than skull base chordomas and differ from them in prognosis and treatment. Methods. Seventeen patients (12 male and five female patients) with histologically verified chondrosarcomas were followed up prospectively over a 12-year period. The mean age at presentation was 35.9 years. Most patients presented with cranial nerve palsies. Seven had undergone surgery prior to referral to the authors' unit. All underwent maximum surgical cytoreduction by the most direct surgical approach; only the two patients harboring the mesenchymal variant underwent radiotherapy. Conclusions. One patient died of a pulmonary embolus; the patients harboring mesenchymal chondrosarcomas died at 20 and 36 months, respectively, after treatment. Of the remaining patients, 93% were alive 5 years postsurgery and had a projected 10-year survival rate of 84% (mean survival time 9.3 years). These data emphasize the very slow progression of this tumor compared with skull base chordoma.

Interoptic course of the anterior cerebral artery associated with anterior cerebral artery aneurysm

1982 ◽  
Vol 56 (2) ◽  
pp. 302-304 ◽  
Author(s):  
Howard J. Senter ◽  
Daniel J. Miller
Keyword(s):  
Carotid Artery ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Optic Nerves ◽  
Content Type ◽  
Anterior Cerebral Artery Aneurysm ◽  
Cerebral Artery Aneurysm ◽  
Fine Print

✓ A ruptured anterior cerebral artery aneurysm is reported in a patient in whom a solitary anterior cerebral artery arose from the proximal carotid artery and ascended between the optic nerves.

Splitting of the optic nerve by a carotid-ophthalmic artery aneurysm

1986 ◽  
Vol 65 (4) ◽  
pp. 560-562 ◽  
Author(s):  
Robert A. Beatty
Keyword(s):  
Optic Nerve ◽  
Ophthalmic Artery ◽  
Artery Aneurysm ◽  
Content Type ◽  
Fine Print

✓ A patient with splitting of the optic nerve by a carotid-ophthalmic artery aneurysm is presented. Possible explanations for this previously unreported configuration are discussed.

Facial nevi associated with anomalous venous return and hydrocephalus

1976 ◽  
Vol 45 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Kenneth Shapiro ◽  
Kenneth Shulman
Keyword(s):  
Pediatric Patients ◽  
Venous Return ◽  
Venous Hypertension ◽  
Communicating Hydrocephalus ◽  
Age Group ◽  
Content Type ◽  
Weber Syndrome ◽  
Sturge Weber Syndrome ◽  
The Relationship ◽  
Fine Print

✓ The authors describe two children with anomalous intracranial venous return associated with bilateral facial nevi, macrocrania, and cephalic venous hypertension. Both children had functional absence of the jugular bulbs, forcing the intracranial venous effluent to exit through persistent emissary pathways. Both children had sustained intracranial hypertension, with one child developing symptomatic communicating hydrocephalus that responded satisfactorily to shunting. The relationship between these patients and those with Sturge-Weber syndrome is discussed. The embryologic abnormality producing the anomalous venous return is characterized. The link between venous hypertension and the development of hydrocephalus is discussed. The increased cranial compliance seen in this age group may predispose certain pediatric patients to develop hydrocephalus when stressed by venous hypertension.

Peripheral ophthalmic artery aneurysm

2001 ◽  
Vol 94 (5) ◽  
pp. 822-825 ◽  
Author(s):  
Shoichiro Kawaguchi ◽  
Toshisuke Sakaki ◽  
Shuzo Okuno ◽  
Yoshitomo Uchiyama ◽  
Toshikazu Nishioka
Keyword(s):  
Ophthalmic Artery ◽  
Color Doppler ◽  
Artery Aneurysm ◽  
Content Type ◽  
Doppler Flow ◽  
Hemodynamic Stress ◽  
Flow Velocimetry ◽  
Color Doppler Flow ◽  
Fine Print

✓ The authors report on two patients with peripheral ophthalmic artery (OphA) aneurysms and demonstrate the mechanism by which these lesions are formed by using OphA color Doppler flow velocimetry imaging. During formation of these two aneurysms, the hemodynamic stress on the OphA was quite significant.

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