RESUMEN
BACKGROUND: Cavernous venous malformations (CVMs) represent the most common benign intraorbital lesions. Enlarging or symptomatic CVMs (progressive proptosis or visual disturbances) are treated by surgical resection. For this, a variety of different surgical approaches have been described. The aim of this study was to present a contemporary series of orbital CVMs treated via open microsurgical approaches. METHODS: In this study, patients who underwent resection of orbital CVMs between 2002 and 2019 were included. Presenting symptoms were noted and neuro-ophthalmologic examinations performed pre- and postoperatively. For surgical resection, the location of the orbital CVM and its relation to the orbital anatomy led to decision-making for appropriate approaches. A comparison between anatomical location and surgical outcome was performed. RESULTS: Overall, 35 patients with orbital CVMs were included. Most common presenting symptoms were progressive proptosis (43%) and visual disturbances (34%). Most common location was the lateral quadrant (37%) followed by the superior quadrant (20%). A subfrontal craniotomy was performed in 40% of cases followed by a supraorbital craniotomy including the orbital rim in 34% of cases. For surgical excision, a cryo-probe was used in 30 patients, and complete resection was feasible in all cases. Location of a CVM within the superior quadrant was associated with improved postoperative recovery of visual acuity. No differences for clinical outcomes were observed depending on the surgical approach. CONCLUSIONS: Resection of orbital CVMs is indicated in patients with visual disturbances or progressive proptosis. In these, microsurgical approaches can be used with minimal morbidity for complete removal of these well-circumscribed lesions.
Asunto(s)
Hemangioma Cavernoso/cirugía , Procedimientos Neuroquirúrgicos/métodos , Neoplasias Orbitales/cirugía , Adulto , Anciano , Diplopía/fisiopatología , Exoftalmia/fisiopatología , Femenino , Hemangioma Cavernoso/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Motilidad Ocular/epidemiología , Neoplasias Orbitales/fisiopatología , Complicaciones Posoperatorias/epidemiología , Resultado del Tratamiento , Trastornos de la Visión/fisiopatologíaRESUMEN
BACKGROUND: We report a rare case of sudden bilateral vision loss due to third ventricular cavernous angioma with intratumoral hemorrhage. CASE PRESENTATION: A 45-year-old woman presented decreased visual acuity in both eyes. Her best corrected visual acuity was 0.1 in the right eye and 0.15 in the left eye. Goldmann perimetry showed bilateral central scotomas and bitemporal visual field defects. MRI demonstrated a lesion with mixed hypo- and hyperintensity at the optic chiasm, which was thought to be an intratumoral hemorrhage. The patient underwent bifrontal craniotomy. The tumor was exposed via an anterior interhemispheric approach, and histological evaluation of the mass led to a diagnosis of cavernous angioma. Six months after the surgery, her best corrected visual acuity was 0.9 in the right eye and 0.9 in the left, with slight bitemporal visual field defects. CONCLUSION: Third ventricular cavernous angioma is considered in the differential diagnosis of chiasmal syndrome. Contrast-enhanced MRI and FDG-PET might be useful for differential diagnosis of cavernous angioma from other chiasmal tumors including glioblastoma.
Asunto(s)
Ceguera/etiología , Neoplasias Encefálicas/complicaciones , Hemangioma Cavernoso/complicaciones , Hemorragias Intracraneales/complicaciones , Tercer Ventrículo/patología , Ceguera/diagnóstico por imagen , Ceguera/fisiopatología , Ceguera/cirugía , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/fisiopatología , Neoplasias Encefálicas/cirugía , Craneotomía , Femenino , Fluorodesoxiglucosa F18/administración & dosificación , Lateralidad Funcional , Hemangioma Cavernoso/diagnóstico por imagen , Hemangioma Cavernoso/fisiopatología , Hemangioma Cavernoso/cirugía , Humanos , Hemorragias Intracraneales/diagnóstico por imagen , Hemorragias Intracraneales/fisiopatología , Hemorragias Intracraneales/cirugía , Imagen por Resonancia Magnética , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Radiofármacos/administración & dosificación , Agudeza Visual/fisiología , Pruebas del Campo Visual , Campos Visuales/fisiologíaAsunto(s)
Anemia , Hemorragia Gastrointestinal , Neoplasias Gastrointestinales , Hemangioma Cavernoso , Neoplasias de Tejido Vascular , Circulación Esplácnica , Anemia/diagnóstico , Anemia/etiología , Anemia/terapia , Transfusión Sanguínea/métodos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Disección/métodos , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Neoplasias Gastrointestinales/patología , Neoplasias Gastrointestinales/fisiopatología , Neoplasias Gastrointestinales/cirugía , Hemangioma Cavernoso/patología , Hemangioma Cavernoso/fisiopatología , Hemangioma Cavernoso/cirugía , Humanos , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/patología , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Neoplasias de Tejido Vascular/patología , Neoplasias de Tejido Vascular/fisiopatología , Neoplasias de Tejido Vascular/cirugía , Recurrencia , Resultado del TratamientoRESUMEN
The authors present a rare case of cavernous angioma mimicking a meningioma in a 58-year-old man who presented with a headache and dizziness. There were no neurological deficits or other neurological symptoms or signs. An extra-axial mass lesion thought to be associated with diffusely well-enhanced falx in the postcontrast sections was noted in the posterior interhemispheric fissure near the posterior part of the corpus callosum splenium. Extra-axial cavernous angiomas (cavernomas) are extremely rare lesions. They most commonly occur in the parenchyma but have been occasionally reported to arise from the dura matter. Dural cavernous angiomas arise from dural sinuses, falx cerebri, tentorium cerebelli, cranial base dura, or internal auditory canal dura and convexity. Parenchymal cavernous angiomas classically have a ring of hemosiderin surrounding the lesions observed on magnetic resonance imaging, but dural cavernous angiomas do not display the same magnetic resonance imaging characteristics and occasionally exhibit a dural tail sign due to which they can often be misdiagnosed as meningiomas.
Asunto(s)
Neoplasias Encefálicas , Hemangioma Cavernoso , Encéfalo/diagnóstico por imagen , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/fisiopatología , Diagnóstico Diferencial , Mareo , Hemangioma Cavernoso/complicaciones , Hemangioma Cavernoso/diagnóstico por imagen , Hemangioma Cavernoso/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Meningioma , Persona de Mediana EdadRESUMEN
A 38-year-old woman presented with rapidly worsening, painless right monocular vision loss. An examination revealed a visual acuity of 1.4/10 and a central scotoma in the right eye. The orbital magnetic resonance imaging (MRI) showed a well-delineated ovoid intraconal mass of the right eye, hyperintense on T2-weighted MRI with homogenous enhancement after contrast injection. The mass abutted and displaced the optic nerve. A diagnosis of cavernous hemangioma was evoked, which is the most common benign adult orbital mass with these MRI features. A biopsy was performed, and the histopathologic examination yielded a diagnosis of optic nerve sheath meningioma based on a positive antiprogesterone receptor antibody immunostaining. Our case highlights the problem with establishing a specific pathologic diagnosis based on MRI alone, even though the morphologic aspect is evocative. It is recommended to always conduct a histopathologic examination before establishing a specific diagnosis as pathology remains the gold standard, especially when the course of action or treatment may change, as in our case.
Asunto(s)
Hemangioma Cavernoso/fisiopatología , Neoplasias Meníngeas/fisiopatología , Meningioma/fisiopatología , Neoplasias del Nervio Óptico/fisiopatología , Receptores de Progesterona/metabolismo , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Neoplasias Meníngeas/diagnóstico por imagen , Meningioma/diagnóstico por imagen , Neoplasias del Nervio Óptico/diagnóstico por imagenRESUMEN
Resective neurosurgery carries the risk of postoperative cognitive deterioration. The concept of 'hub (over)load', caused by (over)use of the most important brain regions, has been theoretically postulated in relation to symptomatology and neurological disease course, but lacks experimental confirmation. We investigated functional hub load and postsurgical cognitive deterioration in patients undergoing lesion resection. Patients (n = 28) underwent resting-state magnetoencephalography and neuropsychological assessments preoperatively and 1-year after lesion resection. We calculated stationary hub load score (SHub) indicating to what extent brain regions linked different subsystems; high SHub indicates larger processing pressure on hub regions. Dynamic hub load score (DHub) assessed its variability over time; low values, particularly in combination with high SHub values, indicate increased load, because of consistently high usage of hub regions. Hypothetically, increased SHub and decreased DHub relate to hub overload and thus poorer/deteriorating cognition. Between time points, deteriorating verbal memory performance correlated with decreasing upper alpha DHub. Moreover, preoperatively low DHub values accurately predicted declining verbal memory performance. In summary, dynamic hub load relates to cognitive functioning in patients undergoing lesion resection: postoperative cognitive decline can be tracked and even predicted using dynamic hub load, suggesting it may be used as a prognostic marker for tailored treatment planning.
Asunto(s)
Neoplasias Encefálicas/fisiopatología , Encéfalo/fisiopatología , Disfunción Cognitiva/fisiopatología , Glioma/fisiopatología , Hemangioma Cavernoso/fisiopatología , Esclerosis Tuberosa/fisiopatología , Adulto , Encéfalo/diagnóstico por imagen , Encéfalo/cirugía , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/cirugía , Cognición/fisiología , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/etiología , Conectoma , Femenino , Glioma/diagnóstico por imagen , Glioma/cirugía , Giro del Cíngulo/diagnóstico por imagen , Giro del Cíngulo/fisiopatología , Giro del Cíngulo/cirugía , Hemangioma Cavernoso/diagnóstico por imagen , Hemangioma Cavernoso/cirugía , Humanos , Imagen por Resonancia Magnética , Magnetoencefalografía , Masculino , Memoria/fisiología , Persona de Mediana Edad , Clasificación del Tumor , Red Nerviosa/diagnóstico por imagen , Red Nerviosa/fisiopatología , Pruebas Neuropsicológicas , Neurocirugia/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatología , Pronóstico , Esclerosis Tuberosa/diagnóstico por imagen , Esclerosis Tuberosa/cirugíaRESUMEN
Intramedullary spinal cavernoma is a rare vascular disease constituting 5-12% of all spinal vascular tumors. The clinical course is usually characterized either by an acute neurological deterioration, recurrent episodes of neurological deficits or by a slowly progressive neurological decline. Microsurgical removal is recommended when the symptoms become clinically relevant and the lesion appears accessible. In this article, we present a surgical technique to completely resect an intramedullary cavernoma with the aid of intraoperative electrophysiological monitoring and intraoperative real-time ultrasound guidance. A brief description of current management of this pathology is also presented.
Asunto(s)
Hemangioma Cavernoso/cirugía , Neoplasias de la Médula Espinal/cirugía , Hemangioma Cavernoso/diagnóstico por imagen , Hemangioma Cavernoso/fisiopatología , Humanos , Microcirugia/métodos , Monitoreo Intraoperatorio , Procedimientos Neuroquirúrgicos/métodos , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/fisiopatologíaRESUMEN
A 70-year-old man was admitted to our clinic with a history of rectal bleeding and constipation, his colonoscopy revealed varicosities and bluish nodular lesions of the rectum (Figure 1). Abdominal CT showed multiple nodular lesions beginning from the distal descending colon and extending to the rectum, calcifications suggesting phleboliths were also seen in these lesions. A contrast enhanced pelvic MRI demonstrated multiple tubular lesions showing hyperintensity on T2-weighted images and hypointensity on T1-weighted images, consistent with the affected areas on the CT scan (Figure 2). It was a diffuse cavernous hemangioma, which mostly affects the rectosigmoid colon in the gastrointestinal tract, and can clinically mimic internal hemorrhoids, ulcerative colitis or cancer (1). Gastrointestinal hemangioma is a rare benign vascular neoplasm, and might be associated with a congenital disorder like Osler-Weber-Rendu disease, Maffucci's syndrome, Klippel-Trénaunay syndrome, or the congenital blue rubber bleb nevus syndrome (2). Even though there are different medical treatment options targeting VEGF and FGF-mediated pathways such as bevacizumab and thalidomide, and endoscopic approaches like sclerotherapy and electrocautery; complete resection of the hemangioma is the only curative treatment method (1, 3). Therefore, the patient was referred to department of surgery for a definitive treatment, and lost to follow-up.
Asunto(s)
Colon/diagnóstico por imagen , Neoplasias del Colon , Colonoscopía/métodos , Hemangioma Cavernoso , Imagen por Resonancia Magnética/métodos , Anciano , Colon/patología , Neoplasias del Colon/complicaciones , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/patología , Neoplasias del Colon/fisiopatología , Diagnóstico Diferencial , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Hemangioma Cavernoso/complicaciones , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/patología , Hemangioma Cavernoso/fisiopatología , Humanos , Aumento de la Imagen/métodos , MasculinoRESUMEN
OBJECTIVES: The aim of the present study was to document the clinical presentation, diagnostic studies, and therapy of gastrointestinal infantile hemangiomas. METHODS: This is a retrospective analysis of children with gastrointestinal hemangiomas culled from our Vascular Anomalies Center database. We detailed the location of visceral and cutaneous tumors, as well as radiologic and procedural methods used for diagnosis and treatment. RESULTS: A total of 9 of the 16 children (14 girls and 2 boys) with hollow visceral hemangiomas also had cutaneous lesions. The most common extravisceral sites were regional facial lesions (nâ=â6), multifocal lesions (nâ=â2), and a solitary chest lesion (nâ=â1). Presenting symptoms were melena and hematochezia in the first 4 months of life (nâ=â14); several infants required multiple blood transfusions. The most frequent locations were small bowel and mesentery. One-half of the patients (nâ=â8) were diagnosed by laparotomy; the majority (nâ=â12) had suspicious radiologic findings. Corticosteroid and/or propranolol were the most common therapies. CONCLUSIONS: Melena and hematochezia, sometimes with profound anemia, in the first 4 months of life, suggest the possibility of intestinal infantile hemangioma even in the absence of cutaneous tumor. Intestinal bleeding, particularly in association with a regional facial lesion, should initiate workup: ultrasonography, computed tomography, and magnetic resonance imaging display diagnostic features. First-line treatment is medical management; bowel resection may be necessary, particularly for perforation.
Asunto(s)
Neoplasias Gastrointestinales/diagnóstico , Hemangioma/diagnóstico , Anemia/etiología , Anemia/prevención & control , Boston , Terapia Combinada , Diagnóstico Diferencial , Registros Electrónicos de Salud , Neoplasias Faciales/diagnóstico , Neoplasias Faciales/fisiopatología , Neoplasias Faciales/terapia , Femenino , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/prevención & control , Neoplasias Gastrointestinales/patología , Neoplasias Gastrointestinales/fisiopatología , Neoplasias Gastrointestinales/terapia , Hemangioma/patología , Hemangioma/fisiopatología , Hemangioma/terapia , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/patología , Hemangioma Cavernoso/fisiopatología , Hemangioma Cavernoso/terapia , Hospitales Pediátricos , Humanos , Lactante , Recién Nacido , Masculino , Melena/etiología , Melena/prevención & control , Mesenterio , Neoplasias Primarias Secundarias/diagnóstico , Neoplasias Primarias Secundarias/patología , Neoplasias Primarias Secundarias/fisiopatología , Neoplasias Primarias Secundarias/terapia , Neoplasias Peritoneales/diagnóstico , Neoplasias Peritoneales/patología , Neoplasias Peritoneales/fisiopatología , Neoplasias Peritoneales/terapia , Estudios Retrospectivos , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/fisiopatología , Neoplasias Cutáneas/terapiaRESUMEN
The authors report a new, non-invasive diagnostic method in the diagnosis of retinal cavernous hemangioma (RCH). A 6-year-old girl was referred for a non-clearing retinal hemorrhage of 6 months' duration. Fourier-domain optical coherence tomography (FD-OCT) showed an intraretinal lesion with cystic-like internal appearance. Optical shadowing was present, preventing establishment of any subretinal component to the lesion. Swept-source OCT (SS-OCT) showed an intraretinal lesion consisting of a group of clearly defined grape-like caverns with overlying preretinal tissue. Wide-field fundus fluorescein angiography (WF-FFA) confirmed the diagnosis of RCH. SS-OCT was superior to FD-OCT in showing the internal anatomy of the RCH and allowing for the measurement of its structures, confirming the intraretinal location of the lesion and the presence of an associated preretinal tissue. SS-OCT may assist in cases in which hemorrhage prevents an accurate diagnosis by ophthalmoscopy or angiography, thus becoming an alternative imaging method to confirm the diagnosis of RCH while avoiding the risks of fluorescein angiography in children.
Asunto(s)
Hemangioma Cavernoso/diagnóstico , Neoplasias de la Retina/diagnóstico , Tomografía de Coherencia Óptica , Niño , Femenino , Angiografía con Fluoresceína , Análisis de Fourier , Hemangioma Cavernoso/fisiopatología , Humanos , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/fisiopatología , Neoplasias de la Retina/fisiopatología , Agudeza Visual/fisiologíaAsunto(s)
Neoplasias del Colon/tratamiento farmacológico , Hemangioma Cavernoso/tratamiento farmacológico , Propranolol/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Vasodilatadores/uso terapéutico , Adolescente , Anemia/etiología , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/fisiopatología , Endoscopía Gastrointestinal , Fatiga/etiología , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/fisiopatología , Humanos , Masculino , Índice de Severidad de la Enfermedad , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/fisiopatología , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the clinical course of radiologically diagnosed orbital cavernous hemangiomas in the setting of presumed changes in estrogen/progesterone levels. METHODS: An institutional review board-approved retrospective cohort chart review of patients from January 1, 1983, to January 1, 2013, was undertaken searching both outpatient ophthalmology diagnoses and radiologic diagnoses, identifying 32 orbital cavernous hemangiomas, which were subsequently divided into group 1, presumed to have stable levels of estrogen/progesterone, and group 2, presumed to have decreasing levels of estrogen/progesterone. Patients were then categorized as having short-term, mid-range, or long-term follow up. Serial imaging studies were evaluated and graded as having increased, decreased, or remained stable in size. RESULTS: In group 1, no lesions decreased in size, 69% remained stable, and 31% increased in size. In group 2, no lesions increased in size, 45% remained stable, and 55% decreased in size. When evaluating only those patients with long-term follow up, many masses in group 1 increased in size, while the majority in group 2 decreased in size. CONCLUSIONS: In this study evaluating orbital cavernous hemangiomas over a span of 30 years, the authors found that in postmenopausal women with assumed decreasing levels of circulating estrogen/progesterone, the vast majority of lesions either remained stable or decreased in size, suggesting the effect of hormone levels on such vascular lesions and supporting the role for observation in asymptomatic individuals in this patient population.
Asunto(s)
Hemangioma Cavernoso/fisiopatología , Menopausia/fisiología , Neoplasias Orbitales/fisiopatología , Adulto , Estrógenos/sangre , Femenino , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/terapia , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias Orbitales/diagnóstico , Neoplasias Orbitales/terapia , Progesterona/sangre , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Traditional treatment for liver hemangiomas is surgery. Currently, it is controversial whether hemangioma surgeries are sufficiently beneficial for the patients. In this study, we evaluated the effectiveness of surgery in patients with liver hemangiomas. METHODS: Forty-two patients who underwent surgical operations for hepatic hemangiomas were retrospectively evaluated and interviewed. RESULTS: Study population included 36 female and 6 male patients whose ages ranged between 26 and 65 years (mean age, 47.8 +-8.7 years). Their mean duration of hospitalization was 6 days (range, 3 - 59 days). The median time since surgery was 50 months (range 0-120 months). There was a statistically significant decrease in numerical rating and adjective rating pain scale scores (p 0.05). Postoperatively, pain did not cease in 10 patients (peptic ulcers requiring medical treatment in four patients, cholelithiasis in four patients, and nephrolithiasis in two patients). CONCLUSION: Patients with cavernous hemangiomas of the liver who require surgical treatment have significant benefits in terms of pain relief following surgery. The lack of pain relief after the surgery in some patients may be related to concomitant medical problems other than the hemangioma.
Asunto(s)
Dolor Abdominal/cirugía , Hemangioma Cavernoso/cirugía , Hepatectomía , Neoplasias Hepáticas/cirugía , Dimensión del Dolor , Satisfacción del Paciente , Dolor Abdominal/etiología , Adulto , Anciano , Femenino , Estudios de Seguimiento , Hemangioma Cavernoso/complicaciones , Hemangioma Cavernoso/fisiopatología , Humanos , Tiempo de Internación , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/fisiopatología , Masculino , Persona de Mediana Edad , Calidad de la Atención de Salud , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
AIM: The aim of our study is to report our experience on the surgery for recurrent varicose veins of the legs over the period 2007-2012. MATERIALS AND METHODS: A series of 480 consecutive surgical procedures for varicose veins of the legs was reviewed; among a total of 480 cases, 65 procedures were for recurrent varicose veins. Data collected included clinical characteristics, surgical techniques, cause of recurrence and surgical outcomes. We analyzed the causes of recurrences in order to determine factors that influence recurrence itself. RESULTS: Sixty-five procedures for recurrent varicose veins were analized. The main causes of recurrence were: persistence of collaterals at the saphenofemoral junction (27.7%), inadequate stripping of the long saphenous vein (18.5%), perforating veins insufficiency (66.1%), sapheno-femoral junction neovascolarisation (12.3%), inguinal or popliteal cavernoma (27.7%), recurrence after short saphenous venous surgery (4.5%). CONCLUSIONS: We concluded that, as is clear from our study, the main cause of recurrence is inadequate surgery. This can only be due to inadequate preoperative assessment (lack of rigorous clinical and US Doppler rigorous evaluation) and not correct surgical technique, as it may occur if the surgery is performed by a surgeon inexperienced in this type of surgery.
Asunto(s)
Várices/etiología , Várices/cirugía , Procedimientos Quirúrgicos Vasculares/efectos adversos , Adulto , Cuidados Posteriores , Anciano , Femenino , Vena Femoral/fisiopatología , Vena Femoral/cirugía , Hemangioma Cavernoso/fisiopatología , Humanos , Pierna/irrigación sanguínea , Pierna/cirugía , Masculino , Persona de Mediana Edad , Vena Safena/fisiopatología , Vena Safena/cirugía , Resultado del Tratamiento , Ultrasonografía Doppler , Várices/diagnóstico por imagen , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
The following case demonstrates a successful en bloc removal of a massive cavernous hemangioma of the orbit via vertical transpalpebral approach with postoperative improvement of optic nerve condition and optimal cosmetic result.
Asunto(s)
Hemangioma Cavernoso/cirugía , Órbita/cirugía , Neoplasias Orbitales/cirugía , Femenino , Hemangioma Cavernoso/patología , Hemangioma Cavernoso/fisiopatología , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Nervio Óptico/fisiopatología , Órbita/patología , Neoplasias Orbitales/patología , Neoplasias Orbitales/fisiopatología , Resultado del TratamientoRESUMEN
Haemangiomas are abnormal proliferation of blood vessels in any vascularised tissue. They can be capillary or cavernous varieties. Cavernous are either of cutaneous or deep types. Cavernous when compared with the capillary haemangioma is rare. Rarer still is the deep type of cavernous haemangioma. This is a report of a 10 year old Nigerian girl who presented with a right posterior leg swelling of 8 year duration, size initially was that of a peanut but increased to fill the entire calf region causing pain to the patient as well as cosmetic and anxiety concern to the parents. No preceding history of trauma, no associated systematic symptoms. She had exploratory laparatomy at 1 year of age at a private hospital for an abdominal mass which was excised. Pre-operative plain radiograph, Magnetic Resonance Imaging(MRI), Abdominopelvic ultrasound scan (USS) were done, fine needle aspiration cytology (FNAC) though done was not helpful. Histo-pathology result of excised leg mass confirmed diagnosis; there was a free margin of excision. Post-operatively, clinical improvement was marked.
Asunto(s)
Disección/métodos , Pie Equino/etiología , Hemangioma Cavernoso , Pierna , Neoplasias de los Tejidos Blandos , Biopsia/métodos , Niño , Pie Equino/diagnóstico por imagen , Pie Equino/terapia , Femenino , Hemangioma Cavernoso/complicaciones , Hemangioma Cavernoso/patología , Hemangioma Cavernoso/fisiopatología , Hemangioma Cavernoso/cirugía , Humanos , Pierna/diagnóstico por imagen , Pierna/cirugía , Imagen por Resonancia Magnética , Radiografía , Recuperación de la Función , Neoplasias de los Tejidos Blandos/complicaciones , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/fisiopatología , Neoplasias de los Tejidos Blandos/cirugía , Resultado del TratamientoRESUMEN
OBJECT: Maximal resection of symptomatic cavernous angioma (CA), including its surrounding gliosis if possible, has been recommended to minimize the risk of seizures or (re)bleeding. However, despite recent neurosurgical advances, such extensive CA removal is still a challenge in eloquent areas. The authors report a consecutive series of patients who underwent awake surgery for CA within the left dominant hemisphere in which intraoperative cortical-subcortical electrical stimulation was used. METHODS: Nine patients harboring a CA that was revealed by seizures in 6 cases and bleeding in 3 cases underwent resection. All CAs were located in the left dominant hemisphere: 3 temporal, 2 insular, 2 parietal, and 2 in the parietotemporal region. Awake mapping was performed in all cases by using intraoperative cortical-subcortical electrical stimulation and ultrasonography (except in 1 insular CA in which a neuronavigation system was used). RESULTS: Total removal of the CA was achieved in all patients, with identification and preservation of language and sensory-motor structures. In addition, the pericavernomatous gliosis was removed in 7 cases, according to the functional boundaries provided by intraoperative subcortical stimulation. In 2 cases, subcortical mapping revealed eloquent areas within the surrounding gliosis, which was voluntarily avoided. There was no postsurgical permanent deficit, no rebleeding, and no epilepsy in 7 cases (2 patients had rare seizures in the 1st year or two after surgery, and then complete arrest), with a mean follow-up of 28.5 months (range 3-64 months). CONCLUSIONS: These results suggest that intraoperative cortical-subcortical stimulation in awake patients represents a valuable adjunct to image-guided surgery with the aim of selecting the safer surgical approach for CAs involving eloquent areas. Moreover, such online mapping can be helpful when removing the pericavernomatous gliosis while preserving functional structures, which can persist within the hemosiderin rim. Thus, the authors propose that awake surgery be routinely considered, both to optimize the resection and to improve the quality of life through seizure control and avoidance of (re)bleeding for CAs located in the left dominant hemisphere.
Asunto(s)
Mapeo Encefálico/métodos , Neoplasias Encefálicas/cirugía , Corteza Cerebral/patología , Corteza Cerebral/cirugía , Hemangioma Cavernoso/cirugía , Monitoreo Intraoperatorio/métodos , Neuronavegación/métodos , Procedimientos Neuroquirúrgicos/métodos , Convulsiones/prevención & control , Vigilia , Adolescente , Adulto , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/fisiopatología , Corteza Cerebral/fisiopatología , Estimulación Encefálica Profunda , Dominancia Cerebral , Femenino , Lóbulo Frontal/patología , Lóbulo Frontal/fisiopatología , Lóbulo Frontal/cirugía , Lateralidad Funcional , Gliosis , Hemangioma Cavernoso/complicaciones , Hemangioma Cavernoso/patología , Hemangioma Cavernoso/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Fibras Nerviosas Mielínicas/patología , Pruebas Neuropsicológicas , Estudios Retrospectivos , Convulsiones/etiología , Resultado del TratamientoRESUMEN
Vascular abnormalities of the spinal cord are an important cause of myelopathy. Clinicians need to be aware of these disorders as they can present with a variety of neurologic symptoms ranging from acute spinal neurologic emergencies, relapsing/remitting spells to gradually progressive dysfunction. The unique topography and vascular anatomy of the spinal cord lends to the variety of clinical presentations. Both ischemic and hemorrhagic insults can occur. Increased clinical suspicion, better detection with newer imaging modalities and early treatment can often impact outcomes. The authors review clinical diagnoses, novel imaging, and advanced treatment modalities for the most common causes of vascular myelopathy.