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1.
Neurosurg Rev ; 43(2): 801-806, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31187343

RESUMO

Distal anterior cerebral artery (DACA) aneurysms are rare, accounting for 1-9% of all intracranial aneurysms. Previous systematic reviews have highlighted that given the markedly increased incidence of major complications after endovascular treatment, microsurgical clipping is the more attractive treatment option with generally excellent clinical outcomes. Subcallosal DACA aneurysms constitute a rare subset of these aneurysms, requiring special anatomic considerations-particularly with regard to the approach. The aim of this study is to review the technical nuances of microsurgical treatment of subcallosal DACA aneurysms, including review of contemporary techniques through presentation of a microneurosurgical operative video. This is a retrospective case series and intraoperative microsurgical videos review. Three subcallosal DACA aneurysms were identified via retrospective query of our institutional neurosurgical database from December 2017 to May 2018. Two were female; median age was 74 years (range 70-83); all 3 underwent bifrontal craniotomy via bicoronal skin incision for aneurysm clipping. Aneurysms were located in left pericallosal-callosomarginal artery junction, bifurcation of azygos A2, and pericallosal artery related with azygos A2, and the anterior interhemispheric approach was used in all 3 operations. No acute stroke, hemorrhage, or major complications occurred, and all patients remained neurologically intact at the time of last follow-up (median 3 months, range 1-6). Although DACA aneurysms are rare, they represent an important variant for cerebrovascular neurosurgeons where microsurgical clipping can have better angiographic outcomes than endovascular treatment. Detail-oriented anterior interhemispheric arachnoid dissection through bifrontal craniotomy with its lower margin sitting at the superior orbital rim maximizes safe and effective clipping of subcallosal DACA aneurysms.

2.
No Shinkei Geka ; 47(11): 1173-1178, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31761779

RESUMO

Intracranial epidermoid cysts are benign cystic lesions that typically exhibit slow growth. Their malignant transformation into squamous cell carcinoma is rare. We report a 77-year-old woman who was admitted to our hospital because of a near-drowning incident due to a seizure sustained in her bathtub. Magnetic resonance imaging(MRI)revealed an extra-axial tumor occupying the right cerebellopontine angle. The lesion appeared hyperintense in diffusion-weighted images and exhibited contrast enhancement after gadolinium injection. Cerebrospinal fluid examination revealed noninfectious meningitis, presumably due to the ruptured epidermoid cyst. Tumor resection was performed and histopathological examination revealed squamous cell carcinoma, which was indicative of malignant transformation of the cyst. The patient underwent adjuvant radiotherapy and has no signs of recurrence 9 months postsurgery. Rapid neurological deterioration and contrast enhancement on MRI are key signs of malignant transformation of epidermoid cysts.


Assuntos
Ângulo Cerebelopontino/cirurgia , Cisto Epidérmico , Idoso , Transformação Celular Neoplásica , Neoplasias Cerebelares , Cisto Epidérmico/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Recidiva Local de Neoplasia
3.
Surg Neurol Int ; 10: 141, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31528476

RESUMO

Background: Endodermal cysts are uncommon cystic lesions usually located at the ventral aspects of the spine. A lateral supratentorial location of such cysts is extremely rare. A unique case of a lateral supratentorial endodermal cyst that required surgical intervention due to uncal herniation, complicated with postoperative seizures, is presented. Case Description: A 48-year-old man presented with transient motor aphasia and diplopia. Magnetic resonance imaging showed a cystic lesion occupying the left frontal and temporal convexity with midline shift and uncal herniation. Cyst resection was performed, and cyst contents with mucous-like components were aspirated. Histopathological examination showed an endodermal cyst. The patient showed no neurological deficits immediately after surgery but developed tonic-clonic seizures 9 h after surgery. Sedation and intubation were required to control the seizures. After administering multiple antiepileptic drugs, he was extubated on the 5th day after surgery. He was discharged home in a month with mild impairment in dexterity of his right hand. Conclusions: Surgical intervention for endodermal cysts can be complicated by postoperative seizures caused by chemical irritation of brain cortex due to spillage of cyst contents. It is important to irrigate the cyst wall very well intraoperatively and pay attention not to spill the cyst fluid to unaffected locations. Preoperative administration of antiepileptic drugs should also be considered if endodermal cysts, not simple arachnoid cysts, are suspected preoperatively.

4.
J Neurosurg ; : 1-8, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443076

RESUMO

OBJECTIVE: Sphenoorbital meningioma (SOM) is a unique skull base tumor, characterized by infiltrative involvement and hyperostosis primarily of the lesser wing of sphenoid bone, with frequent involvement of the orbital compartment. SOM often manifests with proptosis and visual impairment. Surgical technique and outcome are highly variable among studies reported in the literature. The authors present a single-surgeon experience with SOM. METHODS: A retrospective review of a prospectively maintained institutional database was performed. A blinded imaging review by 2 study team members was completed to confirm SOM, after which chart review was carried out to capture demographics and outcomes. All statistical testing was completed using JMP Pro version 14.1.0, with significance defined as p < 0.05. RESULTS: Forty-seven patients who underwent surgery between 2000 and 2017 were included. The median age at surgery was 47 years (range 36-70 years), 81% of patients were female, and the median follow-up was 43 months (range 0-175 months). All operations were performed via a frontotemporal craniotomy, orbitooptic osteotomy, and anterior clinoidectomy, with extensive resection of all involved bone and soft tissue. Preoperatively, proptosis was noted in 44 patients, 98% of whom improved. Twenty-eight patients (60%) had visual deficits before surgery, 21 (75%) of whom improved during follow-up. Visual field defect other than a central scotoma was the only prognostic factor for improvement in vision on multivariate analysis (p = 0.0062). Nine patients (19%) had recurrence or progression during follow-up. CONCLUSIONS: SOM is a unique skull base tumor that needs careful planning to optimize outcome. Aggressive removal of involved bone and periorbita is crucial, and proptosis and visual field defect other than a central scotoma can improve after surgery.

5.
World Neurosurg ; 126: 30-36, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30844522

RESUMO

BACKGROUND: Renal cell carcinoma (RCC) accounts for ∼8% of all brain metastatic disease; however, spread to the cranial nerves and their ganglia is uncommon. To the best of our knowledge, we report the first case of RCC metastatic to Meckel's cave, which was diagnosed secondary to new trigeminal sensory loss. METHODS: A 45-year-old man had presented with acute-onset right V3 numbness. Magnetic resonance imaging demonstrated contrast enhancement of the ipsilateral V3, extending from its root at the Gasserian ganglion to the foramen ovale. RESULTS: He elected for observation, and his symptoms resolved over several weeks. At the scheduled, routine 3-month follow-up examination, he reported symptomatic relapse with new concomitant hyperesthetic/neuropathic pain. Magnetic resonance imaging demonstrated interval enlargement of the enhancing lesion in an atypical pattern, potentially consistent with trigeminal schwannoma versus meningioma, and operative resection was recommended. CONCLUSION: We have reported a case of RCC presenting with numbness via metastatic spread to Meckel's cave. Although uncommon, metastasis is an important diagnostic consideration for enhancing cranial nerve lesions. Our case has demonstrated that, although a history of malignancy, multiple lesions, or systemic/constitutional symptoms are typical, rare cases can demonstrate isolated central nervous system findings. Thus, short-term radiographic surveillance is indicated if the diagnosis of an intracranial or cranial nerve mass lesion is equivocal.


Assuntos
Carcinoma de Células Renais/secundário , Neoplasias Renais/patologia , Metástase Neoplásica/patologia , Gânglio Trigeminal/patologia , Gânglio Trigeminal/cirurgia , Carcinoma de Células Renais/diagnóstico , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neuralgia do Trigêmeo/cirurgia
6.
Surg Neurol Int ; 9: 250, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30603234

RESUMO

Background: Intramedullary hemorrhages involving spinal hemangioblastomas are rare. They are frequently associated with devastating neurologic outcomes, despite with emergent surgical intervention. Here, we presented an example of an intramedullary hemorrhage occurring in a spinal hemangioblastoma, where the patient markedly improved with surgery. Additionally, the appropriate literature was reviewed (including intraoperative video). Case Description: A 49-year-old female with a 4-year history of tingling in the left lower extremity presented with vomiting, stepwise worsening of bilateral scapular pain, new upper motor neuron signs, and severe sensory loss bilaterally below C4 on the left and T4 on the right. The magnetic resonance imaging demonstrated a well-circumscribed, uniformly enhancing intramedullary tumor at the C2 level with hyperintensity on the T2 study consistent with acute hemorrhage and cord edema. An urgent C2 laminectomy was performed for gross total tumor resection. Intraoperatively, intramedullary hemorrhage was identified anterior to the tumor mass and was confirmed histopathologically. Postoperatively, the patient had no new sensorimotor deficits and fully recovered within two postoperative months. Conclusions: Patients presenting with acute intramedullary hemorrhage within hemangioblastomas of the spinal cord may demonstrate significant postoperative neurological recovery.

7.
Pituitary ; 21(3): 231-237, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29236218

RESUMO

PURPOSE: Cavernous sinus syndrome is a rare phenomenon, characterized by simultaneous neuropathies of cranial nerves III-VI. Various pathological processes have been reported as precipitating etiologies, including infection, inflammation, vascular lesions, and neoplasms. PURPOSE: We report a unique case series of cavernous sinus syndrome attributable to prolonged Trendelenburg or prone positioning during non-cranial procedures and review the pertinent literature to enlighten on this rare but catastrophic phenomenon. METHODS: Retrospective case series. RESULTS: In the past year we encountered two patients who presented with acute cavernous sinus syndrome upon awakening from non-cranial operations. One patient underwent an extensive urologic resection of a bladder malignancy positioned in Trendelenburg for approximately 4 h. The second patient underwent a lumbar laminectomy and discectomy in prone position. Both patients were discovered to have infarcted large pituitary macroadenomas as the etiology of their acute ophthalmoplegias, and transnasal, transsphenoidal resection was performed acutely to decompress the cavernous sinus contents. Pathologic analysis of the resected specimens in each case confirmed necrotic, infarcted pituitary adenoma. Both patients made a complete recovery with no evidence of residual or recurrent tumor in short term follow-up. CONCLUSION: We report a brief case series of acute cavernous sinus syndrome resulting from dependent positioning during non-cranial operations in patients with pituitary macroadenoma. Although rare, this highlights a potential danger of "head down" positioning in patients with intracranial pathology-particularly in or around the sella and cavernous sinus. Despite multiple cranial neuropathies upon presentation, both patients made complete recovery following surgical decompression of the cavernous sinuses.


Assuntos
Seio Cavernoso/cirurgia , Neoplasias Hipofisárias/cirurgia , Seio Cavernoso/patologia , Trombose do Corpo Cavernoso/cirurgia , Humanos , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos
8.
J Neurointerv Surg ; 10(5): 493-499, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28965108

RESUMO

INTRODUCTION: Non-saccular aneurysms of the posterior circulation are uncommon but highly dangerous lesions. Flow diverter stents have been demonstrated to be effective treatments of various anterior circulation aneurysms, particularly large and giant proximal internal carotid artery aneurysms. However, evidence regarding the treatment of non-saccular posterior circulation aneurysms with flow diverters is lacking. METHODS: A systematic literature review of the English language literature since 2007 was conducted using PubMed, MEDLINE, and Embase. Keywords and MeSH terms included flow diversion, flow diverter, pipeline, surpass, intracranial aneurysm, vertebrobasilar, and non-saccular. Case reports were excluded. Angiographic and clinical outcomes were pooled using a random effects meta-analysis. RESULTS: 13 retrospective non-comparative studies reporting 129 patients and 131 aneurysm treatments were included. The average number of flow diverters per aneurysm was 4.33. Immediate complete or near complete occlusion of the aneurysm occurred in 25% (95% CI 1% to 60%), and long term occlusion in 52% (29-76%). Periprocedural stroke occurred in 23% of cases. Good long term neurologic outcome (modified Rankin Scale score ≤2) was achieved in 51% (95% CI 31% to 71%). Overall mortality was 21% (95% CI 7% to 38%) and morbidity was 26% (12%-42%). Retreatment was required in 5% (95% CI 0% to 14%). Good neurologic outcome rate was higher in vertebral artery aneurysms (83%) than other locations (18-33%). CONCLUSIONS: Flow diversion is a feasible and efficacious treatment for non-saccular aneurysms in the posterior circulation. However, the intervention carries a significant risk of periprocedural stroke, and is still associated with high overall mortality. Further studies are needed to identify significant treatment risk factors and optimize patient selection.


Assuntos
Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Stents Metálicos Autoexpansíveis , Idoso , Angiografia/métodos , Angiografia/tendências , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Retratamento/instrumentação , Retratamento/métodos , Estudos Retrospectivos , Fatores de Risco , Stents , Resultado do Tratamento
9.
Acta Neurochir (Wien) ; 159(10): 1913-1918, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28762110

RESUMO

BACKGROUND: The frontal bridging vein, which is the venous drainage route of the frontal cortex into the superior sagittal sinus (SSS), sometimes poses an obstacle in the anterior interhemispheric approach during surgery for anterior cerebral artery aneurysms. Although severe complications including venous infarction or edema due to damage to the bridging vein are well known, only a few reports have discussed how to avoid venous injury when we must sacrifice the bridging vein to obtain an appropriate surgical field. This report describes a microvascular technique performed in two patients who underwent rerouting of the bridging vein to obtain an appropriate anterior interhemispheric surgical corridor to treat a ruptured anterior cerebral artery aneurysm. The hindering bridging vein was resected from the entrance to the SSS and anastomosed toward the adjacent cortical vein. METHODS: A 65-year-old male and a 43-year-old male were admitted to our hospital for sudden headache. Computed tomography, magnetic resonance angiogram, or digital subtraction angiography demonstrated a subarachnoid hemorrhage and an anterior cerebral artery aneurysm in both patients. In both cases, a relatively robust bridging vein, which appeared problematic to sacrifice, was draining into the SSS, resulting in a limited surgical corridor. Thus, we performed cortical vein reconstruction, and the aneurysms were successfully clipped under a wider surgical view. RESULTS: We confirmed completed clipping without postoperative venous complications. One patient demonstrated patency of reconstructed venous flow by digital subtraction angiography. No apparent cognitive impairment was seen in either patient. CONCLUSIONS: This technique may be useful for obtaining an appropriate surgical corridor when the frontal bridging vein may be damaged.


Assuntos
Lobo Frontal/cirurgia , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/cirurgia , Seio Sagital Superior/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Angiografia Digital , Lobo Frontal/irrigação sanguínea , Lobo Frontal/diagnóstico por imagem , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Microcirurgia , Hemorragia Subaracnóidea/diagnóstico por imagem , Seio Sagital Superior/diagnóstico por imagem , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios X
10.
Acta Neurochir (Wien) ; 157(8): 1313-8; discussion 1318-9, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26095081

RESUMO

BACKGROUND: Acute extracranial internal carotid artery (ICA) occlusion by a huge cardiogenic embolus is rare, but can be catastrophic. METHODS: Seven patients with acute ischemic stroke due to embolic occlusion of extracranial ICA who underwent emergent cervical surgical embolectomy were retrospectively reviewed. Diagnosis was made in six patients with magnetic resonance imaging (MRI) with optional digital subtraction angiography (DSA), while computed tomography (CT) and DSA were used in one patient with an implanted pacemaker. Clinical outcomes, including recanalization rate, recanalization time, complications, modified Rankin scale (mRS) at 3 months, and National Institute of Health Stroke Scale (NIHSS) score improvement at 1 month were evaluated. RESULTS: Complete recanalization was obtained in seven patients (100 %). Median recanalization time from symptom onset and from start of surgery was 402 and 40 min, respectively. All seven patients showed severe left ventricular hypertrophy (LVH) according to an increased cardiothoracic ratio (CTR) ≥50 %. Complications included recurrence of cardioembolic stroke with the right middle cerebral artery occlusion, minimal expansion of infarction, and aggravation of heart failure, each in one patient, respectively. Four (57.1 %) patients had a history or postoperative recurrence of cardioembolic stroke. Median NIHSS at 1 month was 2 (range, 0-30). Median mRS at 3 months was 2 (range, 0-5). Five patients (71.4 %) had a favorable outcome (mRS2). CONCLUSIONS: Cervical surgical embolectomy for acute extracranial ICA occlusion resulted in a high complete recanalization rate with an acceptable safety profile. A possible association between severe cardiac illness and huge embolus occluding proximal large artery was suggested.


Assuntos
Arteriopatias Oclusivas/cirurgia , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Embolectomia/efeitos adversos , Cardiopatias/etiologia , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Interna/patologia , Embolectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Surg Neurol Int ; 6: 29, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25737799

RESUMO

BACKGROUND: Central retinal artery occlusion (CRAO) is a stroke of the retina and is associated with extremely poor prognosis. Although the pathophysiology of CRAO is diverse, including autoimmune or hematological disorders, neurosurgeons can perform carotid endarterectomy for the causal internal carotid artery stenosis or perform acute recanalization of the extra- or intracranial artery occlusion due to cardiogenic embolism. CASE DESCRIPTION: A 78-year-old male with a history of atrial fibrillation (Af) visited our hospital with a chief complaint of right monocular blindness. Magnetic resonance imaging revealed occlusion of the right internal and external carotid arteries. We performed emergent cervical surgical embolectomy for restoration of vision. Recanalization was accomplished within 8 h after onset, and the patient regained practical vision within 4 months. CONCLUSION: In the diagnosis and treatment of CRAO, occlusion of the internal and/or external carotid artery due to large cardiac emboli should be taken in consideration, especially when the patient has a history of Af, since acute recanalization might restore vision.

12.
Neurosurg Focus ; 38(VideoSuppl1): Video15, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25554837

RESUMO

This video demonstrates combined two separate craniotomies for two difficult unruptured cerebral aneurysms. The anterior communicating artery (ACOM) aneurysm existed at a high position, projected posteriorly, and thus necessitated an interhemispheric approach. Left middle cerebral artery (MCA) aneurysm with complex figure was treated through a separate pterional approach. Meticulous micro-cisternal opening under high magnification enabled safe and effective exposure of both aneurysms with minimal brain retraction, which alleviated brain damage as shown in postoperative images. The video can be found here: http://youtu.be/mBYsaAVekCA .


Assuntos
Craniotomia/métodos , Lateralidade Funcional , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Postura
13.
Acta Neurochir (Wien) ; 156(11): 2085-93; discussion 2093, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25248326

RESUMO

BACKGROUND: Executive functions are complex cognitive control functions that include cognitive flexibility, inhibition (self-control, self-regulation), and working memory. Bilateral frontal lobe ischemia is associated with cognitive impairment, especially in the context of dysexecutive syndrome. This report describes two patients who underwent bilateral anterior cerebral artery (ACA) reconstruction by A3-A3 anastomosis in conjunction with superficial temporal artery (STA)-radial artery (RA) graft-A3 bypass to treat bilateral ACA steno-occlusive hemodynamic ischemia accompanying cognitive and executive dysfunction. METHOD: A 74-year-old woman and a 73-year-old woman were admitted to our hospital for unilateral cerebral infarction in the frontal lobe. Magnetic resonance angiogram (MRA) demonstrated severe bilateral ACA steno-occlusive pathology in both patients. Considering the presence of impaired cognitive function with dysexecutive syndrome as well as hemodynamic compromise shown by single photon emission computed tomography (SPECT), we proceeded with A3-A3 anastomosis in conjunction with STA-RA-A3 bypass. Various neuropsychiatric tests were performed before and after the surgery. RESULTS: We confirmed good bypass patency without periprocedural complications. One patient recovered from apallic and bedridden status and regained ambulatory condition and ability to take in an oral diet. Another patient demonstrated improved scores in several cognitive tests with some persistent executive dysfunction. CONCLUSIONS: Bilateral ACA revascularization was technically feasible in two patients. This bypass surgery could have some positive effects in some basic cognitive function, such as memory, attention, and concentration by bilateral ACA hemodynamic improvement, although executive function, which is specific to prefrontal function, might not be reversible.


Assuntos
Artéria Cerebral Anterior/cirurgia , Infarto Cerebral/cirurgia , Revascularização Cerebral/métodos , Transtornos Cognitivos/cirurgia , Artéria Radial/transplante , Artérias Temporais/transplante , Idoso , Infarto Cerebral/etiologia , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/cirurgia , Transtornos Cognitivos/etiologia , Constrição Patológica , Função Executiva , Feminino , Humanos
14.
J Neurosurg ; 121(3): 631-6, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24905562

RESUMO

Embolic intracranial large artery occlusion with severe neurological deficit is associated with an extremely poor prognosis. The safest and most effective treatment strategy has not yet been determined when such emboli are associated with unstable proximal carotid plaque. The authors performed emergent surgical embolectomy for left middle cerebral artery (MCA) occlusion, and the patient experienced marked neurological recovery without focal deficit and regained premorbid activity. Postoperative investigation revealed "vulnerable plaque" of the left internal carotid artery without apparent evidence of cardiac embolism, such as would be seen with atrial fibrillation. Specimens from subsequent elective carotid endarterectomy (CEA) showed ruptured vulnerable plaque that was histologically consistent as a source of the intracranial embolic specimen. Surgical embolectomy for MCA occlusion due to carotid plaque rupture followed by CEA could be a safer and more effective alternative to endovascular treatment from the standpoint of obviating the risk of secondary embolism that could otherwise occur as a result of the manipulation of devices through an extremely unstable portion of plaque. Further, this strategy is associated with a high probability of complete recanalization with direct removal of hard and large, though fragile, emboli.


Assuntos
Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Embolectomia/métodos , Endarterectomia das Carótidas/métodos , Infarto da Artéria Cerebral Média/etiologia , Infarto da Artéria Cerebral Média/cirurgia , Idoso , Estenose das Carótidas/diagnóstico por imagem , Craniotomia/métodos , Feminino , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Procedimentos Neurocirúrgicos/métodos , Ruptura/complicações , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Acta Neurochir (Wien) ; 156(1): 11-6, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24114076

RESUMO

BACKGROUND: The white-collar sign (WCS) is represented by the formation of neointimal tissue at the level of the aneurysm neck as the successful outcome on follow-up angiography after coil embolization. WCS has been reported only in aneurysms treated with Matrix® coils. This is the first study to report WCS emergence in aneurysms treated with bare platinum coils, and potential factors associated with WCS emergence were evaluated. METHOD: Total 130 unruptured (female: male ratio, 100: 30; mean age, 60 years) cerebral aneurysms were treated with coil embolization. Embolization status was assessed immediately and 1 year after treatment, and emergence of WCS in follow-up angiography was assessed. We evaluated the association between WCS emergence and aneurysm location, dome diameter, neck diameter, dome-neck ratio, and type of coil used (bare platinum or bioactive). RESULTS: WCS appeared in nine aneurysms (6.9%), of which six were treated only with bare platinum coils. Neck diameter was significantly smaller in the WCS-positive group than in the WCS-negative group. The proportion of aneurysms treated with bioactive coils was not significantly different between the groups. Immediate embolization status in the WCS-positive group tended to be slightly better than that in the WCS-negative group. No aneurysmal morphological characteristics other than small neck diameter were associated with WCS emergence. CONCLUSIONS: WCS is not specific to bioactive coil usage. Small neck diameter was significantly associated with WCS emergence in our series. Further investigations to clarify the predictors of WCS will contribute to progress of aneurysmal embolization.


Assuntos
Embolização Terapêutica , Aneurisma Intracraniano/terapia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/diagnóstico , Aneurisma Roto/terapia , Angiografia Cerebral/métodos , Embolização Terapêutica/métodos , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico , Masculino , Pessoa de Meia-Idade , Platina/uso terapêutico , Resultado do Tratamento
16.
Neurosurgery ; 65(3): E626; discussion E626, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19687672

RESUMO

OBJECTIVE: We report on a patient with a neuropathic facial pain syndrome, including elements of trigeminal neuralgia, glossopharyngeal neuralgia, and dysphagia. After failing medical and surgical decompressive treatments, the patient underwent implantation of a motor cortex stimulation (MCS) system. CLINICAL PRESENTATION: A 54-year-old woman presented with a 14-year history of left-sided facial pain, throat pain, and associated nausea and vomiting. The patient failed several open surgical and percutaneous procedures for her facial pain syndrome. Additionally, several medication trial attempts were unsuccessful. Imaging studies were normal. INTERVENTION: The patient underwent placement of a right-sided MCS system for treatment of her neuropathic facial pain syndrome. The procedure was tolerated well, and the trial stimulator provided promising results. The permanent MCS generator needed to be reprogrammed at the time of the 5-week follow-up visit to optimize symptom relief. The patient demonstrated dramatic improvements in her neuropathic facial and oral pain, including improvements in swallowing toleration, after the 5-week follow-up examination with subthreshold MCS. A decline in treatment efficacy also occurred 2 years after implantation due to generator depletion. Symptom improvement returned with stimulation after the generator was replaced. CONCLUSION: A novel implantable MCS system was used to treat this patient's neuropathic facial pain. Durable improvements were noted not only in her facial pain, but also in swallowing toleration. The ultimate role of MCS in the treatment of pain conditions is still not well-defined but might play a part in refractory cases and, as in this case, might improve other functional issues, including dysphagia.


Assuntos
Estimulação Encefálica Profunda/métodos , Transtornos de Deglutição/terapia , Neuralgia Facial/terapia , Córtex Motor/fisiologia , Neuralgia/terapia , Transtornos de Deglutição/etiologia , Neuralgia Facial/complicações , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Neuralgia/complicações , Medição da Dor
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