RESUMO
Dissecting aneurysms of the vertebral artery at its intracranial segment are uncommon lesions, mainly when associated to subarachnoid hemorrhage, being also rare fenestrations of the vertebral artery. They present high morbidity and mortality, with high rebleeding rate and difficulty of surgical approach. We present a 19 years old man who was victim of physical aggression in the occipto-cervical region, presenting subarachnoid hemorrhage and a dissecting aneurysm of the right vertebral artery, which had a fenestration, being submitted to endovascular treatment. We accomplished a literature review about this subject, proposing endovascular treatment as a therapeutic option for these cases.
Assuntos
Hemorragia Subaracnóidea/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Dissecação da Artéria Vertebral/cirurgia , Adulto , Angiografia Cerebral , Humanos , Masculino , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Dissecação da Artéria Vertebral/diagnóstico por imagemRESUMO
Aneurismas dissecantes da artéria vertebral em seu segmento intracraniano são lesões pouco comuns, principalmente quando associadas a hemorragia subaracnóidea, sendo também raras as fenestrações da artéria vertebral. Apresentam elevada morbidade e mortalidade, com elevado índice de ressangramento e dificuldade de abordagem cirúrgica. Apresentamos o caso de um homem de 19 anos, o qual foi vitima de agressão física em região occipto-cervical, apresentando hemorragia subaracnóidea e aneurisma dissecante na artéria vertebral direita, a qual era fenestrada, sendo submetido ao tratamento endovascular. Realizamos revisão da literatura sobre o assunto, sendo colocado o tratamento endovascular como uma opção terapêutica para estes casos.
Assuntos
Adulto , Humanos , Masculino , Hemorragia Subaracnóidea/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Dissecação da Artéria Vertebral/cirurgia , Angiografia Cerebral , Hemorragia Subaracnóidea , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Dissecação da Artéria VertebralRESUMO
BACKGROUND: Intrathoracic meningocele is a rare pathology, almost always associated with neurofibromatosis type I and with a few cases related in the literature. In the majority of cases cysts are small or asymptomatic, and the surgery is indicated when big or symptomatic cysts are present. We report a case of giant intrathoracic cysts surgically extirpated through out thoracotomy. CASE: A 59-year-old male with familiar Von Recklinghausen's disease which developed thoracic radicular pain after a fall. On examination he presented some difficulty in walking fast and dyspneia on small efforts. The chest plain x-ray showed the presence of 3 huge left side intrathoracic cysts (10 to 15cm). The patient was submitted to a surgical treatment and complete extirpation of the cysts was performed through a left side thoracotomy. During the surgery a fourth smaller cyst was detected and also extirpated. Evolution was uneventful and the patient remains well in these last 12 years. This finding of intrathoracic cysts related to neurofibromatosis type I is rare and is probably unique in the literature the presence of 4 huge cysts in one side of the thorax.
Assuntos
Meningocele/complicações , Neurofibromatose 1/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningocele/cirurgia , Pessoa de Meia-Idade , Neurofibromatose 1/cirurgia , Tórax , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Intrathoracic meningocele is a rare pathology, almost always associated with neurofibromatosis type I and with a few cases related in the literature. In the majority of cases cysts are small or asymptomatic, and the surgery is indicated when big or symptomatic cysts are present. We report a case of giant intrathoracic cysts surgically extirpated through out thoracotomy. CASE: A 59-year-old male with familiar Von Recklinghausen's disease which developed thoracic radicular pain after a fall. On examination he presented some difficulty in walking fast and dyspneia on small efforts. The chest plain x-ray showed the presence of 3 huge left side intrathoracic cysts (10 to 15cm). The patient was submitted to a surgical treatment and complete extirpation of the cysts was performed through a left side thoracotomy. During the surgery a fourth smaller cyst was detected and also extirpated. Evolution was uneventful and the patient remains well in these last 12 years. This finding of intrathoracic cysts related to neurofibromatosis type I is rare and is probably unique in the literature the presence of 4 huge cysts in one side of the thorax
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Meningocele , Neurofibromatose 1 , Imageamento por Ressonância Magnética , Meningocele , Neurofibromatose 1 , Tórax , Tomografia Computadorizada por Raios XRESUMO
Clivus fractures are rare and severe entities, usually associated with vascular or cranial nerve lesions and frequently diagnosed postmortem. Cervical epidural haematomas can be traumatic or spontaneous, manifested in acute or chronic form, and are treated surgically in the majority of cases, although the conservative treatment also can be indicated to patients with incomplete and non-progressive deficits. The authors report the case of a female patient, 8 years old, victim of trampling in public way by a high velocity motorized vehicle, admitted in Glasgow 7, anisocoric pupils (left pupil midriatic), whose radiological investigation showed a transverse fracture of the clivus, cervical epidural haematoma and diffuse axonal injury. The patient was submitted to intracranial pressure monitorization, sedation and conservative treatment with dexamethasone, with good outcome. The authors also present a literature review.
Assuntos
Acidentes de Trânsito , Hematoma Epidural Craniano/complicações , Fraturas Cranianas/complicações , Vértebras Cervicais , Criança , Fossa Craniana Posterior/lesões , Feminino , Hematoma Epidural Craniano/diagnóstico , Hematoma Epidural Craniano/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética , Fraturas Cranianas/diagnóstico , Fraturas Cranianas/tratamento farmacológico , Tomografia Computadorizada por Raios XRESUMO
Clivus fractures are rare and severe entities, usually associated with vascular or cranial nerve lesions and frequently diagnosed postmortem. Cervical epidural haematomas can be traumatic or spontaneous, manifested in acute or chronic form, and are treated surgically in the majority of cases, although the conservative treatment also can be indicated to patients with incomplete and non-progressive deficits. The authors report the case of a female patient, 8 years old, victim of trampling in public way by a high velocity motorized vehicle, admitted in Glasgow 7, anisocoric pupils (left pupil midriatic), whose radiological investigation showed a transverse fracture of the clivus, cervical epidural haematoma and diffuse axonal injury. The patient was submitted to intracranial pressure monitorization, sedation and conservative treatment with dexamethasone, with good outcome. The authors also present a literature review
Assuntos
Criança , Feminino , Humanos , Acidentes de Trânsito , Fossa Craniana Posterior , Hematoma Epidural Craniano , Fraturas Cranianas , Vértebras Cervicais , Hematoma Epidural Craniano , Imageamento por Ressonância Magnética , Fraturas Cranianas , Tomografia Computadorizada por Raios XRESUMO
Aneurysm rest occurs in 1 to 10% of operated patients and of these, 21.8% are due to slipped clips. D'Angelo and coworker (1998) found 1 to 10% of residual aneurysms. They suggest that if the residual aneurysm has less than 2 mm, angiographic control must be performed after 3-5 years of the surgical procedure; if between 2 and 4 mm, the angiographic control must be done in the first 6 months after surgery and then, anually. If it has more than 4mm a direct surgical approach is advised. We present the cases of two female patients submitted to microsurgical treatment of intracranial aneurysm, without any intra-operative abnormal event. The angiographic study further made showed displacement of the clip from its original position and aneurysm again. A review of the literature is also presented.
Assuntos
Aneurisma Roto/cirurgia , Migração de Corpo Estranho/complicações , Aneurisma Intracraniano/cirurgia , Instrumentos Cirúrgicos , Aneurisma Roto/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Angiografia Cerebral , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Pessoa de Meia-Idade , Recidiva , ReoperaçãoRESUMO
A incidência de clipagem de aneurismas em que permanecem restos da dilataçäo varia, nas séries estudadas, de 1-10 por cento. Deste percentual, 21,8 por cento é devido à migraçäo do clipe.D Angelo e seus colaboradores (1998), encontraram 1 a 10 por cento de aneurismas residuais. Sugerem que quando o resíduo for menor que 2 mm seja realizado estudo angiográfico entre 3-5 anos após o procedimento cirúrgico; se entre 2 e 4 mm, este estudo deve ser mais precoce, dentro dos primeiros 6 meses e depois anualmente; e, quando maior que 4 mm, a reabordagem. Apresentamos os casos de duas pacientes submetidas a tratamento cirúrgico de aneurismas intracranianos, com intra-operatório sem intercorrências e que, em exames ulteriores, evidenciaram migraçäo do clipe de sua posiçäo original. É apresentada, ainda, revisäo da literatura
Assuntos
Humanos , Feminino , Idoso , Aneurisma Roto , Aneurisma Intracraniano , Complicações Intraoperatórias , Instrumentos Cirúrgicos , Aneurisma Roto , Artéria Carótida Interna , Angiografia Cerebral , Aneurisma Intracraniano , Período Pós-Operatório , ReoperaçãoRESUMO
The per operative rupture of the aneurysm during dissection impairs the delicate microsurgical procedure and increases the risk of a bad evolution for the patient. During operation the aneurysm generally ruptures in its belly but it could happen just in its colon, between the main vessel and the sac. This brings a serious problem to the neurosurgeon once the placement of a clip at this place will increase the bleeding. Our technical suggestion is to perform the clippage over a small piece of temporal muscle gently placed over the hole of bleeding after temporary clippage. This is a very simple procedure but very useful that must be reminded in such cases. We did not found a similar description in the main books and articles related with intraoperative aneurysm rupture.