RESUMO
Juvenile nasopharyngeal angiofibroma (JNA) is a rare histologically benign tumor, highly vascularized, with usually aggressive behavior, and can extend from the nasal cavity to neighboring structures. We present the case of a 14-year-old male harboring a JNA, presenting with an active severe and persistent epistaxis. Two previous surgical attempts of removal were unsuccessful, because of profuse intraoperative bleeding. Angiography showed a highly vascularized neoplasm with multiple branches arising from both internal carotid arteries, with absence of branches from the external carotid due to previous surgical ligation. Direct puncture tumor embolization was not possible because removal of nasal packing triggered major hemorrhage. The only option for embolization was a technique of non-superselective embolization with particles under transient occlusion of the internal carotid artery. The procedure was performed uneventfully from either side, the tumor was subsequently removed, and the patient had no recurrence 2 years after the initial treatment.
Assuntos
Angiofibroma/terapia , Oclusão com Balão , Perda Sanguínea Cirúrgica/prevenção & controle , Artéria Carótida Interna , Embolização Terapêutica/métodos , Neoplasias Nasofaríngeas/terapia , Hemorragia Pós-Operatória/prevenção & controle , Adolescente , Angiofibroma/irrigação sanguínea , Angiofibroma/complicações , Angiofibroma/diagnóstico , Angiofibroma/cirurgia , Angiografia Digital , Epistaxe/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Nasofaríngeas/irrigação sanguínea , Neoplasias Nasofaríngeas/complicações , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/cirurgia , Hemorragia Pós-Operatória/etiologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The type of venous drainage of a direct carotid-cavernous fistula is an important issue to consider for the endovascular therapeutic decision. In case of an inadequate posterior drainage associated with a good anterior drainage, the facial vein is a useful alternative. The exclusive embolization with ethylene vinyl alcohol (EVOH Onyx), arterial and/or venous via the internal carotid artery (ICA) occlusion has been used successfully, in a few cases until now. Nevertheless, the use of this method through anterior transvenous approach has not been previously described. Presented here is the case of a 13-year-old female patient with left posttraumatic carotid-cavernous fistula, with predominant anterior drainage, as well as carrier of traumatic occlusion of the contralateral ICA. The treatment was by means of a transvenous approach with transient occlusion of the left ICA.
Assuntos
Fístula Carótido-Cavernosa/terapia , Traumatismos Craniocerebrais/complicações , Dimetil Sulfóxido/administração & dosagem , Embolização Terapêutica , Polivinil/administração & dosagem , Adolescente , Oclusão com Balão , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Fístula Carótido-Cavernosa/diagnóstico por imagem , Fístula Carótido-Cavernosa/etiologia , Fístula Carótido-Cavernosa/fisiopatologia , Angiografia Cerebral/métodos , Circulação Colateral , Feminino , Humanos , Radiografia Intervencionista , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We describe the case of a 59-year-old female presenting with a disabling pulsatile tinnitus caused by a venous aneurysm of the sigmoid sinus. This is the first successful case of sole stenting, using a closed-cell design in the central part of the stent, leading to the occlusion of the aneurysm and the cure of the tinnitus. Venous aneurysms of the dural sinuses are rare causes of pulsatile tinnitus and the sole stenting technique provides a simpler, safe, and effective approach.
Assuntos
Cavidades Cranianas , Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/terapia , Stents , Angiografia Digital , Angiografia Cerebral/métodos , Cavidades Cranianas/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Pessoa de Meia-Idade , Desenho de Prótese , Zumbido/etiologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We present the case of a female patient who developed chiasmatic apoplexy and menstrual alterations. CT scanning showed a suprasellar hemorrhage. She underwent surgery with the presumptive diagnosis of pituitary tumor. At surgery, we find a brown-grayish lesion involving left optic nerve and chiasm. Cavernous angioma was diagnosed by histopathology. Cavernous angiomas constitute nearly 15% of all central nervous system vascular malformations. Location at the optic pathway is very rare, but must to be ruled out in the diagnosis of a patient with chiasmatic and/or optic apoplexy. Surgery is useful in preventing worsening of the previous deficit or a new visual defect.
Assuntos
Hemangioma Cavernoso/complicações , Quiasma Óptico/irrigação sanguínea , Neoplasias do Nervo Óptico/complicações , Acidente Vascular Cerebral/etiologia , Adenoma/diagnóstico , Adulto , Craniotomia , Diagnóstico Diferencial , Emergências , Feminino , Cefaleia/etiologia , Hemangioma Cavernoso/diagnóstico por imagem , Hemangioma Cavernoso/cirurgia , Humanos , Microcirurgia , Quiasma Óptico/diagnóstico por imagem , Quiasma Óptico/cirurgia , Neoplasias do Nervo Óptico/diagnóstico por imagem , Neoplasias do Nervo Óptico/cirurgia , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Tomografia Computadorizada por Raios X , Transtornos da Visão/etiologia , Campos VisuaisRESUMO
BACKGROUND: There are few data describing the microanatomy of the anterior-ventral spinal (AVSA) and anterior spinal arteries (ASA) and discussing their clinical and surgical implications. We describe the anatomical features of this arterial complex, and highlight their use when planning and performing surgical approaches to lesions involving the ventral aspect of the medulla and the foramen magnum. METHOD: The microsurgical anatomy and branching pattern of the AVSA and the ASA from fifty human cadaver brain stems is described using a surgical microscope. RESULTS: We found one anterior-ventral spinal artery at each side in 30 of the brain stems (60%). The ASA was a direct branch emerging from the left vertebral artery (VA) in 15 (30%), from the right VA in 4 (8%), and from the basilar artery (BA) in one brain stem (2%). The previously described as "typical pattern" of the junction of the AVS arteries from both sides, was observed only in 9 brain stems (18%). The anterior communicating spinal artery (ACoSA) was observed in 15 brain stems (30%). Also multiple ACoS arteries were described in one brain stem. Both, the AVSA and the ASA were observed to send long circumferential branches that supplied irrigation to the olive in 42 (84%) brain stems. CONCLUSIONS: This anatomical study gives important information for a better understanding of the clinical picture of ischemic lesions of the brain stem, such as the medial medullary syndrome, and highlights the remarkable role of the AVSA and ASA as anatomical landmarks during the surgical approaches to lesions involving the ventral aspect of the medulla and the foramen magnum.
Assuntos
Bulbo/irrigação sanguínea , Medula Espinal/irrigação sanguínea , Artéria Vertebral/anormalidades , Artéria Basilar/anormalidades , Artéria Basilar/patologia , Artéria Basilar/cirurgia , Fossa Craniana Posterior/anatomia & histologia , Fossa Craniana Posterior/cirurgia , Forame Magno/anatomia & histologia , Forame Magno/cirurgia , Lateralidade Funcional/fisiologia , Humanos , Bulbo/fisiopatologia , Bulbo/cirurgia , Microcirurgia/métodos , Osso Occipital/anatomia & histologia , Osso Occipital/cirurgia , Base do Crânio/anatomia & histologia , Base do Crânio/cirurgia , Medula Espinal/cirurgia , Artéria Vertebral/patologia , Artéria Vertebral/cirurgiaRESUMO
INTRODUCTION: Cerebral angiography (CA) is considered as the gold standard in diagnosis of intracranial aneurysms; nevertheless, the magnetic resonance angiography (MR-angiography) is wide spread used in detection of unruptured aneurysm. For this reason, several authors had proposed that MR-angiography could replace CA in the diagnosis of ruptured aneurysms. AIMS: To asses the efficacy of MR-angiography in diagnosis of ruptured intracranial aneurysms, and in addition to determine the safeness of its surgical management with MR-angiography alone. PATIENTS AND METHODS: We studied prospectively 52 patients with subarachnoid haemorrhage admitted at Teodoro Maldonado Carbo and Alcívar Guayaquil hospitals of Guayaquil, Ecuador, in a 5 years period. We compared the results of MR-angiography with CA and surgical findings in the diagnosis and categorization of intracranial aneurysms. RESULTS: We made diagnosis of 100% of 54 aneurysms with MR-angiography, while 98% with CA. The surgical findings were similar to the characteristics showed by MR-angiography. CONCLUSIONS: MR-angiography is an excellent no invasive method in the diagnosis of ruptured intracranial aneurysms, and could replace CA in selected cases.
Assuntos
Aneurisma Roto , Angiografia Cerebral , Angiografia por Ressonância Magnética/estatística & dados numéricos , Adulto , Idoso , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico , Aneurisma Roto/patologia , Aneurisma Roto/cirurgia , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/patologia , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/patologia , Hemorragia Subaracnóidea/cirurgiaRESUMO
Schwannomas reach 8 to 10% of all intracranial tumors. Most originate at the vestibular root of VIII cranial nerve, but trigeminal tumors are infrequent. We present the case of a patient admitted at the National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez" (Mexico City) with a mass occupying the infratemporal fossa with involvement of nearby structures. Schwannomas with extension to the infratemporal fossa are rare. We review the anatomy of this region, the surgical approaches, which have been used and propose a different approach.