Giant meningioma of the cranial vertex--case report.
(25/170)
A 55-year-old man was admitted with a swelling on the top of his head progressively growing for 2 years. The swelling had grown to a huge size with the appearance of a double head. A huge meningioma with predominantly extracranial growth and invasion into the superior sagittal sinus was subtotally excised. The excised tumor mass weighed 1380 g. The residual tumor was treated by irradiation. No recurrence was seen at one-year follow-up examination. (+info)
Presigmoid approach for cavernous angioma in the pons--technical note.
(26/170)
Surgical treatment of brainstem lesions has been encouraged after the development of magnetic resonance imaging. However, direct approaches to intra-axial lesions in the brainstem still carry a high risk of morbidity because the neuronal structures can be injured along the entry routes. We present two patients whose pontine cavernous angiomas were removed via incision of the lateral aspect of the pons with presigmoid approach. The first case, a 41-year-old woman, presented with paresis of the cranial nerves VI, VII, and VIII, and left hemiparesis progressing over 2 weeks caused by a cavernous angioma ventrally located in the lower pons. The second case, a 50-year-old woman, developed dizziness over 2 months due to a large cavernous angioma in the center of the pons. These lesions were totally removed through the presigmoid approach and no additional neurological deficits were observed. An image-guided navigation system was used for the craniotomy and removal of the lesion in the second patient. The presigmoid approach provides a safe route to intra-axial lesions in the pons. A technique for presigmoid craniotomy with one-piece bone flap under the image-guided navigation is also described. (+info)
Dural arteriovenous fistula involving the superior sagittal sinus following sinus thrombosis--case report.
(27/170)
A 57-year-old woman presented with a dural arteriovenous fistula (AVF) involving the superior sagittal sinus (SSS) based upon serial radiological examinations. Her chief complaints were headache and vomiting. Cerebral angiography and magnetic resonance (MR) venography revealed the sinus thrombosis involving the SSS, the bilateral transverse sinuses (TSs), and the right sigmoid sinus. Her symptoms disappeared after anticoagulant therapy. Follow-up MR venography revealed almost complete recanalization of the occluded sinuses, followed by restenosis of the SSS and the left TS and occlusion of the right TS without symptoms. She developed transient right hemiparesis 13 months after the initial onset. Cerebral angiography revealed a dural AVF involving the SSS with cortical reflux into the left frontoparietal region. The dural AVF was occluded by transarterial and transvenous embolization. Her symptom disappeared during the follow-up period. (+info)
Subarachnoid hemorrhage caused by dural arteriovenous fistula of the sphenobasal sinus--case report.
(28/170)
A 59-year-old woman presented with a rare middle fossa dural arteriovenous fistula (AVF) unrelated to the cavernous sinus manifesting only as subarachnoid hemorrhage. Angiography revealed shunts between the meningeal branches of both the internal and external carotid arteries and the sphenobasal sinus. The AVF drained into the superficial middle cerebral vein (SMCV) which had a varix and an anastomosis to a superior cerebral vein. The arterial supply vessels were eliminated surgically and the sinus was excised. Bleeding did not recur and there was no venous infarction. Dural AVF of the sphenoparietal sinus is associated with pulsatile exophthalmos and dural AVF of the sphenopetrosal sinus with tinnitus, but dural AVF of the sphenobasal sinus has no obvious symptom. Simple interruption of the SMCV at the penetration of the arachnoid membrane was possible because of the absence of a draining vessel to preserve AVF patency, but the arteries were eliminated in this patient to prevent formation of another AVF. (+info)
The experience of ligation of transverse or sigmoid sinus in surgery of large petroclival meningiomas.
(29/170)
The authors present the experience of ligation of transverse or sigmoid sinus in the surgical removal of petroclival meningiomas. We reviewed the medical records and venograms of 14 patients with petroclival meningiomas, in whom the intraoperative ligation of transverse or sigmoid sinus had been done at our hospital between 1986 and 1999. All patients passed the intraoperative test clamping of the sinus. The drainage pattern of confluence of Herophili was classified into four types: type A, confluence and equal drainage on both transverse sinuses; type B, confluence and non-dominant transverse sinus on the tumor side; type C, confluence and dominant transverse sinus on the tumor side; and type D, unilateral transverse sinus only. Among the 14 cases, four cases were in type A, five cases in type B, and two were type C. There was no evidence of brain swelling after intraoperative test clamping of the sinus for more than 30 min. None of the patients experienced postoperative complications related with sinus ligation. Our observation suggests that the transverse or sigmoid sinus ligation is tolerable to patients who show the drainage patterns of type A, type B, and type C, if the test clamping proves to be safe. (+info)
Normal structures in the intracranial dural sinuses: delineation with 3D contrast-enhanced magnetization prepared rapid acquisition gradient-echo imaging sequence.
(30/170)
BACKGROUND AND PURPOSE: The potential pitfalls in the diagnosis of dural sinus thrombosis include the presence of arachnoid granulations, intrasinus fibrotic bands (so-called septa), and hypoplasia or aplasia of the dural sinuses. The purpose of this study was to assess the appearance, distribution, and prevalence of arachnoid granulations and septa in the dural sinuses by using a high resolution 3D contrast-enhanced magnetization prepared rapid acquisition gradient-echo (MPRAGE) imaging sequence. METHODS: Conventional MR images and contrast-enhanced MPRAGE images of 100 consecutive patients who had no abnormalities of the dural sinuses were retrospectively reviewed. The incidence, site, number, size, signal intensity, and shape of arachnoid granulations and septa within the sinuses and their relationship with adjacent veins were recorded. RESULTS: With 3D contrast-enhanced MPRAGE imaging, 433 round, oval, or lobulated focal filling defects were found in a total of 90 patients. Curvilinear septa were observed in 92 patients. Sixty-nine patients had round, oval, or lobulated defects in the transverse sinus, 59 had such defects in the superior sagittal sinus, and 47 had such defects in the straight sinus. All except two of the above defects were isointense relative to CSF on all images. These structures were presumed to be arachnoid granulations. Of 431 arachnoid granulations, 233 (53.8%) were located in the superior sagittal sinus, 122 (28.1%) in the transverse sinus, and 76 (17.6%) in the straight sinus. One or more veins were seen to enter arachnoid granulations in 414 (96%) instances. CONCLUSION: The contrast-enhanced 3D MPRAGE imaging sequence showed a much higher prevalence and a different distribution of arachnoid granulations and septa within dural sinuses than have been observed in previous radiologic studies. Arachnoid granulations were closely related spatially to veins. (+info)
Transient brain scan abnormalities in renal dialysis patients.
(31/170)
Two patients on chronic renal hemodialysis developed acute neurologic symptoms and unusual brain scan findings, including very prominent cranial sinuses. Symptoms and scan abnormalities reverted to normal within a few days. The possible mechanisms are discussed. (+info)
The jugular foramen in complex and syndromic craniosynostosis and its relationship to raised intracranial pressure.
(32/170)
BACKGROUND AND PURPOSE: Complex and syndromic craniosynostosis can be complicated by raised intracranial pressure (ICP), which in the absence of other identifiable origins, is probably caused by venous hypertension. Children with these conditions have been shown to have narrowing of the sigmoid sinus-jugular vein complex. Evidence of bony narrowing of the jugular foramina in children with complex or syndromic craniosynostosis and raised ICP compared with that in children with craniosynostosis without raised ICP would provide support for the theory that venous hypertension occurs in the former children. METHODS: Measurements of the jugular foramina were obtained from reformatted helical CT scans obtained in 12 children with complex or syndromic craniosynostosis and raised ICP (group 1) and in two control groups of children with normal ICP. The first control group comprised 10 children with simple nonsyndromic synostosis of one or two sutures (group 2), and the second control group included nine children with complex or syndromic craniosynostosis (group 3). RESULTS: Children with raised ICP had narrower jugular foramina than did the age-matched control subjects. For group 1, the mean diameter of jugular foramina was 6.5 mm; group 2, 11.5 mm (P <.01); and group 3, 10 mm (P <.05). No significant difference existed between the two control groups. CONCLUSION: Significantly narrower jugular foramina in children with raised ICP is further evidence of the role of venous outflow obstruction and intracranial venous hypertension in the development of raised ICP in complex and syndromic craniosynostosis. (+info)