Color Doppler study of the venous circulation in the fetal brain and hemodynamic study of the cerebral transverse sinus.
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OBJECTIVES: To describe the venous circulation in the fetal brain; to describe the normal blood flow velocity waveform in the transverse sinus and to establish normal reference ranges for the second half of gestation. POPULATION: A total of 126 pregnant women with uncomplicated pregnancies at 20-42 weeks of gestation. METHODS: A combination of color-coded Doppler and two-dimensional real-time ultrasound was used to identify the main venous systems in the fetal brain. Blood flow velocity waveforms of the transverse sinus were obtained from a transverse plane of the head at the level of the cerebellum. RESULTS: A waveform could be obtained in the cerebral transverse sinus in 98% of the cases. The waveform obtained was triphasic with a forward systolic component, a forward early diastolic component and a lower forward component in late diastole. Reverse flow during atrial contraction was seen before 28 weeks and the diastolic flow increased with gestation thereafter. Pulsatility and resistance indices decreased and flow velocities increased in the transverse sinus throughout gestation. CONCLUSION: The venous circulation of the fetal brain can be identified by color Doppler. The gestational age-related decrease in resistance and increase in flow velocities suggest that hemodynamic studies of the cerebral transverse sinus might have clinical implications in studying compromised fetuses. (+info)
Long-term outcome of surgical treatment of intracavernous giant aneurysms.
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A number of approaches have been proposed for the treatment of intracavernous giant aneurysms. In the present study, we have analyzed long-term surgical outcome of 27 consecutive cases of our experience. All the cases were unruptured and symptomatic, showing symptoms such as extraocular movement disorder or visual disturbances. Thirteen cases were male and 14 cases were female. The age of the patients ranged between 11 and 75 years (average 52.2 years) and follow-up periods were between 1 and 20 years (average 7.7 years). Abducens nerve was distributed in 20 cases, oculomotor nerve in 12 cases, optic nerve in six cases, trigeminal nerve in six cases, and trochlear nerve in five cases. In addition to conventional angiography, three-dimensional computed tomographic angiography, balloon test occlusion (BTO), slow injection angiography, aneurysmography, and single photon emission computed tomography with BTO were used to determine a method of treatment. Therapeutic modalities of the present series were as follows: four cases were unoperated, common carotid artery ligation was performed in eight cases, internal carotid artery (IC) ligation in three cases, IC ligation plus superficial temporal artery (STA)--middle cerebral artery (MCA) anastomosis in four cases, IC ligation plus high flow vein bypass in three cases, IC trapping plus STA-MCA anastomosis in three cases, and direct clipping in two cases. Although two cases showed early and late ischemic complications, other cases demonstrated improvement of cranial nerve dysfunction relatively soon after surgical treatment and long-term outcome was generally good. It is concluded that good long-term surgical outcome is obtained for intracavernous giant aneurysms by selecting adequate surgical treatment based upon careful preoperative evaluation of these aneurysms using sophisticated diagnostic methods. (+info)
Multiple dural arteriovenous shunts in a 5-year-old boy.
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We describe a rare case of multiple dural arteriovenous shunts (DAVSs) in a 5-year-old boy. MR imaging performed at 1 year of age showed only a dilated anterior part of the superior sagittal sinus; however, angiography at 5 years of age revealed an infantile-type DAVS there and two other DAVSs of the adult type. The pathophysiological evolution of DAVSs in children and their treatment strategies are discussed. (+info)
Stereotactic radiosurgery for cavernous sinus cavernous hemangioma--case report.
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A 40-year-old female presented with cavernous sinus cavernous hemangioma manifesting as left abducens and trigeminal nerve pareses. Magnetic resonance imaging revealed a left cavernous sinus tumor. The tumor was partially removed. Histological examination of the specimen confirmed cavernous hemangioma. Radiosurgery was performed using the gamma knife. The tumor markedly decreased in size after radiosurgery and morbidity was avoided. Cavernous sinus cavernous hemangiomas may be difficult to treat surgically due to intraoperative bleeding and cranial nerve injury. Stereotactic radiosurgery can be used either as an adjunct treatment to craniotomy, or as the primary treatment for small cavernous sinus cavernous hemangioma. (+info)
Cavernous aneurysm rupture with balloon occlusion of a direct carotid cavernous fistula: postmortem examination.
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We present a unique case of a patient with a symptomatic carotid cavernous fistula treated successfully with balloon embolization. Her subsequent death from other disease processes allowed direct visualization of the balloon occlusion in situ at postmortem examination. (+info)
Dural arteriovenous fistula of the cavernous sinus with venous congestion of the brain stem: report of two cases.
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We present two cases of dural arteriovenous fistula of the cavernous sinus with venous congestion of the brain stem. Both cases were detected by MR imaging and showed significant improvement on MR images after transvenous embolization. (+info)
Ki-67 labelling index and invasiveness among anterior pituitary adenomas: analysis of 103 cases using the MIB-1 monoclonal antibody.
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AIMS: To investigate the relation between proliferative activity of anterior pituitary adenomas, quantified by the Ki-67 labelling index, and their invasive behaviour. METHODS: Expression of Ki-67 was evaluated in 103 anterior pituitary adenomas consecutively operated on in a 36 month period and correlated with surgical evidence of invasiveness. RESULTS: Non-invasive (n = 65) and invasive (n = 38) adenomas were identified from surgically verified infiltration of sellar floor dura and bone. The wall of the cavernous sinus was infiltrated in 16 cases. Forty one adenomas were non-functioning and 62 functioning (24 prolactin, 21 growth hormone, 10 ACTH, seven mixed). The overall mean (SD) Ki-67 labelling index was 2.64 (3.69) per cent (median 1.5). The mean index was 3.08 (4.59) per cent in functioning and 1.97 (1.78) per cent in non-functioning tumours; 5.47 (9.52) per cent in ACTH adenomas and 2.33 (2.42) per cent in others (p = 0.01); 3.71 (5.17) per cent in invasive and 2.01 (2.45) per cent in non-invasive adenomas (p = 0.027); and 5.58 (7.24) per cent in cavernous sinus infiltrating v 2.10 (2.39) per cent in cavernous sinus non-infiltrating adenomas (p = 0.0005). To identify a value of labelling index beyond which adenomas should be considered invasive and another beyond which cavernous sinus infiltration should be suspected, normality Q-Q plots were obtained: a threshold labelling index of 3.5% for invasive adenomas and of 5% for cavernous sinus infiltrating adenomas was defined, with statistically significant differences (p = 0.02 and p = 0.004, respectively). CONCLUSIONS: The Ki-67 labelling index can be considered a useful marker in determining the invasive behaviour of anterior pituitary adenomas. (+info)
Simultaneous subarachnoid hemorrhage and carotid cavernous fistula after rupture of a paraclinoid aneurysm during balloon-assisted coil embolization.
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We describe an iatrogenic perforation of a paraclinoid aneurysm during balloon-assisted coil embolization that resulted in simultaneous subarachnoid contrast extravasation and a carotid cavernous fistula. The causative factors specifically related to the balloon-assisted method that led to aneurysm rupture are discussed as well as strategies for dealing with this complication. (+info)