摘要:

OBJECTIVE AND IMPORTANCE:We report a unique case of ivory osteoma of the cervical spine.CLINICAL PRESENTATION:The clinical presentation was one of polyradicular deficit without myelopathy after trauma. The imaging characteristics and histology of the lesion were those of a classic ivory osteoma.INTERVENTION:A complete surgical excision of the lesion was accomplished.CONCLUSION:We think we have recorded the only well-documented case of ivory osteoma affecting the spine.

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

OBJECTIVE AND IMPORTANCE:We describe two patients, with progressing neurological deficits, who showed improvement after revascularization of their carotid arteries using stents.CLINICAL PRESENTATION:One patient presented clinically with the symptoms of a middle cerebral artery territory stroke. Angiography demonstrated total occlusion of the right internal carotid artery (ICA), with evidence of clot from the origin of the ICA to the middle cerebral artery trifurcation. The second patient presented with bilateral ICA occlusions and evidence of a progressing left hemispheric deficit; she was receiving therapeutic levels of heparin at the time of deterioration of her condition.INTERVENTION:Thrombolysis and stenting successfully recanalized the occluded vessels, and the deficits of the first patient were reversed. With the second patient, a dissected carotid loop was encountered. Straightening of the loop with a wire and stenting of the carotid artery using two stents allowed revascularization of the left hemisphere and resolution of most of the deficits of this patient.CONCLUSION:This report demonstrates the technical feasibility of placing stents in high-risk patients with carotid artery occlusions from either dissection or atherosclerosis. Both patients sustained much smaller infarctions than would have been expected if the carotid artery territory had been infarcted. We report on the technical feasibility of reopening acutely closed ICAs by using endovascular methods.

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

OBJECTIVE AND IMPORTANCE:Dural arteriovenous fistulas of the superior sagittal sinus (SSS) account for 8% of intracranial dural fistulas. Their association with a thrombosis of the posterior part of the SSS is rare. In such cases, the usual neurosurgical and endovascular approaches cannot provide a good technical solution for treatment of the lesion, and a combined neurosurgical and neuroradiological approach is therefore needed.CLINICAL PRESENTATION:A 68-year-old man presented with rapidly evolving dementia. Cerebral angiography revealed a dural arteriovenous fistula of the SSS associated with thrombosis of the posterior part of the SSS. Various endovascular and neurosurgical approaches failed to cure the fistula.INTERVENTION:A burr hole was drilled in the frontal region, in the neurosurgical room. The patient was then transferred to the angiographic room, and the SSS was occluded using free spirals.CONCLUSION:This procedure led to a complete anatomic cure of the fistula, and a slow clinical improvement was observed.

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

OBJECTIVE:The asterion is defined as the junction of the lambdoid, parietomastoid, and occipitomastoid sutures. The asterion has been used as a landmark in lateral approaches to the posterior fossa. However, its reliability as a landmark comes into question considering the apparent variability of its position. This study was performed to determine the reliability of the asterion as a surgical landmark.METHODS:One hundred dried skulls were obtained for study. A 2-mm drill hole was placed at the asterion on each side. The position of the drill hole on the inner surface of the skull was next determined and recorded.RESULTS:The asterion was located over the posterior fossa dura in 32% on the right and 25% on the left. Its position was over the transverse or sigmoid sinus complex in 61% on the right and 66% on the left. The landmark was located above the transverse-sigmoid sinus complex in 7% on the right and 9% on the left.CONCLUSIONS:The asterion is not a strictly reliable landmark in terms of locating the underlying posterior fossa dura. Its location is very often directly over the transverse-sigmoid sinus complex. Burr holes placed at the asterion may often open the bone directly over the sinus, leading to potential damage.

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

OBJECTIVE:We previously established the ability of intra-aortic balloon counterpulsation (IABC) to improve cerebral blood flow (CBF) significantly in a canine model of cerebral vasospasm. This study was performed to assess the efficacy of IABC in a patient with cardiac dysfunction and severe cerebral vasospasm that was refractory to traditional treatment measures.METHODS:We report our experience with the clinical use of IABC to treat cerebral vasospasm in a patient who suffered subarachnoid hemorrhage and concomitant myocardial infarction. Hypertensive, hypervolemic, hemodilution therapy was ineffective, and IABC was instituted. Xenon-enhanced computed tomography(Xe-CT) was utilized to obtain serial measurements of CBF with and without IABC over a 4-day period.RESULTS:IABC dramatically improved cardiac function in this patient, and Xe-CT demonstrated significant improvement in CBF with IABC. The average global CBF was 20.5 ± 4.4 ml/100g/min before versus 34.7 ± 3.8 ml/100g/min after IABC (p<0.0001, paired student's t-test). The lower the CBF before IABC, the greater the improvement with IABC (correlation coefficient r=0.83, p=0.0007). CBF improvement ranged from 33% to 161% above baseline, average 69.3%. No complications of IABC were observed.CONCLUSIONS:This is the first report demonstrating the ability of IABC to improve CBF in a patient with vasospasm. We suggest that IABC is a rational treatment option in select patients with refractory cerebral vasospasm who do not respond to traditional treatment measures.

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID