Carolina Martins, Mladen Macanovic, Isabel Eugenia Costa e Silva, Fatima Griz, Hildo R C Azevedo-Filho
Department of Neurosurgery, Hospital da Restauração, Recife, PE, Brazil. firstname.lastname@example.org
In this case an aneurysm of the right posterior communicating artery developed 11 months after an infundibular dilation of this artery had been angiographycally and surgically demonstrated. In the best of the authors' knowledge, there are only eleven such cases reported in the literature. This report brings about diagnostic and therapeutic questions regarding arterial infundibula and the need of a better understanding of those lesions.
Centre de recherche du CHUM, Hôpital Notre-Dame, 1560 rue Sherbrooke Est, Bureau Y-3633, Montréal, Québec, Canada H2L 4M1. email@example.com.
BACKGROUND: Intracranial aneurysms (IA) are dilatations of intracranial arteries that occur most commonly at arterial bifurcations. Unruptured IA are present in approximately 1-2% of the population aged over 30 years of age. Aneurysms are only rarely symptomatic unless they rupture, which typically results in a subarachnoid haemorrhage associated with high morbidity and mortality. METHODS: A large French Canadian (FC) family (Aneu60) was identified which contained 12 affected individuals with intracranial aneurysms. Nine of the affected patients and three unaffected individuals were sent for an 8 cM genome-wide scan. Multipoint and two-point methods were used to analyse the scan data by using a dominant parametric model. RESULTS: We identified an IA susceptibility locus (ANIB4) located on chromosome 5p15.2-14.3. The locus was found by genome-wide linkage analysis and follow up analyses provided a maximum multipoint LOD score of 3.57 over the region. An identical haplotype segment of 7.2 Mb was found in a second FC pedigree and contributes to the refinement of the candidate gene interval. CONCLUSIONS: Our results indicate that there is a major gene locus on chromosome 5p.
Dimpled appearance of a posterior communicating artery saccule: an angiographic indicator of arterial infundibula.
Department of Radiology, Mayo Clinic, Mayo Building E2, 200 1st St. SW, Rochester, MN 55905, USA.
Progression of a posterior communicating artery infundibulum into an aneurysm in a patient with Alagille syndrome. Case report.
Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan 48109-0338, USA. firstname.lastname@example.org
The authors present a case in which a posterior communicating artery (PCoA) infundibulum progressed into an aneurysm in a patient with Alagille syndrome (arteriohepatic dysplasia). The 3-mm PCoA infundibulum had been noted on angiography studies obtained 5 years earlier, prior to clip occlusion of a basilar tip aneurysm. Recently, the patient presented to the emergency department with the sudden onset of headache and decreased mental status. A computerized tomography scan of the head with three-dimensional angiography revealed no gross subarachnoid hemorrhage, but did demonstrate a 5-mm PCoA aneurysm. Lumbar puncture demonstrated xanthochromia and a large quantity of red blood cells. The patient underwent open surgery for aneurysm clip occlusion and obtained a good recovery. This case illustrates the small but growing number of examples of infundibulum progression. It also indicates the need for a close follow up in patients with congenital abnormalities that may pose an increased risk for what has traditionally been considered a benign lesion.
Other papers by authors:
J Emerg Med. 2012 Apr 9;: 22494606
Peninsula Radiology Academy, Plymouth, Devon, UK.
BACKGROUND: We present a series of plain chest radiographs taken in acute settings, with artifactual projections from oxygen reservoir bags. These artifacts are shown to simulate chest pathology in each case. OBJECTIVES: The identification of artifacts on imaging prevents misdiagnosis and potential mistreatment of patients in acute settings. We highlight patterns of findings caused by the projection of oxygen reservoir bags in radiographs taken in the emergency setting. CASE REPORTS: We present plain chest films in 4 patients taken in the acute setting, either in the emergency department or acute admissions unit. In this case series, oxygen reservoir bags simulate pneumothoraces, lung edges, and bullous disease. CONCLUSION: Artifacts on chest radiographs are potential causes of misdiagnosis and subsequent inappropriate treatment. By highlighting the patterns created by the projection of oxygen reservoir bags, emergency physicians, radiologists, and reporting radiographers will be aware of the potential problems.
Surg Neurol Int. 2011 ;2 :164 22140649
Usefulness of the contralateral Omega sign for the topographic location of lesions in and around the central sulcus.
Alvaro Campero, Pablo Ajler, Carolina Martins, Juan Emmerich, Luiz Felipe de Alencastro, Albert Rhoton Jr
Department of Neurosurgery, Hospital Padilla, Tucumán, Argentina.
The central sulcus may be located through magnetic resonance imaging (MRI) by identifying the ipsilateral inverted Omega shape. In a brain with a lesion in this area, its identification becomes a hard task irrespective of the technique applied. The aim of this study is to show the usefulness of the contralateral Omega sign for the location of tumors in and around the central sulcus. We do not intend to replace modern techniques, but to show an easy, cheap and relatively effective way to recognize the relationship between the central sulcus and the lesion. From July 2005 through December 2010, 43 patients with lesions in and around the central sulcus were operated using the contralateral Omega sign concept. Additionally, 5 formalin-fixed brains (10 hemispheres) were studied to clarify the anatomy of the central sulcus where the Omega shape is found. The central sulcus has three genua. The middle genu is characterized by an inverted Omega-shaped area in axial sections known as the Omega sign. On anatomical specimens, Omega was 11.2 ± 3.35 mm in height, on average, and 18.7 ± 2.49 mm in width, at the base. The average distance from the medial limit of the Omega to the medial edge of the hemisphere was 24.5 ± 5.35 mm. Identification of the Omega sign allowed for the topographic localization of the contralateral central sulcus in all our surgical cases but one. The contralateral Omega sign can be easily and reliably used to clarify the topographic location of the pathology. Hence, it gives a quick preoperative idea of the relationships between the lesion and the pre- and post-central gyri.
World Neurosurg. 2011 Nov 1;: 22120261
Cognitive Changes in Patients with Aneurysmal Subarachnoid Hemorrhage Before and Early Posttreatment: Differences Between Surgical and Endovascular.
Ana Cláudia C Vieira, Hildo R C Azevedo-Filho, Gustavo Andrade, Izabel Eugênia Costa E Silva, Maria de Fátima Leal Griz, Saul Quinino, Laécio Leitão, Moisés Loyola Ponte Souza, Divaldo Câmara Jr
Department of Neurosurgery, Hospital da Restauração, Recife, Brazil.
INTRODUCTION: The main purpose of occluding a ruptured aneurysm is preventing rebleeding, which may be fatal. Microsurgical or endovascular treatments are the main approaches adopted to prevent new bleeding. Among patients presenting with aneurysmal subarachnoid hemorrhage, about 50% had permanent injuries. Cognitive changes are one of the main morbidities from that illness. The type of treatment for the aneurysm (clipping or coil embolization) can also contribute to the genesis of those complications. OBJECTIVE: Assessing language and verbal memory changes resulting from the aneurysmal lesion occlusion procedures, as well as establish which treatment offers less cognitive sequels. METHOD: This investigation was carried out in Hospital da Restauraão, Recife-PE, from May 2007 to November 2009. One hundred fifty-one patients were divided into two groups, surgical and endovascular, and had their language, fluency, and verbal memory functions tested at two time points, pre- and postoperation. The results of the initial assessment and of the one occurring after the treatment were compared, between both groups and to each other. RESULTS AND CONCLUSIONS: One hundred fifty-one patients were assessed, distributed as 122 surgical and 29 coil embolized. The performances in both groups did not differ in the initial assessment. However, endovascular treatment does not show additional cognitive impairment and had a better performance in language and verbal memory, compared with patients submitted to surgical treatment in an early postoperative period.
World Neurosurg. ;75 (5-6):653-9 21704932
Language, memory, and verbal fluency changes in patients with aneurysmal subarachnoid hemorrhage: results of a preoperative investigation.
Ana Cláudia C Vieira, Hildo R C Azevedo-Filho, Saul Quinino, Moysés Loyola Ponte de Souza, Divaldo Câmara Jr, Laécio Leitão, Gustavo Andrade
Department of Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Brazil; Department of Neurology, Hospital da Restauração, Recife, Brazil.
Department of Neurosurgery, Medical School of Pernambuco-IMIP, Recife, Brazil.
World Neurosurg. ;74 (2-3):351-8 21492569
Carolina Martins, Alberto Capel Cardoso, Luiz Felipe Alencastro, Caio Souza Leão, Albert L Rhoton Jr
Department of Anatomy, Medical School of Pernambuco-IMIP, Recife, Brazil; Department of Neurosurgery, Instituto de Medicina Integral Professor Fernando Figueira-IMIP, Recife, Brazil.
Dural landmark to locate the internal auditory canal in large and giant vestibular schwannomas: the Tübingen line.
Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA. email@example.com
BACKGROUND In cases of large and giant vestibular schwannomas (VS), the visualization of the internal auditory canal (IAC) opening is difficult or impossible. OBJECTIVE To describe the Tübingen line and explore its relationships with the IAC as a landmark to help locate the IAC. METHODS Ten cadaveric heads were used in this study. Between 2004 and 2009, the senior author (M.T.) used the Tübingen line as a landmark to recognize the IAC in 300 consecutive patients with VS. To locate the Tübingen line, the initial step was to identify several vertical foldings of dura located around the area of the vestibular aqueduct. After this, foldings upward consistently reached a linear level where all of the foldings ended and the dura tightly adhered to the bony surface in a smooth, foldless shape. RESULTS The Tübingen line was identified in all temporal bones studied and in all 300 patients operated on, with the exception of 2 cases (<1%). Removal of the bone just above the Tübingen line located the IAC in all temporal bone specimens studied. Similarly, the surgical cases showed that the Tübingen line helped locate the IAC in all patients. CONCLUSION The Tübingen line is an easy, consistent, and safe method to locate the projection of the IAC along the posterior surface of the temporal bone.
Alvaro Campero, A Agustín Campero, Mariano Socolovsky, Carolina Martins, Alexandre Yasuda, Armando Basso, Albert Rhoton
Department of Anatomy, School of Medicine, University of Tucumán, Ayacucho 491, San Miguel de Tucumán, Tucumán 4000, Argentina. firstname.lastname@example.org
We aim to describe the technical details of the transzygomatic approach to intracranial surgery. The incision begins at the level of the inferior border of the zygomatic arch, anterior to the tragus, and extends towards the contralateral pupillary line. A subgaleal and interfascial dissection is performed. Then, the zygomatic arch is vertically sectioned twice and mobilized downwards, together with the masseter muscle. Next, a fronto-temporo-sphenoidal craniotomy is performed and complete exposure of the anterior temporal dura achieved. Thus, the surgical possibilities are:(i) intradural access to the middle fossa;(ii) intradural pretemporal access to the basal cisterns;(iii) intradural transtemporal access to the insular region; and (iv) extradural access to the middle fossa. The transzygomatic approach offers excellent exposure to the floor of the middle fossa and the lateral wall of the cavernous sinus (both intradurally and extradurally). Also, combined with a pretemporal approach, it affords a good view of the interpeduncular cistern; and using a transtemporal approach, it provides good access to the insular region.
Alvaro Campero, Juan Emmerich, Mariano Socolovsky, Carolina Martins, Alexandre Yasuda, A Agustín Campero, Albert Rhoton Jr
Department of Anatomy, School of Medicine, University of Tucumán, Ayacucho 491, San Miguel de Tucumán, Tucumán 4000, Argentina. email@example.com
We aimed to determine the position, number and variability of the sphenoid sinus ostia. A total of 32 dry skulls were examined under x6 magnification. The septum and nasal turbinates were removed to expose the anterior wall of the sphenoid sinus. A caliper was used for measurements. We found 2 ostia per skull, except for one (3%), in which the left ostium was absent. The inferior edges of both ostia were found at the same height in only four skulls (12.5%), and the superior edges of both ostia were found at the same height in only one skull (3%). Thus, in 27 skulls (84%) the lower and upper margins of both ostia were at different levels. The distance from the internal edge of the right ostium to the midline was 2.04mm on average (range: 0.3-5.3mm). The distance from the internal edge of the left ostium to the midline was 2.18mm on average (range: 0.2 to 5.1mm). In most skulls, the sphenoid ostia are located at different heights on each side; also a great variability in the distance from the internal border of the ostia to the midline was found. We found this anatomical knowledge useful when performing a transsphenoidal approach to the sella turcica.
J Clin Neurosci. 2010 Apr 6;: 20378356
Department of Anatomy, School of Medicine, University of Tucumán, Ayacucho 491, San Miguel de Tucumán, Tucumán 4000, Argentina; Department of Surgical Neurology, University of Florida, Gainesville, FL, USA.
The external structure of each cavernous sinus (CS) is made of four dural walls. The aim of this study was to describe the anatomy of the dural walls of the CS. We studied 42 adult cadaveric heads, fixed with formalin and injected with coloured silicon. The main findings were:(i) the lateral wall of the CS has two layers - the external, which is thick and pearly grey, and the internal, which is semi-transparent and containing the cranial nerves (CNs);(ii) the medial wall of the CS has two areas - sellar and sphenoidal, both made up of one dural layer only; and (iii) the superior wall of the CS is formed by three triangles - oculomotor, clinoid and carotid - CN III may be found in a cisternal space of the oculomotor triangle; and (iv) the posterior wall of the CS is made up of two dural layers - meningeal dura and periostic dura - and this wall is close to the vertical segment of CN VI.
Latest similar papers:
Spontaneous concomitant intracranial and spinal subdural hematomas in association with anticoagulation therapy.
Department of Neurosurgery, School of Medicine, Chosun University, Gwangju, Korea.
Simultaneous intracranial and spinal subdural hematomas are extremely rare. In most cases, they are attributed to major or minor trauma and iatrogenic causes, such as those resulting from spinal puncture. To the best of the authors' knowledge, there has been only two reports of spontaneous concomitant intracranial and spinal subdural hematomas in a patient receiving anticoagulant therapy who had an absence of evident trauma history. We report on a case of spontaneous concomitant intracranial and spinal subdural hematomas that occurred in association with anticoagulant therapy and present a review of the relevant literature.
Br J Neurosurg. 2012 Apr 7;: 22483198
CHU de Caen, Service de Neurochirurgie , Caen, F-14000 , France.
Ruptured anterior communicating artery aneurysm presenting with complete third nerve palsy is genuinely rare. We herein report one such case resulting from an interpeduncular haematoma. Three months after the coiling, the patient had fully recovered. This case adds a new branch to the aetiology-to-prognostic decision-making tree of third nerve palsies.
Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada.
A case demonstrating compression of the right ventricular outflow tract by an unruptured coronary sinus of Valsalva aneurysm in which repair resulted in symptomatic improvement is presented. The pathology report revealed that the patient's younger brother had died from a ruptured aneurysm of the coronary sinus of Valsalva. The present report is the first to describe a familial unruptured coronary sinus of Valsalva aneurysm raising questions regarding the screening of relatives of patients with sinus of Valsalva aneurysms of unknown etiology.
Department of Otolaryngology, Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
A case of successful cochlear implantation following irradiation of the temporal bone is presented. Loss of cochlear architecture is demonstrated and is attributable to previous radiation. Viability of cochlear nerve and spiral ganglion following radiation is questioned. To date there has been only one previously published report on the subject.
Department of Ophthalmology, University of Alabama, Birmingham, Alabama, USA.
A 26-year-old woman developed a painful left pupil-involving oculomotor palsy. Magnetic resonance imaging of the brain and orbits with and without fat suppression and gadolinium and magnetic resonance angiography of the head were normal. A computed tomographic angiogram showed a left 7-mm posterior communicating artery aneurysm. The different neuroimaging modalities used to diagnose intracranial aneurysms are discussed.
Coexisting tuberculosis and carcinoma of the colon: a report of two cases and a review of the literature.
Department of Surgery, Government Medical College and Hospital, Chandigarh. firstname.lastname@example.org
Tuberculosis and carcinoma of the colon rarely coexist. We report 2 such cases and review the available literature. Since the potential for misdiagnosis is high in such patients and a preoperative diagnosis of coexistence is usually not possible, important questions regarding the management of patient with a diagnosis of either colonic cancer on tuberculosis need to be addressed.
Urology. 2002 Oct ;60 (4):697 12385940
Division of Pediatric Urology, Children's Mercy Hospital and University of Kansas School of Medicine, Kansas City, Missouri 66211, USA.
The association of limb loss with antenatal urologic intervention has recently been questioned. At present, no such cases have been reported. We present a case of antenatal vesicoamniotic shunting for posterior urethral valves in which the shunt entered the right lower extremity and coursed subcutaneously over the femoral triangle and inguinal canal and into the bladder. Although the limb was intact, we present images and a discussion of the potential for extremity injury with antenatal urologic intervention.
Nervenarzt. 2002 Sep ;73 (9):887-91 12215883
Klinik und Poliklinik für Psychiatrie, Universität Leipzig, Germany. email@example.com
Only a few patients with Parkinson's disease and levodopa dependency or abuse have been reported. We present a 35-year-old patient with young-onset Parkinson's disease who developed motor complications, levodopa dependency, and drug-induced psychosis after primary treatment with levodopa. Diagnostic criteria and treatment guidelines for this neuropsychiatric disorder are presented as well as a tentative neurobiological answer to the question of why levodopa dependency is observed only in a minority of patients with Parkinson's disease.
Late-onset erythema along a sterile functioning ventriculoperitoneal shunt: case report and review of the literature.
Division of Neurosurgery, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Canada.
CASE REPORT: A 6-year-old boy presented with erythema along the tract of his ventriculoperitoneal shunt 6 years after its insertion; there was no associated CSF infection or shunt malfunction.DISCUSSION: The question of what to do in such a situation is addressed. The possible causes of the erythema are discussed, as well as its management, and the literature is reviewed.
Institute of Informatics, China Academy of TCM, Beijing.
Ancient works on women's diseases of successive ages were studied on the question Pang Anshi's acupuncturing the point "Hukou" at the dorsal aspect between the thumb and index finger to cure a case of difficult labor. Query is put forward on the absence of such case report in all those books through deliberated investigation of relevant medical literatures. It is concluded that Pang's case report is convincing and is worthy of attention.