1/102. Complete paraplegia due to multiple intracerebral and spinal cavernomas.We report on a 29-year-old male patient with multiple intracerebral and spinal cavernomas. Bleeding in the thoracic cord at admission and additional bleeding which occurred 12 days later in the cervical cord resulted in complete paraplegia below thoracic level 4 (Th4). Four years earlier multiple cerebral cavernomas had been diagnosed by magnetic resonance imaging (MRI). Based upon reported cases in the literature multiple intracerebral and spinal cavernomas are exceptional. Additionally, the clinical presentation in our case is uncommon.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/102. Conus medullaris hematomyelia associated with an intradural-extramedullary cavernous angioma.A unique case of a 50-year-old woman with a conus medullaris hematomyelia associated with a low thoracic intradural-extramedullary cavernous angioma localized 2 cm above is reported. The patient had a 2-month history of progressive paraparesis, hypoesthesia of legs, and bowel and bladder disturbances. The symptoms worsened acutely during the last days before admission. A thoraco-lumbar MRI showed a space-occupying lesion at T10-T11 (vertebral interspace associated with a hematomyelia localized about 2 cm below. A T10-L1 laminectomy was performed and complete removal of both lesions was obtained with microsurgical technique. A non-traumatic hematomyelia should always prompt the suspicion of a spinal AVM or, more rarely, of a cavernous angioma. The possible anatomical and clinical correlations of this unusual association are discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = spinal (Clic here for more details about this article) |
3/102. Cavernous hemangioma of the intracranial optic pathways: CT and MRI.PURPOSE: The purpose of this work was to describe the CT and MR findings in three patients with cavernous hemangioma (CH) of the intracranial optic pathways. METHOD: CT and MR studies of three patients with CH of the optic chiasm were reviewed. All patients underwent MRI of the chiasmal area, with coronal T2- and T1-weighted studies as well as gadolinium-enhanced coronal and sagittal T1-weighted studies. RESULTS: The patients (mean age, 40 years) presented with chiasmal apoplexy (two cases) and progressive decrease of visual acuity (one case). In all cases, MRI showed regular enlargement of the optic chiasm, with extension to the optic nerve in one case and to the left optic tract in one case. The chiasmatic dimension was 2.5-3 cm in two cases and 1-1.5 cm in the other case. In all cases, MRI revealed an acute (isointense signal on T1-weighted and hypointense signal on T2-weighted sequences) or subacute (hyperintense signal on T1 - and T2-weighted sequences) hemorrhage with, adjacent to it, an area with signals of blood of different ages, highly suggestive of CH. CT showed, in chiasmatic CHs, a suprasellar mass spontaneously denser than adjacent brain parenchyma. In two cases, microcalcifications were associated. In two cases, CT and MRI revealed slight heterogeneous enhancement after contrast agent administration. In one case, no enhancement was observed. Two patients underwent surgery by frontopterional craniotomy. The optic chiasms were swollen with an intrinsic bluish mass. The cerebrospinal fluid was not xanthochromic. Microscope examination confirmed the diagnosis of CH. After 12 months, the operated patients had improved visual acuity and visual field but did not completely recover. The nonoperated patient (because of spontaneous rapid recovery of visual acuity) was followed clinically and on MRI over 18 months. CONCLUSION: CH in the optic chiasm must be suspected in the presence of an acute chiasmatic syndrome. MRI is the best imaging modality, showing either an acute or a subacute chiasmatic hemorrhage or the typical pattern of CH with heterogeneous alternation of foci of blood of different ages, with a central focus of methemoglobin, a peripheral rim of hemosiderin, adjacent foci of acute or subacute hemorrhage, and slight or no enhancement after gadolinium administration.- - - - - - - - - - ranking = 0.16666666666667keywords = spinal (Clic here for more details about this article) |
4/102. patients with spinal cord cavernous malformations are at an increased risk for multiple neuraxis cavernous malformations.OBJECTIVE: To determine the prevalence of multiple neuraxis cavernous malformations in patients who initially presented with intramedullary spinal cord (IMSC) cavernous malformations without knowledge of cavernous malformations elsewhere in the neuraxis. methods: hospital records and radiographic files were analyzed for 17 patients who subsequently underwent surgical resection of an IMSC cavernous malformation (histologically proven) and also underwent brain magnetic resonance imaging studies. These 17 patients represented a subset of 32 patients who underwent surgical resection of an IMSC cavernous malformation during the same period. RESULTS: Of 17 patients, 8 (47%) harbored multiple cavernous malformations. This group was composed of five women and three men (mean age, 35.9 yr). There were four Caucasian and four Hispanic patients. CONCLUSION: The prevalence of multiple cavernous malformations in the neuraxis seems to be increased in patients who harbor IMSC cavernous malformations. This finding has important implications for the evaluation and management of these patients and, in some cases, their family members.- - - - - - - - - - ranking = 0.83333333333333keywords = spinal (Clic here for more details about this article) |
5/102. Radiologic and surgical aspects of pure spinal epidural cavernous angiomas. Report on 5 cases and review of the literature.BACKGROUND: Cavernous angiomas (CAs) that are localized completely in the spinal epidural space are uncommon vascular malformations. Although they have increasingly been reported in the literature in recent years, diagnostic and surgical features are not clearly defined. methods: We report five patients with pure spinal epidural cavernous angiomas (PSECAs) and review the literature, focusing on their radiologic and surgical characteristics. We also compare these tumors with other extra-axial CAs as well as with their intra-axial counterparts. RESULTS: PSECAs, like all other extra-axial CAs, differ from intra-axial ones on MRI: the hemorrhagic variant is less frequent, hemosiderin rim is rare, the signal is different, and contrast enhancement is the rule. They are very similar to spinal meningiomas but they differ in their growth pattern and morphology, since they infiltrate intervertebral foramina and have an oval shape. In PSECA, intraoperative bleeding is rarely profuse, in contrast to other extra-axial CAs, especially those of the cavernous sinus. CONCLUSIONS: On MRI, PSECAs and other extra-axial CAs constitute a homogeneous group since they enhance significantly. At operation, since there is rarely enough bleeding to limit removal, radical excision of PSECAs can be achieved with good results.- - - - - - - - - - ranking = 1.1666666666667keywords = spinal (Clic here for more details about this article) |
6/102. Cavernous angioma of the internal acoustic meatus--case report.A 39-year-old female presented with an intrameatal cavernous angioma manifesting as hearing loss and tinnitus in the right ear which progressed over 8 months. Magnetic resonance (MR) images revealed an intrameatal lesion as ultra-high intensity, nearly as bright as cerebrospinal fluid, on the T2-weighted images, and isointensity on the T1-weighted images. Computed tomography (CT) showed the mass accompanied by stippled patterns of calcification. The patient underwent surgery under a diagnosis of calcified acoustic neurinoma. Histological studies were compatible with cavernous angioma. Intrameatal cavernous angioma is a rare disease which requires differential diagnosis from the more common neurinoma or meningioma in this location. Intrameatal lesion with ultra-high intensity on T2-weighted MR imaging and stippled patterns of calcification on CT is more likely to be cavernous angioma than acoustic neurinoma. These neuroimaging features are important information in deciding the treatment strategy.- - - - - - - - - - ranking = 0.16666666666667keywords = spinal (Clic here for more details about this article) |
7/102. Cavernous hemangioma of the internal auditory canal arising from the inferior vestibular nerve: case report and review of the literature.OBJECTIVE: To describe a case of cavernous hemangioma arising from the inferior vestibular nerve, limited to the internal auditory canal. STUDY DESIGN: Retrospective case review and review of literature. SETTING: A tertiary referral clinic. INTERVENTIONS: Extended middle cranial fossa surgery. RESULTS: The hemangioma was completely resected through the extended middle cranial fossa approach. No serious complications occurred, and the hearing and the facial nerve function were preserved. CONCLUSIONS: Originating from the capillary plexus surrounding Scarpa's ganglion, this hemangioma has to be differentiated from intratemporal hemangioma at the geniculate ganglion. Because of extrinsic growth pattern, the potential for preservation of the facial nerve function is high if surgery is performed early. Complete resection through the extended middle fossa approach is the treatment of choice for cavernous hemangioma with limited extension into the cerebellopontine angle. It remains difficult to distinguish preoperatively from the more common tumors, and surgery is usually planned on assumption of vestibular schwannoma.- - - - - - - - - - ranking = 0.33624601896407keywords = canal (Clic here for more details about this article) |
8/102. Extreme lateral supracerebellar infratentorial approach to the posterolateral mesencephalon: technique and clinical experience.OBJECTIVE: Lesions situated posterolaterally along the mesencephalon present neurosurgeons with a special challenge. The midline and paramedian variations of the supracerebellar infratentorial approaches do not adequately expose this region. The subtemporal approach risks injury to the vein of Labbe. An extreme lateral supracerebellar infratentorial approach with more radical resection of bone superiorly and laterally, and skeletonization of the sigmoid and transverse sinuses, was used to approach lesions at this location in eight methods: Five cavernous malformations, two juvenile pilocytic astrocytomas, and one peripheral superior cerebellar artery aneurysm located in this region were approached in eight patients. In this extreme lateral approach, the sigmoid sinus is unroofed more superiorly and the bone flap includes not only a posterior fossa craniotomy but also a portion that extends just above the transverse sinus. The dural opening is based along the transverse and sigmoid sinuses. After the cerebrospinal fluid has been drained, the lateral aspect of the brainstem is approached via the cerebellar surface. A proximal tentorial incision offers additional rostral exposure where needed. RESULTS: Seven patients in this series underwent successful resection of their lesion. The remaining patient's aneurysm was clipped successfully with no major complications. CONCLUSION: The extreme lateral supracerebellar infratentorial approach differs from the midline and paramedian supracerebellar infratentorial variants in the area of exposure, patient positioning, and location of the craniotomy. The technique is effective for approaching the posterolateral mesencephalon.- - - - - - - - - - ranking = 0.16666666666667keywords = spinal (Clic here for more details about this article) |
9/102. Intramedullary cavernous malformations.Five cases of intramedullary cavernous malformations were retrospectively reviewed. There were 4 women and one man ranging in age from 30 to 67 years. Thoracic spinal cord was involved twice and cervical cord in three cases. Four of them underwent surgery: two improved, one remained stable and symptoms worsened in one. Clinical, radiological features and surgical management are discussed in the light of the follow-up and literature analysis. The role of T2* weighted sequence in MR diagnosis of intramedullary cavernomas is emphasised.- - - - - - - - - - ranking = 0.16666666666667keywords = spinal (Clic here for more details about this article) |
10/102. The transmastoid partial labyrinthectomy approach to medial skull base lesions.INTRODUCTION: It has long been thought that surgical disruption of the membranous labyrinth invariably results in sensorineural hearing loss and balance dysfunction. Recent evidence suggests that the inner ear can withstand such manipulation without loss of function. The technique of transmastoid partial labyrinthectomy has recently been described as a means of providing access to lesions of the medial skull base by removing part of the labyrinth and at the same time attempting to preserve hearing and vestibular function of the lateral semicircular canal (LSCC) and otolithic organs. PROCEDURE: An extended cortical mastoidectomy is performed and the posterior and middle cranial fossa dura are exposed widely. The posterior and superior semicircular canals are occluded at their ampullated ends and at the crus commune, and then resected. The LSCC and vestibule are left undisturbed. The petrous apex is removed and the medial end of the internal auditory canal is exposed. Posterior cranial fossa dural flaps are raised allowing access to the brainstem, petro-clival area and cerebellopontine angle. Temporal and suboccipital craniotomies can be performed, as required. RESULTS: Four patients underwent this procedure by a joint Otolaryngological-Neurosurgical team for access to the following lesions: three intra-axial pontine cavernomas and a basilar artery aneurysm. The preliminary hearing and balance results are discussed. CONCLUSIONS: The partial labyrinthectomy approach provides improved access to certain lesions of the medial skull base and requires less brain retraction compared with the retrolabyrinthine approach. It also has the potential to preserve serviceable hearing.- - - - - - - - - - ranking = 0.20174761137844keywords = canal (Clic here for more details about this article) |
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