1/44. Dural sinus thrombosis and pseudotumor cerebri: unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy.OBJECT: The goal of this study was to document the hazards associated with pseudotumor cerebri resulting from transverse sinus thrombosis after tumor resection. Dural sinus thrombosis is a rare and potentially serious complication of suboccipital craniotomy and translabyrinthine craniectomy. pseudotumor cerebri may occur when venous hypertension develops secondary to outflow obstruction. Previous research indicates that occlusion of a single transverse sinus is well tolerated when the contralateral sinus remains patent. methods: The authors report the results in five of a total of 107 patients who underwent suboccipital craniotomy or translabyrinthine craniectomy for resection of a tumor. Postoperatively, these patients developed headache, visual obscuration, and florid papilledema as a result of increased intracranial pressure (ICP). In each patient, the transverse sinus on the treated side was thrombosed; patency of the contralateral sinus was confirmed on magnetic resonance (MR) imaging. Four patients required lumboperitoneal or ventriculoperitoneal shunts and one required medical treatment for increased ICP. All five patients regained their baseline neurological function after treatment. Techniques used to avoid thrombosis during surgery are discussed. CONCLUSIONS: First, the status of the transverse and sigmoid sinuses should be documented using MR venography before patients undergo posterior fossa surgery. Second, thrombosis of a transverse or sigmoid sinus may not be tolerated even if the sinus is nondominant; vision-threatening pseudotumor cerebri may result. Third, MR venography is a reliable, noninvasive means of evaluating the venous sinuses. Fourth, if the diagnosis is made shortly after thrombosis, then direct endovascular thrombolysis with urokinase may be a therapeutic option. If the presentation is delayed, then ophthalmological complications of pseudotumor cerebri can be avoided by administration of a combination of acetazolamide, dexamethasone, lumbar puncture, and possibly lumboperitoneal shunt placement.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/44. occipital lobe meningioma in a patient with multiple chemical sensitivities.BACKGROUND: The concurrent diagnosis of meningioma with increased intracranial pressure has not been reported previously in a patient who meets diagnostic criteria for multiple chemical sensitivities (MCS). methods: A patient who had been evaluated in an occupational medicine practice, and by several other physicians for sensitivity to chemical odors was found to have papilledema and a visual field deficit. The patient met the clinical criteria set forth by Cullen in 1987 for MCS. A magnetic resonance imaging (MRI) scan was performed. RESULTS: The MRI revealed a large occipital lobe meningioma, which was surgically resected. Removal of the meningioma had little effect on the patient's symptoms. She has been unable to return to her job as a custodian. DISCUSSION: The etiology of MCS has been disputed and is currently unresolved. Those who evaluate patients with MCS are reminded that meningiomas and other intracranial mass lesions can affect olfaction, and that patients with MCS can have treatable intracranial abnormalities.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/44. Unususpected meningioma in a patient with pituitary gigantism. Case report with autopsy findings.A unique example of a clinically unsuspected large parasellar meningioma is described in a 36-yr-old pituitary giant who had been treated initially with conventional irradiation, subsequently by surgical excision of an acidophil adenoma, and ultimately with medroxyprogesterone acetate (MPA) prior to his demise. The patient died of increased intracranial pressure resulting from a combined mass effect of the meningioma and recurrent tumor. The relationship between radiation and the development of the meningioma is discussed, as well as the fine ultrastructure of a highly functioning acidophil adenoma.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/44. dementia in the elderly--a search for treatable illnesses.Forty patients with senile dementia were evaluated prospectively with laboratory and radiologic investigations, including computerized axial transverse tomography. Five patients were believed to have potentially treatable illnesses causing the dementia. After treatment, the dementia in one patient with hypothyroidism was completely resolved. One patient with pernicious anemia was markedly improved, and a second patient with hypothyroidism was somewhat improved. One patient with a brain tumor was not treated, and a severely demented patient with possible normal pressure hydrocephalus died shortly after shunting without improvement. The discovery of these unsuspected illnesses and the gratifying response to treatment in some suggests the importance of systematic evaluation in all patients with senile dementia.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/44. Clinical and hemodynamic responses to balloon test occlusion of the straight sinus: technical case report.OBJECTIVE AND IMPORTANCE: Surgical sacrifice of the straight sinus may be performed during intracranial tumor resection. Sacrifice of the straight sinus is associated with an unpredictable risk of venous infarction. We describe a patient with a falcine meningioma who underwent endovascular balloon test occlusion of the straight sinus before surgical resection. CLINICAL PRESENTATION: A 48-year-old woman presented with symptoms resulting from a 4-cm-diameter meningioma in the left occipital region. Along its inferior margin, the tumor abutted the straight sinus. cerebral angiography demonstrated occlusion of the posterior one-third of the superior sagittal sinus but patency of the straight sinus. TECHNIQUE: A 4-mm angioplasty balloon was directed into the straight sinus via the right jugular vein. In addition to clinical assessments, the pressure within the proximal straight sinus, upstream from the balloon, was measured before and during inflation. Severe headaches followed balloon inflation, and the pressure in the proximal straight sinus increased 18 mm Hg. With balloon deflation, the clinical and hemodynamic findings immediately returned to normal. On the basis of these findings, the straight sinus was preserved during surgery. CONCLUSION: This technique is straightforward and allows some assessment of the physiological responses and individual tolerance to sinus occlusion before surgery.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
6/44. Symptomatic subdural hygroma after petroclival meningioma surgery. Case report of a intractable complication.Although subdural hygroma development after craniotomy or aneurysm surgery is a well-known complication and subdural peritoneal or V-P shunt are commonly successful procedures, there are situations that cannot be treated by available surgical options. We reported a case of a 28-year-old young man who developed a symptomatic subdural hygroma after removal of petroclival meningioma. This hygroma increased in size and became bilateral in spite of implantation of V-P with programmable valve at open pressure variable from 30 to 180 mmH2O, placement of subdural-peritoneal shunt with low-low valve or without valve and external diversion. The occurrence of this case showed that there other factors can play role in hygroma development as disturbance of normal CSF dynamic with shunt of CSF from basal arachnoidal to subdural spaces secondary to surgery and/or slow growth of petroclival meningioma as well as postoperative progressive cerebral atrophy. Actually there are not effective diagnostic tools to detect causes and therefore, there are restricted therapeutic possibilities. This potential and serious complication should be always considered when planning petroclival meningioma surgery because of the severe consequences on functional outcome.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/44. Normal-pressure hydrocephalus due to tentorial meningioma.Normal-pressure hydrocephalus and the associated triad of dementia, apraxic gait and urinary incontinence may be casued by various, sometimes unsuspected, lesions, usually those that block the flow of cerebrospinal fluid (CSF) around the tentorium. A 58-year-old woman with insidious onset of behaviour and gait problems had occult, normal-pressure hydrocephalus and a tentorial meningioma, resection of which produced complete recovery. This case demonstrates that a distinction must be made between the syndrome of normal-pressure hydrocephalus resulting from disturbance in CSF dynamics and the pathophysiologic features of the underlying lesion.- - - - - - - - - - ranking = 7keywords = pressure (Clic here for more details about this article) |
8/44. Reverse brain herniation during posterior fossa surgery.Posterior fossa tumors are commonly associated with obstructive hydrocephalus. Relieving the raised intracranial pressure by draining the cerebrospinal fluid presents the possibility of reverse herniation of the brain. A 5-year-old male child with a diagnosis of posterior fossa space-occupying lesion and hydrocephalus was scheduled for craniectomy in the prone position. After craniectomy, the surgeons placed an intraventricular shunt catheter to drain out cerebrospinal fluid in an attempt to reduce the tense brain so as to facilitate easy dissection of the tumor. The patient had sudden and severe bradycardia followed by asystole. A diagnosis of reverse coning was made. Immediately, the surgeon injected 10-15 mL normal saline into the ventricles. There was a spontaneous return of the sinus rhythm and the rest of the course of surgery was uneventful. We present this case showing a rare phenomenon and its successful management.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/44. Compression of the intracranial optic nerve mimicking unilateral normal-pressure glaucoma.A 66-year-old man developed progressive visual field loss in the inferior arcuate region of the right eye with normal central visual acuity. Intraocular pressures were normal on all but one occasion. The right optic disk showed extensive glaucomalike cupping; the left optic disk was normal. magnetic resonance imaging revealed a tumor of the right medial sphenoid wing impinging upon the intracranial portion of the right optic nerve. It was resected via a frontotemporal craniotomy. Histopathologic examination revealed a meningothelial meningioma. The visual field and optic disk cupping remained unchanged postoperatively. To our knowledge, this is the first report in which both glaucomalike cupping and visual field loss occurred as the result of a compressive lesion of the anterior visual pathway.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
10/44. glaucoma as a complication of superselective ophthalmic angiography.We report a case of glaucoma that resulted as a complication of superselective ophthalmic angiography in a 67-year-old man with a recurrent olfactory groove meningioma. Superselective angiography in the right ophthalmic artery was performed to confirm the orifice of the feeding arteries during preoperative embolization. Immediately after the fourth injection of contrast medium, the patient suffered from acute angle-closure glaucoma with elevation of intraocular pressure. Early treatment, including laser iridotomy, relieved the symptoms completely.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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