Surgery of Angiomas in the Brainstem With a Stress on the Presence of Telangiectasia
|
|
- Stephanie Ramsey
- 6 years ago
- Views:
Transcription
1 II-4. Spinal and Vascular Malformation Other than AVM Surgery of Angiomas in the Brainstem With a Stress on the Presence of Telangiectasia Masashi FUKUI, Toshio MATSUSHIMA, Kiyonobu IKEZAKI, Yoshihiro NATORI, Takanori INAMURA, Shinji OHARA, and Tadao KAWAMURA Department of Neurosurgery, Neurological Institute, Kyushu University Faculty of Medicine, Fukuoka Abstract This report deals with the surgery of angiomas other than arteriovenous malformation in the brainstem. The surgical cases were three cavernomas, two telangiectasias, and two venous malformations. We performed surgery when an angioma bled and the resulting hematoma was situated near the surface of the brainstem or the fourth ventricle. The cases were operated on at the subacute or chronic stages after hemorrhage. Although a magnetic resonance (MR) image showed a subacute or chronic localized hematoma with a low intensity rim, the case was not always a cavernoma, but a telangiectasia. Cavernomas could be totally removed, but telangiectasia could not. In the cases of medullary venous malformation the diagnosis was obtained radiologically, and when the hematoma was large, only hematoma evacuation was performed. In all cases the postoperative Karnofsky scores were improved or unchanged. Postoperative rebleeding in the hematoma cavity continued insidiously in a case of telangiectasia. The abnormal vessels of telangiectasia in the brainstem were preoperatively not visualized by cerebral angiography or MR imaging, but became visualized by enhanced MR imaging after evacuation of hematoma in two cases. It is stressed that an angioma with a hematoma intensity core surrounded by a low intensity rim on MR images is not always a cavernoma, but possibly is a telangiectasia. Key words: telangiectasia, cavernous hemangioma, brainstem, magnetic resonance imaging, surgery Introduction Various forms of angioma occur in the brainstem. McCormick et al.8) examined angiomas of the brainstem and found that (capillary) telangiectasia is the most common one in the pons, though it seldom presents with symptoms and signs. After introduction of magnetic resonance (MR) imaging reports on surgery of angiomas in the brainstem have increased. When MR imaging shows a mass with a core of hematoma intensity surrounded by a low intensity rim on T2-weighted image, it has generally been considered as a ruptured cavernoma. However, there were also cases of telangiectasia among the reports, though its incidence is low. We have experienced seven surgical cases of ruptured angioma in the brainstem, two of which were found to be telangiectasia. We present our surgical experience of angiomas in the brainstem with a stress on the presence of telangiectasia. Subjects and Results Table 1 shows our surgical cases of ruptured angioma other than arteriovenous malformation (AVM) in the brainstem. Out of seven angiomas three were cavernomas, two telangiectasias, and two medullary venous malformations (MVM). We performed surgery when a hematoma was situated near the surface of the brainstem or the fourth ventricle and large enough to cause compression of the surrounding neural structures. The surgical approaches were the midline suboccipital, lateral suboccipital, occipital transtentorial, and pterional or subtemporal depending upon the location of hematoma. Cavernoma could be totally removed in two out of three cases, but the abnormal vessels of telangiectasia were partially removed. In cases of MVM only hematoma removal was performed. Postoperative Karnofsky scores were improved or unchanged. Because the cases of telangiectasia seem to be of interest, two cases are described. 250 Neurol Med Chir Suppl (Tokyo) 38, 250 `254, 1998
2 Surgery of Angiomas in the Brainstem 251 Table 1 Surgical cases of angioma other than arteriovenous malformation in the brainstem (Kyushu University Hospital and affiliate hospitals ) MVM: medullary venous malfomation. Case Presentation Case 4: A 17-year-old girl noticed mild weakness of her right hand fingers followed by double vision in several days. The motor weakness of the right hand progressed to right hemiparesis in a month. She was seen at department of neurology of our hospital. Positive neurological signs were bilateral abducens nerve palsy with medial rotation of the right eye, right spastic hemiparesis with pathological reflexes. MR imaging demonstrated a hematoma in the lower pons (Fig. 1), but no definite vascular abnormalities were demonstrated by MR imaging and cerebral angiography. She had been placed under observation. Nine months after the onset she developed rebleeding in the hematoma cavity, which caused nausea, vomiting, and swallowing difficulty. She was admitted to us and surgery was performed by the midline suboccipital approach. A bluish bulging of the fourth ventricle floor was incised in the midline and a dark bloody fluid escaped with increased pressure. Hematoma in the pons was evacuated and some thin-walled vessels on the cavity wall were left be- Fig. 2 Histological section of the removed hematoma wall in Case 4 showing thin-walled vascular spaces of various sizes intervened by the neural tissue with blood pigments and infiltrated leukocytes. The diagnosis is telangiectasia. HE stain, ~50. Fig. 1 T1- and T2-weighted magnetic resonance images of Case 4 9 months before admission. A hematoma with a niveau in the cavity is seen in the lower pons. Fig. 3 T1-weighted magnetic resonance images with contrast enhancement of Case 4 6 months after surgery. Rebleeding in the hematoma cavity continued. A thread-like contrast-enhancement suggesting the persisting abnormal vessels in the pons is seen.
3 252 M. Fukui et al. hind. Histological examination of the hematoma wall showed telangiectasia with blood pigments (Fig. 2). After surgery she showed improvement of the neurological signs. However, she continued to have insidious rebleeding in the hematoma cavity (Fig. 3). In the enhanced MR images a fine threadlike enhancement, which was considered the abnormal vessels in the pons, was seen (Fig. 3 right). She did not have abnormalities in the laboratory data on platelet aggregation, plasma fibrinolysis, and antibody of autoimmune diseases. She could go to school with mild trunkal ataxia and double vision. Around 1.5 years after surgery the insidious hemorrhage in the pons began to subside. Case 5: A 61-year-old male noticed abnormal taste and mild gait disturbance 9 months before admission to us. One month before admission he noticed loss of thermal sensation in the right half of the body. He was seen at a local hospital and was found to have a hematoma in the midbrain by computed tomography and MR imaging. He was still able to walk without assistance. However, dysarthria, double vision, unsteady gait, and sensory disturbance of the right extremities occurred and MR imaging demonstrated an increase of the hematoma. He was admitted to us to undergo evacuation of the hematoma. Positive neurological signs were horizontal nystagmus on the left lateral gaze, dysarthria, dyscoordination more on the left, marked trunkal ataxia, and right hemihypesthesia including the face. The hematoma was situated on the dorsal side of the midbrain on the left (Fig. 4). MR imaging and MR angiography did not demonstrate abnormal vessels around the hematoma. Surgery was performed by the left occipital transtentorial approach. The dorsal midbrain was exposed and a bluish bulging of the midbrain on Fig. 5 upper: Histological section of Case 5 showing numerous vascular cavities of varying sizes within a well-demarcated hematoma wall. HE stain, ~25. lower: In higher magnification, the thin-walled vascular cavities are intervened by the neural tissue. HE stain, ~160. Fig. 4 T1-andT2-weighted magnetic resonance images of Case 5 before surgery (9 months after the onset). Fig. 6 Enhanced magnetic resonance images of Case 5 6 months after surgery. No hematoma is seen but a thread-like intraparenchymal enhancement suggesting the abnormal vessels around the previous hematoma cavity is seen.
4 Surgery of Angiomas in the Brainstern 253 the left was incised sagittally. Darkish fluid and old clot were evacuated. Fine vessels were traversing the hematoma. Intraoperative impression was a ruptured cavernoma and the hematoma wall was removed. The opening of the midbrain was measured to be 5 mm after hematoma removal. Histological examination of the hematoma wall demonstrated telangiectasia (Fig. 5). MR images taken 6 months after surgery did not demonstrate hemorrhage but a tortuous thread-like enhancement around the previous hematoma cavity, which were considered the persisting abnormal blood vessels (Fig. 6). He was seen 1.5 years after surgery and did not show rebleeding in the hematoma cavity. He could walk with moderate trunkal ataxia. Discussion Though telangiectasias are known to be the most frequent angiomas in the brainstem, they are usually small and asymptomatic.8,12) However, symptomatic cases of large sizes4,5,14) and symptomatic cases due to massive hemorrhage2,13) were also reported. Loboto et al.7) collected 241 reported cases of angiographically occult intracranial vascular malformations including their own and found telangiectasia in 3.8% of the cases. Mixed cases of telangiectasia with cavernoma,1.5,9,10) AVM,3) and MVM11) were also reported and the names of "mixed vascular malformation"1,10) or "cerebral capillary malformation"9) are proposed. The radiological findings of telangiectasia after hemorrhage cannot be distinguished from those of cavernoma. Both angiomas do not show abnormal vessels on angiograms. It has been said as the characteristic of cavernoma that MR images show a reticulated core of mixed intensities surrounded by a low intensity rim on T2-weighted images. The MR images of telangiectasia in our cases, however, showed the same findings. The differential diagnosis between both angiomas before surgery is, thus, not possible. At surgery the diagnosis of telangiectasia could be obtained in our former case, because abnormal vessels were observed in the neural parenchyma outside of hematoma. In our latter case, however, the surgeon could not differentiate it from a cavernoma during surgery. The organized hematoma wall around a long-standing hematoma caused the macroscopical findings to resemble a cavernoma. Postoperatively MR imaging demonstrated a thread-like enhancement around the evacuated hematoma cavity, which was considered the persisting abnormal vessels around the hematoma cavity. Postoperative visualization of the abnormal vessels in the telangiectasia was probably due to some change of the blood vessels after surgery. Though cavernomas and telangiectasias belong to a single spectrum of disease, the treatments for both angiomas are different. Cavernoma can be totally removed without serious neurological deficits, but telangiectasia cannot be totally removed. Aggressive removal of the abnormal vessels in telangiectasia may cause serious neurological deficits. Gamma knife may be the treatment of choice for a surgically inaccessible cavernoma though much higher complications than for AVM have been reported,6) but it may not an indication for telangiectasia in the brainstem. Because preoperative differentiation of both entities is difficult, intraoperative careful observation is important. We should keep in mind that the radiological examinations cannot differentiate telangiectasia from cavernoma. Acknowledgments This work was partly supported by the scientific grant of the Ministry of Education, Science, Sports, and Culture, Japan to M. F. and T. I. References 1) Awad IA, Robinson JR Jr, Mohanty S, Este ML: Mixed vascular malformations of the brain: clinical and pathogenic considerations. Neurosurgery 33: , ) Bland LI, Lapham LW, Ketonen L, Okawara S-H: Acute cerebellar hemorrhage secondary to capillary telangiectasia in an infant. A case report. Arch Neurol 51: , ) Chang SD, Steinberg GK, Rosario M, Crowley RS, Hevner RF: Mixed arteriovenous malformation and capillary telangiectasia. A rare subset of mixed vascular malformations. Case report. J Neurosurg 86: , ) Farrell DF, Forno LS: Symptomatic capillary telangiectasis of the brainstem without hemorrhage. Report of an unusual case. Neurology 20: , ) Hayashi T, Fukui M, Shojima K, Utsunomiya H, Kawasaki K: Giant cerebellar hemangioma in an infant. Childs Nerv Syst 1: , ) Karlsson B, Kihistrom L, Lindquist C, Erricson K, Steiner L: Radiosurgery for cavernous malformation. J Neurosurg 88: , ) Loboto RD, Perez C, Rivas JJ, Cordobes F: Clinical, radiological, and pathological spectrum of angiographically occult intracranial vascular malformations. Analysis of 21 cases and review of the literature. J Neurosurg 68: , ) McCormick WF, Hardman JM, Boulter TR: Vascular malformations (angiomas) of the brain with special
5 254 M. Fukui et al. reference to those occurring in the posterior fossa. J Neurosurg 28: , ) Rigamonti D, Johnson PC, Spetzler RF, Hardley MN, Drayer BP: Cavernous malformations and capillary telangiectasia: a spectrum within a single pathological entity. Neurosurgery 28: 60-64, ) Robinson JR Jr, Awad IA, Masaryk TJ, Este ML: Pathological heterogeneity of angiographically occult vascular malformations of the brain. Neurosurgery 33: , ) Roost DV, Kristof R, Wolf HK, Keller E: Intracerebral capillary telangiectasia and venous malformation: a rare association. Surg Neural 48: , ) Russell DS, Rubinstein LJ: Pathology of Tumours of the Nervous System, ed 3. London, Edward Arnold, 1971, pp ) Smith CML, Batcup G, Blasck JA, Timperley WR: An unusual brainstem capillary telangiectasis in a child. Clin Neuropathol 2: , ) Stahl SM, Johnson KP, Malamud N: The clinical and pathological spectrum of brain-stem vascular malformations. Long-term course stimulates multiple sclerosis. Arch Neurol 37: 25-29, 1980 Address reprint requests to: M. Fukui, M. D., Department of Neurosurgery, Kyushu University Faculty of Medicine, Maidashi, Higashi-ku, Fukuoka , Japan.
DIRECT SURGERY FOR INTRA-AXIAL
Kitakanto Med. J. (S1) : 23 `28, 1998 23 DIRECT SURGERY FOR INTRA-AXIAL BRAINSTEM LESIONS Kazuhiko Kyoshima, Susumu Oikawa, Shigeaki Kobayashi Department of Neurosurgery, Shinshu University School of Medicine,
More informationUncommon Symptomatic Cerebral Vascular Malformations
Uncommon Symptomatic Cerebral Vascular Malformations Mauro Bergui and Gianni Boris Bradac Summary: We describe three cases of unusual vascular malformations in which the most relevant angiographic findings
More informationVASCULAR MALFORMATIONS. Owen Samuels, MD Adam Webb, MD Emory University
VASCULAR MALFORMATIONS Owen Samuels, MD Adam Webb, MD Emory University Introduction Brain and spinal cord vascular malformations can be separated into five main categories: 1) Arteriovenous malformation,
More informationNeurosurg Focus 5 (5):Article 4, 1998
Neurosurg Focus 5 (5):Article 4, 1998 Multiple combined indirect procedure for the surgical treatment of children with moyamoya disease. A comparison with single indirect anastomosis with direct anastomosis
More informationHemorrhagic vestibular schwannoma: an unusual clinical entity Case report
Neurosurg Focus 5 (3):Article 9, 1998 Hemorrhagic vestibular schwannoma: an unusual clinical entity Case report Dean Chou, M.D., Prakash Sampath, M.D., and Henry Brem, M.D. Departments of Neurological
More informationVascular Malformations of the Brain. William A. Cox, M.D. Forensic Pathologist/Neuropathologist. September 8, 2014
Vascular Malformations of the Brain William A. Cox, M.D. Forensic Pathologist/Neuropathologist September 8, 2014 Vascular malformations of the brain are classified into four principal groups: arteriovenous
More informationRESEARCH HUMAN CLINICAL STUDIES
TOPIC RESEARCH HUMAN CLINICAL STUDIES RESEARCH HUMAN CLINICAL STUDIES Cavernous Malformation of Brainstem, Thalamus, and Basal Ganglia: A Series of 176 Patients Paritosh Pandey, MD Erick M. Westbroek,
More informationMicrosurgery for ruptured cerebellar arteriovenous malformations
European Review for Medical and Pharmacological Sciences Microsurgery for ruptured cerebellar arteriovenous malformations S.-F. GONG 1,2, X.-B. WANG 1,3, Y.-Q. LIAO 1,2, T.-P. JIANG 1,2, J.-B. HE 1,2,
More informationRadiological Appearance of Extra-axial CNS Hemangioma
Chin J Radiol 2002; 27: 183-190 183 Radiological Appearance of Extra-axial CNS Hemangioma MING-SHIANG YANG CLAYTON CHI-CHANG CHEN WEN-HSIEN CHEN HAO-CHUN HUNG SAN-KAN LEE Department of Radiology, Taichung
More informationThis article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and
This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution
More informationA mong intracranial vascular malformations the cavernous
PAPER Surgical removal of brain stem cavernous malformations: surgical indications, technical considerations, and results I E Sandalcioglu, H Wiedemayer, S Secer, S Asgari, D Stolke... See end of article
More informationNeurosurg Focus 3 (3):Clinical Pearl, 1997
Neurosurg Focus 3 (3):Clinical Pearl, 1997 De novo formation of a central nervous system cavernous malformation: implications for predicting risk of hemorrhage Case report and review of the literature
More informationDiagnosis and treatment of vascular brain-stem malformations
J Neurosurg 72:27-34, 1990 Diagnosis and treatment of vascular brain-stem malformations SHIRO KASHIWAGI, M.D., HARRY R. VAN LOVEREN, M.D., JOHN M. TEW, JR., M.D., J. GEOFFREY WIOT, M.D., STUART n. WELL,
More informationSupratentorial cerebral arteriovenous malformations : a clinical analysis
Original article: Supratentorial cerebral arteriovenous malformations : a clinical analysis Dr. Rajneesh Gour 1, Dr. S. N. Ghosh 2, Dr. Sumit Deb 3 1Dept.Of Surgery,Chirayu Medical College & Research Centre,
More informationCENTRAL NERVOUS SYSTEM TRAUMA and Subarachnoid Hemorrhage. By: Shifaa AlQa qa
CENTRAL NERVOUS SYSTEM TRAUMA and Subarachnoid Hemorrhage By: Shifaa AlQa qa Subarachnoid Hemorrhage Causes: Rupture of a saccular (berry) aneurysm Vascular malformation Trauma Hematologic disturbances
More informationNeurosurgery. Neurosurgery
Neurosurgery Neurosurgery Neurosurgery Telephone Numbers: Appointment: 202-476-3020 Fax: 202-476-3091 Administration: 202-476-3020 Evenings and Weekends: 202-476-5000 Robert Keating, MD, Chief The Division
More informationStroke School for Internists Part 1
Stroke School for Internists Part 1 November 4, 2017 Dr. Albert Jin Dr. Gurpreet Jaswal Disclosures I receive a stipend for my role as Medical Director of the Stroke Network of SEO I have no commercial
More informationDOWNLOAD PDF RADIOSURGERY FOR CAVERNOUS MALFORMATIONS IN BASAL GANGLIA, THALAMUS AND BRAINSTEM KIDA, Y
Chapter 1 : Stereotactic radiosurgery for cavernous malformations â Mayo Clinic Most of the lesions were located in the brainstem, followed by the lobar region, cerebellum, thalamus, and basal ganglia
More informationOverview of Cerebrovascular Malformations
Overview of Cerebrovascular Malformations Pursuit of Neurovascular Excellence 8 th annual Barbara Albani, MD Chief, Neurointerventional Surgery Christiana Care Health Systems Newark, DE Financial Disclosures
More informationWhat Is an Arteriovenous malformation (AVM)?
American Society of Neuroradiology What Is an Arteriovenous malformation (AVM)? From the Cerebrovascular Imaging and Intervention Committee of the American Heart Association Cardiovascular Council Randall
More informationClinical Symptoms in the Lateral Type of Hypertensive Intracerebral Hemorrhage
676 Correlation Between the Location of Hematoma and its Clinical Symptoms in the Lateral Type of Hypertensive Intracerebral Hemorrhage Observations on Pantopaque Radiography of the Hematoma Cavity in
More informationINTRACRANIAL CAVERNOMA
INTRACRANIAL CAVERNOMA PRESENTER : Dr Shameem Ahmed MODERATOR : Dr P.S. Chandra Dr G.D. Satyarthee DEPT OF NEUROSUGERY, AIIMS INTRODUCTION CEREBRAL CAVERNOUS MALFORMATION (CCM), CAVERNOUS HEMANGIOMA, CAVERNOUS
More informationChiari Malformations. Google. Objectives Seventh Annual NKY TBI Conference 3/22/13. Kerry R. Crone, M.D.
Chiari Malformations Kerry R. Crone, M.D. Professor of Neurosurgery and Pediatrics University of Cincinnati College of Medicine University of Cincinnati Medical Center Cincinnati Children s Hospital Medical
More information7 TI - Radiosurgery of angiographically occult vascular malformations. AU - Kida Y, et al.
1 TI - Cerebral arteriovenous malformation in pregnancy: presentation and neurologic, obstetric, and ethical significance. AU - Finnerty JJ, et al. SO - Am J Obstet Gynecol. 1999 Aug;181(2):296-303. Review.
More informationANALYSIS OF TREATMENT OUTCOMES WITH LINAC BASED STEREOTACTIC RADIOSURGERY IN INTRACRANIAL ARTERIOVENOUS MALFORMATIONS
ANALYSIS OF TREATMENT OUTCOMES WITH LINAC BASED STEREOTACTIC RADIOSURGERY IN INTRACRANIAL ARTERIOVENOUS MALFORMATIONS Dr. Maitri P Gandhi 1, Dr. Chandni P Shah 2 1 Junior resident, Gujarat Cancer & Research
More informationTUMOURS IN THE REGION OF FORAMEN MAGNUM
TUMOURS IN THE REGION OF FORAMEN MAGNUM Abstract Pages with reference to book, From 119 To 122 Naim-ur-Rahman ( Department of Neurosurgery, Rawalpindi Medical College, Rawalpindi. ) A very unusual case
More informationV ASCULAR malformations of the brain stem are
J Neurosurg 70:847-852, 1989 Vascular malformations of the brain stem DOUGLAS CHYATTE, M.D. Section of Neurological Surgery, Subsection of Cerebrovascular Diseases, Yale University School of Medicine,
More informationOverview of Stroke: Etiologies, Demographics, Syndromes, and Outcomes. Alex Abou-Chebl, MD, FSVIN Medical Director, Stroke Baptist Health Louisville
Overview of Stroke: Etiologies, Demographics, Syndromes, and Outcomes Alex Abou-Chebl, MD, FSVIN Medical Director, Stroke Baptist Health Louisville Disclosure Statement of Financial Interest Within the
More informationMarc Norman, Ph.D. - Do Not Use without Permission 1. Cerebrovascular Accidents. Marc Norman, Ph.D. Department of Psychiatry
Cerebrovascular Accidents Marc Norman, Ph.D. Department of Psychiatry Neuropsychiatry and Behavioral Medicine Neuropsychology Clinical Training Seminar 1 5 http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/18009.jpg
More informationVascular Malformations of the Brain: A Review of Imaging Features and Risks
Vascular Malformations of the Brain: A Review of Imaging Features and Risks Comprehensive Neuroradiology: Best Practices October 27-30, 2016 Sudhakar R. Satti, MD Associate Director Neurointerventional
More informationIndex. C Capillary telangiectasia, intracerebral hemorrhage in, 295 Carbon monoxide, formation of, in intracerebral hemorrhage, edema due to,
Neurosurg Clin N Am 13 (2002) 395 399 Index Note: Page numbers of article titles are in boldface type. A Age factors, in intracerebral hemorrhage outcome, 344 Albumin, for intracerebral hemorrhage, 336
More informationINTRACRANIAL CAVERNOMA
INTRACRANIAL CAVERNOMA INTRODUCTION CEREBRAL CAVERNOUS MALFORMATION (CCM), CAVERNOUS HEMANGIOMA, CAVERNOUS ANGIOMA, CRYPTIC VASCULAR MALFORMATION,OCCULT VASCULAR MALFORMATION, HEMORRHOID OF BRAIN. Developmental
More informationArteriovenous malformations in the basal ganglia and thalamus: management and results in 101 cases
J Neurosurg 88:285 292, 1998 Arteriovenous malformations in the basal ganglia and thalamus: management and results in 101 cases TOMIO SASAKI, M.D., PH.D., HIROKI KURITA, M.D., ISAMU SAITO, M.D., PH.D.,
More informationClinical and neuroradiological investigations do not disclose
Value of Repeat Angiography in Patients With Spontaneous Subcortical Hemorrhage Akihiko Hino, MD; Masahito Fujimoto, MD; Tarumi Yamaki, MD; Yoshihiro Iwamoto, MD; Tetsuya Katsumori, MD Background and Purpose
More information2. Subarachnoid Hemorrhage
Causes: 2. Subarachnoid Hemorrhage A. Saccular (berry) aneurysm - Is the most frequent cause of clinically significant subarachnoid hemorrhage is rupture of a saccular (berry) aneurysm. B. Vascular malformation
More informationIsolated Cranial Nerve-III Palsy Secondary to Perimesencephalic Subarachnoid Hemorrhage
Lehigh Valley Health Network LVHN Scholarly Works Department of Medicine Isolated Cranial Nerve-III Palsy Secondary to Perimesencephalic Subarachnoid Hemorrhage Hussam A. Yacoub MD Lehigh Valley Health
More informationARTERIOVENOUS MALFORMATION OR CONTUSION : A DIAGNOSTIC DILEMMA. Yong Pei Yee, Ibrahim Lutfi Shuaib, Jafri Malin Abdullah*
Malaysian Journal of Medical Sciences, Vol. 8, No. 2, July 2001 (47-51) CASE REPORT ARTERIOVENOUS MALFORMATION OR CONTUSION : A DIAGNOSTIC DILEMMA Yong Pei Yee, Ibrahim Lutfi Shuaib, Jafri Malin Abdullah*
More informationOcclusive hyperemia: a theory for the hemodynamic complications following resection of intracerebral arteriovenous malformations
J Neurosurg 78: 167-175, 1993 Occlusive hyperemia: a theory for the hemodynamic complications following resection of intracerebral arteriovenous malformations NAYEF R. F. AL-RODHAN, M.D., PH.D., THORALF
More informationNeurosurgical decision making in structural lesions causing stroke. Dr Rakesh Ranjan MS, MCh, Dip NB (Neurosurgery)
Neurosurgical decision making in structural lesions causing stroke Dr Rakesh Ranjan MS, MCh, Dip NB (Neurosurgery) Subarachnoid Hemorrhage Every year, an estimated 30,000 people in the United States experience
More informationThe outcome of treatment for arteriovenous malformations of the brain: A five-year retrospective series from the Philippines
Neurology Asia 2006; 11 : 91 96 ORIGINAL ARTICLES The outcome of treatment for arteriovenous malformations of the brain: A five-year retrospective series from the Philippines Roland Mark M GIGATARAS MD,
More informationDECISION MAKING IN AVM TREATMENT STRATEGY TREATMENT BOARD SYSTEM AT TOHOKU UNIVERSITY
Kitakanto Med. J. (S1) : 79-84, 1998 79 DECISION MAKING IN AVM TREATMENT STRATEGY TREATMENT BOARD SYSTEM AT TOHOKU UNIVERSITY Takashi Yoshimoto, Hidefumi Jokura Department of Neurosurgery, Tohoku University
More informationApplication of three-dimensional angiography in elderly patients with meningioma
Application of three-dimensional angiography in elderly patients with meningioma Poster No.: C-0123 Congress: ECR 2012 Type: Scientific Paper Authors: X. Han, J. Chen, K. Shi; Haikou/CN Keywords: Neuroradiology
More informationA LTHOUGH the first operation for brain-stem
J Neurosurg 56".222-227, 1982 Brain-stem hematoma A report of six surgically treated cases SEAN A. O'LAOIRE, M.D., F.R.C.S.I., F.R.C.S., H. ALAN CROCKARD, F.R.C.S., DAVID G. T. THOMAS, M.R.C.P., F.R.C.S.,
More informationCT Patterns in Histopathologically Complex Cavernous Hemangiomas
389 CT Patterns in Histopathologically Complex Cavernous Hemangiomas Jamshid Ahmadi1 Carol Ann Miller 2 Hervey D. Segall 1 Sun-Hyung Park 1.3 Chi-Shing Zee 1 Ronald L. Becker 4 Computed tomographic (CT)
More informationANASTAMOSIS FOR BRAIN STEM ISCHEMIA/Khodadad et al.
ANASTAMOSIS FOR BRAIN STEM ISCHEMIA/Khodadad et al. visualization of the posterior inferior cerebellar artery. The patient, now 11 months post-operative, has shown further neurological improvement since
More information/ / / / / / Hospital Abstraction: Stroke/TIA. Participant ID: Hospital Code: Multi-Ethnic Study of Atherosclerosis
Multi-Ethnic Study of Atherosclerosis Participant ID: Hospital Code: Hospital Abstraction: Stroke/TIA History and Hospital Record 1. Was the participant hospitalized as an immediate consequence of this
More informationEffect of clot removal on cerebral vasospasm TETSUJI INAGAWA, M.D., MITSUO YAMAMOTO, M.D., AND KAZUKO KAMIYA, M.D.
J Neurosurg 72:224-230, 1990 Effect of clot removal on cerebral vasospasm TETSUJI INAGAWA, M.D., MITSUO YAMAMOTO, M.D., AND KAZUKO KAMIYA, M.D. Department of Neurosurgery, Shimane Prefectural Central Hospital,
More informationCase Report Intracranial Capillary Hemangioma in the Posterior Fossa of an Adult Male
Case Reports in Radiology Volume 2016, Article ID 6434623, 4 pages http://dx.doi.org/10.1155/2016/6434623 Case Report Intracranial Capillary Hemangioma in the Posterior Fossa of an Adult Male Jordan Nepute,
More informationRadiation-Induced Cavernomas of the Brain
AJNR Am J Neuroradiol 26:1158 1162, May 2005 Case Report Radiation-Induced Cavernomas of the Brain Rajan Jain, Patricia L. Robertson, Dheeraj Gandhi, Sachin K. Gujar, Karin M. Muraszko, and Stephen Gebarski
More informationPontine haemorrhage: a clinical analysis of 26 cases
Journal of Neurology, Neurosurgery, and Psychiatry 1985;48:658-662 Pontine haemorrhage: a clinical analysis of 26 cases SHOJI MASIYAMA, HIROSHI NIIZUMA, JIRO SUZUKI From the Division ofneurosurgery, Institute
More informationVascular malformations: Venous malformations anomalous veins drain normal brain tissue for 65% of all cases 2.5%. was 0, 3% per year
Vascular malformations: 1. Venous malformations: congenital venous anomalies pathologically characterised by anomalous veins (thickened and hyalinised walls) separated by normal brain. These anatomically
More informationExternal carotid blood supply to acoustic neurinomas
External carotid blood supply to acoustic neurinomas Report of two cases HARVEY L. LEVINE, M.D., ERNEST J. FERmS, M.D., AND EDWARD L. SPATZ, M.D. Departments of Radiology, Neurology, and Neurosurgery,
More informationHistologically Classified Venous Angiomas of the Brain: a Controversy
Neurol Med Chir (Tokyo) 43, 1 11, 2003 Histologically Classified Venous Angiomas of the Brain: a Controversy Masamitsu ABE, NaoshiHAGIHARA, KazuoTABUCHI, AkiraUCHINO*, and Yoshio MIYASAKA** Departments
More informationCavernous Malformations at Optic Apparatus: Three Cases
Journal of Cerebrovascular and Endovascular Neurosurgery pissn 2234-8565, eissn 2287-3139, https//doi.org/10.7461/jcen.2018.20.3.176 Case Report Cavernous Malformations at Optic Apparatus: Three Cases
More informationGeneral Data. Gender: Female Birthday and age: 1932/11/03, 73 y/o Occupation: house keeper Date of Admission: 2005/03/30
General Data Gender: Female Birthday and age: 1932/11/03, 73 y/o Occupation: house keeper Date of Admission: 2005/03/30 Chief Complain Dizziness and light headache for recent 1 year. Present illness Hypertension
More informationBrain AVM with Accompanying Venous Aneurysm with Intracerebral and Intraventricular Hemorrhage
Cronicon OPEN ACCESS EC PAEDIATRICS Case Report Brain AVM with Accompanying Venous Aneurysm with Intracerebral and Intraventricular Hemorrhage Dimitrios Panagopoulos* Neurosurgical Department, University
More informationPrinciples Arteries & Veins of the CNS LO14
Principles Arteries & Veins of the CNS LO14 14. Identify (on cadaver specimens, models and diagrams) and name the principal arteries and veins of the CNS: Why is it important to understand blood supply
More informationVascular Malformations
Vascular Malformations LTC Robert Shih Chief of Neuroradiology Walter Reed Medical Center Special thanks to LTC Alice Smith (retired) Disclosures: None. This presentation reflects the personal views of
More informationThe dura is sensitive to stretching, which produces the sensation of headache.
Dural Nerve Supply Branches of the trigeminal, vagus, and first three cervical nerves and branches from the sympathetic system pass to the dura. Numerous sensory endings are in the dura. The dura is sensitive
More informationYear 2003 Paper two: Questions supplied by Tricia
question 43 A 42-year-old man presents with a two-year history of increasing right facial numbness. He has a history of intermittent unsteadiness, mild hearing loss and vertigo but has otherwise been well.
More informationMicrosurgical Resection of Incompletely Obliterated Intracranial Arteriovenous Malformations Following Stereotactic Radiosurgery
II-2. Selection of Treatment Microsurgical Resection of Incompletely Obliterated Intracranial Arteriovenous Malformations Following Stereotactic Radiosurgery Steven D. CHANG*, Gary K. STEINBERG*, Richard
More informationSpontaneous occlusion of a cerebral arteriovenous malformation after subtotal endovascular embolisation
206 Chiriac et al Spontaneous occlusion of a cerebral arteriovenous malformation Spontaneous occlusion of a cerebral arteriovenous malformation after subtotal endovascular embolisation A. Chiriac, N. Dobrin*,
More informationMoyamoya Syndrome with contra lateral DACA aneurysm: First Case report with review of literature
Romanian Neurosurgery Volume XXXI Number 3 2017 July-September Article Moyamoya Syndrome with contra lateral DACA aneurysm: First Case report with review of literature Ashish Kumar Dwivedi, Pradeep Kumar,
More informationSURGICAL TREATMENT OF SPINAL ARTERIOVENOUS MALFORMATIONS: VASCULAR ANATOMY AND SURGICAL OUTCOME
Spinal Arteriovenous Malformations SURGICAL TREATMENT OF SPINAL ARTERIOVENOUS MALFORMATIONS: VASCULAR ANATOMY AND SURGICAL OUTCOME Po-An Tai, Yong-Kwang Tu, and Hon-Man Liu 1 Background and purpose: Spinal
More informationLong term neuroimaging and clinical outcome of brain Arteriovenous Malformations (bavm) treated with stereotactic radiosurgery (SRS).
Long term neuroimaging and clinical outcome of brain Arteriovenous Malformations (bavm) treated with stereotactic radiosurgery (SRS). Poster No.: C-2489 Congress: ECR 2012 Type: Scientific Exhibit Authors:
More informationIdentifying Cerebrovascular Disorders. Wengui Yu, MD, PhD Department of Neurology, University of California, Irvine
Identifying Cerebrovascular Disorders Wengui Yu, MD, PhD Department of Neurology, University of California, Irvine Objectives Review different types of cerebrovascular disorders. Briefly discuss etiology,
More informationCerebral Aneurysms. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service National Institutes of Health
Cerebral Aneurysms U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service National Institutes of Health Cerebral Aneurysms What is a cerebral aneurysm? cerebral aneurysm (also known as an
More informationBrain Arteriovenous Malformations Endovascular Therapy and Associated Therapeutic Protocols Jorge Guedes Cabral de Campos
Endovascular Therapy and Associated Therapeutic Protocols Jorge Guedes Cabral de Campos Neuroradiology Department Hospital de Santa Maria University of Lisbon CEREBRAL AVM CLINICAL / EPIDEMIOLOGY Brain
More informationPre-surgical planning for brain tumor resection using functional MRI
June 2011 Divya S Bolar, HMSIV Pre-surgical planning for brain tumor resection using functional MRI Divya S. Bolar,, HMS IV 1 Our patient: clinical history 85-year year-old right-handed handed woman presents
More informationOriginal Article CT grouping and microsurgical treatment strategies of hypertensive cerebellar hemorrhage
Int J Clin Exp Med 2016;9(8):15921-15927 www.ijcem.com /ISSN:1940-5901/IJCEM0022273 Original Article CT grouping and microsurgical treatment strategies of hypertensive cerebellar hemorrhage Xielin Tang
More informationConcomitant Traumatic Spinal Subdural Hematoma and Hemorrhage from Intracranial Arachnoid Cyst Following Minor Injury
Chin J Radiol 2005; 30: 173-177 173 Concomitant Traumatic Spinal Subdural Hematoma and Hemorrhage from Intracranial Arachnoid Cyst Following Minor Injury HUI-YI CHEN 1 YING-SHYUAN LI 1 CHUNG-HO CHEN 1
More informationInside Your Patient s Brain Michelle Peterson, APRN, CNP Centracare Stroke and Vascular Neurology
Inside Your Patient s Brain Michelle Peterson, APRN, CNP Centracare Stroke and Vascular Neurology Activity Everyone stand up, raise your right hand, tell your neighbors your name 1 What part of the brain
More informationDiffuse Proliferative Cerebral Angiopathy: A case report and review of the literature
Diffuse Proliferative Cerebral Angiopathy: A case report and review of the literature Rohit 1*, Poh Sun Goh 1 1. Department of Radiology, National University hospital, Singapore * Correspondence: Dr. Rohit,
More informationSWISS SOCIETY OF NEONATOLOGY. Severe apnea and bradycardia in a term infant
SWISS SOCIETY OF NEONATOLOGY Severe apnea and bradycardia in a term infant October 2014 2 Walker JH, Arlettaz Mieth R, Däster C, Division of Neonatology, University Hospital Zurich, Switzerland Swiss Society
More informationIntra-Fourth Ventricular Schwannoma With Obstructive Hydrocephalus A Rare Case Report
ISPUB.COM The Internet Journal of Neurosurgery Volume 7 Number 1 Intra-Fourth Ventricular Schwannoma With Obstructive Hydrocephalus A Rare Case Report A Babbu, R Katheerayson Citation A Babbu, R Katheerayson..
More informationCase Report Atypical Presentation of Atypical Teratoid Rhabdoid Tumor in a Child
Case Reports in Oncological Medicine Volume 2013, Article ID 815923, 4 pages http://dx.doi.org/10.1155/2013/815923 Case Report Atypical Presentation of Atypical Teratoid Rhabdoid Tumor in a Child Y. T.
More informationDural Arteriovenous Fistula of the Cavernous Sinus Presenting with Progressive Venous Congestion of the Pons and Cerebrum: Report of one case
Dural Arteriovenous Fistula of the Cavernous Sinus Presenting with Progressive Venous Congestion of the Pons and Cerebrum: Report of one case Soo-Bin Yim, M.D., Jong-Sung Kim, M.D., Yang Kwon,M.D.*, Choong-Gon
More informationThe MRI appearance of cavernous malformations (angiomas)
J Neurosnrg 67:518-524, 1987 The MRI appearance of cavernous malformations (angiomas) DANIELE RIGAMONTI, M.D., BURTON P. DRAYEI~ M.D., PETER C. JOHNSON, M.D., MARK N. HADLEY, M.D., JOSEPH ZABRAMSKI, M.D.,
More informationApproach to a Neurologic Diagnosis
Approach to a Neurologic Diagnosis Neurologic Diagnosis History Physical & Neurological Examination Ancillary Procedures 3 Questions Asked Focal neurologic deficits Increased intracranial pressure Signs
More informationNEURO IMAGING 2. Dr. Said Huwaijah Chairman of radiology Dep, Damascus Univercity
NEURO IMAGING 2 Dr. Said Huwaijah Chairman of radiology Dep, Damascus Univercity I. EPIDURAL HEMATOMA (EDH) LOCATION Seventy to seventy-five percent occur in temporoparietal region. CAUSE Most likely caused
More informationT HIS presentation is a study of a consecutive series of 316 penetrating
INTRACRANIAL HEMATOMAS ASSOCIATED WITH PENETRATING WOUNDS OF THE BRAIN* JOSEPH C. BARNETT, M.D.,t AND ARNOLD M. MEIROWSKY, M.D.:~ (Received for publication September 29, 1954) T HIS presentation is a study
More informationBrain capillary telangiectasia (BCT) is a rare vascular. Symptomatic large or giant capillary telangiectasias: management and outcome in 5 cases
case report J Neurosurg 125:160 166, 2016 Symptomatic large or giant capillary telangiectasias: management and outcome in 5 cases *Tao Yu, MD, 1 Xingwen Sun, MD, 1 Yan You, MD, 2 Jie Chen, MD, 2 Jun-mei
More informationNeurosurgical Management of Stroke
Overview Hemorrhagic Stroke Ischemic Stroke Aneurysmal Subarachnoid hemorrhage Neurosurgical Management of Stroke Jesse Liu, MD Instructor, Neurological Surgery Initial management In hospital management
More informationVascular Malformations of the Central Nervous System: Case Studies
NEUROLOGY BOARD REVIEW MANUAL PUBLISHING STAFF PRESIDENT, PUBLISHER Bruce M.White EXECUTIVE EDITOR Debra Dreger SENIOR EDITOR Miranda J. Hughes, PhD ASSISTANT EDITOR Melissa Frederick EDITORIAL ASSISTANT
More informationCryptogenic Enlargement Of Bilateral Superior Ophthalmic Veins
ISPUB.COM The Internet Journal of Radiology Volume 18 Number 1 Cryptogenic Enlargement Of Bilateral Superior Ophthalmic Veins K Kragha Citation K Kragha. Cryptogenic Enlargement Of Bilateral Superior Ophthalmic
More informationBilateral Carotid and Vertebral Rete Mirabile Presenting with Subarachnoid Hemorrhage Caused by the Rupture of Spinal Artery Aneurysm
Tohoku J. Exp. Med., 2013, 230, 205-209 Carotid and Vertebral Rete Mirabile Presenting with SAH 205 Bilateral Carotid and Vertebral Rete Mirabile Presenting with Subarachnoid Hemorrhage Caused by the Rupture
More informationCNS pathology Third year medical students. Dr Heyam Awad 2018 Lecture 7: Non traumatic brain haemorrhage
CNS pathology Third year medical students Dr Heyam Awad 2018 Lecture 7: Non traumatic brain haemorrhage ILOS To list the causes of intracranial haemorrhage. To understand the pathogenesis of each cause.
More informationMethods. Treatment options for intracranial arteriovenous malformations
AJNR Am J Neuroradiol 25:1139 1143, August 2004 Complete Obliteration of Intracranial Arteriovenous Malformation with Endovascular Cyanoacrylate Embolization: Initial Success and Rate of Permanent Cure
More informationVascular Pattern in Tumours
Acta Radiologica ISSN: 0001-6926 (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/iaro20 Vascular Pattern in Tumours To cite this article: (1957) Vascular Pattern in Tumours, Acta Radiologica,
More informationDelayed Radiation Necrosis With Extensive Brain Edema After Gamma Knife Radiosurgery for Multiple Cerebral Cavernous Malformations
Neurol Med Chir (Tokyo) 43, 391 395, 2003 Delayed Radiation Necrosis With Extensive Brain Edema After Gamma Knife Radiosurgery for Multiple Cerebral Cavernous Malformations Case Report Nobuo TAKENAKA,
More informationCerebrovascular Malformations in the Elderly Indications for Treatment
Cerebrovascular Malformations in the Elderly Indications for Treatment Johanna T. Fifi, MD, FAHA, FSVIN Director of Endovascular Ischemic Stroke Assistant Professor of Neurology, Neurosurgery, and Radiology
More informationFifteen-minute consultation: incidental findings on brain and spine imaging
BEST PRACTICE Editor s choice Scan to access more free content Department of Neurosurgery, Birmingham Children s Hospital, Birmingham, UK Correspondence to Chirag Patel, Department of Neurosurgery, Birmingham
More informationRecombinant Factor VIIa for Intracerebral Hemorrhage
Recombinant Factor VIIa for Intracerebral Hemorrhage January 24, 2006 Justin Lee Pharmacy Resident University Health Network Outline 1. Introduction to patient case 2. Overview of intracerebral hemorrhage
More informationClassical CNS Disease Patterns
Classical CNS Disease Patterns Inflammatory Traumatic In response to the trauma of having his head bashed in GM would have experienced some of these features. NOT TWO LITTLE PEENY WEENY I CM LACERATIONS.
More informationMoyamoya disease in the midwestern United States
Neurosurg Focus 5 (5):Article 1, 1998 Moyamoya disease in the midwestern United States Nicholas M. Wetjen, B.S., P. Charles Garell, M.D., Nicholas V. Stence, and Christopher M. Loftus, M.D. Division of
More informationRebleeding and Outcome in Patients with Symptomatic Brain Stem Cavernomas
Original Paper Received: September 5, 2016 Accepted: February 8, 2017 Published online: March 21, 2017 Rebleeding and Outcome in Patients with Symptomatic Brain Stem Cavernomas Antonio Arauz a Hernán M.
More informationIntracranial spontaneous hemorrhage mechanisms, imaging and management
Intracranial spontaneous hemorrhage mechanisms, imaging and management Dora Zlatareva Department of Diagnostic Imaging Medical University, Sofia, Bulgaria Intracranial hemorrhage (ICH) ICH 15% of strokes
More informationPRIMARY DISEASES OF MYELIN
PRIMARY DISEASES OF MYELIN Acquired forms - Characterized by preferential damage to previously normal myelin with relative preservation of axons and include: 1. Immune-mediated injury, such as multiple
More informationEndosaccular aneurysm occlusion with Guglielmi detachable coils for obstructive hydrocephalus caused by a large basilar tip aneurysm Case report
Neurosurg Focus 7 (4):Article 5, 1999 Endosaccular aneurysm occlusion with Guglielmi detachable coils for obstructive hydrocephalus caused by a large basilar tip aneurysm Case report Akira Watanabe, M.D.,
More informationAnatomy Lab (1) Theoretical Part. Page (2 A) Page (2B)
Anatomy Lab (1) This sheet only includes the extra notes for the lab handout regarding the theoretical part, as for the practical part it includes everything the doctor mentioned. Theoretical Part Page
More information