RESUMEN
Dural arteriovenous malformations may be congenital, but most dural arteriovenous malformations are acquired lesions. The acquired dural arteriovenous malformations are rarely associated with brain tumors. We describe a case of dural arteriovenous malformation at the non-dominant transverse-sigmoid sinus associated with a convexity meningioma on the same side. The lesion was spontaneously disappeared after removal of the meningioma, even though the dural arteriovenous malformation was not manipulated. The authors describe a possible pathophysiology of dural arteriovenous malformations associated with tumors at the remote area and spontaneous closure after tumor resection.
Asunto(s)
Malformaciones Arteriovenosas , Neoplasias Encefálicas , Meningioma , Trombosis de los Senos IntracranealesRESUMEN
Embolization of a carotid cavernous fistula(CCF) by means of a detachable balloon is a well-established method for treating CCFs while preserving a patent parent internal carotid artery(ICA). However, failure to embolize the CCF may occur on a few occasions. Herein we describe a stent-assisted Guglielmi detachable coil embolization that completely occludes the fistulous opening rather than fills the cavernous sinus. By applying this technique, we successfully treated a CCF, without compromise of the parent ICA in patients who has failed with balloon technique previously.
Asunto(s)
Humanos , Seno Cavernoso , Embolización Terapéutica , Fístula , Padres , StentsRESUMEN
Pulsatile tinnitus is a rarely occurring symptom of vascular origin. Most frequently, the symptoms are due to an arteriovenous malformation, to a tumor of the jugular glomus or to a local arterial stenosis. A 39-yr-old Korean male suffering from pulsatile tinnitus of the left ear was diagnosed to have dural arteriovenous malformation of the jugular bulb. Magnetic resonance imaging and angiography revealed a high-velocity vascular lesion encroaching the internal jugular vein and sigmoid sinuses. Digital subtraction angiography demonstrated a dural arteriovenous malformation involving the jugular bulb. The arterial supply was from the neuromeningeal branch of the left ascending pharyngeal artery and inferior tympanic artery. Stenosis of the left jugular vein caused retrograde venous drainage through the contralateral transverse sinus. Superselective embolization of these feeding arteries was successfully performed using 25% mixture of N-butylcyanoacrylate and lipiodol. In postembolization period, his complaints of pulsatile tinnitus and buzzing noise behind his left ear disappeared.
Asunto(s)
Adulto , Humanos , Masculino , Embolización Terapéutica , Malformaciones Arteriovenosas Intracraneales/terapia , Venas Yugulares/anomalías , Acúfeno/etiologíaRESUMEN
OBJECTIVE: The purpose of this non-randomized prospective study was to evaluate the safety and efficacy of continuous intravenous nalbuphine-ketorolac-droperidol(CIA) versus continuous infusion of epidural morphine-bupivacaine(CEA) for pain control after lumbar spinal surgery. METHODS: Twenty-one patients who underwent spine surgery including laminectomy, fusion with fixation were assigned to receive an intravenous bolus of nalbuphine 5mg and ketorolac 15mg, followed by a continuous infusion of nalbuphine 25mg, ketorolac 105mg, and droperidol 5mg mixed with normal saline 98cc(2cc/hr). Twenty patients received a bolus infusion of morphine 2mg and 0.125% bupivacaine 8cc followed by a continuous intravenous infusion of 100cc 0.125% bupivacaine and morphine sulfate 8.0mg(2cc/hr). Pain score was measured on a visual analogue scale(VAS). It's safety and efficacies were compared with the results of continuous infusion of epidural morphine-bupivacaine, which was reported previously by same authors. A continuous infuser was used to give epidural morphine-bupivacaine and intravenous nalbuphine-ketorolac-droperidol. RESULTS: In general, mild pain, pain less than 3 VAS scores, was observed postoperatively from 30minutes to 72hours in CEA group, and from 6 hours to 72 hours in CIA group. The early postoperative pain was controlled easily in 6 hours in CEA group, compared to CIA group(p<0.05). However, there was no statistical significance in 72 hours on pain scores between CEA and CIA groups after 6-12hours of pain managements. Pruritus, nausea and vomiting, and urinary retention were more frequent in CEA group. CONCLUSION: CIA and CEA are considered effective methods in postoperative pain managements. However, adequate doses in early intravenous infusion and continuous intravenous analgesia with nalbuphine-ketorolac-droperidol will be needed for better control in early postoperative pain with less side effects.
Asunto(s)
Humanos , Analgesia , Analgesia Epidural , Anestesia Epidural , Anestesia Intravenosa , Bupivacaína , Droperidol , Infusiones Intravenosas , Ketorolaco , Laminectomía , Morfina , Nalbufina , Náusea , Manejo del Dolor , Dolor Postoperatorio , Estudios Prospectivos , Prurito , Columna Vertebral , Retención Urinaria , VómitosRESUMEN
Conus medullaris hemangioblastoma is very rare. We report a hemangioblastoma which was removed after embolization in conus medullaris. It was associated with syringomyelia from cervical cord to conus medullaris. There was no manifestation of von Hippel-Lindau disease. The literature on conus medullaris hemangioblastoma is reviewed and the mechanism of the syringomyelia associated with the hemangioblastoma is discussed.
Asunto(s)
Caracol Conus , Hemangioblastoma , Siringomielia , Enfermedad de von Hippel-LindauRESUMEN
Fracture of the occipital condyle is rare. We report the case of a patient with this fracture who presented with negative plain films and delayed hypoglossal nerve palsy. Diagnosis was estabilished with high resolution computed tomography. In a trauma patient with neck or occipital pain, with or without cranial nerve palsy, this fracture should be considered, even if a plain radiograph is negative.
Asunto(s)
Humanos , Enfermedades de los Nervios Craneales , Diagnóstico , Enfermedades del Nervio Hipogloso , Nervio Hipogloso , CuelloRESUMEN
The authors report a case of thoracic disc herniation at T11/12 level which was downward migrated, presenting with signs of progressive spinal cord compression. The lesion was diagnosed by MRI. The operation was done by transthoracic transpleural approach using surgical microscope and the rib was not resected due to floating ribs of T11, 12. A Carbon cage with cancellous bones were used for the graft at the partial corpectomy site. The result of operation was good.
Asunto(s)
Carbono , Imagen por Resonancia Magnética , Costillas , Compresión de la Médula Espinal , TrasplantesRESUMEN
We present a case of Brown-Sequard syndrome due to a massive cervical disc herniation at C5/6 level, presenting sings of sudden and severe spinal cord compression. The lesion was diagnosed by MRI and herniated cervical disc was removed under the surgical microscope via anterior route. The result of operation was good. A brief review of the literature is given.