ABSTRACT
BACKGROUND: We report the efficacy and safety of surgical treatment with the orbitozygomatic transsylvian approach and the rarity of accompanying subarachnoid hemorrhage, Terson syndrome, and ruptured giant basilar tip aneurysm in a patient affected by moyamoya disease with a good outcome. METHODS: A 40-year-old man with a history of exertional headache from childhood and hypertension diagnosed 5 years previously was referred to us with the presenting symptom of headache. After 1 day, he developed left hemiplegia, decreased level of consciousness, and blindness in the left eye. Imaging studies revealed a subarachnoid hemorrhage and giant basilar tip aneurysm. He underwent surgical clipping of the aneurysm using the orbitozygomatic transsylvian approach. RESULTS: With obvious improvement in strength and consciousness, the patient was discharged. Early diagnosis and treatment of the other possible complications of moyamoya disease were recommended. CONCLUSIONS: The rarity and different manifestations of moyamoya disease require individualized decision making with regard to cerebrovascular complications. Individualized decision making and the cooperation of medical teams are the mainstays of treatment.
Subject(s)
Intracranial Aneurysm/surgery , Moyamoya Disease/surgery , Adult , Angiography, Digital Subtraction , Blindness/etiology , Cerebral Angiography , Consciousness Disorders/etiology , Headache/etiology , Hemiplegia/etiology , Humans , Intracranial Aneurysm/complications , Male , Moyamoya Disease/complications , Neurosurgical Procedures/methods , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/surgery , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The aim of this study was to investigate the feasibility and effectiveness of endoscopic neurosurgery for patients with third ventricular colloid cysts but without ventriculomegaly. METHODS: Seventy-one patients with third ventricular colloid cysts were identified and recruited to this study. Eighteen of these patients did not have concomitant hydrocephalus and underwent primary endoscopic surgery for cyst resection. The surgical technique, the success rate, and patients' outcome were assessed and compared with another 53 patients with hydrocephalus who underwent similar procedures. Our study was performed in a retrospective basis, although in middle of our work we decided to study and follow nonhydrocephalus cases prospectively. RESULTS: The ventricular compartments were successfully cannulated and gross total resection and near total resection of the colloid cysts was achieved in all patients. There were no persistent operative complications related to the endoscopic procedure. The success rate for endoscopic surgery in patients without hydrocephalus was similar to its value in patients with hydrocephalus. CONCLUSIONS: Endoscopic resection of third ventricular colloid cyst in patients without hydrocephalus seems to be feasible, effective, and not contraindicated.
Subject(s)
Colloid Cysts/surgery , Neuroendoscopy , Adolescent , Adult , Colloid Cysts/complications , Colloid Cysts/pathology , Feasibility Studies , Female , Humans , Hydrocephalus , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Acquired non-traumatic transethmoidal encephaloceles are very infrequent lesions that are generally caused by a tumor or hydrocephalus. As far as we know, there is no reported case of encephalocele after CSF diversion in the literature. We present a 25-year-old woman with hydrocephalus due to aquiductal stenosis who was treated with endoscopic third ventriculostomy. Nine months later, she had developed rhinorrhea and on imaging she had a transethmoidal encephalocele. She underwent endonasal endoscopic repair of the defect and removal of herniated parenchyma. CSF diversion to parasellar cisterns is not a known iatrogenic cause of basal encephalocele and is not noted elsewhere as a complication of third ventriculostomy. However, as third ventriculostomy is performed usually for intracranial hypertension treatment and intracranial hypertension itself is a known but rare cause of lacunar skull defect and encephalocele, this co-incidence may occur.
Subject(s)
Cerebral Aqueduct/pathology , Encephalocele/etiology , Ethmoid Sinus/pathology , Intracranial Hypertension/complications , Intracranial Hypertension/surgery , Postoperative Complications/etiology , Adult , Cerebrospinal Fluid Leak , Cerebrospinal Fluid Rhinorrhea/etiology , Constriction, Pathologic , Female , Humans , Hydrocephalus/surgery , Third Ventricle/surgery , Treatment Outcome , VentriculostomyABSTRACT
We report the safety and efficacy of bilateral foraminoplasty of Monro in a patient with partial occlusion of right Monro and complete occlusion of the left one. A 38-year-old man who underwent a ventriculoperitoneal shunt three years ago, and shunt revision surgery twice, presented with hydrocephalus, and was referred to us because of continuing complaints of headaches, nausea and vomiting. The primary surgical treatment of the patient was bilateral endoscopic Monro foraminoplasty. Then, the patient did not need a ventriculoperitoneal shunt, and hydrocephalus was resolved. Bilateral monroplasty in a single-session surgery can be the treatment of choice, instead of microsurgically open reconstruction of the foramen of Monro. The procedure can be less invasive, and it avoids ventriculoperitoneal shunting.
Subject(s)
Cerebral Ventricles/surgery , Hydrocephalus/surgery , Neuroendoscopy/methods , Postoperative Complications/surgery , Ventriculoperitoneal Shunt/methods , Adult , Humans , Male , Plastic Surgery Procedures/methods , ReoperationABSTRACT
The authors report an unusual case of intradural epidermoid tumour in a 19-year-old girl presenting with refractory complex partial seizures including auditory hallucinations, and memory dysfunction. A complete resection was carried out sparing the hippocampus resulting in seizure freedom.
