Subject(s)
Neurosurgical Procedures/standards , Platelet Aggregation Inhibitors , Platelet Function Tests/standards , Practice Guidelines as Topic/standards , Stents/standards , Humans , Neurosurgical Procedures/adverse effects , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/pharmacology , Platelet Aggregation Inhibitors/standards , Stents/adverse effectsABSTRACT
BACKGROUND AND OBJECT: Complex intracranial aneurysms present a treatment challenge for both open and endovascular modalities of treatment. This report seeks to illustrate a series of patients with aneurysms treated with telescoping stents as a method of flow diversion for small and fusiform intracranial aneurysms. MATERIAL AND METHODS: A retrospective evaluation of six patients treated with a telescoping stent technique utilizing available stents (at that time before the pipeline era) for complex cerebral aneurysms between January 2009 and January 2010 was performed. Five patients had dissecting aneurysms and one patient had a small superior hypophyseal artery aneurysm. One of the patients was treated in the setting of a Hunt and Hess grade IV subarachnoid hemorrhage. Follow-up cerebral angiography was performed postprocedure at 6 months. RESULTS: At a mean follow-up period of 9 months, all the patients experienced complete or near-complete occlusion (>95%). No periprocedural complications were noted in this series. No episodes of hemorrhage or thromboembolic complications occurred. CONCLUSIONS: Overlapping Neuroform and Enterprise stents may induce complete thrombosis of intracranial aneurysms and facilitate parent artery remodeling. The use of self-expanding stents is still an adequate treatment modality, especially if there is a need for vessel wall stabilization rather than flow diversion. The technique is also a sufficient alternative in small intracranial aneurysms not readily amenable to open surgical treatment or traditional endovascular coil embolization.
Subject(s)
Endovascular Procedures/instrumentation , Endovascular Procedures/methods , Intracranial Aneurysm/surgery , Neurosurgical Procedures/instrumentation , Neurosurgical Procedures/methods , Stents , Adult , Aged , Blood Vessel Prosthesis , Cerebral Angiography , Endovascular Procedures/adverse effects , Female , Follow-Up Studies , Humans , Incidence , Intracranial Aneurysm/diagnostic imaging , Middle Aged , Neurosurgical Procedures/adverse effects , Retrospective Studies , Subarachnoid Hemorrhage/epidemiology , Thromboembolism/epidemiology , Treatment Outcome , Young AdultABSTRACT
OBJECTIVES: To present a case of subacute infratemporal fossa cellulitis with subsequent abscess formation to show important anatomic relationships as they effect presentation and treatment of infections in this area. STUDY DESIGN: Case report and brief literature review. METHODS: The case of an immunocompromised patient who developed subacute infratemporal fossa cellulitis with subsequent abscess formation is presented. A literature review discusses etiology, diagnosis, and treatment of these infections. RESULTS: Careful history and physical examination revealed unilateral facial pain, swelling, and trismus to be caused by an infratemporal fossa abscess. Intraoral drainage and intravenous antibiotic therapy led to resolution of the infection. CONCLUSION: Infratemporal fossa abscesses are potentially dangerous complications of odontogenic infections. Although clinical diagnosis may be difficult, knowledge of relevant anatomy and pathways of spread allow more effective diagnosis and treatment of these infections.
Subject(s)
Abscess/etiology , Cellulitis/complications , Immunocompromised Host , Nasopharyngeal Diseases/etiology , Temporomandibular Joint Disorders/etiology , Abscess/therapy , Adult , Cellulitis/diagnosis , Cellulitis/etiology , Cellulitis/therapy , Diabetes Mellitus, Type 1/complications , Female , Humans , Kidney Failure, Chronic/complications , Nasopharyngeal Diseases/therapy , Nasopharynx , Temporomandibular Joint , Temporomandibular Joint Disorders/therapy , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE AND IMPORTANCE: We describe the first reported use of temporary balloon occlusion of the cavernous internal carotid artery for controlled removal of a foreign object from the cavernous sinus. This endovascular approach may be an alternative to craniotomy in highly selected cases. CLINICAL PRESENTATION: A 34-year-old incarcerated male attempted suicide by stabbing the earpiece of his glasses through his right orbit into the intracranial compartment. He presented with complete ophthalmoplegia. The earpiece traversed the cavernous sinus, penetrating its posterior wall to enter the perimesencephalic cistern and cerebellum. Angiography demonstrated a small direct carotid-cavernous fistula. INTERVENTION: Removal of the foreign body was performed under general anesthesia in the angiography suite with the operating room on standby. Nondetachable and detachable balloons were inflated in the cavernous carotid artery to provide vascular control while the foreign body was withdrawn from the cranium at the orbit. Follow-up angiographic runs with the balloons deflated revealed minimal arteriovenous shunting, which disappeared on subsequent studies. The balloons were removed. The patient remained neurologically stable with his baseline right ophthalmoplegia and V1-V2 hemianesthesia. At the 6-week follow-up, the patient remained clinically stable with no evidence of carotid-cavernous fistula or interval abscess formation. CONCLUSION: Endovascular temporary balloon occlusion of the cavernous carotid artery provides immediate control of the vessel (with an option of permanent carotid sacrifice), allowing removal of a foreign body without craniotomy in appropriate cases.
