ABSTRACT
A case is reported in which a large false aneurysm and small associated fistula formed in the cavernous carotid artery as the result of laceration at the time of transsphenoidal surgery. The clinical syndrome associated with the enlarging mass and the surgical management of the lesion itself are described. The value of the midline approach to the sella is stressed, along with anatomical variants of the carotid artery.
Subject(s)
Aneurysm/etiology , Hypophysectomy/adverse effects , Ophthalmoplegia/etiology , Adenoma/surgery , Carotid Artery Injuries , Humans , Male , Middle Aged , Pituitary Neoplasms/surgery , Sphenoid BoneABSTRACT
Interhemispheric subdural hematomas are rare. Bilateral interhemispheric subdural hematomas in a patient with a ventriculoperitoneal shunt for hydrocephalus were diagnosed by computerized tomographic (CT) scan after mild head trauma. The value of CT scanning, the clinical presentation and treatment, and a review of the literature are presented.
Subject(s)
Dominance, Cerebral , Hematoma, Subdural/surgery , Adult , Cerebral Ventriculography , Cerebrospinal Fluid Shunts , Female , Hematoma, Subdural/diagnostic imaging , Humans , Hydrocephalus/diagnostic imaging , Postoperative Complications/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
A simplified technique available to most neurosurgeons is described for using computerized tomography (CT) to localize and/or biopsy intracranial lesions. Illustrative cases are presented.
Subject(s)
Brain Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Adult , Aged , Biopsy, Needle , Female , Humans , Male , Middle Aged , Tomography, X-Ray Computed/methodsABSTRACT
Occlusion of the cervical portion of the internal carotid artery (ICA) has been treated by vein graft bypass from the common carotid to the supraclinoid segment. However, this procedure has the disadvantages of requiring temporary occlusion of collateral flow, the short length of ICA available for anastomosis, and the retraction required for exposure of the supraclinoid area. In an attempt to find a more suitable bypass site for grafting, the petrous portion of 50 carotid arteries was studied in cadavers. It was found that there was a 1-cm length of the horizontal segment of the petrous carotid that could be exposed in the floor of the middle fossa lateral to the trigeminal nerve. This segment was covered by dura only or a thin layer of cartilage in approximately half of the specimens. In the remainder, there was often a thin shell of bone covering the artery, which could be drilled away. The petrous portion of the carotid artery had branches in only 38% of specimens, a Vidian branch in 30%, and a periosteal branch in 8%. The carotico-tympanic artery, previously reported to be the most common branch, was not found in a single case. These branches allow the retrograde flow needed to maintain the patency of this segment following proximal occlusions. The relationship of the carotid artery to structures include the cochlea, middle ear, Eustachian tube, tensor tympani muscle, geniculate ganglion, and facial, greater petrosal, and trigminal nerves.
Subject(s)
Carotid Artery, Internal/surgery , Microsurgery/methods , Carotid Artery, Internal/anatomy & histology , Cochlea/anatomy & histology , Ear, Middle/anatomy & histology , Eustachian Tube/anatomy & histology , Facial Nerve/anatomy & histology , Humans , Petrous Bone/surgery , Trigeminal Nerve/anatomy & histologyABSTRACT
The topographic and internal anatomy of the temporal bone is reviewed with emphasis on the relationships important to the suboccipital, middle fossa and translabyrinthine surgical approaches to the internal auditory canal. The equipment and materials needed for temporal bone dissection in the laboratory are reviewed. A stepwise method of dissection for each of the three surgical approaches to the internal acoustic meatus is outlined for both the dry and wet temporal bone.
