ABSTRACT
BACKGROUND: Normal perfusion pressure breakthrough (NPPB) phenomenon is a major life-threatening complication that restricts the treatment of complex intracranial arteriovenous malformations. The aim of the study it to develop a rat model mimicking NPPB phenomenon that enables the evaluation of any therapy to prevent such complication. METHODS: Twenty Wistar male rats were randomly assigned to either a study or a control group. Study animals underwent an end-to-side left external jugular vein-common carotid artery anastomosis and ligation of bilateral external carotid arteries. Control animals only underwent ligation of bilateral external carotid arteries. All animals were sacrificed sixty days after the procedure. Hemodynamic parameters [mean arterial pressure (MAP), intracranial pressure (ICP) and cerebral perfusion pressure (CPP)], blood-brain barrier (BBB) permeability (measured by fluorescein staining) and histological features were then compared between both groups. RESULTS: A significant decrease in MAP and CPP was confirmed in the study group. An increase in ICP was also observed. A significant decrease in MAP and CPP was also present in the study group when comparing preoperative values with those recorded on days 0 (postoperative), 7 and 60. Fluorescein staining findings were consistent with signs of BBB disruption in study animals. Histological analysis demonstrated an increased number of pyknotic neurons in the ipsilateral hemisphere of rat brains included in the study group. CONCLUSION: These results confirm that this model mimics a vascular steal state with chronic cerebral hypoperfusion comparable to patients with AVMs behavior and disruption of the BBB after fistula closure comparable to NPPB phenomenon disorders
INTRODUCCIÓN: El síndrome de restablecimiento de la presión de perfusión cerebral (PPC) normal es una complicación grave, que supone un riesgo vital y limita el tratamiento de malformaciones arteriovenosas complejas. El objetivo de este estudio es desarrollar un modelo animal remedando dicho síndrome que permita evaluar terapias para su prevención. MÉTODOS: Veinte ratas macho Wistar fueron asignadas aleatoriamente a un grupo estudio o control. Los animales de estudio se sometieron a una anastomosis término-lateral entre la vena yugular externa y la arteria carótida común izquierdas y ligadura bilateral de las arterias carótidas externas. Los animales control se sometieron a la ligadura bilateral de las arterias carótidas externas. Todos los animales se sacrificaron 60 días después. Se compararon parámetros hemodinámicos (presión arterial media [PAM], presión intracraneal [PIC] y PPC), permeabilidad de la barrera hemato-encefálica (BHE) y características histológicas entre ambos grupos. RESULTADOS: El grupo estudio mostró un descenso significativo de la PAM y la PPC, así como un aumento de la PIC respecto al grupo control. Al comparar los valores preoperatorios con aquéllos registrados los días 0 (postoperatorio), 7 y 60 en el grupo estudio, también se confirmó un descenso significativo de la PAM y la PPC. La disrupción de la BHE fue constatada únicamente en el grupo estudio mediante la extravasación de fluoresceína sódica. El análisis histológico demostró mayor número de neuronas picnóticas en el hemisferio ipsilateral a la anastomosis de los animales estudio. CONCLUSIÓN: Los resultados descritos apuntan a un modelo que remeda el estado de robo vascular con hipoperfusión cerebral crónica comparable al que sufren los pacientes con malformaciones arteriovenosas, así como la disrupción de la BHE tras el cierre de la anastomosis, comparable al acontecido en el síndrome de restablecimiento de la PPC normal tras la exclusión de la malformación
Subject(s)
Animals , Male , Rats , Intracranial Arteriovenous Malformations/therapy , Intracranial Pressure , Models, Animal , Intracranial Arteriovenous Malformations/veterinary , Rats, Wistar , Arteriovenous Anastomosis , Ligation/veterinary , Hemodynamic Monitoring/veterinaryABSTRACT
BACKGROUND: Normal perfusion pressure breakthrough (NPPB) phenomenon is a major life-threatening complication that restricts the treatment of complex intracranial arteriovenous malformations. The aim of the study it to develop a rat model mimicking NPPB phenomenon that enables the evaluation of any therapy to prevent such complication. METHODS: Twenty Wistar male rats were randomly assigned to either a study or a control group. Study animals underwent an end-to-side left external jugular vein-common carotid artery anastomosis and ligation of bilateral external carotid arteries. Control animals only underwent ligation of bilateral external carotid arteries. All animals were sacrificed sixty days after the procedure. Hemodynamic parameters [mean arterial pressure (MAP), intracranial pressure (ICP) and cerebral perfusion pressure (CPP)], blood-brain barrier (BBB) permeability (measured by fluorescein staining) and histological features were then compared between both groups. RESULTS: A significant decrease in MAP and CPP was confirmed in the study group. An increase in ICP was also observed. A significant decrease in MAP and CPP was also present in the study group when comparing preoperative values with those recorded on days 0 (postoperative), 7 and 60. Fluorescein staining findings were consistent with signs of BBB disruption in study animals. Histological analysis demonstrated an increased number of pyknotic neurons in the ipsilateral hemisphere of rat brains included in the study group. CONCLUSION: These results confirm that this model mimics a vascular steal state with chronic cerebral hypoperfusion comparable to patients with AVMs behavior and disruption of the BBB after fistula closure comparable to NPPB phenomenon disorders.
Subject(s)
Brain Ischemia , Animals , Brain Ischemia/etiology , Cerebrovascular Circulation , Humans , Intracranial Pressure , Male , Perfusion , Rats , Rats, Wistar , ReperfusionABSTRACT
BACKGROUND: We present the case of a 51-year-old male with an occult transorbital intracranial injury after a car accident. The identified foreign object was a windshield wiper handle. To our knowledge, this is the first case reported. CASE DESCRIPTION: Multidisciplinary treatment with maxillofacial and otorhinolaryngology departments was planned. A bifrontal craniotomy with removal of the foreign object and posterior orbital reconstruction were performed. A review of the literature was done, in order to highlight certain general principles in decision making despite the variability in case presentation. CONCLUSIONS: Occult TII is a rare subtype of penetrating brain injury. Diagnosis requires high suspicion as it can be missed during physical examination. Computed tomography (CT) scan, CT angiogram, and magnetic resonance imaging should be performed in order to design the optimal treatment for each patient. Magnetic resonance imaging should be avoided when metallic density on CT is observed. The use of a broad-spectrum antibiotic regimen is critical.
Subject(s)
Foreign Bodies/diagnostic imaging , Foreign Bodies/surgery , Head Injuries, Penetrating/diagnostic imaging , Head Injuries, Penetrating/surgery , Orbit/injuries , Accidents, Traffic , Foreign Bodies/etiology , Head Injuries, Penetrating/etiology , Humans , Male , Middle Aged , Neurosurgical Procedures/methods , Orbit/diagnostic imaging , Orbit/surgery , Treatment OutcomeABSTRACT
We present the case of a 57-year-old male who presented with progressive right side vision loss whose workup revealed a large suprasellar lesion with invasion of the third ventricle. The pituitary stalk was not visible. Hormonal panel showed no hormonal deficits. The initial diagnosis was of a type II transinfundibular craniopharyngioma (as classified by Kassam et al). An endoscopic endonasal transplanum transtuberculum approach was done using a standard binostril four-hand technique, with the patient positioned supine with the head turned to the right side and tilted to the left, fixed in a three-pin head clamp, under imaging guidance. The tumor was carefully dissected away from the optic apparatus while preserving the vessels, mainly the superior hypophyseal artery. The stalk was identified around the tumor and preserved. The third ventricle was entered and inspected at the end of the procedure and a near-total resection (a small residual in the right hypothalamus) with decompression of the optic apparatus was achieved. Reconstruction was done in a multilayered fashion, using collagen matrix and a nasoseptal flap. Patient had an uneventful postoperative stay and was discharged on POD 4, neurologically stable with no hormonal deficits. Pathology confirmed an adamantinomatous craniopharyngioma. Due to a small growth of the residual, patient underwent fractionated stereotactic radiation (50.4Gy in 28 sessions). He presented with panhypopituitarism 2 years after radiation therapy. At 3-month follow-up, his vision was back to normal and 6-year postoperative magnetic resonance imaging showed no signs of recurrence. The link to the video can be found at: https://youtu.be/chG7XIz7a_A .
