ABSTRACT
BACKGROUND: Sigmoid sinus wall dehiscence can lead to pulsatile tinnitus with a significant decrease in quality of life, occasionally leading to psychiatric disorders. Several surgical and endovascular procedures have been described for resolving dehiscence. Within endovascular procedures, the sagittal sinus approach could be a technical alternative for tracking and accurate stent positioning within the sigmoid sinus when the jugular bulb anatomy is unfavorable. CASE PRESENTATION: A retrospective case series of three patients with pulsatile tinnitus due to sigmoid sinus wall dehiscence without intracranial hypertension was reviewed from January 2018 to January 2022. From the participants enrolled, the median age was 50.3 years (range 43-63), with 67% self-identifying as female and 33% as male. They self-identified as Hispanic. Sigmoid sinus dehiscence was diagnosed using angiotomography, and contralateral transverse sinus stenosis was observed in all patients. Patients underwent surgery via a navigated endovascular sagittal sinus approach for sigmoid sinus stenting. No neurological complications were associated with the procedure. Pulsatile tinnitus improved after the procedure in all patients. CONCLUSIONS: Superior sagittal sinus resection for sigmoid sinus wall stenting is a safe and effective technique. Pulsatile tinnitus due to sigmoid sinus wall dehiscence could be treated using the endovascular resurfacing stenting technique. However, further research is needed to evaluate the potential benefit of contralateral stenting for removing sinus dehiscence when venous stenosis is detected. However, resurfacing sigmoid sinus wall dehiscence results in symptomatic improvement.
Subject(s)
Endovascular Procedures , Stents , Tinnitus , Humans , Female , Male , Tinnitus/surgery , Tinnitus/etiology , Adult , Middle Aged , Endovascular Procedures/methods , Retrospective Studies , Cranial Sinuses/surgery , Superior Sagittal Sinus/surgery , Treatment Outcome , Constriction, Pathologic/surgeryABSTRACT
OBJECTIVE: To describe the roadmapping technique and our three-year experience in the management of intracranial aneurysms in the hybrid operating room. METHODS: We analyzed all patients who underwent surgical clipping for cerebral aneurysms with the roadmapping technique from January 2017 to September 2019. We report demographic, clinical, and morphological variables, as well as clinical and radiological outcomes. We further describe three illustrative cases of the technique. RESULTS: A total of 13 patients were included, 9 of which (69.2%) presented with subarachnoid hemorrhage, with a total of 23 treated aneurysms. All patients were female, with a mean age of 47.7 years (range 31-63). All cases were anterior circulation aneurysms, the most frequent location being the ophthalmic segment of the internal carotid artery (ICA) in 11 cases (48%), followed by posterior communicating in 8 (36%), and ICA bifurcation in 2 (8%). Intraoperative clip repositioning was required in 9 aneurysms (36%) as a result of the roadmapping technique in the hybrid operating room. There were no residual aneurysms in our series, nor reported mortality. CONCLUSIONS: The roadmapping technique in the hybrid operating room offers a complementary tool for the adequate occlusion of complex intracranial aneurysms, as it provides a real time fluoroscopic-guided clipping technique, and clip repositioning is possible in a single surgical stage, whenever a residual portion of the aneurysm is identified. This technique also provides some advantages, such as immediate vasospasm identification and treatment with intra-arterial vasodilators, balloon proximal control for certain paraclinoid aneurysms, and simultaneous endovascular treatment in selected cases during a single stage.
ABSTRACT
Sinus pericranii (SP) is an abnormal communication between the intracranial and extracranial venous drainage pathways. Treatment of this condition has mainly been recommended for aesthetic reasons and prevention of hemorrhage. The authors report a conservative treatment for the potentially lethal complications.
Subject(s)
Angiography, Digital Subtraction , Cerebral Angiography , Sinus Pericranii/diagnostic imaging , Tomography, X-Ray Computed , Child , Humans , Male , Predictive Value of Tests , Radiographic Image Interpretation, Computer-Assisted , Sinus Pericranii/therapyABSTRACT
Carotid atherosclerosis accounts for about 25 % of all ischemic cerebrovascular events. A thorough knowledge of the pathophysiology of the plaque and its clinical consequences are fundamental elements for a well-balanced approach of the management of the disease. The evolution of the imaging techniques allow to visualize the plaque and the analysis of its structure and characteristics. The awareness of the physiopathology and the understanding of the imaging modalities are key issues when planning the treatment of the patient.
Subject(s)
Atherectomy , Carotid Artery Diseases/diagnosis , Carotid Artery Diseases/surgery , Stents , HumansABSTRACT
Carotid endarterectomy has for long been regarded as the gold standard for the management of symptomatic atherosclerosis of the carotid bifurcation, and carotid angioplasty is merely considered a secondary alternative reserved to surgically high-risk patients. However, several studies have shown that the efficacy of carotid angioplasty has equaled that of carotid endarerectomy and additionally provides unshared advantages: local anesthesia is sufficient, the whole extracranial and intracranial carotid circulation are amenable to treatment and wound-related complications are not seen. Besides a thorough review of the main published studies comparing both techniques, we provide updated criteria for the endovascular management of carotid artery disease, discussing their benefits and limitations.
Subject(s)
Atherectomy , Carotid Artery Diseases/surgery , Endarterectomy, Carotid , HumansABSTRACT
Los autores hacen una amplia revisión de la anatomía, fisiología y la patología de la región pineal. Informan 13 tumores pineales encontrados en una serie de 13,000 estudios de Tomografía Computada (TC) entre mayo de 1976 y diciembre de 1983 en el Instituto Nacional de Neurología y analizan sus principales caracteres. Refieren la utilidad de la TC y la correlacionan con otros estudios radiológicos
Subject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , Pineal Gland/pathology , Brain Neoplasms , Tomography, X-Ray ComputedABSTRACT
Se revisaron un total de 210 tomografías con diagnóstico de meningioma, de las cuales se efectúa una estricta depuración, ya que todas aquellas sin expediente completo o bien sin comprobación así como aquellas tomografías de pacientes operados, fueron eliminadas con la finalidad de observar el comportamiento de los meningiomas a través de la T.C. De los 95 probables, en 77 se comprobó el diagnóstico de meningioma, obteniéndose una certeza diagnóstica del 96.1%; en cuanto a su densidad en el estudio simple, se pudo corroborar que el 74% eran hiperdensos; en relación al edema, se comprobó que debido a su lento crecimiento, son tumores con pobre producción del mismo, hallazgo encontrado en casi el 70%. La utilización del contraste fue de gran utilidad para establecer el grado de vascularidad así como la extensión real de la masa; en el 85% el reforzamiento fue homogéneo
