RESUMO
Hemorrhagic isolated dural arteriovenous fistulas (DAVFs) are often challenging to treat. Here, we report a case of the lateral cavernous sinus (CS) DAVF successfully treated by transarterial intravenous coil embolization using a curved multiplanar reconstruction (MPR) image assistance. A 54-year-old man presented with a severe headache and was diagnosed with subarachnoid hemorrhage caused by CSDAVF. Angiography indicated that the fistula was fed by branches of the left external carotid artery and drained into cortical veins. There were multiple shunting points at the left sphenobasal vein accompanied by varicose veins. Using curved MPR images, the left accessory meningeal artery was chosen for the endovascular approach into the affected veins, including ruptured varix. The shunt was completely occluded by detachable coils. When the curved MPR image indicates a developing feeding artery and a large shunting point, transarterial intravenous coil embolization becomes a good treatment option for CSDAVF, which has no venous access.
RESUMO
BACKGROUND: Nowadays, it is getting easier to search information about helium-assisted suicide online. Therefore, healthcare professionals must understand helium-associated medical conditions. CASE PRESENTATION: A 27-year-old man was found with his head covered with a bag connected to a helium tank. Hyperbaric oxygen therapy was not given because his head computed tomography showed no cerebral vasculature air embolism and there was no obvious limb paralysis. The diagnosis was impaired consciousness with hypoxic encephalopathy; he needed mechanical ventilation for 2 days. He was discharged after intelligence tests with no obvious higher brain dysfunction. CONCLUSION: We successfully treated a patient with hypoxic encephalopathy due to helium inhalation. Our analysis suggests that the pathophysiology and appropriate intervention of helium intoxication might be different according to the devices used.
RESUMO
Spinal cord herniation (SCH) is a rare disease characterized by herniation of the thoracic spinal cord through an anterior dural defect, presenting with progressive myelopathy. A case of a 69-year-old woman who presented with Brown-Sequard syndrome and a bone defect, in which an osteophyte created a hemisphere-like cavity with spinal cord herniation, is presented. The strangled spinal cord was released, and the defect was closed microsurgically using an artificial dural patch to prevent re-herniation. Postoperatively, the patient experienced gradual improvement in neurologic function. The SCH mechanism and surgical strategy are discussed.
RESUMO
BACKGROUND: An intracranial lesion of intravascular papillary endothelial hyperplasia (IPEH) is extremely rare and often difficult to resect completely. We describe a case in which a lesion at the superior orbital fissure was successfully treated by postoperative radiosurgery. CASE DESCRIPTION: A 41-year-old woman presented with progressive left abducens nerve paresis and left facial sensory disturbance over a 1-year period. Radiological examination demonstrated a left middle fossa tumor involved in the cavernous sinus. About a half removal of the tumor was performed. The pathological diagnosis was IPEH. The residual tumor was treated with gamma knife radiosurgery. CONCLUSION: Gamma knife radiosurgery was effective to reduce the residual tumor in the present case. During a follow-up period of 2 years, the lesion has not recurred. This report suggests that additional gamma knife radiosurgery after incomplete resection of the lesion could be an alternative therapeutic modality.
