Showing papers on "Cavernous sinus published in 1975"

Electrothrombosis of carotid-cavernous fistula.

Abstract: ✓ The author describes a technique for directly closing a carotid cavernous fistula with electrothrombosis while preserving the intracranial arterial circulation. Copper wires are introduced through the superior ophthalmic vein or a frontotemporal craniotomy, and thus directly into the portion of the sinus into which the fistula drains; if posterior, into the posterior segment of Parkinson's triangle, if inferior, into the pterygoid plexus, and if anterior, through the sphenoparietal sinus and/or middle cerebral vein to the anterior-inferior portion of the sinus. A direct current is applied until a thrombus is confirmed angiographically and the wires are left in place. Four patients treated by this method are presented.

Experiences with intraluminal occlusion with the Fogarty catheter in the treatment of carotid-cavernous sinus fistulas and other lesions at the base of the skull.

Abstract: Indications for the occlusion of the extradural portions of the carotid and vertebral arteries with the Fogarty catheter are demonstrated in 5 cases of traumatic carotid-cavernous sinus fistulas, in1 case of an extradural carotid aneurysm originating from the anterior portion of the carotid siphon, in1 case of traumatic carotid-jugular vein fistula and vertebral artery aneurysm with a-v shunt at the level of the atlas, and in2 cases of large tumours of the base of the skull extending into the cavernous sinus. The limitation of the method is shown in one case where the catheter could not be passed through a “high” kink of the carotid artery. “Low” kinking, at the typical site above the bifurcation, can be overcome by mobilization and stretching of the vessel while introducing the catheter.

Complications of acute frontal sinusitis.

Abstract: The bone separating the frontal sinus from the anterior cranial fossa and the orbit is often quite thin. This, plus the interrelated venous drainage system of these areas, forms the anatomic basis for serious orbital and intracranial complications that must be recognized early. These include orbital cellulitis and abscess, cavernous sinus thrombosis, subdural and brain abscess and meningitis. Early hospitalization for intravenous antibiotic therapy and, occasionally, emergency surgical drainage are required.

Anatomical studies on the arteries of the brain of buffalo (Bubalus bubalis). I. The rete mirabile cerebri.

Abstract: The arterial circulation to the brain of buffalo is accomplished through the rete mirabile cerebri. It is an interwined arterial mass located in the cavernous sinus on either side of the sella turcica and extend from foramen orbitorotundum to the sphenococcipital junction. The major contribution of blood reaches through the arteriae anastomotica and ramus anastomoticus, the branches of the internal maxillary artery. The vertebral and condyloid arteries form a plexus on basioccipital bone (plexus basioccipitalis). An emergent artery from the latter plexus bifurcates and joins the rete along its caudomedial angle. The internal carotid artery plays hardly any role in the cerebral circulation of buffalo.

Treatment of Traumatic Cavernous Fistulas

Abstract: The ideal treatment of carotid cavernous fistulas would consist in selective closure of the fistula with preservation of the carotid patency. Because of the anatomical situation of the fistula within the cavernous sinus, this direct and selective attack has been impossible for a long time.

Preoperative laminagraphic evaluation of the sphenoid sinus for transsphenoidal surgery.

Abstract: In recent years the transethmoidal and transnasal approaches to the pituitary gland have become increasingly popular. In each case, detailed preoperative analysis of the anatomy of the sphenoid sinus and its boundaries is crucial in facilitating entry to the pituitary fossa and in reducing intraoperative complications. Certain operative difficulties and complications are the result of the marked variability in the anatomy of the sphenoid bone and its sinus. These include: loss of orientation within a capacious sinus; perforation of the carotid artery or cavernous sinus; injury to the optic nerve or ophthalmic artery; and violation of the subarachnoid space with resultant pneumocephalus or cerebrospinal fluid rhinorrhea. Pneumatization develops originally within the presphenoid, beginning anteriorly and proceeding posteriorly. Around the time of puberty the pneumatization usually penetrates up to the spheno-occipital synchondrosis. Dense bony septa remain within the sinus along the plane of fusion of the various sphenoidal segments. Preoperative laminagraphy of these ridges and septa is extremely helpful in planning the safest and most direct route to the sella. Laminagraphy is preferable to routine skull films because the septal detail is unobscured by the overlying facial structures. Pleuridirectional laminagraphic motion (circular or hypocycloidal) is preferred to linear motion because of the clarity and detail that they provide.

Radiological and anatomical aspects of the cranial metastases of neuroblastomas

Abstract: The radiological findings in 5 children with metastatic neuroblastoma are described. These consist, in addition to the moth eaten lacunae of the vault, of very wide diastases of the cranial bones, including those of the orbit, irregular thickening of the bones with “hair brush” images, displacement of the circumsellar cisterns, obstruction of the carotid siphon, thrombosis of the cavernous sinus, and excessive vascularization of the metastases. Clinical symptoms caused by the metastases usually preceed the symptoms due to the primary tumor.

Progress in the Arteriographic Study of Cavernous Sinus Disease

Abstract: The following presentation is the result of personal surveys intending to identify routinely the feeding arteries of the cavernous sinus area. The material we used was anatomic and angiographic (for further details see 9).

Orbital phlebography in the diagnosis of painful ophthalmoplegia.

Abstract: Three cases of painful ophthalmoplegia have been described in which symptoms suggesting a tumor of the orbit justified neuroradiological assessment. Phlebography in each case revealed stenosis of the superior ophthalmic vein in its third portion, and non-opicification of the cavernous sinus. Hirtz incidences revealed contralateral cavernous sinus opacification and venous drainage through the coronary sinus. These neuroradiological findings helped to differentiate this syndrome from other affections which have similar signs and symptoms.

Spontane Carotis-cavernosus-Fistel bei Morbus Osler-Rendu

Abstract: A 37-year-old woman suffered from headaches, right facial pain, double vision and occasional tinnitus. On examination there was only a slightly dilatated right pupil, weakened corneal reflex and capillary bleeding from telangiectasia of both hands. Similar bleedings occured in her mother (mouth and hands) and son (nose). The arteriography of the right carotid artery showed a cavernous sinus fistula with a small shunt. Steady compression of the carotid artery by hand caused a marked improvement in the subjective symptomatology.

[A giant aneurysm of the internal carotid artery treated by intracranial direct surgery--with a special reference to the anatomical relationship between the cavernous sinus and the internal carotid artery (author's transl)].

Abstract: There have been a few reports about intracranial giant aneurysms treated by intracranial direct approaches. Especially, for giant aneurysms of the internal carotid artery, direct operation has been thought to be difficult to perform because of the anatomical particularity and the danger of rupture during surgery. So the cervical carotid ligation has frequently been indicated. However, the carotid ligation does not relieve the symptoms caused by the giant aneurysm as an "intracranial mass lesion". The authors have reported here, a cured case of a giant aneurysm of the intracavernous portion of the internal carotid artery, to which, as the first step, ligation of the internal carotid artery in the cervical region was performed, and as the second step, endaneurysmorrhaphy was carried out for the remaining symptoms caused by the "intracranial mass lesion". Furthermore, the surgical techniques for treatment of giant aneurysms of the internal carotid artery were discussed citing literatures, and the authors concluded that the combined operation of carotid ligation and endane-urysmorrhaphy could be effective to giant aneurysms in this region. Meanwhile, a new concept concerning the anatomy of the carotid-cavernous region already proposed by Bedford, was confirmed by our observation at operation. It may be considered that the intracranial direct approach to aneurysms in this region and also to carotid cavernous fistulae should more frequently be indicated than ever performed, according to the new concept of the anatomy in this region.

Collateral circulation between the internal and external carotid arteries after occlusion of the external carotid artery

Abstract: Four cases of partial or complete ocelusion of the external carotid artery, due to various etiology, are reported and the resulting collateral circulation demonstrated. This consists principally, of connections through the lateral main stem artery of Schnurer and Stattin (inferior cavernous sinus artery of Parkinson) which originates from the horizontal segment of the carotid siphon, to the maxillary artery.

Problems in the Treatment of Basal Meningiomas

Abstract: Basal meningiomas represent a rather heterogenous group. Postoperative mortality depends on location and size of the tumor; generally it is rather high. Relapses are frequent. Microsurgical techniques and the development of better methods for repair of skull base defects have allowed neurosurgical procedures to be more radical. Radical tumor removal, however, still remains a problem. It is obvious, that meningiomas with close topographical relationship to carotid arteries or cavernous sinus present special difficulties in treatment.

[Bilateral giant carotid aneurysm in the cavernous sinus with a carotid-cavernous fistula on one side, case report (author's transl)].

Abstract: Since Sir Gilbert Blane's report of a case in the year 1800, bilateral aneurysms of the internal carotid artery within the cavernous sinus of nontraumatic origin are extremely rare. In reviewing literatures, only 22 cases have been described, including the present case (Table 1). We are reporting our own case in which carotid angiograms revealed the presence of bilateral giant aneurysms with a carotid-cavernous fistula on one side, and discussed briefly with reference to its clinical features, radiological observations and treatment. (case report) M.R, a woman aged 78, was admitted on May 15, 1973, with a complaint of sudden onset of right supra- and periorbital headache and a loud bruit about 2 months previously. She became aware of ptosis of the right eyelid and prominence of the right eyeball. The carotid arteriogram showed bilateral giant aneurysms in the region of the cavernous sinus (Fig 2, Fig. 3). A carotid cavernous fistula due to the ruptured giant aneurysm was seen on the right and poor filling of the right anterior and middle cerebral artery was also observed (Fig. 2). An attempt was made to close the fistula by using propelling method (polyurethane foam emboli after Ohta's technique) with great success (Fig. 4). No special treatment was done to the left giant aneurysm. She is now in good condition 7 months after discharge.

Treatment of Arterio-Venous Fistulas and Aneurysms with an Inflatable Released Balloon

Abstract: Some authors have successfully treated carotid-cavernous fistulas with a Fogarty catheter: PROLO and HAMBERY1; ROUGERIE et al.2; PICARD et al.3.

Diagnosis and treatment of bilateral traumatic carotid-cavernous sinus fistulae.

Abstract: The authors report the diagnosis and successful treatment of a case of traumatic bilateral carotid-cavernous sinus fistula. Direct tamponade of the fistula with a Fogarty catheter and ligation of all cervical carotid vessels was carried out on the left side following ligation on the right side of the common carotid, the internal carotid extra- and intracranially, and of the external carotid artery. The pre-requisite for this procedure was the development of a functional collateral circulation via the posterior communicating arteries from the basilar system. The 18 months follow-up report and the rare reports in the world literature on the operative techniques and the results of treatment of similar cases are discussed.

Orbital phlebography in evaluation of the cavernous sinus and adjacent basal veins of the skull.

Abstract: Frontal vein phlebography has proven to be of great diagnostic value in the evaluation of pituitary tumours and of lesions in the vicinity of the sella turcica. It permits the diagnosis of venous thrombosis; similar phlebographic changes may be the only positive radiologic finding in cases with malignant tumour of the skull base. Phlebography is thus to be recommended as an early method to be used in possibly malignant lesions at the skull base.

[Three cases of spontaneous bilateral external carotid-cavernous sinus fistula (dural arteriovenous shunts in the region of the cavernous sinus) (author's transl)].

Abstract: Since Fincher reported a case with arteriovenous fistula between the external carotid artery and dural sinus, many type of cases have been reported. On the other hand, so called the external carotid avernous fistula has been recognized less 20 cases in literature. We have observed three additional cases of dural arteriovenous shunts in the region of the cavernous sinus. Case 1. A 52 year old woman had suffered from left side sever headache. There was weakness of the left extraocular muscles and left ptosis. A bruit was heard over the left orbit. She was treated for hypertension since 38 year old. And she has no history of recent trauma. Selective internal and external carotid angiographies showed the bilateral external carotid cavernous sinus fistula. No operative treatment was performed in this case and the symptomes disappeared with decrease of blood pressure. Case 2. A 50 year old man came to this clinic with chief complaints of right ptosis, diplopia and headache. He was treated for diabetes mellitus and hypertension for six month...

[Neuroradiologic diagnosis of trigeminal neurinoma originating from the gasserian ganglion (author's transl)].

Abstract: Three cases of trigeminal neurinoma originating from the Gasserian ganglion were reported. The findings observed on plain roentgenograms, cerebral angiograms and pneumoencephalograms were described in detail. Neuroradiologic examinations used routinely our department for the diagnosis of the skull base tumors were as follows; (1) plain skull examinations, including lateral, straight posterior-anterior, anterior-posterior half axial (Towne), axial, Stenvers, optic canal as well as tomograms in frontal, sagittal and axial projections; (2) angiographies by transfemoral catheter technique including selective internal carotid, external carotid and vertebral angiograms, and orbital-cavernous sinus venography via frontal and femoral veins; (3) pneumoencephalography with tomography. Bone destruction of the middle fossa including foramen ovale, foraman spinosum and lateral aspect of the sella was seen in all cases. Superior orbital fissure, optic canal and anterior surface of the petrous bone were also eroded depending upon the extent of tumors. Sharply circumscribed erosion of the petrous apex was seen in one of 3 cases, indicating the tumor extention into the posterior fossa. A soft tissue mass in the sphenoid sinus and ethmoidal air cells was recognized in all cases. Selective internal and external carotid angiograms demonstrated tumor vessels in 2 of 3 cases. Orbital-cavernous sinus venography was helpful for the interpretation of the lesion extending to the cavernous sinus and its neighboring structures. Conventional gas encephalography showed elevation of the temporal horn, and the concave arch formed by the supracornual cleft and lateral cleft was directed basally and medially in all of the cases. Tomography was also useful in the more detailed analysis of temporal horn. It should be stressed that the plain skull features are most important for deciding which contrast examination should be performed further.

Malignant Pituitary Tumors

Abstract: Adenohypophysial tumors usually grow in an expansive manner. The primary effects of tumors without positive endocrinological symptoms result from compression of the normal pituitary gland or nearby neuronal structures—particularly the optic chiasm and optic nerves. Expansive growth can give rise to extremely large tumors that compress the third ventricle or erode the sphenoid bone. There is a minority of tumors with locally invasive growth extending beyond the durai capsule into the cavernous sinus, middle cranial fossa, temporal lobe, diencephalon, clivus, sphenoid sinus, and epipharynx. A small number of tumors may metastasize to the subarachnoid space remote from the primary lesion, to extracranial organs via the blood circulation, or to both (Table 13).

[An attempt of electrothrombosis of carotid-cavernous fistula (author's transl)].

Abstract: The patient was 50 year-old female who was admitted to our department on June 13, 1973 complaining of left conjunctival injection and ipsilateral exophthalmos. Visual acuity of her right eye had been lost almost completely due to the previous ocular injury. Ophthalmological examination revealed left conjunctival injection, slight ipsilateral proptosis but pulsation of eye ball, chemosis and bruit were not so obvious. She had a visual acuity of 1.2 on her left eye. Left intraocular pressure was 30 mmHg while right was normal. Left CAG revealed a left carotid-cavernous fistula with anterior, posterior, inferior venous drainage. Temporal craniotomy was done and copper needles were inserted into the posterior part of Parkinson's triangle. An angiogram after operation demonstrated the persistency of the anterior and posterior venous drainage. 6 weeks later, electrothrombosis of left superior ophthalmic vein was carried out. After that, carotid-cavernous fistula disappeared perfectly. Important points of the surgical technique are; 1) to apply a silverclip to the tentorial edge just posterior to the third nerve, than anatomical realtionship of internal carotid artery, cavernous sinus and the clip applied are carefully investigated on the subsequent angiograms. 2) to repeat angiography several titate of embolization of cavernous sinus should often be checked.

Thermography in the management of carotid-cavernous fistulas.

Abstract: The authors report their experiences with thermography as a new tool to assess the diagnosis and postoperative control of patients with carotid-cavernous fistulas (CCF) A zone of increased temperature on the homolateral orbital region is described in cases of CCF A supraorbital "cool" area, as seen in patients with carotid stenosis or occlusion, is observed when surgery with the Jaeger-Hamby technique has been successful Thermograms obtained in five patients are presented and the pathophysiology of these findings is discussed

Research of New Techniques and Protocols to Study the Orbital and Basal Veins

Abstract: Techniques to opacify the orbital and basal veins may be divided into two main groups: phlebographies and the venous phase of angiograms.