Showing papers on "Cavernous sinus published in 1980"

Invading meningiomas of the sphenoid ridge

Abstract: The authors report a series of 34 meningiomas of the sphenoid ridge. Eight tumors were totally removed uneventfully: two from the middle sphenoid ridge and six from the pterion or Sylvian point. Five tumors were not operated on because of their extensions or the patient's age. Twenty-one tumors raised serious surgical problems, resulting in a classification into three groups: deep or clinoidal, invading beyond the sphenoid wings, and a combination of both. Histological study of the hyperostotic bone showed meningiomatous cells in the bone in 12 of 13 cases so examined. Surgical limitations included invasion of the cavernous sinus (15 cases), of the dura mater of the sella turcica (seven cases), of the lateral part of the sphenoid body at the insertion point of the ala magna (seven cases), and of the common tendinous annulus of Zinn in the orbit (five cases), and basilar extracranial extension, particularly in the pterygomaxillary fossa (three cases). Following extensive removal, there were no early recurrences and three late recurrences (9 years and more). In 13 cases with a follow-up period of 1 to 8 years, there were no clinical recurrences. In only two cases was the meningioma totally removed. There were three postoperative deaths, two cases of hemiparesis with aphasia and epilepsy, one case with a frontal lobe syndrome, and nine with slight oculomotor, visual, or esthetic sequelae.

Carotid-cavernous sinus fistulas and venous thrombosis.

Abstract: Radiographic signs of cavernous sinus thrombosis were found in eight consecutive patients with an angiographic diagnosis of carotid-cavernous sinus fistula; six were of the dural type and the ninth case was of a shunt from a cerebral hemisphere vascular malformation. Diagnostic features consisted of filling defects within the cavernous sinus and its tributaries, an abnormal shape of the cavernous sinus, an atypical pattern of venous drainage, and venous stasis. Progression of thrombosis was demonstrated in five patients who underwent follow-up angiography. Because of a high incidence of spontaneous resolution, patients with dural-cavernous sinus fistulas who show signs of venous thrombosis at angiography should be followed conservatively.

Carotid-cavernous sinus thrombosis caused by Aspergillus fumigatus. Case report.

Abstract: ✓ A case is presented of Aspergillus fumigatus granuloma involving the sphenoid sinus, sella turcica, cavernous sinus, and the internal carotid artery. The diagnosis was established by a transsphenoidal biopsy. The infection proved difficult to treat and finally remitted after chemotherapy with a combination of amphotericin B, rifampin (rifampicin), and flucytosine (5-fluorocytosine). The spectrum of aspergillosis of the central nervous system is reviewed, and difficulties in treating this infection are considered.

Metastatic infiltration of nerves in the cavernous sinus.

Abstract: • Painful dysesthesia in association with ocular motor palsies characterized intraneural carcinomatous invasion in a 48-year-old man. Transcranial biopsy of the cavernous sinus stopped the pain; the specimen confirmed the diagnosis and provided the rationale for radiation therapy. One year after treatment, the patient was healthy and pain-free, with improved ocular motor function. The source of the carcinoma remains unknown.

Implications of very high serum prolactin levels associated with pituitary tumors.

Abstract: ✓ Five patients with pituitary tumors associated with unusually high serum prolactin levels are presented. Tumor size and the presence of suprasellar extension were variable, but the finding common to all five cases was invasion of the cavernous sinus. It is proposed that very high serum prolactin levels suggest an invasive tumor, perhaps, specifically, invasion into a cavernous sinus. The surgical significance of this proposition is discussed.

Tolosa‐hunt syndrome: A case with associated facial nerve palsy

Abstract: A 54-year-old man developed a painful right third nerve palsy with signs of involvement of the first two divisions of the trigeminal nerve and, later, ipsilateral peripheral facial nerve weakness. A cavernous sinus venogram demonstrated narrowing of the third portion of the right ophthalmic vein and poor filling of the adjacent cavernous sinus. Resolution occurred with steroid therapy. The Tolosa-Hunt syndrome may be a variant of a larger syndrome of recurrent multiple cranial polyneuropathies without identifiable cause.

Pituitary surgery for endocrine disorders

Abstract: The use of pituitary surgery for patients with over-production of growth hormone, corticotrophin and prolactin is reviewed. The value of specialized neuroradiological techniques is discussed including computerized tomography, air-encephalography and cavernous sinus venography. The indications for transcranial as opposed to trans-sphenoidal surgery are considered. The place of trans-sphenoid surgery in the treatment of acromegaly is emphasized and the indications for surgical treatment are reviewed. The two syndromes due to over-production of ACTH are considered--Cushing's disease and Nelson's syndrome. The increasing use of pituitary surgery for the treatment of Cushing's syndrome due to increased ACTH production is noted, but a warning is given about the small ACTH-secreting pulmonary carcinoid tumour that may closely mimic Cushing's disease. The difficulties encountered in trying to treat patients with Nelson's syndrome are stressed. It is recommended that in the rate case where total adrenalectomy is required in Cushing's disease, pituitary irradiation should be given before or shortly after adrenalectomy. The present position relating to the surgical treatment of the small prolactin-secreting pituitary tumour is reviewed. Published data and personal experience suggests that for many of these patients, treatment with bromocriptine is preferable to trans-sphenoidal surgery. Large prolactinomas usually need transfrontal surgery and X-ray therapy, sometimes followed by bromocriptine treatment. The need for steroid cover for pituitary surgery is discussed and it is suggested that a glucocorticoid with less salt-retaining action than cortisol should be used. The importance of post-operative endocrine assessment is emphasized and a convenient method suggested. The incidence of complications after transsphenoidal surgery is low, although panhypopituitarism occurred in 14% of the cases reported.

Transsphenoidal Surgery for Pituitary Tumors

Abstract: The transsphenoidal approach to the sella dates back to Schloffer,1 who in 1907 reported the decompression of a growth hormone (GH)-producing tumor via this route. He had modified the operation of Giordano2 by not resecting the frontal sinus or floor of the anterior fossa. Further modifications ensued, including a submucosal dissection,3 a sublabial incision,4 the use of a headlight,5 and image-intensified fluoroscopy.6 Hardy7–10 added the operating microscope and microsurgical techniques to the procedure, so that with minimal morbidity and mortality, both microadenomas and large tumors could be safely removed or decompressed while sparing the pituitary gland.

Evaluation of brain tumour laser surgery.

Abstract: A surgical carbon dioxide laser unit (laser) has been used since 1977 in twentyfive cases of various brain tumours, including ten meningiomas (four sphenoid ridge, two parasagittal, two falx, one olfactory, one posterior fossa), eleven gliomas (seven glioblastoma, four astrocytoma), two metastatic brain tumours, one haemangioblastoma, and one arteriovenous malformation (AVM). The criteria for laser use, as based on evaluation and location of meningioma, were: grade 1, convenient but adjuvant; grade 2, also necessary; grade 3, indispensable. The laser is obligatory in sphenoid ridge meningioma in order to peel the tumour away from the internal carotid artery, middle cerebral artery, cavernous sinus etc. The grade of necessity for laser use is therefore either 2 or 3. In convexity or parasagittal meningioma, on the other hand, the necessity grade is either 1 or 2. In the glioma group hemorrhage in seven cases of glioblastoma was easily laser-controlled, and the tumours were wasted away in a short time through vaporization, with minimum mechanical effect on adjacent tissue. The laser is therefore very useful in cases of glioma, especially glioblastoma, considering the shortened operating time, decreased blood loss, and extended area of tumour resection. Laser surgery is proposed as being most appropriate, mainly for its vaporizing and coagulating functions, in cases of brain tumour involving the elderly and poor risk cases.

Hypopituitarism after aseptic cavernous sinus thrombosis

Abstract: A 44-year-old man developed aseptic thrombosis of the cavernous sinuses. He recovered but 3 months later presented a clinical and laboratory picture of pituitary insufficiency. After 3 years of hormonal replacement therapy, he was in good physical condition.

Magnification angiography of dural carotid-cavernous sinus fistulae with emphasis on clinical and angiographic evolution.

Abstract: Eleven patients with dural carotid-cavernous sinus fistulae were studied with selective magnification angiography The angiographic features of this condition were analyzed in detail The arterial plexus normally present in and around the cavernous sinus has been thought to rupture into the sinus and establish an arteriovenous fistula with an extensive dural arterial supply Changeable angiographic and clinical findings, including spontaneous regression, can be explained on the basis of thrombosis and occlusion in the arterial network The indications for and methods of embolization are also discussed

Course and relations of the abducens nerve.

Abstract: The authors describe the course and relations of the abducens nerve in the posterior cranial fossa and in the cavernous sinus, observed during the dissection of 60 hemi-heads of cadavers of brazilian adult individuals of both sexes. It was observed that the abducens nerve after crossing the cranial dura mater it, in most cases, goes through the interior of the inferior petrosal sinus, and in few cases the lateral wall of this sinus. At this level, the nerve is attached to the sinusal wall by means of delicate fibrous septum. Afterwards, the abducens nerve passes inferiorly to the petroclinoid ligament and crosses medially the superior petrosal sinus, thus reaching the cavernous sinus, where it stands laterally to the internal carotid artery. Measurements of the abducens nerve penetration point in the dura mater of the posterior cranial fossa also were made. For these above mentioned measurements we used the jugular tubercle of the occipital bone as landmark.

Radiosurgery Therapy for Pituitary Adenoma

Abstract: The dramatic advances of the past two decades afford patients with pituitary adenomas unprecedented prospects of recognition, therapy, and “living happily ever after.”

[Diagnosis and differential diagnosis of cerebro-vascular malformations by CT (author's transl)].

Abstract: In 38 patients, the diagnosis of a cerebrovascular malformation (17 arteriovenous agniomas including one low-flow- and two venous angiomas; 10 aneurysms; 4 arteriovenous fistulae of the cavernous sinus, the tentorium and one of the Great Vein of Galen; 6 megadolical basilar arteries) was initially made by computertomographic (CT) examination, including contrast enhancement. The characteristic and pathognomonic CT findings are described and compared with those of cerebral angiography also done in these cases. The problems of differential diagnosis and the reasons for a false CT diagnosis in 5 other patients with a cerebro-vascular malformation are investigated; and the diagnostic value of cerebral angiography and CT is discussed and their complementary functions are being pointed out.

[Ipsilateral exophthalmos in chronic extradural fluid-hematoma, case report (author's transl)].

Abstract: A case of chronic extradural hematoma with liquid contents that had showed ipsilateral exophthalmos was reported. A 10-year-old girl fell and struck on her head. Neurological examination, on admission to our hospital on tenth day after the injury, revealed left exophthalmos and slight right hemiparesis. Plain craniogram showed linear fractures of frontal bone and orbital roof on left side. Left carotid angiogram and computerized tomogram revealed a huge extradural hematoma with liquid contents in the left frontal region. Extirpation of the hematoma was performed on the twenty-third day after the injury. When a burr hole was drilled on the left frontal region, there was no capsule of the hematoma and contents of the hematoma was dark brownish fluid. The source of bleeding in our case was considered to be the diploic vein. The blow to the head at the time of the injury distorted the skull and separated the dura from the bone. The venous bleeding developed in the space thus formed, and a small hematoma was produced. The small hematoma might have enlarged by a process similar to that postulated in chronic subdural hematoma. Thus a huge extradural hematoma with liquid contents might have been produced. There may be two factors as causes of exophthalmos. 1) Blood from the frontal extradural hematoma through the fracture of orbital roof into the orbit is postulated to have compressed the periorbita. 2) Direct pressure by the frontal hematoma on the cavernous sinus and the superior ophthalmic vein produced venous circulatory disturbance of the orbit and was postulated to have caused the ipsilateral exophthalmos.

Clinical picture and complex treatment of septic thromboses of the cavernous sinuses

Abstract: Under analysis are etiology, clinical picture and diagnosis of a septic thrombosis of cavernous sinuses in 28 patients. The authors have shown the interrelationship between local manifestations of the disease, injuries of the brain and its sheaths and septic complications (abscessing pneumonia as the most severe of them). A scheme of the complex treatment of patients with thrombosis of the cavernous sinus is proposed. The leading role in this treatment is played by intracarotid infusion of antibiotics in combination with anticoagulant drugs, vasodilatatory agents and novocaine as well as the therapy of septic complications (abscesses of the face and hairy part of the head, meningoencephalitis, pneumonia).

Tumors of the sellar region and the cavernous sinus. Evaluation of diagnostic procedures and therapeutic orientation

Abstract: Two cases of infrequently seen tumors of the cavernous sinus and the clivus regions are presented. One of them was a chordoma and the other, a myeloma, and both were approached by the transphenoidal route. The clinical picture and the diagnostic procedures are reviewed, and the several surgical approaches to these regions are discussed. These regional processes should be submitted to a precise radiological evaluation: plain skull films, conventional tomography, arteriography, and computerized tomography scan, in order to establish their origin and their extension, and also to determine the proper approach. The authors conclude that all these regional tumors must be operated on, and that the transphenoidal approach is the most effective. This approach is extradural, well known through the experience brought about by the pituitary surgery, and with a low morbi-mortality rate.

[Evaluation of laser surgery against brain tumor (author's transl)].

Abstract: UNLABELLED A surgical carbon dioxide laser unit (Laser) has been used in 26 cases of various brain tumors, including 10 meningioma (4 sphenoid ridge, 3 parasagittal, 1 falx, 1 olfactory, 1 posterior fossa); 12 glioma (7 glioblastoma, 5 astrocytoma); two metastatic brain tumors; 1 hemangioblastoma, and 1 AVM. Criteria for Laser use based on evaluation and location of meningioma were: grade 1, convenient but adjuvant; grade 2, also necessary; grade 3, indispensable. Most meningioma in convexity and parasagittal were grade 1-2, with those in the sphenoid ridge grade 2-3. In the glioma group, hemorrhage in 3 cases of glioblastoma was easily Laser-controlled, and the tumors wasted away in a short time with vaporization. There was minimal mechanical effect on the adjacent tissue. CONCLUSION In neurosurgery, Laser is obligatory in sphenoid ridge meningioma to dissect the internal carotid artery, middle cerebral artery, cavernous sinus, sphenoid ridge, etc. It is very useful in glioma, especially glioblastoma, considering shortened surgical duration, decreased blood loss and extended tumor resection. Laser surgery is proposed as most appropriate for brain tumors in elderly and poor risk cases mainly for its vaporizing function.

With Emphasis on Clinical and Angiographic Evolution

Abstract: Summary. Eleven patients with dural carotid-cavernous sinus fistulae were studied with selective magnification angiography. The angiographic features of this condition were analyzed in detail. The arterial plexus normally present in and around the cavernous sinus has been thought to rupture into the sinus and establish an arteriovenous fistula with an extensive dural arterial supply. Changeable angiographic and clinical findings, including spontaneous regression, can be explained on the basis of thrombosis and occlusion in the arterial network. The indications for and methods of embolization are also discussed.

Implications of very high serum associated with pituitary tumors prolactin levels

Abstract: w' Five patients with pituitary tumors associated with unusually high serum prolactin levels are presented. Tumor size and the presence of suprasellar extension were variable, but the finding common to all five cases was invasion of the cavernous sinus. It is proposed that very high serum prolactin levels suggest an invasive tumor, perhaps, specifically, invasion into a cavernous sinus. The surgical significance of this proposition is discussed. HE significance of the serum prolactin level associated with pituitary tumors has been discussed in the literature primarily as a predictive value indicating the presence of a true secreting tumor, as opposed to a functional abnormality, x,2,4,~,1~ A correlation has been suggested between elevation of serum prolactin and pituitary tumor size? '8 The great majority of pituitary tumors are associated with serum prolactin levels of less than 1000 ng/ml, and it is unusual for the serum prolactin to be above 2000 ng/ml. Although there are cases reported with serum prolactin levels of greater than 2000 ng/ml, the significance of this finding has received little comment. In a review of 97 patients with pituitary adenomas treated from 1976 to 1979, five patients were found with preoperative prolactin levels greater than 2000 ng/ml (range 2880 to 8120 ng/ml), while no other patient had a value greater than 1000 ng/ml. In these five patients, tumor size was variable. Two patients had no suprasellar extension and one had minimal suprasellar extension. All five patients had lateral extension of tumor involving a cavernous sinus. Two exhibited clinical signs referable to cavernous sinus invasion, and all five had angiographic or computerized tomography (CT) confirmation of such involvement. Invasion of tumor through the dura into the cavernous sinus could be seen at surgery in two of the patients. In the remaining three, there was tumor growth into the area where the cavernous sinus would normally be, but dural penetration could not clearly be seen. In two of the latter group there were clinical signs suggesting cavernous sinus invasion. Fourteen other patients in the series had prolactin-secreting tumors larger than any in the five cases reported, but none had a serum prolactin level greater than 1000 ng/ml. It is postulated that very high serum prolactin levels (greater than 2000 ng/ml) are related not to tumor size, but to tumor invasion into the blood stream, perhaps specifically into the cavernous sinus.