Showing papers on "Cavernous sinus published in 1984"
TL;DR: Petrosal sinus sampling to distinguish pituitary from ectopic-ACTH syndromes must always be performed bilaterally, and if plain radiographs or CT scans provide unequivocally positive findings in Cushing syndrome (less than 20%), inferior petrosal Sinus sampling is not indicated.
Abstract: ACTH-producing microadenomas of the pituitary gland drain unilaterally into the adjacent cavernous sinus; therefore, petrosal sinus sampling to distinguish pituitary from ectopic-ACTH syndromes must always be performed bilaterally A negative finding from a unilateral petrosal sinus sample does not exclude the presence of a contralateral ACTH-producing microadenoma Hemiresection of the pituitary gland based on results of bilateral sampling can be performed if the adenoma is too small to be recognized at surgery Large pituitary adenomas produce elevated ACTH levels in the petrosal sinuses bilaterally However, if plain radiographs or CT scans provide unequivocally positive findings in Cushing syndrome (less than 20%), inferior petrosal sinus sampling is not indicated
128 citations
TL;DR: The principles of the orbitofrontomalar approach and of reconstruction of the orbital cone and of the frontomalar region with an orbitotemporal prop are discussed.
Abstract: Twenty-five cases of frontotemporosphenoid meningioma are reported. The principles of the orbitofrontomalar approach and of reconstruction of the orbital cone and of the frontomalar region with an orbitotemporal flap are discussed.
116 citations
TL;DR: Extraocular muscle enlargement can result from a wide variety of disease processes, and observations of the pattern of muscle involvement, muscle shape and enhancement, superior ophthalmic vein and cavernous sinus enlargement, sinus and bony wall abnormalities, and proptosis can lead to a limited differential diagnosis.
Abstract: Extraocular muscle enlargement can result from a wide variety of disease processes. Although observations of the pattern of muscle involvement, muscle shape and enhancement, superior ophthalmic vein and cavernous sinus enlargement, sinus and bony wall abnormalities, and proptosis can lead to a limited differential diagnosis in some cases, no radiographic finding in itself seems to be pathognomonic. Correlative clinical findings are necessary to make a secure diagnosis.
99 citations
TL;DR: Vascular dynamics of dural shunts are reviewed, and it is suggested that many of these communications may be congenital and that the onset of clinical abnormalities may be associated with the occurrence of intracranial venous thrombosis.
87 citations
TL;DR: Two cases of post-operative dural arteriovenous malformation are reported: in one, a pure dural AVM was located in the region of the cavernous sinus and in another a mixed pial and duralAVM was found in the posterior fossa.
Abstract: The occurrence of post-operative dural arteriovenous malformation (AVM) has rarely been proved angiographically. The authors report two such cases: in one, a pure dural AVM was located in the region of the cavernous sinus and in another a mixed pial and dural AVM was found in the posterior fossa. The literature about pathogenesis is reviewed.
73 citations
TL;DR: The aetiology of ophthalmoplegia in 15 patients with carotid-cavernous sinus fistula is discussed, and the clinical findings are correlated with angiographic and orbital CT appearances.
Abstract: The aetiology of ophthalmoplegia in 15 patients with carotid-cavernous sinus fistula is discussed, and the clinical findings are correlated with angiographic and orbital CT appearances. After closure of the fistula the majority of patients with generalised ophthalmoplegia recovered full ocular movements rapidly, while patients with an isolated abduction weakness required much longer to return to normal. Orbital CT studies showed enlarged extraocular muscles in the patients with generalised ophthalmoplegia but muscles of normal size in those with abduction failure alone. After closure of the fistula repeat CT studies of patients with enlarged extraocular muscles showed a diminution in muscle size. We suggest that generalised ophthalmoplegia in carotid cavernous sinus fistula is due to hypoxic, congested extraocular muscles. Isolated abduction weakness is due to a sixth nerve palsy, which probably occurs either in the cavernous sinus or more posteriorly near the inferior petrosal sinus. A combination of these 2 mechanisms may be found in some patients.
62 citations
TL;DR: Septic cavernous sinus thrombosis remains a potentially lethal disease, although advances in therapy have lowered the morbidity and mortality substantially.
51 citations
TL;DR: The authors believe that carotid arteriography is obligatory in cases of cavernous sinus thrombophlebitis in which ophthalmoplegia persists despite adequate antibiotic therapy.
Abstract: Six cases of bacterial intracavernous carotid artery aneurysms of extravascular origin secondary to cavernous sinus thrombophlebitis are reported along with a review of 12 similar cases collected from the literature. Of the authors' six cases, there were three children and three adults. Meningitis was found in five patients. All patients received prolonged antibiotic therapy. Spontaneous resolution of the aneurysm occurred in one patient, thrombosis of the internal carotid artery in another, and progressive enlargement of the aneurysm was seen on sequential angiography in the other two. Evidence of associated arteritis was present in all of the patients. Carotid ligation for persistent ophthalmoplegia was carried out in two patients, of whom one had a giant aneurysm and the other progressive aneurysm enlargement. The results of treatment were good in all cases. The authors believe that carotid arteriography is obligatory in cases of cavernous sinus thrombophlebitis in which ophthalmoplegia persists despite adequate antibiotic therapy.
50 citations
TL;DR: In both the cases described, painful ophthalmoplegia was the first indication of infiltration of the cavernous sinus by a lymphosarcoma, and Symptomatic remission could be obtained with treatment, although the prognosis remained poor.
Abstract: In both the cases described, painful ophthalmoplegia was the first indication of infiltration of the cavernous sinus by a lymphosarcoma. The onset of symptoms and the course of the disease were different in the two cases. CT scan which has been the crucial investigation for detecting lymphomas in the cavernous sinus, was normal in the early stages. Symptomatic remission could be obtained with treatment, although the prognosis remained poor.
43 citations
TL;DR: In one patient with recurrent painful ophthalmoplegia a biopsy from an eye muscle showed venous vasculitis, probably indicating the basic pathology behind the phlebographic changes in patients with Tolosa-Hunt's syndrome.
Abstract: Orbital phlebography has been reported to be pathologic in some patients with Tolosa-Hunt's syndrome (recurrent painful ophthalmoplegia). A systematic study of the phlebographic findings in Tolosa-Hunt's syndrome in comparison with a normal material seems not to have been performed. In this investigation, orbital phlebography was performed in 19 patients with Tolosa-Hunt's syndrome and in a reference group of 23 persons without the disease. In 13 of 19 patients (68%) with Tolosa-Hunt's syndrome, the phlebography was pathologic (narrowing or occlusion of particularly the third segment of the superior ophthalmic vein, partial occlusion of the cavernous sinus). Orbital phlebography was normal in all but one of the subjects in the reference group. The medical history of this subject in retrospect revealed symptoms other than painful ophthalmoplegia commonly found in patients with Tolosa-Hunt's syndrome, suggesting that he suffered from a variant of the disease causing the syndrome. In one patient with recurrent painful ophthalmoplegia a biopsy from an eye muscle showed venous vasculitis, probably indicating the basic pathology behind the phlebographic changes in patients with Tolosa-Hunt's syndrome.
42 citations
TL;DR: Twelve of 17 patients with cavernous carotid aneurysms had balloon embolization directed through a percutaneous double lumen catheter for progressive pain, ophthalmoplegia, or visual loss, and nine had improvement in the extraocular eye muscle and lid function.
Abstract: Twelve of 17 patients with cavernous carotid aneurysms had balloon embolization directed through a percutaneous double lumen catheter for progressive pain, ophthalmoplegia, or visual loss. Functional angiography was carried out with systemic heparinization and double-lumen balloon catheters to test tolerance to carotid occlusion. Eleven were successfully treated, though two patients with initial preservation of the ipsilateral carotid artery had unplanned deflation of the balloon, necessitating re-embolization. No serious permanent neurologic complications occurred. All patients had complete resolution of pain, and nine had improvement in the extraocular eye muscle and lid function. Balloon trapping of the cavernous carotid artery, rather than placing the balloon directly into the aneurysm, resulted in involution of the aneurysm and decompression of the involved cranial nerves.
TL;DR: A 29-year-old previously healthy man died of spread of infection from gingivitis to both parapharyngeal (pharyngomaxillary) spaces and to the cavernous sinus.
Abstract: • A 29-year-old previously healthy man died of spread of infection from gingivitis to both parapharyngeal (pharyngomaxillary) spaces and to the cavernous sinus. The diagnosis was delayed because gingival and parapharyngeal sources of cavernous sinus thrombosis were not initially considered, and the ophthalmic congestion was believed at first to represent orbital cellulitis rather than cavernous sinus thrombosis.
TL;DR: A persistent carotid-basilar anastomosis (primitive trigeminal artery), identified by four-vessel vertebral angiography, was shown to be the cause of a cavernous sinus fistula in a 51-year-old woman and was repaired through a direct surgical approach.
Abstract: ✓ A persistent carotid-basilar anastomosis (primitive trigeminal artery), identified by four-vessel vertebral angiography, was shown to be the cause of a cavernous sinus fistula in a 51-year-old woman. The fistula, but not the primitive artery, was identified on a carotid arteriogram. Because of the flow contribution from the posterior circulation, balloon embolization via the carotid system failed, and the fistula was repaired through a direct surgical approach. The operative technique is described and the hemodynamic aspects of a cavernous sinus fistula that is related to this primitive anastomosis are reviewed.
TL;DR: The authors believe that in rapidly evolving neuro-ophthalmological syndromes of basal origin, accompanied by intractable headache, sphenoid sinus cancer must be considered.
Abstract: Three cases of sphenoid sinus carcinoma observed personally and 39 identified in the English language publications are reviewed. Sphenoid carcinoma constitutes only 0.3 per cent of sinus cancer. Its symptoms and signs are nonspecific until the sinus wall is penetrated. Once breached, specific neuro-ophthalmological symptoms and signs ensue, resulting from involvement of anatomically contiguous structures. These are characterized most commonly by the sphenocavernous syndrome and less frequently by isolated sixth nerve palsies and visual loss. Identified best by plain radiography, polytomography and computerized tomography, diagnosis of sphenoid carcinoma requires direct biopsy. Treatment, principally with radiotherapy supplemented by chemotherapy, has been disappointing with most patients dead by three years. The authors believe that in rapidly evolving neuro-ophthalmological syndromes of basal origin, accompanied by intractable headache, sphenoid sinus cancer must be considered.
Journal Article•
TL;DR: Immediatement apres l'angioplastie, l'arteriographie montre une dilatation de la stenose, mais 30 minutes plus tard on trouve une stenose partielle de la carotide interne gauche au niveau de la lesion initiale.
Abstract: Immediatement apres l'angioplastie, l'arteriographie montre une dilatation de la stenose, mais 30 minutes plus tard on trouve une stenose partielle de la carotide interne gauche au niveau de la lesion initiale. Neanmoins, la malade n'a pas de symptome un an plus tard
TL;DR: Two patients presented with unilateral peri-orbital pain, proptosis, chemosis and external ophthalmoplegia were shown to have dural arteriovenous fistulae related to the cavernous sinus, which gave rise to focal seizures and signs of unilateral hemisphere dysfunction.
Abstract: Two patients presented with unilateral peri-orbital pain, proptosis, chemosis and external ophthalmoplegia. They were shown to have dural arteriovenous fistulae related to the cavernous sinus. Intracerebral haemorrhage occurred in both patients within 18 months of presentation; this gave rise to focal seizures and signs of unilateral hemisphere dysfunction. The haematomas were in the region drained by the superficial middle cerebral vein ipsilateral to the shunt and are presumed to have been the result of locally raised venous pressure.
01 Jan 1984
TL;DR: Although not presented in this review, chemotherapy by infusion in situ, chemoembolization by microspheres, and angioplasty should not be forgotten.
Abstract: Embolization procedures now dominate therapeutic angiography. Although not presented in this review, chemotherapy by infusion in situ, chemoembolization by microspheres, and angioplasty should not be forgotten.
Journal Article•
TL;DR: The name cavernous venous plexus has been proposed for the cavernous sinus in sheep, which may have migrated proximally in the adventitia of the intracranial portion of the internal carotid artery as its extracranial portions degenerates early in life.
Abstract: Paraffin sections of the carotid rete-cavernous sinus complex of sheep were studied, using different stains The carotid rete of sheep was composed of medium-sized arteries with smooth muscle layers that were oriented in different directions The carotid body cells may have migrated proximally in the adventitia of the intracranial portion of the internal carotid artery as its extracranial portion degenerates early in life The cavernous sinus shared a common tunica adventitia with surrounding rete branches At places, the wall of the cavernous sinus had a distinct tunica media interposed between the endothelial cells and the tunica adventitia Therefore, the name cavernous venous plexus has been proposed for the cavernous sinus in sheep
TL;DR: Electrothrombosis by copper needle insertion was used to treat three cases of spontaneous carotid-cavernous fistula, and the symptoms improved after the operation, but one patient had postoperative transient 3rd nerve palsy.
Abstract: Electrothrombosis by copper needle insertion was used to treat three cases of spontaneous carotid-cavernous fistula. These patients had been treated conservatively for 6 months or more, but their symptoms had not improved. Angiography showed that the feeding arteries were branches of both the ipsilateral internal and the ipsilateral external carotid artery. Frontotemporal craniotomy was performed, and copper needles were inserted transdurally into the cavernous sinus. Closure of the fistula was verified by intraoperative angiography in all cases, and the symptoms improved after the operation. However, one patient had postoperative transient 3rd nerve palsy. Another had Gerstmann's syndrome due to narrowing of the internal carotid artery by a needle and worsening of the preoperative 6th nerve palsy. In one case, the operation was uneventful. Based on our experience, we discuss several problems with this technique.
TL;DR: Twenty-six cases with spontaneous carotid-cavernous fistulas were followed up for periods ranging between 4 months and 9 years 8 months, and a complete regression of symptoms without reappearance for more than 6 months was noted in 19 cases.
TL;DR: Fat density in the cavernous sinus on computed tomography (CT) is described in 6 out of 16 patients with Cushing disease, and this finding may aid in making a specific diagnosis in patients with a pituitary mass.
Abstract: Fat density in the cavernous sinus on computed tomography (CT) is described in 6 out of 16 (37.5%) patients with Cushing disease. This finding may aid in making a specific diagnosis in patients with a pituitary mass. It was not seen in 30 random CT studies of the sella; however, parasellar fat was incidentally noted in one patient with acromegaly.
TL;DR: Despite mild developmental delay, the patient's visual acuity apparently remained normal and the ophthalmologic findings did not change significantly during the 18-month follow-up period.
Journal Article•
TL;DR: A successful case of ruptured aneurysm of the persistent trigeminal artery (PTA) treated with direct operation is reported, and surgical keypoints in opening the cavernous sinus under normothermia and getting the landmark for orientation are described.
Abstract: A successful case of ruptured aneurysm of the persistent trigeminal artery (PTA) treated with direct operation is reported. Only 14 cases out of ever-reported 400 cases with persistent trigeminal artery have aneurysms developing from PTA itself or its junction. These aneurysms originate most frequently from the trunk portion of the PTA. In our case, aneurysms are found at the rt. internal carotid-PTA junction and the rt. IC-PC junction. Six out of 14 are associated with another intracranial aneurysms, indicating high multiplicity. Of 14 cases, only 2 including our case are treated by direct surgery. Since the internal carotid-PTA junction aneurysm is located in the cavernous sinus, special consideration is needed during the operation. Surgical keypoints in opening the cavernous sinus under normothermia and getting the landmark for orientation are described.
TL;DR: A case of a high-flow posttraumatic carotid-cavernous fistula, with complete steal of the blood flow from the ipsilateral internal carotids artery (ICA), is reported.
Abstract: ✓ The authors report a case of a high-flow posttraumatic carotid-cavernous fistula, with complete steal of the blood flow from the ipsilateral internal carotid artery (ICA). Direct attack on the intracavernous carotid artery was performed using the approach of Parkinson with temporary isolation of the ICA. Complete transection of the artery within the cavernous sinus was encountered. The fistula was occluded by clipping the two ends of the ICA within the sinus. The implications of this previously unreported finding are discussed.
TL;DR: The course and lengths or the cranial nerves in the lateral wall of the cavernous sinus (Parkinson's triangle) and their relations to the internal carotid artery are described.
Abstract: The course and lengths or the cranial nerves in the lateral wall of the cavernous sinus (Parkinson's triangle) and their relations to the internal carotid artery are described.
TL;DR: The sphenoid sinus maintains intimate anatomic relationships with the first six cranial nerves, with the dura mater, internal carotid arteries, cavernous sinus, pituitary, upper orbital fissure, optic chiasma, sphenopalatine nerve, and nerve of the pterygoid canal.
Abstract: Sphenoid sinus mucocele is a rare occurrence. Since the original description by Berg in 1889,181 cases had been reported worldwide in the literature by 1970. Etiology is controversial. Hypotheses have been advanced of slow and progressive accumulation of secretions due to obstruction of the draining ostium caused by chronic sinusitis,1,2-4cystic dilatation of glandular mucous cells,3,5cyst formation by embryonic pituitary rests,1and an unusual form of craniopharyngioma.1The sphenoid sinus maintains intimate anatomic relationships with the first six cranial nerves, with the dura mater, internal carotid arteries, cavernous sinus, pituitary, upper orbital fissure, optic chiasma, sphenopalatine nerve, and nerve of the pterygoid canal.1,4Cystic dilatation with compression of these structures determines the signs and symptoms observed.3 REPORT OF A CASE A 33-year-old woman was admitted to the hospital on July 15, 1982, with complaints of left frontal headache that had been
Journal Article•
TL;DR: A intracavernous arterial aneurysm spontaneously developing into a carotid-cavernous fistula is discussed and the aetiopathology of these fistulas is discussed.
Abstract: Chez une malade avec epilepsie bravais jacksonienne, la carotidographie montre un petit anevrysme de la carotide interne intracaverneuse. Quelques mois apres, elle presente une exophtalmie pulsatile avec souffle periorbitaire, la carotidographie met en evidence une fistule carotidocaverneuse liee a la rupture de l'anevrysme precedemment decelee. Aucune notion de traumatisme, la pathogenie de la fistule est discutee
TL;DR: A case with brain ischemia induced by the absence of bilateral internal carotid arteries, in which a superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis was performed is reported.
Abstract: A case with brain ischemia induced by the absence of bilateral internal carotid arteries, in which a superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis was performed is reported. No similar case has been reported before. The patient was a 27-year-old female who had suffered from syncope and right hemiconvulsion since the age of 15. After the first delivery hemiparesis occurred on the right side. The plain skull Xray films including tomograms showed no carotid canal. The aortograms showed a right aortic arch and an aberrant left subclavian artery. The angiograms demonstrated no bifurcation of either common carotid arteries and absence of bilateral internal carotid arteries, except for the cavernous sinus portion and the supraclinoid portion of the right internal carotid artery. The intracranial blood was supplied mainly by the dilated right vertebral artery and the enlarged collateral artery from the right maxillary artery to the cavernous sinus portion of the right internal carotid artery. The supraclinoid portion of the right internal carotid artery was dilated in fusiform. STA-MCA anastomosis was carried out on the left side. Symptoms and the regional cerebral blood flow improved postoperatively.