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Cavernous sinus

Kouichi Misaki, Naoyuki Uchiyama, Masanao Mohri, Yasuhiro Aida, Takehiro Uno, Mitsutoshi Nakada
Dural arteriovenous fistulas (DAVFs) presenting with ocular symptoms, such as exophthalmos and chemosis, are commonly situated in cavernous sinus (CS). DAVFs at the sphenoid wing with a drainage route into the superior orbital vein (SOV) should be considered as one of differential diagnosis of ocular symptoms. A 41-year-old woman presented with progressive left-sided chemosis and proptosis after left pulsating tinnitus that disappeared spontaneously. Cerebral angiography showed that the fistula was situated along the inferior edge of the superior orbital fissure on the greater sphenoid wing and drained solely into the SOV without flowing into the CS that caused ocular symptoms...
October 19, 2016: World Neurosurgery
F Heran Dreyfus, O Galatoire, P Koskas, F Lafitte, E Nau, O Bergès
Orbito-palpebral vascular pathology represents 10% of all the diseases of this area. The lesion may be discovered during a brain CT scan or MRI, or because it causes clinical symptoms such as orbital mass, visual or oculomotor alteration, pain, proptosis, or acute bleeding due to a complication of the lesion (hemorrhage, thrombosis). We present these lesions using an anatomical, clinical, imaging and therapeutic approach. We distinguish four different entities. Vascular tumors have common imaging characteristics (hypersignal on T2 sequence, contrast enhancement, abnormal vascularization well depicted with ultrasound and Doppler, and possible bleeding)...
October 18, 2016: Journal Français D'ophtalmologie
Chai Kobkitsuksakul, Pakorn Jiarakongmun, Ekachat Chanthanaphak, Sirintara Pongpech
PURPOSE: The classic symptoms and signs of carotid cavernous sinus fistula or cavernous sinus dural arteriovenous fistula (AVF) consist of eye redness, exophthalmos, and gaze abnormality. The angiography findings typically consist of arteriovenous shunt at cavernous sinüs with ophthalmic venous drainage with or without cortical venous reflux. In rare circumstances, the shunts are localized outside the cavernous sinus, but mimic symptoms and radiography of the cavernous shunt. We would like to present the other locations of the arteriovenous shunt, which mimic the clinical presentation of carotid cavernous fistulae, and analyze venous drainages...
October 21, 2016: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
Veysel Burulday, Mehmet Hüseyin Akgül, Nuray Bayar Muluk, Mehmet Faik Ozveren, Ahmet Kaya
In the present study, we investigated the types and ratio of posterior clinoid process (PCP) pneumatization in paranasal sinus multidetector computed tomography (MDCT). Paranasal MDCT images of 541 subjects (227 males, 314 females), between 15 and 65 years old, were included into the study. Pneumatization of anterior clinoid process and pneumatization types (I, II, or III) were evaluated in the males and females. PCP pneumatization was detected in 20.7 % of the males and 11.5 % of the females. Right, left, and bilateral PCP pneumatizations were detected in 7...
October 21, 2016: Neurosurgical Review
Hasan A Zaidi, David J Cote, Ian F Dunn, Edward R Laws
Despite formal pathological criteria, not all atypical pituitary adenomas display clinically aggressive behavior. We set out to determine which factors predict a clinically aggressive phenotype among a cohort of atypical pituitary adenomas. Medical records were retrospectively reviewed from April 2008 to July 2015. Of 569 pituitary adenomas, 47 (8.3%) patients were surgically treated for atypical adenomas as defined by the WHO criteria. Clinically aggressive adenomas were defined as occurring in those patients who necessitated additional therapeutic intervention after the index (first) surgery, including additional surgery, medical therapy, or radiosurgery...
October 17, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Darren Yap, Hannah Fox, Julia Addams-Williams
Neurofibroma is a slow growing benign tumour of the peripheral nerve sheath which is frequently associated with neurofibromatosis type 1 (Prakash et al., 2014). Isolated solitary occurrence of neurofibroma in the maxillary sinus is rare with only 29 reported cases in the literature. We present a rare case of a 70-year-old gentleman who was referred to ENT with a right maxillary sinus neurofibroma with extension into the right inferior orbit. He has significant proptosis, ptosis, and limitation in abduction of the right eye...
2016: Case Reports in Pathology
Kevin Phan, Joshua Xu, Rajesh Reddy, Piyush Kalakoti, Anil Nanda, Jacob Fairhall
BACKGROUND: The pituitary adenoma causing acromegaly is typically resected through a transsphenoidal approach and visualised with an operating microscope or endoscope. We undertook a systematic review and meta-analysis examining the clinical efficacy of endoscopic and microsurgical approaches. METHODS: Relevant studies using either endoscopic or microscopic transphenoid approaches for growth-hormone pituitary adenomas were identified up to Feb 2016. Data were extracted and analyzed according to predefined clinical endpoints...
October 15, 2016: World Neurosurgery
Bhaskar Roy, Brian M Grosberg
No abstract text is available yet for this article.
October 18, 2016: Headache
Venkatraman Bhat, Jenna Devere, Athira Ramakrishanan, Moni A Kuriakose
A case of malignant cutaneous lesion of the face diagnosed initially as sebaceous carcinoma, subsequently proven to be squamous cell carcinoma is presented. Patient was initially evaluated at an outside institution by computed tomography, which indicated extension of lesion to the maxillary sinus. Patient underwent local resection. Further imaging by magnetic resonance imaging was done for recurrent tumour. Examination revealed extensive, large volume, perineural extension of the disease via infraorbital nerve to the cavernous sinus...
September 2016: Journal of Maxillofacial and Oral Surgery
Anton M Kolomeyer, Ken K Nischal, Ellen Mitchell
PURPOSE: To report a case of bilateral cavernous sinus thrombosis (CST) in a patient with tacrolimus-associated posttransplant thrombotic microangiopathy. METHODS: Case report. RESULTS: An 8-year-old boy with a medical history of orthotopic heart transplant, posttransplant lymphoproliferative disease, and recurrent infections was hospitalized for nausea, vomiting, and diarrhea. His ocular history included accommodative esotropia, hyperopia with astigmatism, Molluscum contagiosum lid lesions, and idiopathic intracranial hypertension...
October 13, 2016: European Journal of Ophthalmology
Giorgio Spatola, Laura Frosio, Marco Losa, Antonella Del Vecchio, Martina Piloni, Pietro Mortini
BACKGROUND: Gamma knife radiosurgery is an effective and safe treatment modality in the management of pituitary adenomas. Internal carotid occlusion is a rare but possible complication of Gamma Knife Radiosurgery for lesions within the cavernous sinus. AIM: To stress the importance of considering the Internal carotid artery as an organ at risk in cavernous sinus invading adenomas and reduce the dose delivered to this structure whenever possible. CASE DESCRIPTION: We report two cases of asymptomatic occlusion of the intracavernous segment of the internal carotid artery seven years after treatment in acromegalic patients...
November 2016: Reports of Practical Oncology and Radiotherapy
Tatsuya Ueno, Haruo Nishijima, Rie Haga, Masahiko Tomiyama
No abstract text is available yet for this article.
November 2016: Clinical Neurology and Neurosurgery
Diane Donegan, John L D Atkinson, Mark Jentoft, Neena Natt, Tod B Nippoldt, Bradley Erickson, Fredric Meyer, Dana Erickson
OBJECT: Prolactinomas are primarily treated with medical therapy. Given the efficacy of Dopamine agonists (DA), surgery has remained a second line treatment option. Despite medical therapy, some tumors display resistance and or patients maybe intolerant of DA requiring alternative treatment options. We examined the indications, efficacy and safety of pituitary surgery for the treatment of prolactinomas. METHODS: We performed a retrospective analysis of all patients who had surgery for a prolactinoma at our institution from January 1993 to October 2014...
September 28, 2016: Endocrine Practice
William Ruger Porter, Jayc C Sedlmayr, Lawrence M Witmer
Extant crocodilians are a highly apomorphic archosaur clade that is ectothermic, yet often achieve large body sizes that can be subject to higher heat loads. Therefore, the anatomical and physiological roles that blood vessels play in crocodilian thermoregulation need further investigation to better understand how crocodilians establish and maintain cephalic temperatures and regulate neurosensory tissue temperatures during basking and normal activities. The cephalic vascular anatomy of extant crocodilians, particularly American alligator (Alligator mississippiensis) was investigated using a differential-contrast, dual-vascular injection technique and high resolution X-ray micro-computed tomography (μCT)...
September 28, 2016: Journal of Anatomy
Margarita G Todorova, Cameron F Parsa
BACKGROUND: Variable pupillary responses have been described with carotid-cavernous sinus fistulas. These often are associated with a decrease in visual acuity and attributed to retinal ischemia. We propose a novel pathophysiologic mechanism for changes in pupillary reactivity involving anatomic changes secondary to choroidal effusion. METHODS: To demonstrate proof-of-concept, we investigated 2 consecutive patients with carotid-cavernous sinus fistulas and pupillary disturbances using repeated refractions and anterior segment ultrasound biomicroscopy...
September 22, 2016: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Philip V Theodosopoulos, Helene Cebula, Almaz Kurbanov, Arnau Benet Cabero, Joseph Osorio, Lee A Zimmer, Sebastien C Froelich, Jeffrey T Keller
OBJECTIVE: The zenith of surgical interest in the cavernous sinus peaked in the 1980s, as evidenced by reports of 10 surgical triangles that could access the contents of the lateral sellar compartment (LSC). However, these transcranial approaches later became marginalized, first by radiosurgery's popularity and lower morbidity, and then by clinical potential of endoscopic corridors noted in several qualitative studies. Our anatomic study, taking a contemporary look at the medial extra-sellar corridor, gives a detailed qualitative-quantitative analysis for its use with increasingly popular endoscopic endonasal approaches to the cavernous sinus...
September 19, 2016: World Neurosurgery
Anthony Liberatore, Ronald M Lechan
Carotid-cavernous fistulas (CCFs) are rare, pathologic communications of the carotid artery and the venous plexus of the cavernous sinus. They can develop spontaneously in certain at risk individuals or following traumatic head injury. Typical clinical manifestations include headache, proptosis, orbital pain, and diplopia. We report a case of bilateral carotid-cavernous fistulas associated with these symptoms and also with pituitary enlargement and hypopituitarism, which improved following surgical intervention...
2016: Case Reports in Endocrinology
Alex Botsford, Jai Jai Shiva Shankar
INTRODUCTION: Indirect carotid cavernous fistulas are treated with coil embolization when they present with orbital/visual symptoms or if there is cortical venous reflux. Most of the time, the treatment is done by non-specifically packing the whole cavernous sinus with coils. The purpose of this case series was to examine whether DSA-Dynavision before embolization would improve treatment by shortening the procedure time, requiring fewer coils, or reducing the complication rate. MATERIALS AND METHOD: 8 patients with 9 fistula sites were retrospectively identified...
September 20, 2016: Journal of Neurointerventional Surgery
Shinya Watanabe, Hiroyoshi Akutsu, Shingo Takano, Tetsuya Yamamoto, Eiichi Ishikawa, Hiroaki Suzuki, Akira Matsumura
OBJECTIVE: Withdrawal of cabergoline is generally challenging, especially in patients with large or invasive macroprolactinomas. Therefore, we aimed to assess long-term results of cabergoline therapy for macroprolactinomas and remission achievement results after withdrawal in patients with macroprolactinomas. We also investigated clinical characteristics and factors related to remission after withdrawal. METHODS: This was an institutional review board-approved retrospective analysis...
September 21, 2016: Clinical Endocrinology
Hans C Fledelius
PURPOSE: To examine long-term data on optic disc drusen (ODD) from an outpatient hospital series that indicated more cases with advanced visual field constriction than is apparent from other clinical reports. The underlying pathophysiology is discussed, also with regard to enlarged blind spot, which, in view of the small disc at risk, may seem a paradox. METHODS: This is an observational retrospective study on an eye clinic series (n = 49), focusing on visual acuity, kinetic/static perimetry, and longitudinal trends, to include the question of eventual visual incapacity...
August 24, 2016: European Journal of Ophthalmology
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