Transvenous embolization of indirect carotid-cavernous fistula via upper ophthalmic/facial vein - Case report and literature review

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Sirakov, S.; Penkov, M.; Sirakov, A.; Kamenov, B.; Todorov, Y.; Ninov, K.; Bachvarov, Ch.

2015-01-01

Indirect carotid-cavernous fistula or dural arterio-venous fistula of cavernous sinus is relatively rare pathologic finding. Different classifications of carotid-cavernous fistulae are proposed. Now days more and more they are treated by endovascular approach. A case of authors' practice of transvenous embolization of carotid-cavernous fistula via upper ophthalmic vein in 52 year old female is presented with review of the literature. A week later ocular symptoms of the patient regressed. Control angiography at the third month follow up does not visualize fistula. The transvenous approach in management of carotid cavernous fistulae is safe and effective in cases direct arterial approach is absent or technically impossible. Key words: Indirect Carotid-Cavernous Fistula. Embolization. Transvenous Approach

Spontaneous Carotid-Cavernous Fistula in the Type IV Ehlers-Danlos Syndrome

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Kim, Jeong Gyun; Cho, Won-Sang; Kim, Jeong Eun

2014-01-01

Ehlers-Danlos syndrome (EDS) is a rare inherited connective disease. Among several subgroups, type IV EDS is frequently associated with spontaneous catastrophic bleeding from a vascular fragility. We report on a case of carotid-cavernous fistula (CCF) in a patient with type IV EDS. A 46-year-old female presented with an ophthalmoplegia and chemosis in the right eye. Subsequently, seizure and cerebral infarction with micro-bleeds occurred. CCF was completely occluded with transvenous coil embolization without complications. Thereafter, the patient was completely recovered. Transvenous coil embolization can be a good treatment of choice for spontaneous CCF with type IV EDS. However, every caution should be kept during invasive procedure. PMID:24653803

Giant cavernous carotid aneurysm with spontaneous ipsilateral ICA occlusion: Report of 2 cases and review of literature

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Savitr BV Sastri

2013-01-01

Full Text Available Giant aneurysms of the cavernous carotid artery are rare entities which present predominantly with features of compression of the adjacent neural structures, most commonly the III, IV, VI and V cranial nerves. Historically, treatment options included occlusion of the feeding vessel, direct surgery on the aneurysm, bypass procedures and in recent times, the use of endovascular devices. While intramural thrombus formation is commonly seen in giant aneurysms, we present 2 cases of giant cavernous aneurysms which on evaluation were found to have spontaneous occlusion of the feeding internal carotid artery secondary to thrombus formation, and review the available literature regarding the same.

Occipital lobe infarction: a rare presentation of bilateral giant cavernous carotid aneurysms: a case report.

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Vanikieti, Kavin; Poonyathalang, Anuchit; Jindahra, Panitha; Cheecharoen, Piyaphon; Chokthaweesak, Wimonwan

2018-02-02

Cavernous carotid aneurysm (CCA) represents 2-9% of all intracranial aneurysms and 15% of internal carotid artery (ICA) aneurysms; additionally, giant aneurysms are those aneurysms that are > 25 mm in size. Bilateral CCAs account for 11-29% of patients and are commonly associated with structural weaknesses in the ICA wall, secondary to systemic hypertension. CCAs are considered benign lesions, given the low risk for developing major neurologic morbidities (i.e., subarachnoid hemorrhage, cerebral infarction, or carotid cavernous fistula). Moreover, concurrent presentation with posterior circulation cerebral infarction is even rarer, given different circulation territory from CCA. Here, we report on a patient with bilateral giant CCAs who presented with both typical and atypical symptoms. An 88-year-old hypertensive woman presented with acute vertical oblique binocular diplopia, followed by complete ptosis of the right eye. Ophthalmic examination showed dysfunction of the right third, fourth, and sixth cranial nerves. Further examination revealed hypesthesia of the areas supplied by the ophthalmic (V1) and maxillary (V2) branches of the right trigeminal nerve. Bilateral giant cavernous carotid aneurysms, with a concurrent subacute right occipital lobe infarction, were discovered on brain imaging and angiogram. Additionally, a prominent right posterior communicating artery (PCOM) was revealed. Seven months later, clinical improvement with stable radiographic findings was documented without any intervention. Dysfunction of the third, fourth, and sixth cranial nerves, and the ophthalmic (V 1 ) and maxillary (V 2 ) branches of the trigeminal nerves, should necessitate brain imaging, with special attention given to the cavernous sinus. Despite unilateral symptomatic presentation, bilateral lesions cannot be excluded solely on the basis of clinical findings. CCA should be included in the differential diagnosis of cavernous sinus lesions. Although rare, ipsilateral

Fat in the normal cavernous sinus

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Hosoya, Takaaki; Kera, Masahiro; Suzuki, Toshifumi; Yamaguchi, Koichi

1986-01-01

The cavernous sinuses of 17 patients examined by metrizamide CT cisternography with 1.5 mm-thick silces were reviewed. Most of the cavernous sinuses contained fatty components. Anterior lateral end and posterior end of the cavernous sinus are the comon sites where the fat is visible. (orig.)

The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: our first experience

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Chiriac A.

2016-06-01

Full Text Available Complex cavernous sinus fistulae (CCF are still a technical challenge to neurovascular team. The most commonly performed treatment consists in endovascular embolization of the lesion through an arterial or venous approach. Not always these conventional routes are feasible, requiring alternative routes. We report a case of a 44-year-old woman with a complex indirect (Barrow D carotid cavernous sinus fistula treated by two interventional sessions that imposing a retrograde direct transvenous approach via the superior ophthalmic vein.

Arteriovenous Malformation in Temporal Lobe Presenting as Contralateral Ocular Symptoms Mimicking Carotid-Cavernous Fistula

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Fadzillah Mohd-Tahir

2013-01-01

Full Text Available Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.

Recovery of opthalmoplegia associated with cavernous sinus dural arteriovenous fistulas after transvenous cavernous sinus packing

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Xianli, Lv; Chuhan, Jiang; Youxiang, Li; Xinjian, Yang [Beijing Neurosurgical institute, Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, Chongwen, Beijing (China); Wu Zhongxue, E-mail: ttyyzjb@sina.co [Beijing Neurosurgical institute, Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, Chongwen, Beijing (China)

2010-08-15

Background: We report the recovery of ophthalmoplegia in 11 patients with cavernous sinus dural arteriovenous fistula (CSDAVF) after sinus packing at follow-up. Methods: Of 18 patients with CSDAVF treated with transvenous cavernous sinus packing between August 2002 and December 2007 at Beijing Tiantan Hospital, there were 9 patients with initial CNIII or CNVI dysfunction and 2 patients with CNVI dysfunction immediately after cavernous sinus packing selected and reevaluated. Results: Of 11 patients with CNIII or CNVI palsy, recovery was complete in 10. In 1 patient, complete CNVI palsy was unchanged because the CSDAVF was not cured. There were 6 men and 5 women with a mean age of 52.9 years. In 5 patients, CNVI palsy was associated with chemosis, proptosis and pulsatile tinnitus. Timing of treatment after onset of symptoms was from 4 to 35 days in 9 patients. All CSDAVFs were Barrow type D. Mean follow-up after treatment was 17.7 months (range, 2-54 months). Conclusion: CSDAVF-induced CNIII or CNVI palsies can be cured after cavernous sinus packing transvenously in most patients.

Recovery of opthalmoplegia associated with cavernous sinus dural arteriovenous fistulas after transvenous cavernous sinus packing

International Nuclear Information System (INIS)

Lv Xianli; Jiang Chuhan; Li Youxiang; Yang Xinjian; Wu Zhongxue

2010-01-01

Background: We report the recovery of ophthalmoplegia in 11 patients with cavernous sinus dural arteriovenous fistula (CSDAVF) after sinus packing at follow-up. Methods: Of 18 patients with CSDAVF treated with transvenous cavernous sinus packing between August 2002 and December 2007 at Beijing Tiantan Hospital, there were 9 patients with initial CNIII or CNVI dysfunction and 2 patients with CNVI dysfunction immediately after cavernous sinus packing selected and reevaluated. Results: Of 11 patients with CNIII or CNVI palsy, recovery was complete in 10. In 1 patient, complete CNVI palsy was unchanged because the CSDAVF was not cured. There were 6 men and 5 women with a mean age of 52.9 years. In 5 patients, CNVI palsy was associated with chemosis, proptosis and pulsatile tinnitus. Timing of treatment after onset of symptoms was from 4 to 35 days in 9 patients. All CSDAVFs were Barrow type D. Mean follow-up after treatment was 17.7 months (range, 2-54 months). Conclusion: CSDAVF-induced CNIII or CNVI palsies can be cured after cavernous sinus packing transvenously in most patients.

Recurrent Syncope Due to Carotid Sinus Hypersensitivity and Sick Sinus Syndrome

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Feng-Yu Kuo

2008-10-01

Full Text Available Syncope is a sudden and brief loss of consciousness with postural tone. Its recovery is usually spontaneous. There are various causes of syncope including cardiac, vascular, neurologic, metabolic and miscellaneous origins. The tracing is usually time-consuming and costly. The diagnosis of carotid sinus syncope may sometimes be difficult since the symptoms are nonspecific, especially in older persons. Here, we report the case of a 72-year-old woman who sought medical attention at our hospital due to repeated syncope episodes over the previous 5 years. Neurologic examinations showed negative results (including brain computed tomography. Twenty-four-hour ambulatory electrocardiogram monitoring showed atrial and ventricular premature contractions only. Electrophysiologic study disclosed prolonged corrected sinus node recovery time (1,737 ms with poor atrioventricular conduction. Drop of blood pressure together with sinus bradycardia developed after left side carotid sinus massage. Both carotid sinus hypersensitivity with sick sinus syndrome contributed to this patient's syncope, and after pacemaker placement together with selective serotonin reuptake inhibitor treatment, she was free from syncope thereafter.

Arachnoid cyst in cavernous sinus: case report

International Nuclear Information System (INIS)

Lim, Hyoung Gun; Yoo, Won Jong; Jung, So Lyung; Lee, Hae Gui; Lim, Hyun Wook; Im, Soo Ah

2002-01-01

Arachnoid cyst of the cavernous sinus is very rare. When present, its anatomic location frequently gives rise to cranial nerve palsy. We report a case of arachnoid cyst of the cavernous sinus in a 38-year-old man with impaired eyeball movement and diplopia

Arachnoid cyst in cavernous sinus: case report

International Nuclear Information System (INIS)

Lim, Hyoung Gun; Yoo, Won Jong; Jung, So Lyung; Lee, Hae Giu; Lim, Hyun Wook; Im, Soo Ah

2002-01-01

Arachnoid cyst of the cavernous sinus is very rare. When present, its anatomic location frequently gives rise to cranial nerve palsy. We report a case of arachnoid cyst of the cavernous sinus in a 38-year-old man with impeder eyeball movement and diplopia

Arachnoid cyst in cavernous sinus: case report

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Lim, Hyoung Gun; Yoo, Won Jong; Jung, So Lyung; Lee, Hae Giu; Lim, Hyun Wook; Im, Soo Ah [The Catholic University of Kore College of Medicine, Puchun (Korea, Republic of)

2002-12-01

Arachnoid cyst of the cavernous sinus is very rare. When present, its anatomic location frequently gives rise to cranial nerve palsy. We report a case of arachnoid cyst of the cavernous sinus in a 38-year-old man with impeder eyeball movement and diplopia.

Cavernous sinus invasion by pituitary adenomas. Relationship between magnetic resonance imaging findings and histologically verified dural invasion

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Daita, Go; Yonemasu, Yukichi; Nakai, Hirofumi; Takei, Hidetoshi; Ogawa, Katsuhiro [Asahikawa Medical Coll., Hokkaido (Japan)

1995-01-01

The relationship between magnetic resonance (MR) imaging findings and histologically verified invasion of the cavernous sinus by tumor cells was studied in 26 patients treated surgically for pituitary adenoma. Dural invasion of the sellar floor by tumor cells was found in 10 cases (38%). All patients were classified according to MR imaging findings into three types. Type I showed a gadolinium-enhanced stripe medial to the carotid artery (5 patients), none of which showed dural invasion. Type II showed no enhanced stripe (17 patients), six of which showed dural invasion. Within this type, tumor size and dural invasion showed no correlation. Type III showed displacement or encasement of the carotid artery by the tumor with or without extracranial extension (4 patients), all of which showed massive infiltration of the tumor cells into the dura mater. This study shows that preoperative MR imaging can provide information for assessment of invasion into the cavernous sinus in patients with pituitary adenoma. (author).

Results of stereotactic radiosurgery for patients with imaging defined cavernous sinus meningiomas

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Pollock, Bruce E.; Stafford, Scott L.

2005-01-01

Introduction: The purpose of this study was to evaluate the efficacy and safety of stereotactic radiosurgery as primary management for patients with imaging defined cavernous sinus meningiomas. Methods: Between 1992 and 2001, 49 patients had radiosurgery for dural-based masses of the cavernous sinus presumed to be meningiomas. The mean patient age was 55.5 years. The mean tumor volume was 10.2 mL; the mean tumor margin dose was 15.9 Gy. The mean follow-up was 58 months (range, 16-144 months). Results: No tumor enlarged after radiosurgery. Twelve of 38 patients (26%) with preexisting diplopia or facial numbness/pain had improvement in cranial nerve function. Five patients (10%) had new (n = 3) or worsened (n = 2) trigeminal dysfunction; 2 of these patients (4%) underwent surgery at 20 and 25 months after radiosurgery despite no evidence of tumor progression. Neither patient improved after partial tumor resection. One patient (2%) developed an oculomotor nerve injury. One patient (2%) had an ischemic stroke related to occlusion of the cavernous segment of the internal carotid artery. Event-free survival was 98%, 85%, and 80% at 1, 3, and 7 years after radiosurgery, respectively. Univariate analysis of patient and dosimetric factors found no analyzed factor correlated with postradiosurgical morbidity. Conclusions: Radiosurgery was an effective primary management strategy for patients with an imaging defined cavernous sinus meningioma. Except in situations of symptomatic mass effect, unusual clinical presentation, or atypical imaging features, surgery to confirm the histologic diagnosis is unlikely to provide clinical benefit

Necrotizing Fasciitis of the Nose Complicated with Cavernous Sinus Thrombosis

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D. Swaminath

2014-01-01

Full Text Available Necrotizing fasciitis is a rapidly progressive life threatening bacterial infection of the skin, the subcutaneous tissue, and the fascia. We present a case of necrotizing fasciitis involving the nose complicated by cavernous sinus thrombosis. Few cases of septic cavernous sinus thrombosis have been reported to be caused by cellulitis of the face but necrotizing fasciitis of the nose is rare. It is very important to recognize the early signs of cavernous thrombosis. Treatment for septic cavernous sinus thrombosis is controversial but early use of empirical antibiotics is imperative.

Lateral sellar compartment O.T. (cavernous sinus): history, anatomy, terminology.

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Parkinson, D

1998-08-01

Claudios Galen (119-199 a.d.) dissected lower animals with parasellar carotid retia bathed in venous blood and transposed his findings to human anatomy. Andreas Vesalius (1514-1564) corrected most of Galen's errors but apparently never looked into this small, extradural compartment, nor, apparently, did Winslow (Exposition Anatomique de la Structure du Corps Humain. London: N. Prevast, 1734), who christened it the "cavernous sinus," (CS) presumably thinking that it would resemble the corpora cavernosa of the penis. Multiple surgical explorations, gross dissections, microscopic views, and vascular casts from early fetuses to an 81 year old have been examined and reviewed. The CS is not a dural sinus nor is it cavernous. The compartment is extradural, and the venous structures contained within consist of a greatly variable plexus of extremely thin-walled veins. The name, CS, is a barrier to the understanding of the structure and function of this extradural anatomical jewel box, which contains fat, myelinated and nonmyelinated nerves, arteries, and a plexus of veins. It is proposed that this name be changed, because it is inaccurate and misleading. The replacement should leave no doubt about its meaning. The lateral sellar compartment is descriptive and accurate. The veins within are a parasellar plexus.

Gallium scintigraphy in a case of septic cavernous sinus thrombosis

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Palestro, C.J.; Malat, J.; Gladstone, A.G.; Richman, A.H.

1986-01-01

Septic cavernous sinus thrombosis, a relatively uncommon disease entity, frequently can be fatal. Early diagnosis is imperative in order that appropriate treatment be instituted. A 59-year-old woman who was admitted to our institution with complaints of diplopia, blurred vision and fevers that developed following a tooth extraction is presented. Initial CT and lumbar puncture on the day of admission were totally normal. A repeat CT performed 48 hours after admission, on the same day as gallium imaging, demonstrated findings consistent with cavernous sinus thrombosis. Gallium imaging demonstrated intense uptake in the left cavernous sinus and left orbit as well as moderately increased activity in the right cavernous sinus and orbit, confirming infection. The patient was treated with antibiotics, and repeat CT and gallium imaging were performed ten days later, both of which demonstrated near total resolution of the disease process. Conceivably, if gallium imaging had been initiated on the day of admission it may have been the first study to demonstrate an infectious process in the cavernous sinus. Gallium imaging should be considered as a diagnostic tool in the noninvasive workup of this entity

Brainstem edema caused by traumatic carotid-cavernous fistula: A case report and review of the literature

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YU, JINLU; GUO, YUNBAO; ZHAO, SHUJIE; XU, KAN

2015-01-01

Brainstem edema caused by traumatic carotid-cavernous fistula (TCCF) is rare, and there is little information available regarding its clinical characteristics. The present report describes the case of a 51-year-old man with TCCF, who presented with right exophthalmos and intracranial bruit for 1 week. One month prior to admission at hospital, he fractured the frontal and ethmoid sinuses. Digital subtraction angiography confirmed the diagnosis of TCCF, and magnetic resonance imaging (MRI) sugg...

Treatment of a direct carotid-cavernous fistula in a patient with type IV Ehlers-Danlos syndrome: a novel approach

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Hollands, J.K.; Santarius, T.; Kirkpatrick, P.J. [Addenbrooke' s Hospital, Department of Neurosurgery, Cambridge (United Kingdom); Higgins, J.N. [Addenbrooke' s Hospital, Department of Neuroradiology, Cambridge (United Kingdom)

2006-07-15

We report a case of a 34-year-old female with type IV Ehlers-Danlos syndrome diagnosed with a carotid cavernous fistula presenting with progressive proptosis. Endovascular embolization using balloons or coils carries a high risk of complications in this group of patients, owing to the extreme fragility of the blood vessels. Initial treatment was conservative until an intracerebral haemorrhage occurred. To avoid transfemoral angiography, the ipsilateral carotid arteries and the internal jugular vein were surgically exposed for insertion of two endovascular sheaths. The patient was transferred from theatre to the angiography suite and the sheaths were used for embolization access. The fistula was closed, with preservation of the carotid artery, using Guglielmi detachable coils deployed in the cavernous sinus from the arterial and venous sides. Rapid resolution of symptoms and signs followed, which was sustained at 6-month follow-up. This technique offers alternative access for endovascular treatment, which may reduce the high incidence of mortality associated with catheter angiography in this condition. (orig.)

Treatment of a direct carotid-cavernous fistula in a patient with type IV Ehlers-Danlos syndrome: a novel approach

International Nuclear Information System (INIS)

Hollands, J.K.; Santarius, T.; Kirkpatrick, P.J.; Higgins, J.N.

2006-01-01

We report a case of a 34-year-old female with type IV Ehlers-Danlos syndrome diagnosed with a carotid cavernous fistula presenting with progressive proptosis. Endovascular embolization using balloons or coils carries a high risk of complications in this group of patients, owing to the extreme fragility of the blood vessels. Initial treatment was conservative until an intracerebral haemorrhage occurred. To avoid transfemoral angiography, the ipsilateral carotid arteries and the internal jugular vein were surgically exposed for insertion of two endovascular sheaths. The patient was transferred from theatre to the angiography suite and the sheaths were used for embolization access. The fistula was closed, with preservation of the carotid artery, using Guglielmi detachable coils deployed in the cavernous sinus from the arterial and venous sides. Rapid resolution of symptoms and signs followed, which was sustained at 6-month follow-up. This technique offers alternative access for endovascular treatment, which may reduce the high incidence of mortality associated with catheter angiography in this condition. (orig.)

A Rare Diabetic Autonomic Neuropathy: Carotid Sinus Hypersensitivity

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Ahmet Kaya

2016-03-01

Full Text Available Carotid sinus hypersensitivity is a common cause of fainting and falls in the elderly, and can be diagnosed by carotid sinus massage. We present a 67-year-old diabetic man who was admitted with hyperglycemia. During thyroid examination, clouding of consciousness occurred with unilateral palpation. Asystole was documented for 4.8 seconds and suspected for 7 seconds upon carotid sinus massage. A cardioverter defibrillator was implanted. Carotid sinus hypersensitivity should be kept in mind when examining diabetic patients.

Value of gamma knife radiosurgery for tumors invading cavernous sinus

International Nuclear Information System (INIS)

Jokura, Hidefumi; Yoshimoto, Takashi

1999-01-01

The usefulness of radiosurgery for cavernous sinus tumors was evaluated based on our experience and recent published reports from other institutes. Twenty-six meningiomas involving the cavernous sinus were treated by radiosurgery. The length of follow-up average 3 years. Tumors regressed in 40% and remained stable in 56% of cases. A total of 96% of the tumors were controlled with only a few minor complications. We believe surgical resection to reduce the volume of the tumor without causing new neurological deficits, followed by radiosurgery on the tumor located in the cavernous sinus is the best choice in many cases. Twenty-five pituitary adenomas with cavernous sinus invasion were treated by a combination of transsphenoidal removal and radiosurgery. All the tumors are controlled in terms of volume during the follow-up (average of 34 months). There were no new neurological deficits, including visual disturbance. Hormone elevation was able to be corrected at an early stage without pituitary insufficiency more by radiosurgery than by fractionated radiation. However, to obtain good results by radiosurgery, it must be preceded by complete surgical decompression of optic nerves and chiasma from the tumor. (author)

Tolerance of cranial nerves of the cavernous sinus to radiosurgery

International Nuclear Information System (INIS)

Tishler, R.B.; Loeffler, J.S.; Alexander, E. III; Kooy, H.M.; Lunsford, L.D.; Duma, C.; Flickinger, J.C.

1993-01-01

Stereotactic radiosurgery is becoming a more accepted treatment option for benign, deep seated intracranial lesions. However, little is known about the effects of large single fractions of radiation on cranial nerves. This study was undertaken to assess the effect of radiosurgery on the cranial nerves of the cavernous sinus. The authors examined the tolerance of cranial nerves (II-VI) following radiosurgery for 62 patients (42/62 with meningiomas) treated for lesions within or near the cavernous sinus. Twenty-nine patients were treated with a modified 6 MV linear accelerator (Joint Center for Radiation Therapy) and 33 were treated with the Gamma Knife (University of Pittsburgh). Three-dimensional treatment plans were retrospectively reviewed and maximum doses were calculated for the cavernous sinus and the optic nerve and chiasm. Median follow-up was 19 months (range 3-49). New cranial neuropathies developed in 12 patients from 3-41 months following radiosurgery. Four of these complications involved injury to the optic system and 8 (3/8 transient) were the result of injury to the sensory or motor nerves of the cavernous sinus. There was no clear relationship between the maximum dose to the cavernous sinus and the development of complications for cranial nerves III-VI over the dose range used (1000-4000 cGy). For the optic apparatus, there was a significantly increased incidence of complications with dose. Four of 17 patients (24%) receiving greater than 800 cGy to any part of the optic apparatus developed visual complications compared with 0/35 who received less than 800 cGy (p = 0.009). Radiosurgery using tumor-controlling doses of up to 4000 cGy appears to be a relatively safe technique in treating lesions within or near the sensory and motor nerves (III-VI) of the cavernous sinus. The dose to the optic apparatus should be limited to under 800 cGy. 21 refs., 4 tabs

[Improved methods for researching isolated carotid sinus baroreceptors automatically controlling for sinus pressure].

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Wei, Hua; Zhao, Hai-Yan; Liu, Ping; Huang, Hai-Xia; Wang, Wei; Fu, Xiao-Suo; Niu, Wei-Zhen

2013-01-01

To develop a system for automatically controlling carotid sinus pressure in the study on baroreceptors. The preparation containing carotid sinus with parts of the connected vessels and carotid sinus nerve (CS-CSN) were isolated and perfused. A critical pressure controlling component (PRE-U, Hoerbiger, Deutschland) dictated by a computer was integrated into the system to clamp the intrasinus pressure. The pressure command and the relevant intrasinus pressure were compared to evaluate the validity of the pressure controlling system. A variety of sinus pressure-controlling patterns, including pulsation, ramp and step pressures, could be achieved accurately by using the system, and the pressure-dependent discharge activities of sinus nerve were confirmed. This system for clamping carotid sinus pressure could realize multiple pressure-controlling patterns and is a useful and flexible pressure controlling method that could applied in the study on mechano-electric transduction of baroreceptors.

Is there a dural wall between the cavernous sinus and the pituitary fossa? Anatomical and MRI findings

International Nuclear Information System (INIS)

Dietemann, J.L.; Diniz, R.; Reis, M. Jr.; Neugroschl, C.; Vinclair, L.; Maillot, C.

1998-01-01

We compared MRI studies of the sellar area and embryological and adult histological studies of the cavernous sinuses and pituitary fossa. MRI studies were performed in 50 normal subjects with coronal sections using a fast inversion-recovery sequence to demonstrate the dural walls of the cavernous sinus and pituitary fossa. With this sequence, dura mater appears as a high-signal linear structure. The lateral and superior walls of the cavernous sinus was easily identified on all studies, but demonstration of a dural wall separating the cavernous sinus from the pituitary fossa was not possible. These results correlated well with embryological and adult histological studies obtained from 14 specimens. The absence of a strong separation between the pituitary fossa and the cavernous sinus explains the high incidence of extension of pituitary tumours to the cavernous sinuses and vice versa. (orig.) (orig.)

Rhino-orbitocerebral mucormycosis associated with cavernous sinus thrombosis: case report

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Haber, Daniel Martiniano

2008-12-01

Full Text Available Introduction: Mucormycosis is a rare opportunistic infection caused by Mucorales fungi, and the Rhizopus is the most common one (70% of the cases. It is an acute invasive fungal disease whose form is disseminated, cutaneous, pulmonary, gastrointestinal and rhino-orbitocerebral. The latter is the most common form and its symptoms comprise of unilateral sinusitis, fever and headache. Once established in the orbit the symptoms can be chemosis, diplopia and reduced vision. The infection can spread to the brain via the orbital apex, orbital arteries or via the cribriform plate. Mucormycosis is a medical emergency and the treatment consists of a surgery to an aggressive debridement and in the use of antifungal therapy. Despite the appropriate management, the mortality rate can reach 40% of the cases. One possible intracranial complication of Mucormycosis is the Cavernous Sinus Thrombosis which is a rare and fatal infective disease. The initial symptoms of Cavernous Sinus Thrombosis are headache, retro-orbital pain, periorbital edema, proptosis, diplopia and reduced vision. Case Report: We describe the case of 43-year-old woman with medical history of diabetes mellitus and use of immunosuppressant drugs after kidney transplantation. The patient developed Acute Bacterial Sinusitis and Rhino-orbitocerebral Mucormycosis associated with Cavernous Sinus Thrombosis.

Fatal Peritoneal Bleeding Following Embolization of a Carotid-Cavernous Fistula in Ehlers-Danlos Syndrome Type IV

International Nuclear Information System (INIS)

Usinskiene, Jurgita; Mazighi, Mikael; Bisdorff, Annouk; Houdart, Emmanuel

2006-01-01

We report the case of a 25-year-old woman treated for a spontaneous carotid-cavernous fistula in a context of Ehlers-Danlos syndrome type IV. Embolization with a transvenous approach was achieved without complications; however, the patient died 72 hr later of massive intraperitoneal bleeding. At autopsy, no lesion of the digestive arteries was identified. Possible causes of this bleeding are discussed

Gd-DTPA in the evaluation of the normal and adnormal cavernous sinus

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Marks, M.P.; Thrush, A.; Enzmann, D.

1989-01-01

This paper reports on Gd-DTPA used in the evaluation of normal and abnormal cavernous sinus anatomy. Twenty-five normal subjects and 11 patients with cavernous sinus invasion were studied before Gd-DTPA enhancement. Normal studies were assessed for the conspicuity of the dural margins, the trigeminal cistern, and intracavernous and exiting cranial nerves. Contrast medium enhancement improved deductibility of the medical cavernous sinus margin (68% vs 38% on precontrast images) and intracavernous cranial nerves. Cranial nerves were inconsistently seen even on postcontrast images (cranial nerve III, 88%; v 1 , 36%, V 2 , 38%). On the abnormal images, contrast enhancement was beneficial in defining the relationship of tumor to parasellar structures, egress of tumor through bony foramina, and compression of the trigeminal cistern

Complex carotid cavernous sinus fistulas Barrow type D: endovascular treatment via the ophthalmic vein, imaging control with standardized MRI, long-term results; Interdisziplinaere Embolisation spontaner Karotis-Cavernosus-Fisteln Typ D nach Barrow ueber die Vena ophthalmica: klinische Langzeitergebnisse und kernspintomografische Befunde

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Struffert, T.; Grunwald, I.Q.; Reith, W. [Abteilung fuer Diagnostische und Interventionelle Neuroradiologie, Universitaetsklinikum des Saarlandes (Germany); Muecke, I. [Klinik fuer Augenheilkunde, Universitaetsklinikum des Saarlandes (Germany)

2007-04-15

Purpose: Since feeding arteries from both the internal and external carotid artery are common, cavernous fistulas of Barrow type D are difficult to treat. Embolization using the transarterial approach is considered to be the standard therapy. However, it is often impossible to embolize feeders from the internal carotid artery. The transorbital approach after anterior orbitotomy through the ophthalmic vein is an alternative in this complex situation. The following reports our experience with three female patients who underwent transvenous embolization. Procedural success was documented using standardized MRI and clinical reevaluation. Materials and Methods: Three female patients between 57 and 78 years of age were diagnosed with carotid cavernous fistulas by conventional angiogram. All patients were suffering from exophthalmus and visual impairment. Two patients showed secondary glaucoma and diplopia. In one patient we performed a technically successful transarterial embolization using particles, but no relevant improvement of the patient's condition was seen. Transfemoral transvenous access via the sinus petrosus was not possible in any patient. All patients were then embolized via the ophthalmic vein using GDC detachable coils. All patients were clinically reevaluated by an ophthalmologist. Also a standardized MRI was performed for documentation. Follow-up was performed for the first patient for 32 months, for the second patient for 34 months and for the third patient for 50 months. Results: Transvenous embolization was technically successful in all three cases. Clinical symptoms disappeared rapidly. Postprocedural MRI showed a symmetric diameter of the ophthalmic vein. Venous congestion of the orbit caused by fatty tissue edema regressed completely. Contrast-enhanced magnetic resonance angiography showed normal arterial vessels without evidence of fistula. (orig.)

Helical CT finding of carotid-cavernous fistula: a sign of early enhancing superior ophthalmic vein

International Nuclear Information System (INIS)

Kim, Jae Hyung; Na, Dong Gyu; Byun, Hong Sik; Ryoo, Jae Wook

2000-01-01

The purpose of this study was to determine the diagnostic value of a sign of early enhancing superior ophthalmic vein (SOV), as seen on helical CT images in patients with carotid-cavernous fistula (CCF). This study involved 16 patients with CCF and 28 control patients. Axial CT images with scanning delays of 30 seconds following bolus injection of contrast material (90 mL, 3 mL/sec) were obtained, and this procedure was followed by coronal CT imaging. To determine the presence or absence of early enhancement or, dilatation of the SOV, bulging of the cavernous sinus, and enlargement of extraocular muscle, CT images were analysed by three observers in a blinded, random manner. Early enhancement of SOV was determined to be present where enhancement of the SOV was similar to or stronger than that of the ipsilateral posterior cerebral artery. A sign of early enhancing SOV was seen in 14 of the 16 patients with CCF but in no control patients (88% sensitivity and 100% specificity). The respective sensitivity and specificity of other CT features were 71% and 100% (dilatation of the SOV, as seen on axial images), 60% and 83% (dilatation of the SOV, as seen on coronal images), 71% and 89% (dilatation of the cavernous sinus), and 65% and 98% (enlargement of extraocular muscle). A sign of early enhancing SOV is a characteristic and specific CT finding of CCF, and is useful for the diagnosis of CCF. (author)

[Bilateral spontaneous carotid-cavernous fistula revealing Ehler-Danlos disease].

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Girardin, M; Puzenat, E; Humbert, P; Aubin, F

2013-04-01

A 34-year-old woman with an extensive surgical history developed two spontaneous carotido-cavernous fistula bilaterally. Skin examination revealed an acrogeric form of vascular Ehlers-Danlos syndrome and this diagnosis was confirmed by genetic analysis. Vascular Ehlers-Danlos syndrome is a rare autosomal dominant genetic disease that may be suspected on the grounds of clinical symptoms. Severe complications can occur in early life and are associated with a high mortality rate. The prognosis of vascular Ehlers-Danlos syndrome has been radically changed by the use of beta-blockers. The originality of our observation lies in the long time to onset of the initial complications in the absence of any problems during the numerous operations undergone by the patient, as well as the two childbirths. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Effects of long-term vasodilator therapy in patients with carotid sinus hypersensitivity.

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Brignole, M; Menozzi, C; Gaggioli, G; Musso, G; Foglia-Manzillo, G; Mascioli, G; Fradella, G; Bottoni, N; Mureddu, R

1998-08-01

In patients affected by carotid sinus hypersensitivity, long-term vasodilator therapy might increase the risk of syncopal episodes by reducing systolic blood pressure and venous return to the heart. Thirty-two patients (mean age 73 +/- 9 years; 20 men) who met all the following criteria were included: (1) one or more episodes of syncope occurring during long-term (>6 months) treatment with angiotensin-converting enzyme inhibitors, long-acting nitrates, calcium antagonists, or a combination of these; (2) a positive response to carotid sinus massage, defined as the reproduction of spontaneous syncope in the presence of ventricular asystole > or =3 seconds or a fall in systolic blood pressure > or =50 mm Hg; (3) negative workup for other causes of syncope. The patients were randomly assigned to continue or to discontinue use of vasodilators; carotid sinus massage was repeated 2 weeks after randomization. By the end of the study period, the baseline values of systolic blood pressure were significantly different between the 2 groups of patients both in supine (P=.01) and upright (P=.03) positions. Syncope had been induced by carotid sinus massage in 81% of patients in the "on-vasodilator" group and in 62% of patients in the "off-vasodilator" group (P=.21). The cardioinhibitory reflex was of similar magnitude in the 2 groups, being found in 50% of the patients in each group, with a maximum ventricular pause of 7.1 +/- 2.7 and 6.7 +/- 1.8 seconds, respectively. The percentage decrease of blood pressure did not differ between the 2 groups, even if, in absolute values, the baseline difference of blood pressure roughly persisted for the duration of the test. In consequence of that, the rise of blood pressure to similar values was delayed approximately 30 seconds in the "on-vasodilator" group and took more than 2 minutes to return to baseline values. In patients affected by carotid sinus hypersensitivity, chronic vasodilator therapy does not have a direct effect on carotid

Resolution of clinical symptoms after reopening of an occluded inferior petrosal sinus in a patient with a cavernous sinus dural arteriovenous fistula. A case report.

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Kojima, A; Onozuka, S; Kinoshita, Y

2013-03-01

We describe a rare case with a cavernous sinus (CS) dural arteriovenous fistula (DAVF) in which the clinical symptoms disappeared after the patient underwent reopening of an occluded inferior petrosal sinus (IPS). A 66-year-old woman presented with increased intraocular pressure, chemosis, and proptosis on the left side. Angiography demonstrated a left CS DAVF supplied by the dural branches of bilateral internal carotid arteries. The shunt flow was directed to the superior and inferior ophthalmic veins, while the bilateral IPSs were not opacified. Accordingly, a transvenous embolization of the fistula was attempted. Although the microcatheter was navigated to the cavernous sinus through the occluded left IPS, obliteration of the fistula was unsuccessful because of the failure of superselective catheterization at the fistulous point. However, the final image demonstrated the development of an antegrade shunt flow through the left IPS to the internal jugular vein and disappearance of the retrograde reflux to the superior and inferior ophthalmic veins. The patient's clinical symptoms immediately resolved after the operation, and the symptoms have not recurred during a one-year follow-up period. Inappropriate transvenous embolization of CS DAVFs can result in vascular complications arising from the unintentional redistribution of shunt flow. The present case illustrates that the disappearance of retrograde shunt flow to the ophthalmic veins after reopening of the occluded IPS may be sufficient if a superselective approach fails or is anticipated to result only in an incomplete embolization of the fistulous point.

Roentgenological investigation of cavernous sinus structure with special reference to paracavernous cranial nerves

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Tsuha, M.; Aoki, H.; Okamura, T.

1987-01-01

We have evaluated the anatomical structure of cavernous sinuses in parasellar blocks obtained from adult cadavers to gain clinically useful information. Ten microdissectional studies of parasellar blocks (20 sides of cavernous sinus) were carried out with special emphasis on the course of paracavernous cranial nerves (3rd to 6th). These were also examined on plain radiographs. Secondly, CT investigations of the cavernous sinuses (notably as to paracavernous cranial nerves) were undertaken in twenty clinical cases having presumed parasellar lesions and in three parasellar blocks from cadavers. The results from microdisectional studies and plain radiographs were as follows. It was found that the 3rd cranial nerve entered the lateral wall of the cavernous sinus close to the antero-inferior part of the posterior clinoid on lateral projection. The 4th cranial nerve, on the other hand, entered near the postero-inferior portion of the posterior clinoid on the same view. Variations in Parkinson's triangle were fairly often noted, although marked asymmetry was not seen in individual cases. From CT findings, it was found that a postenhanced, magnified direct coronal study was essential for identifying paracavernous cranial nerves more clearly. The 3rd and 5th cranial nerves were fairly well identified on axial and coronal projections. Careful radiological investigation including plain skull radiographs and CT seems to be of value for those who diagnose or treat parasellar lesions. (orig.)

Cavernous sinus syndrome in dogs and cats: case series (2002-2015

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Aslynn M. Jones

2018-05-01

Full Text Available The cavernous sinus (CS is a paired venous sinus that runs along either side of the pituitary gland on the floor of the calvarium. Cavernous sinus syndrome (CSS refers to deficits in more than one of the cranial nerves III, IV, V, and VI, as they are in close association in this region. The purpose of this study was to identify the presenting complaints, neurologic findings, diagnosis, and outcomes in dogs and cats with confirmed cavernous sinus syndrome (CSS. Medical records between 2002 and 2015 were reviewed. Inclusion criteria were neurologic signs consistent with CSS and advanced imaging and/or post-mortem examination. Thirteen dogs and 2 cats were included. Twelve dogs received advanced imaging. Post-mortem examination was performed on 2 cats and 3 dogs. Dogs were 6 -13 years (mean= 10.8 years of age and comprised of several different breeds. Both cats were male neutered domestic shorthair, ages 3 and 14 years. Presenting complaints included mydriasis (N=4, behavior changes (N=3, hyporexia (N=3, ptosis (N=2, ataxia (N=2, pain (N=2, weakness (N=2, lethargy (N=2, and one each of epiphora, ocular swelling, polydipsia, seizures, facial muscle atrophy, dysphagia, and head tilt. Neurologic signs included ophthalmoparesis/plegia (N=13, reduced/absent pupillary light response (N= 11, mydriasis (N= 10, reduced/absent corneal sensation (N= 7, ptosis (N= 6, reduced facial sensation (N= 2, and enophthalmos (N=1. Thirteen patients had a mass lesion within the cavernous sinus, 6 of which were confirmed neoplastic via histopathology. Median survival time for the 4 patients treated with radiation therapy was 1035 days (range 150-2280. Median survival for the 4 patients that received medical treatment was 360 days (range 7-1260 days, and for the 5 non-treated patients 14 days (range 0-90 days. In conclusion mydriasis and ophthalmoplegia are common signs of CSS. A mass lesion within the CS is the most common cause. Survival time may be improved with

Ehlers-Danlos syndrome type IV and recurrent carotid-cavernous fistula: review of the literature, endovascular approach, technique and difficulties

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Desal, H.A.; Toulgoat, F.; Raoul, S.; Guillon, B.; Bommard, S.; Naudou-Giron, E.; Auffary-Calvier, E.; Kersaint-Gilly, A. de [Department of Neuroradiology, Laennec Hospital, University of Nantes (France); 1

2005-04-01

We report the follow-up of a previously published case (Forlodou et al. Neuroradiology 38:595-597, 1996) of carotido-cavernous fistulas (CCFs) in a patient presenting with type IV Ehlers-Danlos syndrome (EDS 4) that were successfully treated twice by an endovascular approach. Initial treatment with a detachable balloon was in 1994 for a right CCF, and, 8 years later, a left CCF was treated by selective transarterial occlusion of the cavernous sinus with coils. Unfortunately, the patient suffered from a spontaneous post-operative intracranial haemorrhage in the left hemisphere and died. Review of the literature, technical considerations for bilateral CCF and complication are discussed.

Ehlers-Danlos syndrome type IV and recurrent carotid-cavernous fistula: review of the literature, endovascular approach, technique and difficulties

International Nuclear Information System (INIS)

Desal, H.A.; Toulgoat, F.; Raoul, S.; Guillon, B.; Bommard, S.; Naudou-Giron, E.; Auffary-Calvier, E.; Kersaint-Gilly, A. de

2005-01-01

We report the follow-up of a previously published case (Forlodou et al. Neuroradiology 38:595-597, 1996) of carotido-cavernous fistulas (CCFs) in a patient presenting with type IV Ehlers-Danlos syndrome (EDS 4) that were successfully treated twice by an endovascular approach. Initial treatment with a detachable balloon was in 1994 for a right CCF, and, 8 years later, a left CCF was treated by selective transarterial occlusion of the cavernous sinus with coils. Unfortunately, the patient suffered from a spontaneous post-operative intracranial haemorrhage in the left hemisphere and died. Review of the literature, technical considerations for bilateral CCF and complication are discussed

The usefulness of carotid sinus massage in different patient groups.

Science.gov (United States)

Kumar, Narasimhan Pradeep; Thomas, Alan; Mudd, Paul; Morris, Robert O; Masud, Tahir

2003-11-01

to determine the positive yield of carotid sinus massage in different patient groups: unexplained syncope, falls, dizziness and controls. observational study. teaching hospital. we studied consecutive patients over the age of 60 years referred to the 'falls clinic' with a history of unexplained syncope, unexplained falls and unexplained dizziness. We also studied asymptomatic control subjects recruited from a general practice register aged 60 years and over. All patients and control subjects underwent a full clinical assessment (comprehensive history and detailed clinical examination including supine and erect blood pressure measurements) and 12-lead electrocardiography. We performed carotid sinus massage in the supine position for 5 seconds separately on both sides followed by repeating the procedure in the upright positions using a motorised tilt table. Heart rate and blood pressure were recorded using a cardiac monitor and digital plethysmography respectively. The test was considered positive if carotid sinus massage produced asystole with more than a 3 second pause (cardioinhibitory type of carotid sinus syndrome), or a fall in systolic blood pressure of more than 50 mmHg in the absence of significant cardioinhibition (vasodepressor type of carotid sinus syndrome) or where there was evidence of both vasodepressor and cardio-inhibition as above (mixed type). we studied 44 asymptomatic control subjects and 221 symptomatic patients (130 with unexplained syncope, 41 with unexplained falls and 50 with unexplained dizziness). In the overall symptomatic patient group, the positive yield (any type of carotid sinus syndrome) was 17.6% (95% CI = 12.7-22.5). The positive yield in men (26.3% (95% CI = 16.4-36.2)) was twice that in women (13.1% (95% CI = 7.6-18.6)) (P = 0.014). Overall any type of carotid sinus syndrome was present in 22.3% (n = 29) of the syncope group, 17.1% (n = 7) in the unexplained fallers group and 6% (n = 3) in the dizziness group. We also found that

Successful Transarterial Embolization of a Posttraumatic Fistula Between a Posterior Communicating Artery Aneurysm and the Cavernous Sinus: A Case Report.

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Jinbo, Yin; Jun, Liu; Kejie, Mou; Zheng, Zhou

2015-01-01

Posterior communicating artery (PCoA) aneurysm-cavernous sinus fistulae are an extremely rare complication of head injury . The treatment of PCoA aneurysm-cavernous sinus fistulae has not been well described. A 27-year-old man was admitted with a retroocular bruit and blurred vision of the left eye seven months after a severe head injury. We report the angiographic appearance of a posterior communicating artery (PCoA) aneurysm with a fistula to the cavernous sinus. This injury had been previously misinterpreted to be a PCoA aneurysm by computerized tomographic angiography (CTA). The patient was successfully treated with coils and Onyx of a fistula between the PCoA aneurysm and cavernous sinus.

[Clinical picture and complex treatment of septic thromboses of the cavernous sinuses].

Science.gov (United States)

Mozhaev, S V; Zubkov, Iu N; Ponomarev, A M; Shimchenko, P Ia

1980-07-01

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).

Cavernous sinus thrombophlebitis related to dental infection--two case reports.

Science.gov (United States)

Okamoto, Hiroaki; Ogata, Atsushi; Kosugi, Masafumi; Takashima, Hiroshi; Sakata, Shuji; Matsushima, Toshio

2012-01-01

Two cases of cavernous sinus thrombophlebitis (CST) caused by dental infection are described. A 64-year-old woman presented with palsies of the left oculomotor and trochlear nerves after tooth extraction for dental caries in the left maxilla. A 54-year-old man presented with palsy of the left trochlear nerve, sensory disturbance in the ophthalmic and maxillary divisions of the left trigeminal nerve, ptosis, proptosis, and chemosis after dental treatment for caries and periodontitis in the left maxilla. In both patients, computed tomography and magnetic resonance imaging with contrast medium showed non-enhanced lesions within the left cavernous sinus and dilation of the superior ophthalmic veins, which indicated CST. These conditions were resolved by administration of broad-spectrum antibiotics. CST is rare but lethal, so prompt diagnosis is crucial, and immediate appropriate treatment is essential.

Endovascular treatment of carotid-cavernous vascular lesions

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GUILHERME BRASILEIRO DE AGUIAR

Full Text Available ABSTRACT Objective: to evaluate the endovascular treatment of vascular lesions of the cavernous segment of the internal carotidartery (ICA performed at our institution. Methods: we conducted a descriptive, retrospective and prospective study of patients with aneurysms of the cavernous portion of the ICA or with direct carotid-cavernous fistulas (dCCF undergoing endovascular treatment. Results: we included 26 patients with intracavernous aneurysms and ten with dCCF. All aneurysms were treated with ICA occlusion. Those with dCCF were treated with occlusion in seven cases and with selective fistula occlusion in the remaining three. There was improvement of pain and ocular proptosis in all patients with dCCF. In patients with intracavernous aneurysms, the incidence of retro-orbital pain fell from 84.6% to 30.8% after treatment. The endovascular treatment decreased the dysfunction of affected cranial nerves in both groups, especially the oculomotor one. Conclusion: the endovascular treatment significantly improved the symptoms in the patients studied, especially those related to pain and oculomotor nerve dysfunction.

Acinic cell carcinoma of parotid gland metastasis to left cavernous sinus: a case report and review of literature

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LIN Xiao-yan

2013-12-01

Full Text Available Objective To investigate the clinical manifestations and pathological features of parotid gland papillary acinic cell carcinoma metastasis to left cavernous sinus. Methods The clinical manifestations, pathological features and differential diagnosis were studied in one case of parotid papillary acinic cell carcinoma metastasis to left cavernous sinus. Related literatures were also reviewed. Results The patient was a 50-year-old female who presented paroxysmal dizziness for 5 months and blurred vision in her left eye for 10 months. The MRI examination showed left parasellar space-occupying mass in the cavernous sinus. In operation, the tumor was located in the superior wall of left cavernous sinus, soft and red-grey in color, with abundant blood supply. The histomorphological examination revealed the tumor cells were arranged in solid, acinar or papillary pattern. The tumor cells were large, with eosinophilic cytoplasm, round or oval nuclei and small nucleoli. Immunohistochemical staining found that the tumor cells expressed cytokeratin (CK, epithelial membrane antigen (EMA, vimentin (Vim and S-100 protein (S-100, and showed weak positive expression of glial fibrillary acidic protein (GFAP and focal positive expression of P53 protein. Ki-67 labeling index was about 5%-10% . The tumor cells were negative for neuroendocrine markers and pituitary hormone protein markers. This case was difficult to differentiate from other primary intracalvarium tumors, including papillary meningioma, papillary tumor of choroid plexus, papillary ependymoma, papillary glioneuronal tumors as well as chordoma. According to the medical history and the comparison of histomorphology and immunophenotyping between parotid gland tumor cells and left cavernous sinus tumor cells, the final diagnosis was metastatic papillary parotid acinar cell carcinoma of the left cavernous sinus. The patient was followed for 21 months and no recurrence was seen. Conclusion It is very rare and

Carotid sinus hypersensitivity: Entity warrants a caution in the critical care unit

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Sugata Dasgupta

2016-01-01

Full Text Available Carotid sinus hypersensitivity (CSH syndrome is an entity caused by an overreaction of the carotid sinus baroreceptors to stimulation. Three subtypes of CSH syndrome are recognized according to the response to carotid sinus massage (CSM: Predominantly cardioinhibitory, predominantly vasodepressor and a mixed subtype. We report here the case of a middle-aged female patient admitted in our critical care unit with respiratory failure requiring mechanical ventilation. There were episodes of severe bradycardia whenever her head was rotated to any side, relieved on neutralizing head position and administering intravenous atropine. CSM revealed she had predominantly cardioinhibitory type of CSH syndrome. A cardioinhibitory form of hypersensitive carotid sinus reflex, which is idiopathic in causation, probably explains the severe bradycardia on head rotation seen in our patient. A heightened awareness of this syndrome is necessary for timely diagnosis and management. CSH syndrome results from an overreaction of the carotid sinus baroreceptors to stimulation, manifesting commonly as bradycardia, hypotension and syncope. It is an entity, which warrants caution during routine critical care practices.

Virtual Reality Model of the Three-Dimensional Anatomy of the Cavernous Sinus Based on a Cadaveric Image and Dissection.

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Qian, Zeng-Hui; Feng, Xu; Li, Yang; Tang, Ke

2018-01-01

Studying the three-dimensional (3D) anatomy of the cavernous sinus is essential for treating lesions in this region with skull base surgeries. Cadaver dissection is a conventional method that has insurmountable flaws with regard to understanding spatial anatomy. The authors' research aimed to build an image model of the cavernous sinus region in a virtual reality system to precisely, individually and objectively elucidate the complete and local stereo-anatomy. Computed tomography and magnetic resonance imaging scans were performed on 5 adult cadaver heads. Latex mixed with contrast agent was injected into the arterial system and then into the venous system. Computed tomography scans were performed again following the 2 injections. Magnetic resonance imaging scans were performed again after the cranial nerves were exposed. Image data were input into a virtual reality system to establish a model of the cavernous sinus. Observation results of the image models were compared with those of the cadaver heads. Visualization of the cavernous sinus region models built using the virtual reality system was good for all the cadavers. High resolutions were achieved for the images of different tissues. The observed results were consistent with those of the cadaver head. The spatial architecture and modality of the cavernous sinus were clearly displayed in the 3D model by rotating the model and conveniently changing its transparency. A 3D virtual reality model of the cavernous sinus region is helpful for globally and objectively understanding anatomy. The observation procedure was accurate, convenient, noninvasive, and time and specimen saving.

Delayed massive epistaxis from traumatic cavernous carotid false aneurysms: A report of two unusual cases.

Science.gov (United States)

Mankahla, Ncedile; LeFeuvre, David; Taylor, Allan

2017-08-01

Introduction Blunt head trauma can injure the cavernous segment of the internal carotid artery (ICA). This may result in a carotid cavernous fistula (CCF). Rarely, a traumatic aneurysm may bleed medially causing massive epistaxis. Case presentation We present two cases of traumatic intracavernous carotid pseudoaneurysms with delayed massive epistaxis. The patients were managed with endovascular treatment involving coil embolization with parent vessel sparing and detachable balloon occlusion with carotid sacrifice. Early clinical outcome was good in both patients. Wherever possible, the CARE 1 guidelines were followed in the reporting. Conclusion These cases illustrate the delayed nature of traumatic aneurysms and the need for a high index of suspicion in the presence of skull base fractures. The use of endovascular detachable balloon occlusion and coil embolization treatment with parent vessel preservation is shown.

Role of fractionated radiotherapy in patients with hemangioma of the cavernous sinus

International Nuclear Information System (INIS)

Park, Sun Min; Yoon, Sang Min; Lee, Su Min; Park, Jin Hong; Song, Si Yeol; Lee, Sang Wook; Ahn, Seung Do; Kim, Jong Hoon; Choi, Eun Kyung

2017-01-01

We performed this retrospective study to investigate the outcomes of patients with hemangioma of the cavernous sinus after fractionated radiotherapy. We analyzed 10 patients with hemangioma of the cavernous sinus who were treated with conventional radiotherapy between January 2000 and December 2016. The median patient age was 54 years (range, 31–65 years), and 8 patients (80.0%) were female. The mean hemangioma volume was 34.1 cm"3 (range, 6.8–83.2 cm"3), and fractionated radiation was administered to a total dose of 50–54 Gy with a daily dose of 2 Gy. The median follow-up period was 6.8 years (range, 2.2–8.8 years). At last follow-up, the volume of the tumor had decreased in all patients. The average tumor volume reduction rate from the initial volume was 72.9% (range, 18.9–95.3%). All 10 of the cranial neuropathies observed before radiation therapy had improved, with complete symptomatic remission in 9 cases (90%) and partial remission in 1 case (10%). No new acute neurologic impairments were reported after radiotherapy. One probable compressive optic neuropathy was observed at 1 year after radiotherapy. Fractionated radiotherapy achieves both symptomatic and radiologic improvements. It is a well-tolerated treatment modality for hemangiomas of the cavernous sinus

Role of fractionated radiotherapy in patients with hemangioma of the cavernous sinus

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Park, Sun Min; Yoon, Sang Min; Lee, Su Min; Park, Jin Hong; Song, Si Yeol; Lee, Sang Wook; Ahn, Seung Do; Kim, Jong Hoon; Choi, Eun Kyung [Dept. of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

2017-09-15

We performed this retrospective study to investigate the outcomes of patients with hemangioma of the cavernous sinus after fractionated radiotherapy. We analyzed 10 patients with hemangioma of the cavernous sinus who were treated with conventional radiotherapy between January 2000 and December 2016. The median patient age was 54 years (range, 31–65 years), and 8 patients (80.0%) were female. The mean hemangioma volume was 34.1 cm{sup 3} (range, 6.8–83.2 cm{sup 3}), and fractionated radiation was administered to a total dose of 50–54 Gy with a daily dose of 2 Gy. The median follow-up period was 6.8 years (range, 2.2–8.8 years). At last follow-up, the volume of the tumor had decreased in all patients. The average tumor volume reduction rate from the initial volume was 72.9% (range, 18.9–95.3%). All 10 of the cranial neuropathies observed before radiation therapy had improved, with complete symptomatic remission in 9 cases (90%) and partial remission in 1 case (10%). No new acute neurologic impairments were reported after radiotherapy. One probable compressive optic neuropathy was observed at 1 year after radiotherapy. Fractionated radiotherapy achieves both symptomatic and radiologic improvements. It is a well-tolerated treatment modality for hemangiomas of the cavernous sinus.

Fat deposition in the cavernous sinus in Cushing disease

International Nuclear Information System (INIS)

Bachow, T.B.; Hesselink, J.R.; Aaron, J.O.; Davis, K.R.; Taveras, J.M.

1984-01-01

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, supra seller fat was incidentally noted in the patient with acromegaly

Fat deposition in the cavernous sinus in Cushing disease

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Bachow, T.B.; Hesselink, J.R.; Aaron, J.O.; Davis, K.R.; Taveras, J.M.

1984-10-01

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, supra seller fat was incidentally noted in the patient with acromegaly.

Possible role of the cavernous sinus veins in cerebrospinal fluid absorption

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Koh Lena

2007-04-01

Full Text Available Abstract The purpose of this investigation was to enhance our understanding of cerebrospinal fluid (CSF absorption pathways. To achieve this, Microfil (a coloured silastic material was infused into the subarachnoid space (cisterna magna of sheep post mortem, and the relevant tissues examined macroscopically and microscopically. The Microfil was taken up by an extensive network of extracranial lymphatic vessels in the olfactory turbinates. In addition however, Microfil also passed consistently through the dura at the base of the brain. Microfil was noted in the spaces surrounding the venous network that comprises the cavernous sinus, in the adventitia of the internal carotid arteries and adjacent to the pituitary gland. Additionally, Microfil was observed within the endoneurial spaces of the trigeminal nerve and in lymphatic vessels emerging from the epineurium of the nerve. These results suggest several unconventional pathways by which CSF may be removed from the subarachnoid space. The movement of CSF to locations external to the cranium via these routes may lead to its absorption into veins and lymphatics outside of the skull. The physiological importance of these pathways requires further investigation.

Baroreflex Sensitivity And Autonomic Nervous System Function In Carotid Sinus Hypersensitivity

DEFF Research Database (Denmark)

Brinth, Louise Schouborg; Pors, Kirsten; Theibel, Ann Cathrine

2015-01-01

hypersensitivity ranging from reduced to increased sensitivity compared to controls. We wanted to establish whether measures of baroreflex sensitivity and autonomic function differed between patients diagnosed with carotid sinus hypersensitivity and age matched controls. We included 36 patients (12 women; 74 +/-10...... sensitivity may not follow the same neuronal pathways as those responding to the crude external pressures applied during carotid sinus massage...

Presentation of a glomus carotid tumor as carotid sinus syndrome with syncopal episodes

International Nuclear Information System (INIS)

Dickschas, A.; Harmann, B.; Herzog, T.; Marienhagen, J.

1987-01-01

An 80 year old patient was referred to neurology for clarification of her episodes of syncope. A set of radiological examinations indicated a diagnosis of paraganglion of the left carotid bifurcation. Using this case, an attempt is made to provide recommendations concerning the order of step-wise visualization techniques of clarifying glomus carotid tumors. This unusual case also provides an impetus for considering the physiology and pathogenesis of different forms of carotid sinus syndrome. (orig.) [de

Primary extradural leiomyosarcoma involving cavernous sinus in an immunocompetent patient

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Hanni V Gulwani

2014-01-01

Full Text Available Intracranial leiomyosarcoma (LMS are uncommon malignancies and usually encountered after systemic metastases. Limited cases of primary intracranial LMSs have been reported in the literature. It mostly affects immunocompromised individuals in association with Epstein-Barr virus infection. This is the unusual first case being reported of primary LMS in immunocompetent patient with involvement of cavernous sinus.

Cranial nerve assessment in cavernous sinus tumors with contrast-enhanced 3D fast-imaging employing steady-state acquisition MR imaging

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Amemiya, Shiori; Aoki, Shigeki; Ohtomo, Kuni [University of Tokyo, Department of Radiology, Graduate School of Medicine, Bunkyo-ku, Tokyo (Japan)

2009-07-15

The purpose of this study is to apply contrast-enhanced 3D fast-imaging employing steady-state acquisition (3D-FIESTA) imaging to the evaluation of cranial nerves (CN) in patients with cavernous sinus tumors. Contrast-enhanced 3D-FIESTA images were acquired from ten patients with cavernous sinus tumors with a 3-T unit. In all cases, the trigeminal nerve with tumor involvement was easily identified in the cavernous portions. Although oculomotor and abducens nerves were clearly visualized against the tumor area with intense contrast enhancement, they were hardly identifiable within the area lacking contrast enhancement. The trochlear nerve was visualized in part, but not delineated as a linear structure outside of the lesion. Contrast-enhanced 3D-FIESTA can be useful in the assessment of cranial nerves in and around the cavernous sinus with tumor involvement. (orig.)

Cranial nerve assessment in cavernous sinus tumors with contrast-enhanced 3D fast-imaging employing steady-state acquisition MR imaging

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Amemiya, Shiori; Aoki, Shigeki; Ohtomo, Kuni

2009-01-01

The purpose of this study is to apply contrast-enhanced 3D fast-imaging employing steady-state acquisition (3D-FIESTA) imaging to the evaluation of cranial nerves (CN) in patients with cavernous sinus tumors. Contrast-enhanced 3D-FIESTA images were acquired from ten patients with cavernous sinus tumors with a 3-T unit. In all cases, the trigeminal nerve with tumor involvement was easily identified in the cavernous portions. Although oculomotor and abducens nerves were clearly visualized against the tumor area with intense contrast enhancement, they were hardly identifiable within the area lacking contrast enhancement. The trochlear nerve was visualized in part, but not delineated as a linear structure outside of the lesion. Contrast-enhanced 3D-FIESTA can be useful in the assessment of cranial nerves in and around the cavernous sinus with tumor involvement. (orig.)

Carotid artery protrusion and dehiscence in patients with acromegaly.

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Sasagawa, Yasuo; Tachibana, Osamu; Doai, Mariko; Hayashi, Yasuhiko; Tonami, Hisao; Iizuka, Hideaki; Nakada, Mitsutoshi

2016-10-01

Acromegaly is a systemic disease which causes multiple bony alterations. Some authors reported that acromegalic patients have risk factors for an intraoperative vascular injury due to the specific anatomical features of their sphenoid sinus. The objective of our study was to analyze the anatomic characteristics of sphenoid sinus in acromegalic patients compared with controls, by evaluation of computed tomography (CT) findings. We examined 45 acromegalic (acromegaly group) and 45 non-acromegalic patients (control group) with pituitary adenomas who were matched for sex, age, height, tumor size, and cavernous sinus invasion (Knosp grade). Preoperative CT of the pituitary region including the sphenoid sinus was used to evaluate the following anatomic characteristics: type of sphenoid sinus (sellar or pre-sellar/conchal); intrasphenoid septa (non/single or multiple); carotid artery protrusion; carotid artery dehiscence; intercarotid distance. Sixteen acromegalic patients (35.5 %) and 6 controls (13.3 %) had carotid artery protrusion. Additionally, 10 acromegalic patients (22.2 %) and 3 controls (6.6 %) had carotid artery dehiscence. Carotid artery protrusion and dehiscence were more frequent in the acromegaly group than in control group (p = 0.013 and 0.035, respectively). Other anatomic characteristics (type of sphenoid sinus, intrasphenoid septa, and intracarotid distance) showed no significant differences between acromegaly and control groups. Our study suggests that carotid artery protrusion and dehiscence occur more frequently among acromegalic patients, compared with non-acromegalic patients. It is important for surgeons to be aware of these anatomic variations to avoid vital complications, such as carotid injuries, during surgery.

Direct traumatic carotid cavernous fistula: angiographic classification and treatment strategies. Study of 172 cases.

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Chi, Cuong Tran; Nguyen, Dang; Duc, Vo Tan; Chau, Huynh Hong; Son, Vo Tan

2014-01-01

We report our experience in treatment of traumatic direct carotid cavernous fistula (CCF) via endovascular intervention. We hereof recommend an additional classification system for type A CCF and suggest respective treatment strategies. Only type A CCF patients (Barrow's classification) would be recruited for the study. Based on the angiographic characteristics of the CCF, we classified type A CCF into three subtypes including small size, medium size and large size fistula depending on whether there was presence of the anterior carotid artery (ACA) and/or middle carotid artery (MCA). Angiograms with opacification of both ACA and MCA were categorized as small size fistula. Angiograms with opacification of either ACA or MCA were categorized as medium size fistula and those without opacification of neither ACA nor MCA were classified as large size fiatula. After the confirm angiogram, endovascular embolization would be performed impromptu using detachable balloon, coils or both. All cases were followed up for complication and effect after the embolization. A total of 172 direct traumatic CCF patients were enrolled. The small size fistula was accountant for 12.8% (22 cases), medium size 35.5% (61 cases) and large size fistula accountant for 51.7% (89 cases). The successful rate of fistula occlusion under endovascular embolization was 94% with preservation of the carotid artery in 70%. For the treatment of each subtype, a total of 21/22 cases of the small size fistulas were successfully treated using coils alone. The other single case of small fistula was defaulted. Most of the medium and large size fistulas were cured using detachable balloons. When the fistula sealing could not be obtained using detachable balloon, coils were added to affirm the embolization of the cavernous sinus via venous access. There were about 2.9% of patient experienced direct carotid artery puncture and 0.6% puncture after carotid artery cut-down exposure. About 30% of cases experienced

Emergency treatment by intravascular embolization in traumatic carotid cavernous fistula

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Tang Jun; Sun Zengtao; Liu Zuoqin; Liu Yanjun; Li Fengxin

2006-01-01

Objective: To discuss the method of intervenfional intravascular treatment in traumatic carotid cavernous fistula (TCCF) and the significance of clinical application in emergency. Methods: In 297 eases of TCCF, 36 cases were treated by interventional intravascular embolization by detachable balloon, embolization orificium or occlusion in one side of carotid artery. In the 36 cases, serious epistaxis occurred in 22 eases, cortical vein inflow in 9 cases, intracranial hemorrhage in 3 cases, aggravation of eyesight in 3 cases, and limb dysfunction in 2 cases. Results: Fistula was successfully embolized and internal carotid artery remained patent in 19 cases. Complete embolization of orificium or internal carotid artery was achieved in 17 eases. The serious epistaxias in 22 cases and intracranial hemorrhage in 3 cases stopped. Eyesight recovered in 2 eases and improved in 1 case. Limb dysfunction improved evidently in 2 cases. Conclusion: Intravascular embolization treatment is the first therapeutic choice for TCCF, especially in emergency. It is necessary, safe and effective. (authors)

Spontaneous thrombosis of internal carotid artery: a natural history of giant carotid cavernous aneurysms Trombose espontânea da artéria carótida interna: a história natural dos aneurismas gigantes intracavernosos

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Lucas Perez de Vasconcellos

2009-06-01

Full Text Available OBJECTIVE: To describe five cases of giant carotid cavernous aneurysms which evolved with spontaneous thrombosis of internal carotid artery (STICA, with emphasis at epidemiology, clinical presentation, natural history, related factors and neurological outcome. METHOD: There were 711 consecutives patients with 802 aneurysms with and without surgical treatment during a period of 19 years. We selected 35 patients with 40 carotid cavernous aneurysms (5% of which 20 (50% were giant aneurysms. Among those cases, 5 patients evolved with STICA (25%. Symptoms and findings at presentation were recorded and compared with those at outcome. RESULTS: Clinical presentation was commonly related to atherosclerotic factors such as elevated blood pressure (80%, diabetes mellitus (40% and dislipidemy (40%. All patients presented with hemicranial headache, ophthalmparesy and retro bulbar pain, and after STICA all presented improvement of symptoms. After STICA, 4 patients had regression of deficit, 2 partial and 2 complete. Four patients had sensorial trigeminal neuropathy in V1 and V2 territories, also showing improvement of symptoms after STICA. CONCLUSION: STICA is a common outcome in giant carotid cavernous aneurysms, and is related with significant improvement of symptoms; however, it may be catastrophic for those patients without efficient collateral circulation.OBJETIVO: Relatar cinco casos de aneurismas gigantes intracavernosos que evoluíram com trombose espontânea da artéria carótida interna (TEACI, estudando-se: prevalência, apresentação clínica, história natural, fatores associados e prognóstico neurológico. MÉTODO: Análise de 711 pacientes consecutivos com diagnóstico de 802 aneurismas cerebrais submetidos a tratamento clínico ou cirúrgico num período de 19 anos. Foram identificados 40 aneurismas intracavernosos, sendo que 20 desses eram gigantes. Dentre esses, 5 pacientes com aneurismas gigantes intracavernosos que evoluíram com TEACI

Unilateral duplicated abducens nerve coursing through both the sphenopetroclival venous gulf and cavernous sinus: a case report.

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Coquet, Thomas; Lefranc, Michel; Chenin, Louis; Foulon, Pascal; Havet, Éric; Peltier, Johann

2018-03-15

In this anatomy report, we describe the first case of abducens nerve duplication limited to the sphenopetroclival venous gulf and the cavernous sinus. The objective point of division of the two duplicated roots was localized at the gulfar face of the dural porus, just distal to the unique cisternal trunk of the abducens nerve, as it pierced the petroclival dural mater. In the gulfar segment, both roots traveled through a variant of Dorello's canal called the "petrosphenoidal canal" and remained separated through the posterior half of the cavernous sinus. Both roots finally fused in the anterior half of the cavernous sinus to innervate the lateral rectus muscle as a single trunk. Although many variants of the abducens nerve have been reported over the recent decades, this anatomic variation has never been previously described and enriches the continuum of abducens nerve variations reported in the literature data. Awareness of this variation is crucial for neurosurgeons, especially during clival or petrosal surgical approaches used for resection of skull base chordomas.

Endovascular management of a carotid aneurysm into the sphenoid sinus presenting with epistaxis.

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Akkari, Mohamed; Gascou, Grégory; Trévillot, Vincent; Bonafé, Alain; Crampette, Louis; Machi, Paolo

2015-12-01

Non-traumatic cavernous internal carotid artery (ICA) aneurysms are rare, and favour the occurrence of massive recurrent epistaxis, which is associated with a high mortality rate. We report the case of a 67-year-old woman presenting a ruptured ICA aneurysm extending into the sphenoid sinus, revealed by epistaxis. Selective coil embolization of the aneurysm was performed. Flow-diverter stents were deployed in order to utterly exclude the aneurysm and prevent revascularization. Anti-platelet treatment was provided to lower the risk of in-stent thrombosis. A left frontal hematoma associated with a subarachnoid haemorrhage occurred at day 2. Outcome was favourable with no neurological sequelae, and no clinical recurrence of epistaxis occurred. A 4 months follow-up digital subtraction angiography showed a complete exclusion of the aneurysm. In addition, a magnetic resonance cerebral angiography at 16 months showed stable results. Thus, this two-stage endovascular procedure has proven its effectiveness in preventing epistaxis recurrence while preserving the ICA patency. © The Author(s) 2015.

The primary study of fistulae isolation for difficult-cured traumatic carotid cavernous by two accesses

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Wang Ziliang; Li Tianxiao; Zhai Shuiting; Cao Huicun; Xu Jiangyu; Bai Weixing; Liu Jian

2007-01-01

Objective: To investigate the feasibility and security of the isolation of fistulae for difficult-cured traumatic carotid cavernous by the anterio or inferior communicating artery. Methods: Five patients with difficult-cured TCCF including four males and one female. They were cathetered by both femoral arteries. Balloon-catheter directly attached to the near of fistulae and microcatheter conversely attached to the far of fistulae. Detachable balloons and micro coils were used to isolated the fistulae. Results: Five patients were cured with fistulae isolation and angiography did not show remnants fistulae in time. Clinical signs and symptoms got better and better. During follows-up no one recurred. Conclusions: The isolation of fistulae is a feasible and secure therapy for the difficult-cured traumatic direct carotid cavernous fistulae. (authors)

Post-traumatic pseudoaneurysm of internal carotid artery: a cause of intractable epistaxis.

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Adeel, Mohammad; Ikram, Mubasher

2012-05-23

In this case report, the authors are presenting a case of a 35-year-old lady who presented to our clinic with recurrent episodes of massive epistaxis and loss of right eye vision for last 6 months following road traffic accident. There was no other significant medical and surgical history. Bleeding episodes were sometimes very severe with loss up to 400-500 cc and would stop spontaneously. She was given multiple blood transfusions after these episodes. A complete otorhinolaryngological examination including rigid endoscopy and coagulation investigation did not reveal any abnormality. CT with contrast of paranasal region showed blood within the right sphenoid sinus with linear fracture of the lateral wall with post-traumatic cavernous pseudoaneurysm of internal carotid artery localised to right sphenoid sinus. That was managed successfully by embolisation using a detachable balloon and a coil. She was followed up in the clinic at 6 weeks and 6 months interval with no symptoms.

Flow diversion in vasculitic intracranial aneurysms? Repair of giant complex cavernous carotid aneurysm in polyarteritis nodosa using Pipeline embolization devices: first reported case.

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Martinez Santos, Jaime; Kaderali, Zul; Spears, Julian; Rubin, Laurence A; Marotta, Thomas R

2016-07-01

Intracranial aneurysms in polyarteritis nodosa (PAN) are exceedingly rare lesions with unpredictable behavior that pose real challenges to microsurgical and endovascular interventions owing to their inflammatory nature. We introduce a safe and effective alternative for treating these aneurysms using Pipeline embolization devices (PEDs). A 20-year-old man presented with diplopia, headaches, chronic abdominal pain, and weight loss. Diagnostic evaluations confirmed PAN, including bilateral giant cavernous carotid aneurysms. Cyclophosphamide and steroids achieved significant and sustained clinical improvement, with a decision to follow the aneurysms serially. Seven years later the left unruptured aneurysm enlarged, causing a sudden severe headache and a cavernous sinus syndrome. Treatment of the symptomatic aneurysm was pursued using flow diversion (PED) and the internal carotid artery was successfully reconstructed with a total of four overlapping PEDs. At 6 months follow-up, complete exclusion of the aneurysm was demonstrated, with symptomatic recovery. This is the first description of using a flow-diverting technique in an inflammatory vasculitis. In this case, PEDs not only attained a definitive closure of the aneurysm but also reconstructed the damaged and fragile arterial segment affected with vasculitis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Epistaxis revealing the rupture of a carotid aneurysm of the cavernous sinus extending into the sphenoid: treatment using an uncovered stent and coils. Review of literature.

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Lehmann, Pierre; Saliou, Guillaume; Page, Cyril; Balut, Antonia; Le Gars, Daniel; Vallée, Jean Noel

2009-05-01

True carotid aneurysms with sphenoid extension and revealed by epistaxis are rare. A review of the literature shows the mortality risk of this pathology and the different therapeutic options. A 41-year-old female presented with a cavernous carotid aneurysm with sphenoid extension revealed by massive epistaxis. We propose a combined treatment of the affected vessel using coils and an uncovered stent. The first stage to stop the hemorrhages and occlude the aneurysm using the coil and the second stage several days later after anticoagulation using the stent to prevent revascularization. This treatment has been shown to be effective in producing immediate hemostasis and stable long-term occlusion.

Cavernous sinus hemangioma: a fourteen year single institution experience.

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Bansal, Sumit; Suri, Ashish; Singh, Manmohan; Kale, Shashank Sharad; Agarwal, Deepak; Sharma, Manish Singh; Mahapatra, Ashok Kumar; Sharma, Bhawani Shankar

2014-06-01

Cavernous sinus hemangioma (CSH) is a rare extra-axial vascular neoplasm that accounts for 2% to 3% of all cavernous sinus tumors. Their location, propensity for profuse bleeding during surgery, and relationship to complex neurovascular structures are factors which present difficulty in excising these lesions. The authors describe their experience of 22 patients with CSH over 14 years at a tertiary care center. Patients were managed with microsurgical resection using a purely extradural transcavernous approach (13 patients) and with Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden) (nine patients). Retrospective data analysis found headache and visual impairment were the most common presenting complaints, followed by facial hypesthesia and diplopia. All but one patient had complete tumor excision in the surgical series. Transient ophthalmoparesis (complete resolution in 6-8 weeks) was the most common surgical complication. In the GKRS group, marked tumor shrinkage (>50% tumor volume reduction) was achieved in two patients, slight shrinkage in five and no change in two patients, with symptom improvement in the majority of patients. To our knowledge, we describe one of the largest series of CSH managed at a single center. Although microsurgical resection using an extradural transcavernous approach is considered the treatment of choice in CSH and allows complete excision with minimal mortality and long-term morbidity, GKRS is an additional tool for treating residual symptomatic lesions or in patients with associated comorbidities making surgical resection unsuitable. Copyright © 2013. Published by Elsevier Ltd.

The carotid body of the spontaneous insulin-dependent diabetic rat

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Clarke J.A.

1999-01-01

Full Text Available The carotid bodies from adult spontaneous insulin-dependent diabetic rats (strain BB/S were perfusion-fixed at normal arterial blood pressure with 3% phosphate-buffered glutaraldehyde and compared with the organs from control rats (strain BB/Sc prepared in the same way. Serial 5-µm sections were cut, stained, and using an interactive image analysis system, were analysed to determine the volumes of the carotid body and its vascular and extravascular compartments. There was no evidence of systemic arterial disease in the carotid stem arteries in either group of animals, and the microvasculature of the organs appeared normal by light microscopy. The volume of the carotid body was unchanged 3 months after the onset of diabetes but was increased at 6 months. The total vascular volume of the organ was unchanged, but the volume of the small vessels (5-12 µm was increased. In the control group the small vessels comprised 5% of the total volume of the carotid body, or about 44% of the vascular compartment. The percentage of small vessels increased at 3 months in the diabetic group, but had returned to normal at 6 months. The extravascular volume followed the same pattern as the total carotid body volume and so did not change appreciably when expressed as a percentage of the total volume of the organ. The increase in size of the carotid body in diabetic rats is due, therefore, to an augmented extravascular volume. In one diabetic specimen the carotid sinus nerve showed signs of diabetic neuropathy, axonal swelling and intramyelinic oedema. The clinical implications of these results are discussed.

The effect of (+)-lysergic acid diethylamide and other drugs on the carotid sinus reflex.

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GINZEL, K H

1958-09-01

In cats, lysergic acid diethylamide (LSD) selectively blocked the reflex blood pressure rise following carotid chemoreceptor stimulation. It also reduced or abolished the chemoreceptor component of the pressor response to occlusion of the common carotid arteries. It did not inhibit the respiratory reflexes arising from the carotid chemoreceptors, unless spontaneous respiration was interfered with as a whole. The site of action was central, probably below the intercollicular level, regardless of whether the drug was administered by the intravenous route or into the lateral ventricle of the brain.LSD did not block the baroreceptor depressor reflex elicited by stimulation of one carotid sinus nerve. LSD frequently caused the systemic pressure to fall, even after vagotomy and atropine, and this effect might account for the occasional reduction of the baroreceptor component of the carotid occlusion response. On the other hand, no relationship was found between the action of LSD on vasomotor tone and its blocking effect on the chemoreceptor pressor reflex.Some derivatives of LSD produced effects similar to those described for LSD, whether or not they possessed a psychotropic action in man, and independently of their efficiency as antagonists to 5-hydroxytryptamine. Of a series of compounds chemically unrelated to LSD, chlorpromazine was found to block the chemoreceptor pressor rise after intracerebroventricular injection.

Limited endoscopic transsphenoidal approach for cavernous sinus biopsy: illustration of 3 cases and discussion.

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Graillon, T; Fuentes, S; Metellus, P; Adetchessi, T; Gras, R; Dufour, H

2014-01-01

Advances in transsphenoidal surgery and endoscopic techniques have opened new perspectives for cavernous sinus (CS) approaches. The aim of this study was to assess the advantages and disadvantages of limited endoscopic transsphenoidal approach, as performed in pituitary adenoma surgery, for CS tumor biopsy illustrated with three clinical cases. The first case was a 46-year-old woman with a prior medical history of parotid adenocarcinoma successfully treated 10 years previously. The cavernous sinus tumor was revealed by right third and sixth nerve palsy and increased over the past three years. A tumor biopsy using a limited endoscopic transsphenoidal approach revealed an adenocarcinoma metastasis. Complementary radiosurgery was performed. The second case was a 36-year-old woman who consulted for diplopia with right sixth nerve palsy and amenorrhea with hyperprolactinemia. Dopamine agonist treatment was used to restore the patient's menstrual cycle. Cerebral magnetic resonance imaging (MRI) revealed a right sided CS tumor. CS biopsy, via a limited endoscopic transsphenoidal approach, confirmed a meningothelial grade 1 meningioma. Complementary radiosurgery was performed. The third case was a 63-year-old woman with progressive installation of left third nerve palsy and visual acuity loss, revealing a left cavernous sinus tumor invading the optic canal. Surgical biopsy was performed using an enlarged endoscopic transsphenoidal approach to the decompress optic nerve. Biopsy results revealed a meningothelial grade 1 meningioma. Complementary radiotherapy was performed. In these three cases, no complications were observed. Mean hospitalization duration was 4 days. Reported anatomical studies and clinical series have shown the feasibility of reaching the cavernous sinus using an endoscopic endonasal approach. Trans-foramen ovale CS percutaneous biopsy is an interesting procedure but only provides cell analysis results, and not tissue analysis. However, radiotherapy and

Stent-assisted coil embolization for cavernous carotid artery aneurysms.

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Kono, Kenichi; Shintani, Aki; Okada, Hideo; Tanaka, Yuko; Terada, Tomoaki

2014-01-01

Internal carotid artery (ICA) occlusion with or without a bypass surgery is the traditional treatment for cavernous sinus (CS) aneurysms with cranial nerve (CN) dysfunction. Coil embolization without stents frequently requires retreatment because of the large size of CS aneurysms. We report the mid-term results of six unruptured CS aneurysms treated with stent-assisted coil embolization (SACE). The mean age of the patients was 72 years. The mean size of the aneurysms was 19.8 mm (range: 13-26 mm). Before treatment, four patients presented with CN dysfunction and two patients had no symptoms. SACE was performed under local or general anesthesia in three patients each. Mean packing density was 29.1% and tight packing was achieved. There were no neurological complications. CN dysfunction was cured in three patients (75%) and partly resolved in one patient (25%). Transient new CN dysfunction was observed in two patients (33%). Clinical and imaging follow-up ranged from 6 to 26 months (median: 16 months). Recanalization was observed in three patients (50%; neck remnant in two patients and dome filling in one patient), but no retreatment has yet been required. No recurrence of CN dysfunction has occurred yet. In summary, SACE increases packing density and may reduce requirement of retreatment with an acceptable cure rate of CN dysfunction. SACE may be a superior treatment for coiling without stents and be an alternative treatment of ICA occlusion for selected patients, such as older patients and those who require a high-flow bypass surgery or cannot receive general anesthesia.

Trans-zygomatic middle cranial fossa approach to access lesions around the cavernous sinus and anterior parahippocampus: a minimally invasive skull base approach.

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Melamed, Itay; Tubbs, R Shane; Payner, Troy D; Cohen-Gadol, Aaron A

2009-08-01

Exposure of the cavernous sinus or anterior parahippocampus often involves a wide exposure of the temporal lobe and mobilization of the temporalis muscle associated with temporal lobe retraction. The authors present a cadaveric study to illustrate the feasibility, advantages and landmarks necessary to perform a trans-zygomatic middle fossa approach to lesions around the cavernous sinus and anterior parahippocampus. The authors performed bilateral trans-zygomatic middle fossae exposures to reach the cavernous sinus and parahippocampus in five cadavers (10 sides). We assessed the morbidity associated with this procedure and compared the indications, advantages, and disadvantages of this method versus more extensive skull base approaches. A vertical linear incision along the middle portion of the zygomatic arch was extended one finger breadth inferior to the inferior edge of the zygomatic arch. Careful dissection inferior to the arch allowed preservation of facial nerve branches. A zygomatic osteotomy was followed via a linear incision through the temporalis muscle and exposure of the middle cranial fossa floor. A craniotomy along the inferolateral temporal bone and middle fossa floor allowed extradural dissection along the middle fossa floor and exposure of the cavernous sinus including all three divisions of the trigeminal nerve. Intradural inspection demonstrated adequate exposure of the parahippocampus. Exposure of the latter required minimal or no retraction of the temporal lobe. The trans-zygomatic middle fossa approach is a simplified skull base exposure using a linear incision, which may avoid the invasivity of more extensive skull base approaches while providing an adequate corridor for resection of cavernous sinus and parahippocampus lesions. The advantages of this approach include its efficiency, ease, minimalism, preservation of the temporalis muscle, and minimal retraction of the temporal lobe.

Direct-puncture approach to the extraconal portion of the superior ophthalmic vein for carotid cavernous fistulae

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Kurata, A.; Suzuki, S.; Iwamoto, K.; Miyazaki, T.; Inukai, M.; Abe, K.; Niki, J.; Yamada, M.; Fujii, K.; Kan, S.

2009-01-01

The transvenous approach via the superior ophthalmic vein (SOV) is an available approach for carotid cavernous fistula (CCF), especially in the event that there is no other suitable approach route to the fistula. Surgical exposure of the peripheral roots of the SOV is commonly used; however, often, the SOV is often not accessible because of anatomical problems and/or complications. In this paper, we present and discuss our original direct-puncture approach to the extraconal portion of the SOV. An attempt on three patients with traumatic CCF failed with the transarterial approach and the conventional venous approach via the inferior petrosal sinus; therefore, the patients were treated with the direct-puncture approach to the extraconal portion of the SOV using two-dimensional digital subtraction angiography with local anesthesia. All cases that had tortuous and partially stenotic division of the SOV were treated successfully with this approach and without complications. This approach will become an alternate approach, especially when the peripheral roots of the SOV are focally narrowed and tortuous, making it impossible to insert a catheter. (orig.)

Treatment and experience of traumatic carotid artery injury with massive epistaxis

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RAO Hai-cheng

2013-09-01

Full Text Available A retrospective analysis was made on 5 cases who had the traumatic carotid artery injury with massive epistaxis (from September 2007 to June 2011. All of them were finally diagnosed by digital substraction angiography (DSA. Among them, 2 cases of traumatic pesudoaneurysm from internal maxillary artery were embolized with polyvinyl alcohol particles and gelatin sponge. One case was carotid-cavernous fistula (CCF with traumatic pesudoaneurysm located in the sphenoid sinus. This patient's internal carotid artery (ICA and fistula was blocked with balloon, and then ICA was clipped proximal to the posterior communicating artery. One case with injuried ICA was treated with blocking by balloon. The pesudoaneurysm located in ICA cavernous segment of one case was embolized with coil and liquid glue. No recurrence was found after successful surgeries. Patients with massive epistaxis or recurrent epistaxis after craniofacial trauma should undergo CT angiography (CTA or DSA examination so as to get proper diagnosis and treatment as early as possible.

Congenital pial arteriovenous fistula in the temporal region draining into cavernous sinus: A case report

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Zhang, Ziyin; Wang, Chaohua; Zhang, Changwei; Xie, Xiaodong; Wang, Kun; Tang, Jianjian

2013-01-01

This report concerns a 4-month-old infant with progressive prominent and redness of his left eye since birth. This report concerns a 4-month-old infant with progressive prominent redness of his left eye since birth. Angiography revealed a congenital pial arteriovenous fistula between the temporal branch of the left posterior cerebral artery and left cavernous sinus through the sphenoparietal sinus, a condition not reported in the literature. The fistula was successfully occluded with two micro-coils by vertebrobasilar approach.

The benign course of carotid-cavernous fistula in a child

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Kurul, Semra E-mail: skurul@hotmail.com; Cakmakci, Handan; Kovanlikaya, Arzu; Dirik, Eray

2001-08-01

Carotid-cavernous fistulas (CCF) are reported very rarely in childhood and their clinical course and prognosis are uncertain. We report a 9-year-old boy presented with left eye swelling, neck pain and headache. The MRI findings suggested a CCF with enlarged left superior ophthalmic vein. Ocular Doppler ultrasonography revealed enlarged left superior ophthalmic vein, and arterialization of Doppler wave form. The cerebral angiogram showed normal anatomy. Control Doppler examination findings supported the diagnosis of closure of fistula. The clinical and radiological findings of this unusual presentation are discussed.

The benign course of carotid-cavernous fistula in a child

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Kurul, Semra; Cakmakci, Handan; Kovanlikaya, Arzu; Dirik, Eray

2001-01-01

Carotid-cavernous fistulas (CCF) are reported very rarely in childhood and their clinical course and prognosis are uncertain. We report a 9-year-old boy presented with left eye swelling, neck pain and headache. The MRI findings suggested a CCF with enlarged left superior ophthalmic vein. Ocular Doppler ultrasonography revealed enlarged left superior ophthalmic vein, and arterialization of Doppler wave form. The cerebral angiogram showed normal anatomy. Control Doppler examination findings supported the diagnosis of closure of fistula. The clinical and radiological findings of this unusual presentation are discussed

Aggressive cavernous sinus dural arteriovenous fistula: Angioarchitecture analysis and embolization by various approaches

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Chao-Bao Luo

2016-03-01

Conclusion: Aggressive CSDAVFs are associated with occlusion/stenosis of the IPS or compartment of IPS–cavernous sinus with leptomeningeal reflux. In this limited case series, aggressive CSDAVFs most presented with brainstem ischemia, followed by nonhemorrhagic/hemorrhagic stroke in the cerebrum. Embolization through various access routes is a feasible method to manage these aggressive CSDAVFs, with an acceptable level of periprocedural risks.

Efficacy of transsphenoidal surgery in achieving biochemical cure of growth hormone-secreting pituitary adenomas among patients with cavernous sinus invasion: a systematic review and meta-analysis.

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Briceno, Vanessa; Zaidi, Hasan A; Doucette, Joanne A; Onomichi, Kaho B; Alreshidi, Amer; Mekary, Rania A; Smith, Timothy R

2017-05-01

Growth hormone-secreting pituitary adenomas in adults can result in severe craniofacial disfigurement and potentially fatal medical complications. Surgical resection leading to remission of the disease is dependent on complete surgical resection of the tumor. Lesions that invade the cavernous sinus may not be safely accessible via an endonasal transsphenoidal surgery (TSS), and the rates of biochemical remission of patients with residual disease vary widely in the literature. We conducted a meta-analysis to examine the prevalence of biochemical remission after TSS among patients with growth hormone-secreting pituitary adenomas with and without cavernous sinus invasion. Embase, PubMed, and Cochrane Library databases were searched for relevant publications. Fourteen studies with 972 patients with biochemically confirmed growth hormone-secreting pituitary adenomas were included in the meta-analysis. The overall remission prevalence under a fixed-effect model was 47.6% (95% CI = 40.8-54.4%) for patients with invasive macroadenomas (I 2  = 74.6%, p < 0.01); 76.4% (95% CI = 72.2-80.1%) for patients with non-invasive macroadenomas (I 2  = 59.6%, p = 0.03); and 74.2% (95% CI = 66.3-80.7%) for patients with non-invasive microadenomas (I 2  = 36.4, p = 0.10). The significant difference among the three groups resulted from the difference between patients with or without cavernous sinus invasion (p = 0.01) and not from the size of adenomas among those without cavernous sinus invasion (p = 0.66). The prevalence of biochemical remission in patients with cavernous sinus invasion was lower than in patients without cavernous sinus invasion after TSS for acromegaly.

Anatomical Variations of Carotid Artery and Optic Nerve in Sphenoid Sinus Using Computerized Tomographic Imaging

Directory of Open Access Journals (Sweden)

Nikakhlagh

2014-12-01

Full Text Available Background Sphenoid sinus is surrounded by many vital vascular and nervous structures. In more than 20% of patients with chronic sinusitis, involvement of sphenoid sinus has been observed. Besides, sphenoid sinus is an appropriate route to access anterior and middle cranial fossa in surgery. Therefore, it is important to have an adequate knowledge about the contents of sphenoid sinus and its proximity for nasal endoscopy, sinus surgeries and neurosurgeries. Objectives The aim of this study was to study sphenoid sinus proximity with carotid artery and the optic nerve using computerized tomographic imaging. Materials and Methods In this prospective study, computerized tomographic images of sphenoid sinus of patients referred to Imam Khomeini and Apadana hospitals were studied. The images were studied regarding any bulging, as well as not having a bone covering in sphenoid sinus regarding internal carotid artery and optic nerve. Furthermore, unilateralness or bilateralness of their relationships was studied. Results Among 468 coronal and axial CT scan images of sphenoid sinus, 365 (78% showed post-sellar pneumatization and 103 (22% pre-sellar pneumatization. Regarding existence of internal septa, 346 (74% cases showed multiple septation, and the remaining images were reported to have a single septum. According to the reports of CT scan images, the existence of bulging as a result of internal carotid artery and uncovered artery were 4.22% and 5.8% in the right sinus, 4.9% and 5.4% in the left sinus, and 4.34% and 4.6% in both sinuses, respectively. According to the reports of CT scan images, existence of bulging as a result of optic nerve and uncovered nerve were 5.7% and 4.3% in the right sinus, 6% and 5.4% in the left sinus, and 12% and 3.2% in both sinuses, respectively. Conclusions Due to variability of sphenoid sinus pneumatization and the separator blade of the two sinus cavities, careful attention is required during sinus surgery to avoid

Successful Treatment of Dental Infection-Induced Chronic Cavernous Sinus Thrombophlebitis With Antibiotics and Low-Molecular-Weight Heparin: Two Case Reports.

Science.gov (United States)

Li, Yuan; Zheng, Bo; Chen, Kangning; Gui, Li

2015-08-01

Two patients developed cavernous sinus thrombophlebitis from a tooth infection. A 36-year-old man experienced a severe headache with bilateral third and sixth cranial nerve palsies after extraction of his left upper third molar. Another 53-year-old diabetic man developed fever, headache, and bilateral complete ophthalmoplegia after a tooth infection. The brain magnetic resonance imaging scans of both patients showed bilateral cavernous sinus partial thrombosis. Broad-spectrum antibiotics plus low-molecular-weight heparin successfully resolved all symptoms. Both patients recovered fully without any recurrence at the 3-month follow-up visit. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

[An automatic system controlled by microcontroller for carotid sinus perfusion].

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Yi, X L; Wang, M Y; Fan, Z Z; He, R R

2001-08-01

To establish a new method for controlling automatically the carotid perfusion pressure. A cheap practical automatic perfusion unit based on AT89C2051 micro controller was designed. The unit, LDB-M perfusion pump and the carotid sinus of an animal constituted an automatic perfusion system. This system was able to provide ramp and stepwise updown perfusion pattern and has been used in the research of baroreflex. It can insure the precision and reproducibility of perfusion pressure curve, and improve the technical level in corresponding medical field.

Depiction of the cranial nerves around the cavernous sinus by 3D reversed FISP with diffusion weighted imaging (3D PSIF-DWI)

International Nuclear Information System (INIS)

Ishida, Go; Oishi, Makoto; Jinguji, Shinya; Yoneoka, Yuichiro; Fujii, Yukihiko; Sato, Mitsuya

2011-01-01

The purpose of this study was to evaluate the anatomy of cranial nerves running in and around the cavernous sinus, we employed three-dimensional reversed fast imaging with steady-state precession (FISP) with diffusion weighted imaging (3D PSIF-DWI) on 3-T magnetic resonance (MR) system. After determining the proper parameters to obtain sufficient resolution of 3D PSIF-DWI, we collected imaging data of 20-side cavernous regions in 10 normal subjects. 3D PSIF-DWI provided high contrast between the cranial nerves and other soft tissues, fluid, and blood in all subjects. We also created volume-rendered images of 3D PSIF-DWI and anatomically evaluated the reliability of visualizing optic, oculomotor, trochlear, trigeminal, and abducens nerves on 3D PSIF-DWI. All 20 sets of cranial nerves were visualized and 12 trochlear nerves and 6 abducens nerves were partially identified. We also presented preliminary clinical experiences in two cases with pituitary adenomas. The anatomical relationship between the tumor and cranial nerves running in and around the cavernous sinus could be three-dimensionally comprehended by 3D PSIF-DWI and the volume-rendered images. In conclusion, 3D PSIF-DWI has great potential to provide high resolution 'cranial nerve imaging', which visualizes the whole length of the cranial nerves including the parts in the blood flow as in the cavernous sinus region. (author)

[Depiction of the cranial nerves around the cavernous sinus by 3D reversed FISP with diffusion weighted imaging (3D PSIF-DWI)].

Science.gov (United States)

Ishida, Go; Oishi, Makoto; Jinguji, Shinya; Yoneoka, Yuichiro; Sato, Mitsuya; Fujii, Yukihiko

2011-10-01

To evaluate the anatomy of cranial nerves running in and around the cavernous sinus, we employed three-dimensional reversed fast imaging with steady-state precession (FISP) with diffusion weighted imaging (3D PSIF-DWI) on 3-T magnetic resonance (MR) system. After determining the proper parameters to obtain sufficient resolution of 3D PSIF-DWI, we collected imaging data of 20-side cavernous regions in 10 normal subjects. 3D PSIF-DWI provided high contrast between the cranial nerves and other soft tissues, fluid, and blood in all subjects. We also created volume-rendered images of 3D PSIF-DWI and anatomically evaluated the reliability of visualizing optic, oculomotor, trochlear, trigeminal, and abducens nerves on 3D PSIF-DWI. All 20 sets of cranial nerves were visualized and 12 trochlear nerves and 6 abducens nerves were partially identified. We also presented preliminary clinical experiences in two cases with pituitary adenomas. The anatomical relationship between the tumor and cranial nerves running in and around the cavernous sinus could be three-dimensionally comprehended by 3D PSIF-DWI and the volume-rendered images. In conclusion, 3D PSIF-DWI has great potential to provide high resolution "cranial nerve imaging", which visualizes the whole length of the cranial nerves including the parts in the blood flow as in the cavernous sinus region.

Assessing the impact of sinus-saving modifications of carotid endarterectomy on autonomic regulation and central hemodynamics

Directory of Open Access Journals (Sweden)

А. А. Фокин

2016-03-01

Full Text Available BackgroundSuch complications as myocardial infarction, hyperperfusion syndrome and its effects, postoperative hematomes constitute a life-threatening event during early follow-up of carotid surgery. One of the main risk factors for these complications is a variation of central hemodynamics, especially that leading to arterial hypertension.ObjectiveThe study aimed to evaluate the safety of carotid sinus surgery as a way of preventing arterial hypertension after carotid artery reconstructions. The other objective was to compare the resultant data with the heart rate variations obtained during rhythmocardiography.MethodsThe study focused on central hemodynamics indicators and included 290 cases. All patients were broken down in two groups. 167 patients of the first group underwent dissection of carotid sinus nerves. The carotid sinus nerves of patients from the second group (123 patients were kept intact. Analysis of autonomic regulation of 13 patients from the first group and 17 patients from the other one was then carried out, with the heart rate variations accurately estimated at the neurocardiological laboratory.ResultsOn the first postoperative day all hemodynamic indicators (such as SBP, DBP, pulse pressure, heart rate in the second group were lower than those in the first group of patients (p<0.05, while tending to recover by the third day. This fact kept postoperative complications to a minimum. The patients from the second group also demonstrated a lower activity of the sympathetic nervous system and a higher activity of the parasympathetic one. These results explain the difference between the central hemodynamic indicators in two groups.ConclusionCarotid sinus-saving surgery decreases the risk of early postoperative complications caused by arterial hypertension. 

Screen for intracranial dural arteriovenous fistulae with carotid duplex sonography.

Science.gov (United States)

Tsai, L-K; Yeh, S-J; Chen, Y-C; Liu, H-M; Jeng, J-S

2009-11-01

Early diagnosis and management of intracranial dural arteriovenous fistulae (DAVF) may prevent the occurrence of stroke. This study aimed to identify the best carotid duplex sonography (CDS) parameters for screening DAVF. 63 DAVF patients and 170 non-DAVF patients received both CDS and conventional angiography. The use of seven CDS haemodynamic parameter sets related to the resistance index (RI) of the external carotid artery (ECA) for the diagnosis of DAVF was validated and the applicability of the best CDS parameter set in 20 400 patients was tested. The CDS parameter set (ECA RI (cut-off point = 0.7) and internal carotid artery (ICA) to ECA RI ratio (cut-off point = 0.9)) had the highest specificity (99%) for diagnosis of DAVF with moderate sensitivity (51%). Location of the DAVF was a significant determinant of sensitivity of detection, which was 70% for non-cavernous DAVF and 0% for cavernous sinus DAVF (pdetected abnormality in 92 of 20 400 patients. These abnormalities included DAVF (n = 25), carotid stenosis (n = 32), vertebral artery stenosis (n = 7), intracranial arterial stenosis (n = 6), head and neck tumour (n = 3) and unknown aetiology (n = 19). Combined CDS parameters of ECA RI and ICA to ECA RI ratio can be used as a screening tool for the diagnosis of DAVF.

Cavernous sinus thrombosis following dental extraction: a rare case report and forgotten entity

OpenAIRE

Aggarwal, Karun; Rastogi, Sanjay; Joshi, Atul; Kumar, Ashish; Chaurasia, Archana; Prakash, Rajat

2017-01-01

Prior to the advent of efficacious antimicrobial agents, the mortality rate from cavernous sinus thrombosis (CST) was effectively 100%. There have been very few reports of CST associated with tooth extraction. A 40-year-old female presented to the emergency room with swelling over the right side of the face and history of extraction in the upper right region by an unregistered dental practitioner. The patient presented with diplopia, periorbital ecchymosis, and chemosis of the right eye. A co...

Embolization of carotid-cavernous fistula using a silicone balloon and a tracker-catheter system

International Nuclear Information System (INIS)

Kim, Sun Yong; Cho, Kil Ho; Park, Bok Hwan

1992-01-01

With the recent introduction and development of the detachable balloon system, it has become the treatment of choice in the management of carotid cavernous fistulas(CCFs). But, since most delivery systems for embolization of CCF mainly depend on flow guidance for balloon delivery, in case of small fistula, pseudo aneurysm and arterialized venous collaterals, failure of balloon embolization can occur. To overcome these limitation, the authors designed and used a new versatile, steerable, and flow-guided detachable balloon system by using a Tracker catheter system with silicone or latex balloons. Using this maneuver, we could get successful fistula occlusion in 7 out of 8 patients (silicone balloon). But in one case, we had to occlude the internal carotid artery at the fistula site, proximal and distal cervical portions of the internal carotid artery. This balloon delivery system proved to provide high selectivity for fistula and relatively ease of handing

Cavernous sinus lesions biopsy with neuronavigation and tip-cut needle

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Lorenzetti, Martin; Carvalho, Herculano; Cattoni, Maria; Gonçalves-Ferreira, Antonio; Pimentel, José; Antuñes, Joao

2014-01-01

Background: Transoval biopsy of cavernous sinus (CS) lesions is the last non-invasive diagnostic option in those 15% of patients in whom etiology remains unclear in spite of extensive neuroradiological imaging, clinical assessment, and laboratory evaluation. However, there are no guidelines defining indications and the most appropriate technique for this procedure. Case Description: We present four patients in whom we performed X-ray and neuronavigation-assisted transoval CS biopsies using tip-cut needles. Conclusion: The technique described allows the operator to determine the optimal angle for entering the CS, avoiding the complications due to distorted anatomy, and facilitating orientation once inside the CS. It reduces both radiation exposure as well as general anesthesia duration. PMID:25593783

Indirect carotid cavernous fistula mimicking ocular myasthenia.

Science.gov (United States)

Leishangthem, Lakshmi; Satti, Sudhakar Reddy

2017-10-19

71-year-old woman with progressive left-sided, monocular diplopia and ptosis. Her symptoms mimicked ocular myasthenia, but she had an indirect carotid cavernous fistula (CCF). She was diagnosed with monocular myasthenia gravis (negative acetylcholinesterase antibody) after a positive ice test and started on Mestinon and underwent a thymectomy complicated by a brachial plexus injury. Months later, she developed left-sided proptosis and ocular bruit. She was urgently referred to neuro-interventional surgery and was diagnosed with an indirect high-flow left CCF, which was treated with Onyx liquid and platinum coil embolisation. Mestinon was discontinued. Her ophthalmic symptoms resolved. However, she was left with a residual left arm and hand hemiparesis and dysmetria secondary to a brachial plexus injury. Indirect CCF usually can present with subtle and progressive symptoms leading to delayed diagnosis or misdiagnosis. It is important for ophthalmologists to consider this differential in a patient with progressive ocular symptoms. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Carotid Artery Stenting in a Patient with Spontaneous Recanalization of a Proximal Internal Carotid Artery Occlusion: a Case Report

International Nuclear Information System (INIS)

Kim, Eui Jong; Koh, Jun Seok; Choi, Woo Suk

2006-01-01

We report here on a rare case of carotid artery angioplasty and stenting in a patient with spontaneous recanalization after complete occlusion of the proximal internal carotid artery (ICA). The patient initially showed severe stenosis at the left proximal ICA on MR angiography (MRA). Digital subtraction angiography (DSA) performed three days after MRA showed complete occlusion of the proximal ICA. The follow-up DSA after four weeks showed recanalization of the ICA, and then carotid artery stenting was successfully performed. There has been no neurologic complication during more than one year follow-up. cute internal carotid artery (ICA) occlusions may result in profound disability and death (1). An occluded ICA can spontaneously recanalize, but this doesn't happen frequently, and the natural course of a proximal ICA occlusion and its possibility of recanalization, including the exact time of recanalization after occlusion, are not well known (2, 3). A few studies have reported the incidence of spontaneous recanalization of the proximal internal carotid artery, which has mostly occurred in patients with ICA dissections (4 6). A few limited studies have reported a considerable incidence of spontaneous recanalization in patients with underlying atherosclerotic lesion or atherothombotic diseases (2). The possibility of repeated occlusion and repeated cerebral ischemic infarction may exist for the patients exhibiting spontaneous recanalization of the ICA and underlying atherosclerosis. We report here on a case of carotid artery stenting (CAS) in a patient who exhibited underlying atherosclerosis with spontaneous recanalization after complete occlusion of the proximal ICA

Modified three-dimensional skull base model with artificial dura mater, cranial nerves, and venous sinuses for training in skull base surgery: technical note.

Science.gov (United States)

Mori, Kentaro; Yamamoto, Takuji; Oyama, Kazutaka; Ueno, Hideaki; Nakao, Yasuaki; Honma, Keiichirou

2008-12-01

Experience with dissection of the cavernous sinus and the temporal bone is essential for training in skull base surgery, but the opportunities for cadaver dissection are very limited. A modification of a commercially available prototype three-dimensional (3D) skull base model, made by a selective laser sintering method and incorporating surface details and inner bony structures such as the inner ear structures and air cells, is proposed to include artificial dura mater, cranial nerves, venous sinuses, and the internal carotid artery for such surgical training. The transpetrosal approach and epidural cavernous sinus surgery (Dolenc's technique) were performed on this modified model using a high speed drill or ultrasonic bone curette under an operating microscope. The model could be dissected in almost the same way as a real cadaver. The modified 3D skull base model provides a good educational tool for training in skull base surgery.

Single-Session Hematoma Removal and Transcranial Coil Embolization for a Cavernous Sinus Dural Arteriovenous Fistula: A Technical Case Report.

Science.gov (United States)

Akamatsu, Yosuke; Sato, Kenichi; Endo, Hidenori; Matsumoto, Yasushi; Tominaga, Teiji

2017-08-01

Patients with cavernous sinus dural arteriovenous fistulas (CS dAVFs) with cortical venous varix are indicated for aggressive treatment because of the associated risk for intracranial hemorrhage. We present a case of surgical transvenous embolization in an 84-year-old woman with CS dAVF who presented with massive intracerebral hematoma. Cerebral angiograms revealed the dural AVF drained only into the superficial middle cerebral vein. Because an emergent mass reduction and prevention of rebleeding were necessary, single-session hematoma removal and transcranial embolization of a CS dAVF were performed in the neurosurgical operating room, using a mobile C-arm fluoroscopy. After the right frontotemporal craniotomy, intracerebral hematoma was removed and coil packing of the affected cavernous sinus was successfully performed via the dilated superficial middle cerebral vein. The transcortical vein approach enables occlusion of CS dAVF with isolated cortical venous drainage and may be a valuable alternative approach for some cases needed emergency craniotomy. Copyright © 2017 Elsevier Inc. All rights reserved.

Fistule carotido-caverneuse indirecte post traumatique: diagnostic ...

African Journals Online (AJOL)

The indirect carotido-cavernous fistula is an abnormal communication between multiple arterioles coming from dural or meningeal branches of the external carotid artery and/or of the internal carotid artery and the cavernous sinus. Its definitive diagnosis relies on carotid angiography showing the fistula. This imaging ...

Fate of the three embryonic dural sinuses in infants: the primitive tentorial sinus, occipital sinus, and falcine sinus.

Science.gov (United States)

Mizutani, Katsuhiro; Miwa, Tomoru; Akiyama, Takenori; Sakamoto, Yoshiaki; Fujiwara, Hirokazu; Yoshida, Kazunari

2018-03-01

The primitive tentorial, occipital, and falcine sinuses are thought to attain the adult pattern or regress between the fetal stage and adulthood. The anatomy of these three primitive dural sinuses has seldom been studied in the infant population, and it remains unclear when these dural sinuses reach the adult condition. Using computed tomography digital subtraction venography (CT-DSV), we analyzed the anatomy of these embryonic dural sinuses in infants. We included 13 infants who underwent CT-DSV prior to neurosurgery and 35 cases with unruptured cerebral aneurysms as normal adult controls. Three embryonic dural sinuses, i.e., the primitive tentorial, occipital, and falcine sinuses, were retrospectively analyzed in CT-DSV images of infants and adults. We also analyzed the drainage patterns of the superficial middle cerebral vein (SMCV), determined by the connection between the primitive tentorial sinus and the cavernous sinus. The primitive tentorial, occipital, and falcine sinuses were present in 15.4%, 46.2%, and none of the infants, respectively, and in 10.0, 8.6, and 2.9% of the adults, respectively. The difference in SMCV draining pattern between infants and adults was insignificant. The incidence of the occipital sinus was significantly higher in infants than in adults. The connection between the primitive tentorial sinus and the cavernous sinus appears to be established before birth. The occipital sinus is formed at the embryonic stage and mostly regresses after infancy. The falcine sinus is usually obliterated prenatally. Our findings form the basis for interventions by pediatric interventional neuroradiologists and neurosurgeons.

Successful Transarterial Guglielmi Detachable Coil Embolization of Post-Traumatic Fistula between a Posterior Communicating Artery Aneurysm and the Cavernous Sinus

Science.gov (United States)

Chen, Y.; Jiang, D-Y.; Tan, H-Q.; Wang, L-H.; Chen, X-Y.; Sun, J-H.

2009-01-01

Summary We describe a case of a post-traumatic posterior communicating artery (PCoA) aneurysmcavernous sinus fistula, which is an extremely rare complication of craniocerebral trauma, successfully treated with endosaccular coil embolization via transarterial route. Endosaccular embolization with Guglielmi detachable coils via transarterial route appears to be a feasible, effective and minimally invasive option for the treatment of post-traumatic fistula between the PCoA aneurysm with a small ostia and the cavernous sinus in the subacute phase. PMID:20465883

Intracranial cavernous angioma

International Nuclear Information System (INIS)

Yuhi, Fumiaki; Gondou, Masazumi; Sasahira, Masahiro; Ichitsubo, Hidenori; Asakura, Tetsuhiko.

1986-01-01

The present authors have experienced 2 cases of intracranial cavernous angioma. Of these cases, one was admitted because of generalized convulsions, while the other was admitted because of headache. In both cases, neither plain X-ray films nor carotid angiography showed any abnormality, but computerized tomography (CT) revealed a slightly high-density area which was not enhanced with contrast media. Histologically, the tumors had many vascular cavities with walls lined with a single layer of endothelial cells and had no neural tissue between the vascular cavities; therefore, they were diagnosed as cases of cavernous angioma. The authors discussed the radiological findings of the intracranial cavernous angioma with a review of the literature and stressed the role of computerized tomography in the diagnosis of cavernous angioma. (author)

MRI of growth hormone-secreting pituitary adenomas: factors determining pretreatment hormone levels

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Saeki, N.; Iuchi, T.; Eda, M.; Yamaura, A. [Dept. of Neurological Surgery, Chiba University School of Medicine (Japan); Isono, S. [Dept. of Neurological Surgery, Anesthesiology, Chiba University School of Medicine, Chiba (Japan)

1999-10-01

Preoperative serum growth hormone (GH) level is one of the most important determinants of outcome. Our aim was to assess MRI findings which may correlate with pretreatment GH levels in GH-secreting adenomas. We retrospectively studied 29 patients with acromegaly caused by a pituitary adenoma. Tumor size (height, width, thickness and volume), suprasellar extension, sphenoid or cavernous sinus invasion, signal intensity and contrast enhancement were studied. Linear regression analysis or Fisher's exact probability test was used for statistical analysis. Factors related to high GH levels were the maximum dimension of the tumour (r = 0.496, P < 0.01), its volume (r = 0.439, P < 0.05), spenoid sinus invasion (P < 0.01) and intracavernous carotid artery encasement (P < 0.01). The other items were not related to serum GH levels. Since we believe surgery is the first choice of treatment and the cavernous sinus is difficult of access with a conventional surgical approach, preoperative assessment of invasion into the cavernous sinus is critical for predicting the surgical outcome. Low GH levels (5-50 ng/ml) were found with tumours medial to the intercarotid line and high levels (more than 101 ng/ml) with invasive tumours with carotid artery encasement. Variable GH levels were noted with tumours extending beyond the intercarotid line. Because functioning adenomas invading the cavernous sinus tend to have markedly high hormone levels, and only patients with carotid artery encasement showed markedly elevated GH levels, we believe carotid artery encasement a reliable MRI indicator of cavernous sinus invasion. (orig.)

Preoperative depiction of cavernous sinus invasion by pituitary macroadenomas using three-dimensional anisotropy contrast (3DAC) magnetic resonance axonography on a 3-tesla system

International Nuclear Information System (INIS)

Watanabe, Naoto

2006-01-01

The purpose of this study is to examine whether the cavernous invasion of pituitary macroadenomas can be preoperatively depicted by 3DAC MR images, by comparison of surgical and imaging findings. The depiction is desirable to make the surgical injury of cranial nerves minimal. Subjects are 33 patients (15 males, 18 females; mean age 52.8 y) with macroadenomas who underwent its extraction by endoscopic endonasal transsphenoidal surgery in author's hospital and 25 normal healthy volunteers (12 males, 13 females). Signa-3.0T equipment (General Electric) was used for PROPELLER MR 3DAC and T2 reverse images of coronary cross sections to identify cranial nerves (oculomotor, trochlear, abducent, ophthalmic and maxillary) in the cavernous sinus. Localization of the imaged tumor/nerves in the sinus was statistically analyzed with the endoscopic surgical findings for the invasion. The former obtained here by the high magnetic field imaging was found quite useful for preoperative depiction of the sinus invasion with high sensitivity and specificity. (T.I.)

Spontaneous carotid artery dissection causing a juvenile cerebral infarction

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Trattnig, S.; Huebsch, P.; Schindler, E.

1988-11-01

The case of a 19-year-old patient is presented who was admitted with aphasia and hemiparesis due to basal ganglia infarction as a result of spontaneous dissection of the internal carotid artery. The difficulties in diagnosing this disease with CT and MRI in the acute stage are demonstrated. Angiography is still imperative in order to ascertain that a carotid dissection has occurred.

Spontaneous carotid artery dissection causing a juvenile cerebral infarction

International Nuclear Information System (INIS)

Trattnig, S.; Huebsch, P.; Schindler, E.

1988-01-01

The case of a 19-year-old patient is presented who was admitted with aphasia and hemiparesis due to basal ganglia infarction as a result of spontaneous dissection of the internal carotid artery. The difficulties in diagnosing this disease with CT and MRI in the acute stage are demonstrated. Angiography is still imperative in order to ascertain that a carotid dissection has occurred. (orig.) [de

Gamma knife radiosurgery for benign cavernous sinus tumors. Treatment concept and outcomes in 120 cases

International Nuclear Information System (INIS)

Hayashi, Motohiro; Chernov, Mikhail; Tamura, Noriko

2012-01-01

Availability of modern computer-aided robotized devices, such as the Automatic Positioning System (APS TM ; Elekta Instruments AB, Stockholm, Sweden) and Perfexion TM (Elekta Instruments AB), allowed us to develop the original concept of robotic gamma knife microradiosurgery, which is based on the very precise irradiation of the lesion with regard to conformity and selectivity; intentional avoidance of the excessive irradiation of functionally-important anatomical structures, particularly cranial nerves, located both within and in the vicinity of the target; and delivery of sufficient irradiation energy to the tumor with the intention to attain lesion shrinkage, while keeping the marginal dose sufficiently low for prevention of possible complications. The results of such treatment strategy were evaluated retrospectively in 120 patients with benign cavernous sinus neoplasms (pituitary adenomas, meningiomas, schwannomas, and hemangiomas), who were followed up from 24 to 78 months (mean 47 months) after radiosurgery. Tumor growth control and shrinkage rates were 98% and 68%, respectively. More than 50% volume reduction was noted in 25% of lesions. The most prominent volumetric tumor response was observed in hemangiomas, followed by schwannomas, pituitary adenomas, and meningiomas. Treatment-related complications were marked in 7% of cases, and were mainly related to transient isolated cranial neuropathy appearing within several months after radiosurgery. Major morbidity was limited to one patient (0.8%). Application of microradiosurgical treatment principles provides effective and safe management of benign cavernous sinus tumors and is associated with high probability of lesion shrinkage and minimal risk of complications. (author)

Carotid sinus syndrome and cardiovagal regulation in elderly patients with suspected syncope-related falls

DEFF Research Database (Denmark)

Brinth, Louise; Latif, Tabassam; Pors, Kirsten

2014-01-01

) positions. A hypersensitive response was defined by current guidelines. Results: In the supine position, heart rate (HR) and systolic blood pressure (SBP) decreased during CSM on the right side by 17.0 +/- 15.2 min-1 and 32.5 +/- 25.5 mmHg, and on the left side by 12.8 +/- 14.3 min-1 and 22.7 +/- 20.7 mm....... Conclusions: The hemodynamic response to CSM has a well-defined pattern and differs both with respect to the stimulus site and patient position. We suggest that CSS is not a distinct pathophysiological process or disease entity but rather an acquired cardiovascular instability due to age-related degeneration......Background: Falls and syncope in the elderly may be caused by hypersensitivity in the high-pressure baroreflex control - carotid sinus syndrome (CSS). The pathophysiological process causing CSS remains poorly understood. Methods: We studied the hemodynamic response to carotid sinus massage (CSM...

Multidetector CT angiography in the diagnosis and classification of carotid–cavernous fistula

International Nuclear Information System (INIS)

Lee, J.Y.; Jung, C.; Ihn, Y.K.; Kim, D.J.; Seong, S.O.; Kwon, B.J.

2016-01-01

Aim: To evaluate the performance of multidetector computed tomography angiography (MDCTA) in identifying and classifying carotid–cavernous fistulas (CCFs). Materials and methods: The neuro-interventional database was searched for patients with CCFs at four different institutions and for normal controls at one of the four institutions. Thirty-four patients were divided into the case group (direct type, n=8; indirect type, n=8) and the control group (n=18). Two readers retrospectively evaluated thin-section CTA images for the presence and laterality of four findings: (1) engorged ophthalmic vein, (2) engorged cavernous sinus, (3) similar enhancement of the cavernous sinus (CS) and internal carotid artery (ICA), and (4) greater enhancement of the CS than the transverse sinus (TS). Dehiscent ICA for the direct type was assessed only in the case group. Sensitivity, specificity, and inter-reader agreement were determined. Attenuation differences between the ICA and CS and between the CS and TS were compared across groups. Results: The sensitivity/specificity for two engorgement and two enhancement findings were 81%/100%, 88%/94%, 100%/100%, and 88%/100%, respectively, for Reader 1, and 75%/100%, 75%/100%, 88%/100%, and 88%/100%, respectively, for Reader 2. Agreement between readers was excellent for all findings (κ>0.80). Dehiscent ICA identified the direct type with a sensitivity/specificity of 100%/75% for Reader 1 and 100%/88% for Reader 2 (κ=0.871). In the case group, the difference between ICA and CS attenuation values was significantly lower (180.1±76.6 versus 7.5±23.7; ⤳<0.001) and that between CS and TS were higher (–31.2±69 versus 102.6±59.3; ⤳<0.001). The area under the curve for the latter values was 0.95. Conclusion: The engorgement and enhancement categories in MDCTA may perform comparably in identifying CCFs and measurements of vessel attenuation differences may be of high diagnostic value. Dehiscent ICA can greatly aid in identifying the

Fractionated stereotactic radiation therapy in the management of benign cavernous sinus meningiomas. Long-term experience and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Milker-Zabel, S.; Zabel-du Bois, A.; Debus, J. [Heidelberg Univ. (Germany). Dept. of Radiation Oncology; Huber, P. [Heidelberg Univ. (Germany). Dept. of Radiotherapy; Schlegel, W. [German Cancer Research Center, Heidelberg (Germany). Dept. of Medical Physics

2006-11-15

Purpose: To analyze own long-term results with fractionated stereotactic radiotherapy (FSRT) in patients with benign meningiomas of the cavernous sinus and to review the literature on these rare lesions. Patients and Methods: 57 patients were treated with FSRT for benign meningiomas of the cavernous sinus between 01/1990 and 12/2003 at the authors' institution. Histology was WHO grade I in 28/57 lesions, and undetermined in 29/57 lesions. 29 patients received radiotherapy as primary treatment, ten following surgery, and 18 patients were irradiated for recurrent disease. Median target volume was 35.2 cm{sup 3}. Median total dose was 57.6 Gy with 1.8 Gy per fraction. 51/57 patients showed clinical symptoms before radiotherapy like reduced vision (n=19), diplopia (n=25), or trigeminal hyp-/dysesthesia (n=17). Results: Median follow-up period was 6.5 years. 50/57 patients were followed for >36 months. Overall local tumor control was 100%. 39/57 patients had stable disease based on CT/MRI, while 18/57 had a partial remission of tumor volume. Overall survival for patients with WHO grade I meningiomas was 95.5% after 5 and 10 years. Two patients died 2.8 and 4.1 years after radiotherapy due to cardiac failure. In 11/57 patients, preexisting neurologic deficits improved. There was one patient with recurrent hyperlacrimation of one eye on the side of the irradiated meningioma. Three patients complained about subjective visual deterioration after FSRT without any objective findings in an ophthalmologic examination. No late toxicity RTOG{>=} III was seen. Conclusion: These data demonstrate that FSRT is an effective and safe treatment modality for local control of benign cavernous sinus meningiomas with a minimal risk of significant late toxicity. (orig.)

Three-dimension visualization of transnasal approach for revealing the metasellar organization

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Liang XUE

2012-07-01

Full Text Available Objective To elevate the anatomical cognitive level by investigating the metasellar organization viatransnasal approach in a virtual-reality (VR setting. Methods Twenty-eight patients, with spontaneous subarachnoid hemorrhage but without pathological changes of nasal cavity and sella turcica, underwent the lamellar imaging examination and CT angiogram with Discovery Ultra 16. The data were collected and entered in the Dextroscope in DICOM format. Visualization research was carried out viathe transnasal approach in a virtual-reality (VR setting. Results The anatomic structures of transnasal approach were allowed to be observed dynamically and spatially. When exposing the lateral border of cavernous carotid artery, it was important to excise the ethmoid cornu, open posterior ethmoid sinus and sphenopalatine foramen, control sphenopalatine artery, properly drill out pterygoid process and reveal pterygoid canal. Conclusion It is the key point to remove the ethmoid cornu, uncinate process and bone of the anterior region of sphenoidal sinus, and control sphenopalatine artery viatransnasal approach to expose the metasellar structure. The cavernous carotid arteries are the most important anatomic structure, should be adequately exposed and conserved.

Dynamic changes of intramural hematoma in patients with acute spontaneous internal carotid artery dissection.

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Heldner, Mirjam R; Nedelcheva, Mila; Yan, Xin; Slotboom, Johannes; Mathier, Etienne; Hulliger, Justine; Verma, Rajeev K; Sturzenegger, Matthias; Jung, Simon; Bernasconi, Corrado; Arnold, Marcel; Wiest, Roland; Fischer, Urs

2015-08-01

We prospectively investigated temporal and spatial evolution of intramural hematomas in patients with acute spontaneous internal carotid artery dissection using repeated magnetic resonance imaging over six-months. The aim of the present study was to assess dynamic changes of intramural hematoma in patients with acute spontaneous internal carotid artery dissection at multiple follow-up time-points with T1w, PD/T2w, and magnetic resonance angiography. We performed serial multiparametric magnetic resonance imaging in 10 patients with spontaneous internal carotid artery dissection on admission, at days 1, 3, 7-14 and at months 1·5, 3, and 6. We calculated the volume and extension of the hyperintense intramural hematoma using T1w and PD/T2w fat suppressed sequences and assessed the degree of stenosis due to the hematoma using magnetic resonance angiography. Mean interval from symptom onset to first magnetic resonance imaging was two-days (SD 2·7). Two patients presented with ischemic stroke, three with transient ischemic attacks, and five with pain and local symptoms only. Nine patients had a transient increase of the intramural hematoma volume, mainly up to day 10 after symptom onset. Fifty percent had a transient increase in the degree of the internal carotid artery stenosis on MRA, one resulting in a temporary occlusion. Lesions older than one-week were predominantly characterized by a shift from iso- to hyperintese signal on T2w images. At three-month follow-up, intramural hematoma was no longer detectable in 80% of patients and had completely resolved in all patients after six-months. Spatial and temporal dynamics of intramural hematomas after spontaneous internal carotid artery dissection showed an early volume increase with concomitant progression of the internal carotid artery stenosis in 5 of 10 patients. Although spontaneous internal carotid artery dissection overall carries a good prognosis with spontaneous hematoma resorption in all our patients, early

Spontaneous Recanalization of Complete Internal Carotid Artery: A ...

African Journals Online (AJOL)

examination revealed global aphasia and right hemiplegia. No carotid bruits or heart murmurs were. ABSTRACT. Spontaneous recanalization of atherothrombotic extracranial cerebral arteries is rare vis-à-vis recanalization of intracranial vessels. The time course is unknown. The question is the advisability and timing of ...

Spontaneous indices are inconsistent with arterial baroreflex gain.

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Lipman, Ruth D; Salisbury, Julie K; Taylor, J Andrew

2003-10-01

Spontaneously occurring, parallel fluctuations in arterial pressure and heart period are frequently used as indices of baroreflex function. Despite the convenience of spontaneous indices, their relation to the arterial baroreflex remains unclear. Therefore, in 97 volunteers, we derived 5 proposed indices (sequence method, alpha-index, transfer function, low-frequency transfer function, and impulse response function), compared them with arterial baroreflex gain (by the modified Oxford pharmacologic technique), and examined their relation to carotid distensibility and respiratory sinus arrhythmia. The subjects comprised men and women (n=41) aged 25 to 86 years, 30% of whom had established coronary artery disease. Generally, the indices were correlated with each other (except alpha-index and low-frequency transfer function) and with baroreflex gain. However, the Bland-Altman method demonstrated that the spontaneous indices had limits of agreement as large as the baroreflex gain itself. Even in individuals within the lowest tertile of baroreflex gain for whom baroreflex gain appears to be the most clinically relevant, spontaneous indices failed to relate to baroreflex gain. In fact, for these individuals, there was no correlation between any index and baroreflex gain. Forward stepwise linear regression showed that all spontaneous indices and baroreflex gain were related to respiratory sinus arrhythmia, but only baroreflex gain was related to carotid distensibility. Therefore, these data suggest that spontaneous indices are inadequate estimates of gain and are inconsistent with arterial baroreflex function.

Clinical importance of the basal cavernous sinuses and cavernous carotid arteries relative to the pituitary gland and macroadenomas: quantitative analysis of the complete anatomy.

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Yilmazlar, Selcuk; Kocaeli, Hasan; Eyigor, Ozhan; Hakyemez, Bahattin; Korfali, Ender

2008-08-01

macroadenomas, some part of the CA's diameter was located below the line passing from the basal dural layer ranging from 12.5% to 100%. Our results indicate that a working area of 15.0 +/- 2.6 x 10.3 +/- 2.1 mm is safe during TSS. The position of the CCA posterior segment was notably more caudal than the anterior segment with respect to the basal dura, which should be taken into account during extended exposure. Also, preoperative recognition of the anatomical variations is beneficial for detection of the boundaries of dissection, which is particularly important in the BCS, where variable course of CCAs may transform the anatomical configuration. Slowly growing pituitary adenomas stretch out both CCAs considerably from medial to lateral directions, and they cause widening of intercarotid distances in all segments. Processing of fixation, decalcification, and paraffin embedding for the cadaveric tissue in contrast to physiologically hydrated tissues may change the accuracy of measurements. These measurements are significantly different than those in the radiologic images when arterial blood under pressure is in the CCA as well as when venous blood fills the cavernous sinus as is the case in vivo. In clinical practice, these facts must be taken into consideration in the cadaveric measurements.

[Usefulness of a protocol for carotid sinus massage in supine and erect postures in patients with syncope without other cardiovascular or neurological diseases].

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Bocchiardo, M; Alciati, M; Buscemi, A; Cravetto, A; Richiardi, E; Gaita, F

1995-05-01

Carotid sinus massage is a first level test when investigating the cause of syncope. It is normally performed in the supine and erect positions. However, there is no standard complete protocol. So we have devised a new protocol to evaluate the utility of carotid sinus massage in different postures and the influence of patients age on the response. Two groups of subjects were selected: a group of 167 patients (mean age 50 ys +/- 18, 105 males, 62 females) with a history of syncope without cardiovascular and neurological disease and 20 asymptomatic control subjects (mean age 52 ys +/- 13, 11 males, 9 females). Carotid sinus massage was performed supine, just after passive tilt, after 5 minutes of tilt and just after passive return to supine. If a pause > 3" was detected, the protocol was repeated after atropine i.v. injection. Borderline vasodepressor: blood pressure reduction > 30 but blood pressure reduction > 50 mm Hg or > 30 mm Hg with symptoms like dizziness, vertigo or syncope; cardioinhibitory: pause > 3"; mixed: cardioinhibitory with blood pressure reduction > 30 mm Hg after atropine. Carotid sinus massage gave all informations in the supine position in 14 (12%) patients, after passive tilt in 67 (57%), after 5 minutes of tilt in 30 (26%), and after return to supine in 6 (5%). The responses were: 13 (8%) borderline vasodepressor, 32 (19%) vasodepressor, 2 (1%) cardioinhibitory, 70 (42%) mixed, 50 (30%) negative. Positive responses were more frequent in patients over 45 years (90% versus 43%). In the control group only 3 (15%) positive responses were elicited (2 borderline vasodepressor, and 1 vasodepressor, all in subjects over 45). This protocol for carotid sinus massage evidenced positive responses in 70% of patients with syncope without cardiovascular and neurological disease; cardioinhibitory responses are rare (2%); positive responses are more frequent in patients over 45 years; the protocol specificity was 85%.

Clinical features of 10 patients with spontaneous cervical internal carotid artery dissection

International Nuclear Information System (INIS)

Nagoya, Harumitsu; Takeda, Hidetaka; Dembo, Tomohisa; Kato, Yuzi; Deguchi, Ichiro; Fukuoka, Takuya; Maruyama, Hazime; Horiuchi, Yohsuke; Tanahashi, Norio

2011-01-01

We clinically investigated 10 patients with spontaneous cervical internal carotid artery dissections (age range 36-70, mean 52±12 years; 8 male and 2 female) who were admitted to our university hospital between August 2002 and 2009. Cervical internal carotid artery dissection was diagnosed using findings from MRI, MR angiography (MRA), 3D-CTA, cerebral angiography, and carotid artery ultrasonography according to the diagnostic criteria of brain artery dissociation defined by the brain artery dissociation working group of the Strategies Against Stroke Study for Young Adults in Japan. The initial symptoms were stroke in eight patients, only neck pain in another, and no symptoms in the last. Four patients (40%) had neck pain or headache at onset. Five of the 10 patients had radiological improvements within three months after onset. The outcomes at three months were relatively good, with seven and three patients scoring 1 and 2, respectively, on the modified Rankin Scale. Disease did not recur in any patients during an average of 17.2 months of follow up. Spontaneous cervical internal carotid artery dissection is not rare in Japan. This condition should be considered when patients present with internal carotid artery occlusion or stenosis. (author)

Long-Term Outcomes of Stereotactic Radiosurgery for Treatment of Cavernous Sinus Meningiomas

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Santos, Marcos Antonio dos; Bustos Pérez de Salcedo, José; Gutiérrez Diaz, José Angel; Calvo, Felipe A.; Samblás, José; Marsiglia, Hugo; Sallabanda, Kita

2011-01-01

Purpose: Patients with cavernous sinus meningiomas (CSM) have an elevated risk of surgical morbidity and mortality. Recurrence is often observed after partial resection. Stereotactic radiosurgery (SRS), either alone or combined with surgery, represents an important advance in CSM management, but long-term results are lacking. Methods and Materials: A total of 88 CSM patients, treated from January 1991 to December 2005, were retrospectively reviewed. The mean follow-up was 86.8 months (range, 17.1–179.4 months). Among the patients, 22 were followed for more than 10 years. There was a female predominance (84.1%). The age varied from 16 to 90 years (mean, 51.6). In all, 47 patients (53.4%) received SRS alone, and 41 patients (46.6%) had undergone surgery before SRS. A dose of 14 Gy was prescribed to isodose curves from 50% to 90%. In 25 patients (28.4%), as a result of the proximity to organs at risk, the prescribed dose did not completely cover the target. Results: After SRS, 65 (73.8%) patients presented with tumor volume reduction; 14 (15.9%) remained stable, and 9 (10.2%) had tumor progression. The progression-free survival was 92.5% at 5 years, and 82.5% at 10 years. Age, sex, maximal diameter of the treated tumor, previous surgery, and complete target coverage did not show significant associations with prognosis. Among the 88 treated patients, 17 experienced morbidity that was related to SRS, and 6 of these patients spontaneously recovered. Conclusions: SRS is an effective and safe treatment for CSM, feasible either in the primary or the postsurgical setting. Incomplete coverage of the target did not worsen outcomes. More than 80% of the patients remained free of disease progression during long-term follow-up.

Long-Term Outcomes of Stereotactic Radiosurgery for Treatment of Cavernous Sinus Meningiomas

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Santos, Marcos Antonio dos, E-mail: marcosrxt@gmail.com [Radiotherapy Department, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Bustos Perez de Salcedo, Jose; Gutierrez Diaz, Jose Angel [Radiotherapy Department, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Neurosurgery Department, Sanatorio San Francisco de Asis, Madrid (Spain); Calvo, Felipe A. [Radiotherapy Department, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Department of Oncology, Hospital General Universitario Gregorio Maranon, Madrid (Spain); Samblas, Jose [Radiotherapy Department, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Neurosurgery Department, Sanatorio San Francisco de Asis, Madrid (Spain); Marsiglia, Hugo [Radiotherapy Department, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Sallabanda, Kita [Radiotherapy Department, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Neurosurgery Department, Sanatorio San Francisco de Asis, Madrid (Spain)

2011-12-01

Purpose: Patients with cavernous sinus meningiomas (CSM) have an elevated risk of surgical morbidity and mortality. Recurrence is often observed after partial resection. Stereotactic radiosurgery (SRS), either alone or combined with surgery, represents an important advance in CSM management, but long-term results are lacking. Methods and Materials: A total of 88 CSM patients, treated from January 1991 to December 2005, were retrospectively reviewed. The mean follow-up was 86.8 months (range, 17.1-179.4 months). Among the patients, 22 were followed for more than 10 years. There was a female predominance (84.1%). The age varied from 16 to 90 years (mean, 51.6). In all, 47 patients (53.4%) received SRS alone, and 41 patients (46.6%) had undergone surgery before SRS. A dose of 14 Gy was prescribed to isodose curves from 50% to 90%. In 25 patients (28.4%), as a result of the proximity to organs at risk, the prescribed dose did not completely cover the target. Results: After SRS, 65 (73.8%) patients presented with tumor volume reduction; 14 (15.9%) remained stable, and 9 (10.2%) had tumor progression. The progression-free survival was 92.5% at 5 years, and 82.5% at 10 years. Age, sex, maximal diameter of the treated tumor, previous surgery, and complete target coverage did not show significant associations with prognosis. Among the 88 treated patients, 17 experienced morbidity that was related to SRS, and 6 of these patients spontaneously recovered. Conclusions: SRS is an effective and safe treatment for CSM, feasible either in the primary or the postsurgical setting. Incomplete coverage of the target did not worsen outcomes. More than 80% of the patients remained free of disease progression during long-term follow-up.

The problem of dizziness and syncope in old age: transient ischemic attacks versus hypersensitive carotid sinus reflex.

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Uesu, C T; Eisenman, J I; Stemmer, E A

1976-03-01

In the elderly, a transient ischemic attack (TIA) and a hypersensitive carotid sinus reflex (HCSR) often co-exist and can pose a diagnostic challenge. Seven cases are presented. HCSR is a relative condition; besides increased irritability of the receptor or target organs, susceptibility of the nerve center to ischemia probably is induced by a slow heart rate or low blood pressure in any patient with pre-existing occlusive cerebrovascular disease. Dizziness and syncope of this type represent hemodynamic TIA in contrast to thromboembolic TIA. The carotid sinus massage test is recommended for differentiating the two types of TIA; the treatments differ. At present there is no uniform management that can be applied to either TIA or HCSR routinely. Therefore, treatment should be approached on an individual basis, keeping in mind the different pathophysiologic factors operating in the specific patient.

[Sinus pericranii associated to spontaneous thrombosis of the ophthalmic vein: neuroimaging studies].

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Murias, E; Villota, E; Saiz, A; Gil, A; Calleja, S

2009-01-01

Sinus pericranii is an abnormal venous communication between the intracranial dural sinuses and epicranial venous dilatations. The periorbital location is uncommon; spontaneous partial thromboses of the subcutaneous varices have been reported in association with local signs and symptoms; however, to our knowledge there are no reports of sinus pericranii associated to thrombosis in the ophthalmic vein. Sinus pericranii is related to arteriovenous and lymphatic-venous malformations. We present the case of a patient with a generalized and diffuse disorder of venous drainage that affected the right cerebral hemisphere who presented at the emergency department with ophthalmologic signs and symptoms after thrombosis of the superior ophthalmic vein and who had three sinus pericranii located in the frontal, parietal, and occipital areas.

Evaluation of results and radiologic follow-up in detachable balloon occlusion therapy of the internal carotid artery aneurysms

International Nuclear Information System (INIS)

Chung, Sun Yang; Kim, Dong Ik; Lee, Kyu Chang; Huh, Seung Kon; Yoon, Pyeong Ho; Choi, Jin Young; Kim, Dong Jun

1999-01-01

The author has studied the clinical results of CT and MR findings of proximal carotid artery occlusion using detachable balloons in the treatement of unclippable internal carotid (IC) aneurysms. From 1987 to 1995, twenty-eight patients with IC aneurysms were treated by proximal artery occlusion with detachable balloons. Of these patients, 4 had aneurysms arising from the supraclinoid portion of the IC artery, 23 had aneuryms arising from cavernous portion of the IC artery, and one had aneurysm arising from cervical portion of the IC artery. Of the 28 patients, 7 patients without CT or MR examinations were excluded in this study. The mean follow-up period was 18.6 months. The causes of aneurysm formation were spontaneous in 17 cases and traumatic in 4 cases. Of 20 patients with aneurysms arising from supraclinoid and cavernous portion of the IC artery, 16 patients (80%) had cranial nerve symptoms by mass effect. Five patients had epistaxis (3 patient), carotid cavernous fistula (1 patient) or subarachnoid hemorrhage (1 patient) due to aneurysm rupture. Two patients, each with aneuryms arising from supraclinoid and cervical portion of carotid artery had 9th and 12th cranial nerve symptom. There were three instances of complication after permanent occlusion; two patients had subarachnoid and intracerebral hemorrhage by aneurysm rupture and expired. One patient had ischemia of posterior cerebral artery teritorry after one day. Delayed ischemic event did not occur during the follow-up period. All aneurysms of the carotid artery below the level of ophthalmic artery presented radiographic proof of complete thrombosis within two months. However, complete thrombosis of aneurysm was considerably delayed in two aneurysms arising from the supraclinoid portion of the carotid artery. In long-term follow-up study, completely thrombosed aneurysms decreased in size slowly. But incompletely thrombosed aneurysms did not decrease in size for a long time and began to contract after

Evaluation of results and radiologic follow-up in detachable balloon occlusion therapy of the internal carotid artery aneurysms

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Chung, Sun Yang; Kim, Dong Ik; Lee, Kyu Chang; Huh, Seung Kon; Yoon, Pyeong Ho; Choi, Jin Young; Kim, Dong Jun [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

1999-06-01

The author has studied the clinical results of CT and MR findings of proximal carotid artery occlusion using detachable balloons in the treatement of unclippable internal carotid (IC) aneurysms. From 1987 to 1995, twenty-eight patients with IC aneurysms were treated by proximal artery occlusion with detachable balloons. Of these patients, 4 had aneurysms arising from the supraclinoid portion of the IC artery, 23 had aneuryms arising from cavernous portion of the IC artery, and one had aneurysm arising from cervical portion of the IC artery. Of the 28 patients, 7 patients without CT or MR examinations were excluded in this study. The mean follow-up period was 18.6 months. The causes of aneurysm formation were spontaneous in 17 cases and traumatic in 4 cases. Of 20 patients with aneurysms arising from supraclinoid and cavernous portion of the IC artery, 16 patients (80%) had cranial nerve symptoms by mass effect. Five patients had epistaxis (3 patient), carotid cavernous fistula (1 patient) or subarachnoid hemorrhage (1 patient) due to aneurysm rupture. Two patients, each with aneuryms arising from supraclinoid and cervical portion of carotid artery had 9th and 12th cranial nerve symptom. There were three instances of complication after permanent occlusion; two patients had subarachnoid and intracerebral hemorrhage by aneurysm rupture and expired. One patient had ischemia of posterior cerebral artery teritorry after one day. Delayed ischemic event did not occur during the follow-up period. All aneurysms of the carotid artery below the level of ophthalmic artery presented radiographic proof of complete thrombosis within two months. However, complete thrombosis of aneurysm was considerably delayed in two aneurysms arising from the supraclinoid portion of the carotid artery. In long-term follow-up study, completely thrombosed aneurysms decreased in size slowly. But incompletely thrombosed aneurysms did not decrease in size for a long time and began to contract after

A Direct Carotid-Cavernous Fistula due to Penetrating Trauma by a Knitting Needle to the Temporal Region

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Selcuk Gocmen

2012-08-01

Full Text Available Traumatic carotid-cavernous and #64257;stulas (CCF usually occur after closed head injuries. In addition, CCFs can also be caused by penetrating injuries with stab or gunshot injuries. We present the case of traumatic CCF that was caused with a knitting needle directly penetrating through the temporal region. A 46-year-old man consulted with a progressive left swollen eye. His head computed tomography (CT revealed a left temporal lobe contusion and fracture of the left temporal bone. Digital subtraction angiography (DSA showed a direct high-flow fistula (Type-A lesion. After the balloon occlusion test, which was well tolerated by the patient, the internal carotid artery was occluded by the interventional radiologist. A review of the literature demonstrated that all of the traumatic CCFs occurred due to penetrating stab injuries through the orbita. To our knowledge, such a case has not been previously reported. [Arch Clin Exp Surg 2012; 1(4.000: 261-264

Postraumatic delayed loss of vision

International Nuclear Information System (INIS)

Partington, C.R.; Graves, V.B.; Ruetenacht, D.A.; Weinstein, J.M.; Strother, C.M.

1989-01-01

The imaging studies and clinical findings in 10 patients who suffered delayed vision loss beginning 1 day to 13 years after head trauma have been reviewed. Two different primary lesions could be identified: pseudoaneurysm of the internal carotid artery and carotid cavernous fistula. The pathologic changes associated with pseudoaneurysm included compression of the optic nerves and/or chiasm by arterial aneurysm and intracranial hematoma. Carotid cavernous fistula caused delayed vision loss by compression of the optic nerves and chiasm by saccular dilatation of the cavernous sinus and by abnormal orbital venous drainage with retinal venous stasis, retinal edema, and glaucoma

Arachnoid Pit and Extensive Sinus Pnematization as the Cause of Spontaneous Lateral Intrasphenoidal Encephalocele

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Ali AlMontasheri

2012-01-01

Full Text Available Lateral sphenoid encephalocele, especially within the lateral aspect of the sphenoid sinus, when the sphenoid sinus has pneumatized extensively into the pterygoid recess, are considered exceedingly rare. We report a rare case of lateral intrasphenoidal encephalocele with spontaneous cerebral spinal fluid (CSF rhinorrhea. Computed tomography demonstrated bilateral arachnoid pit, extensive sphenoid sinus pneumatization, and a defect in the superior wall of the left lateral recess of the sphenoid sinus. Magnetic resonance imaging demonstrated anteromedial temporal lobe herniating through the bony defect.

海绵窦内海绵状血管瘤

Institute of Scientific and Technical Information of China (English)

史继新; 王汉东; 杭春华; 潘云曦; 刘承基; 张祖喧

1999-01-01

Extra-axial cavemous hemangiomas are rare lesions and have a propensity to occur within the cavernous sinus. Clinical presentations of cavernous hemangiomas include headache and cranial nerve deficits. As the tumors grow, the internal carotid artery(ICA) and cranial

Endoscopic endonasal repair of spontaneous sphenoid sinus lateral wall meningocele presenting with cerebrospinal fluid leak

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Ali Erdem Yildirim

2014-01-01

Full Text Available Spontaneous sphenoid sinus lateral wall meningoceles are rare lesions with an unknown etiology. Endoscopic endonasal technique is a considerable route in the treatment of this condition. The aim of this paper is to report the etiology, surgical technique, and outcome in a patient repaired via endoscopic endonasal approach. A 51-year-old male patient applied with rhinorrhea started three months ago after an upper respiratory infection. There were no history of trauma or sinus operation. Biochemical analysis of the fluid was positive for beta-2-transferrin. This asypthomatic patient had undergone for repairment of lateral sphenoid sinus meningocele with endoscopic endonasal transsphenoidal approach. After endoscopic endonasal meningocele closure procedure no complications occured and a quick recovery was observed. Endoscopic endonasal approach is an effective and safe treatment modality of spontaneous lateral sphenoid sinus meningoceles and efficient in anterior skull base reconstruction.

Cavernous sinus thrombosis following dental extraction: a rare case report and forgotten entity.

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Aggarwal, Karun; Rastogi, Sanjay; Joshi, Atul; Kumar, Ashish; Chaurasia, Archana; Prakash, Rajat

2017-10-01

Prior to the advent of efficacious antimicrobial agents, the mortality rate from cavernous sinus thrombosis (CST) was effectively 100%. There have been very few reports of CST associated with tooth extraction. A 40-year-old female presented to the emergency room with swelling over the right side of the face and history of extraction in the upper right region by an unregistered dental practitioner. The patient presented with diplopia, periorbital ecchymosis, and chemosis of the right eye. A computed tomography scan revealed venous dilatation of the right superior ophthalmic vein. The patient was immediately treated with incision and drainage, intravenous antibiotics, and heparin (low molecular weight). Unfortunately, the patient died two days after surgery due to complications from the disease. CST is a rare disease with a high mortality rate. Therefore, dental health education in rural areas, legal action against unregistered dental practitioners, early diagnosis, and aggressive antibiotic treatment can prevent future mortality resulting from CST.

Endovascular treatment of a cavernous sinus dural arteriovenous fistula by transvenous embolisation through the superior ophthalmic vein via cannulation of a frontal vein

International Nuclear Information System (INIS)

Venturi, C.; Bracco, S.; Cerase, A.; Gennari, P.; Lore, F.; Polito, E.; Casasco, A.E.

2003-01-01

We describe a new approach for transvenous embolisation of cavernous sinus dural arteriovenous fistulae through the superior ophthalmic vein (SOV), i.e., via percutaneous cannulation of a frontal vein. Modern neurointerventional angiographic materials make it possible to reach the SOV in this way without puncturing it in the orbit or a surgical exposure. Orbital phlebography should still be in the repertoire of interventional neuroradiology units in large centres. (orig.)

Development of a posterior cerebral artery aneurysm subsequent to occlusion of the contralateral internal carotid artery for giant cavernous aneurysm

International Nuclear Information System (INIS)

Wolf, R.L.; Hurst, R.W.; Imbesi, S.G.; Galetta, S.L.; Sinson, G.P.; Grossman, R.I.

2002-01-01

We report a case of a patient who developed a left posterior cerebral artery aneurysm 5 years after balloon occlusion of the right internal carotid artery for a giant cavernous aneurysm. The location of the new aneurysm was outside of the primary collateral pathways to the contralateral, proximally occluded, anterior circulation, illustrating the complexity of hemodynamic factors contributing to the development of intracranial saccular aneurysms. The appearance of an aneurysm in this setting supports the hypothesis that degenerative factors and hemodynamic stresses are important in the etiology of intracranial aneurysms. (orig.)

Carotid cavernous fistula with central retinal artery occlusion and Terson syndrome after mid-facial trauma

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Karna, Satya

2017-05-01

Full Text Available Objectives: To report a rare occurrence combination of central retinal artery occlusion (CRAO and Terson syndrome in a Barrow’s type A carotid cavernous fistula (CCF patient.Methods: Observational case report.Results: A twenty-year-old male patient with a history of road traffic accident presented with periorbital swelling and redness in the left eye. Examination revealed a CRAO with intraretinal and preretinal hemorrhages. On imaging, type A CCF and subarachnoid hemorrhage were detected. He underwent embolization of the fistula for cosmetic blemish. The possible mechanisms and clinical implications are discussed. Conclusion: Patients with a head injury can have serious ocular damage. Posterior segment manifestations of CCFs are varied and at times can occur in various rare combinations, making it challenging. Early recognition of these rare manifestations and a multi-disciplinary approach are needed in patients with head trauma.

Clinical features and management of cavernous and venous angiomas in the head

International Nuclear Information System (INIS)

Tokunaga, Koji; Date, Isao

2011-01-01

Cerebral cavernous angiomas consist of well-circumscribed collections of thin-walled sinusoidal vascular channels lacking the intervening brain tissue. They are present in 0.4-0.8% of the population, and can occur in a sporadic or familial form. Most common symptoms are seizures, hemorrhage, and focal neurological deficits. The annual bleeding rate of the patient is reported to be 0.25%-20%. High-resolution magnetic resonance imaging (MRI) is a useful diagnostic tool with a high degree of sensitivity and specificity. Microsurgical excision of the lesion is a good treatment choice for cavernous angiomas in the brain, even in the brainstem. Although stereotactic radiosurgery may reduce the incidence of rebleeding and the frequency of seizures, its indication should be carefully investigated because of the relatively high rate of radiation-induced side effects. Less frequently, cavernous angiomas can be located at the extra-axial regions of the head, which include the cavernous sinus, the orbit, and the cranial nerves. Cavernous angiomas in the cavernous sinus pose a neurosurgical challenge due to the high vascularity and involvement of the neurovascular structures, and stereotactic radiosurgery is considered as an additional option. Surgical resection is recommended for symptomatic cavernous angiomas in the orbit; however, the rate of complications after resection is not necessarily low for cavernous angiomas within the apex. Venous angiomas are anomalies of normal venous drainage, which show characteristic appearance of the drainage system in the late phase of angiography (caput medusae). They are found either alone or in combination with other vascular malformations. Conservative treatment is recommended except for patients with a large hematoma or with a coexisting cavernous angioma. (author)

SU-E-T-304: Dosimetric Comparison of Cavernous Sinus Tumors: Heterogeneity Corrected Pencil Beam (PB-Hete) Vs. X-Ray Voxel Monte Carlo (XVMC) Algorithms for Stereotactic Radiotherapy (SRT)

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Pokhrel, D; Sood, S; Badkul, R; Jiang, H; Saleh, H; Wang, F [University of Kansas Hospital, Kansas City, KS (United States)

2015-06-15

Purpose: To compare dose distributions calculated using PB-hete vs. XVMC algorithms for SRT treatments of cavernous sinus tumors. Methods: Using PB-hete SRT, five patients with cavernous sinus tumors received the prescription dose of 25 Gy in 5 fractions for planning target volume PTV(V100%)=95%. Gross tumor volume (GTV) and organs at risk (OARs) were delineated on T1/T2 MRI-CT-fused images. PTV (range 2.1–84.3cc, mean=21.7cc) was generated using a 5mm uniform-margin around GTV. PB-hete SRT plans included a combination of non-coplanar conformal arcs/static beams delivered by Novalis-TX consisting of HD-MLCs and a 6MV-SRS(1000 MU/min) beam. Plans were re-optimized using XVMC algorithm with identical beam geometry and MLC positions. Comparison of plan specific PTV(V99%), maximal, mean, isocenter doses, and total monitor units(MUs) were evaluated. Maximal dose to OARs such as brainstem, optic-pathway, spinal cord, and lenses as well as normal tissue volume receiving 12Gy(V12) were compared between two algorithms. All analysis was performed using two-tailed paired t-tests of an upper-bound p-value of <0.05. Results: Using either algorithm, no dosimetrically significant differences in PTV coverage (PTVV99%,maximal, mean, isocenter doses) and total number of MUs were observed (all p-values >0.05, mean ratios within 2%). However, maximal doses to optic-chiasm and nerves were significantly under-predicted using PB-hete (p=0.04). Maximal brainstem, spinal cord, lens dose and V12 were all comparable between two algorithms, with exception of one patient with the largest PTV who exhibited 11% higher V12 with XVMC. Conclusion: Unlike lung tumors, XVMC and PB-hete treatment plans provided similar PTV coverage for cavernous sinus tumors. Majority of OARs doses were comparable between two algorithms, except for small structures such as optic chiasm/nerves which could potentially receive higher doses when using XVMC algorithm. Special attention may need to be paid on a case

Gamma Knife radiosurgery for hemangioma of the cavernous sinus.

Science.gov (United States)

Lee, Cheng-Chia; Sheehan, Jason P; Kano, Hideyuki; Akpinar, Berkcan; Martinez-Alvarez, Roberto; Martinez-Moreno, Nuria; Guo, Wan-Yuo; Lunsford, L Dade; Liu, Kang-Du

2017-05-01

OBJECTIVE Cavernous sinus hemangiomas (CSHs) are rare vascular tumors. A direct microsurgical approach usually results in massive hemorrhage and incomplete tumor resection. Although stereotactic radiosurgery (SRS) has emerged as a therapeutic alternative to microsurgery, outcome studies are few. Authors of the present study evaluated the role of SRS for CSH. METHODS An international multicenter study was conducted to review outcome data in 31 patients with CSH. Eleven patients had initial microsurgery before SRS, and the other 20 patients (64.5%) underwent Gamma Knife SRS as the primary management for their CSH. Median age at the time of radiosurgery was 47 years, and 77.4% of patients had cranial nerve dysfunction before SRS. Patients received a median tumor margin dose of 12.6 Gy (range 12-19 Gy) at a median isodose of 55%. RESULTS Tumor regression was confirmed by imaging in all 31 patients, and all patients had greater than 50% reduction in tumor volume at 6 months post-SRS. No patient had delayed tumor growth, new cranial neuropathy, visual function deterioration, adverse radiation effects, or hypopituitarism after SRS. Twenty-four patients had presented with cranial nerve disorders before SRS, and 6 (25%) of them had gradual improvement. Four (66.7%) of the 6 patients with orbital symptoms had symptomatic relief at the last follow-up. CONCLUSIONS Stereotactic radiosurgery was effective in reducing the volume of CSH and attaining long-term tumor control in all patients at a median of 40 months. The authors' experience suggests that SRS is a reasonable primary and adjuvant treatment modality for patients in whom a CSH is diagnosed.

Carotid cavernous fistula after elective carotid endarterectomy: Case report

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Andres Asser

2014-12-01

This is a case to illustrate a rare complication of carotid artery surgery. The patient had atherosclerotic vessel damage of ICA visible on earlier CT scans. This combined with abrupt increase of transmural pressure due to the revascularization procedure could possibly lead to arterial wall rupture and fistula formation.

ANCA-Negative Granulomatosis with Polyangiitis Presenting with Hypertrophic Cranial Pachymeningitis, Abducens Nerve Palsy, and Stenosis of the Internal Carotid Artery

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Shohei Harabuchi

2017-01-01

Full Text Available We report a rare case of granulomatosis with polyangiitis (GPA presenting with hypertrophic cranial pachymeningitis (HCP, abducens nerve palsy, and stenosis of the internal carotid artery (ICA. A 59-year-old Japanese man presented with a year history of nasal obstruction and a 2-month history of slight headache. Histopathological examination of the granulomatous mucosa in the ethmoid sinuses resected by endoscopic sinus surgery revealed necrotizing vasculitis with multinucleated giant cells. The patient was diagnosed with the limited form of GPA as a result of the systemic examination. He declined immunosuppressive treatment. Eighteen months after the diagnosis of GPA, he presented with diplopia and severe headache. Though nasal findings indicating GPA were not observed in the nasal cavity, CT scan revealed a lesion of the right sphenoid sinus eroding the bone of the clivus. Gadolinium-enhanced MRI of the brain showed thickening of the dura mater around the right cavernous sinus and clivus. Magnetic resonance angiography and cerebral angiography revealed narrowing at the C5 portion of the ICA. Intravenous methylprednisolone pulse therapy followed by oral prednisolone and cyclophosphamide resolved headache and dramatically improved HCP and stenosis of the ICA.

Spontaneous CSF-leaks and meningoencephaloceles in sphenoid sinus by persisting Sternberg's canal.

Science.gov (United States)

Tomazic, Peter Valentin; Stammberger, Heinz

2009-12-01

Cerebrospinal fluid (CSF) leaks and meningoencephaloceles of the lateral recess of sphenoid sinuses are rare findings. A congenital bony defect in the lateral wall of sphenoid sinus called Sternberg's canal could be the origin of these lesions. Their endoscopic transnasal management is challenging though less traumatic than transcranial approaches. The aim of this study was to define Sternberg's canal as a potential source for these rare lesions and to describe their endoscopic endonasal management. In a retrospective analysis clinical charts of 27 patients with CSF-leaks and / or meningoencephaloceles operated between March 2002 and October 2008 at the University ENT-hospital Graz have been reviewed. All patients were treated by an endoscopic endonasal approach. Five patients (4 female / 1 male) were identified with spontaneous CSF-leaks from sphenoid sinus and meningoencephaloceles. In all five cases, Sternberg's canal was the site of leakage, with the bony and dural defects always located laterally between the maxillary and Vidian nerves. Mean age was 51.2 years and mean body mass index (BMI) was 31.9 kg/m2. All patients were operated using a multilayer closure technique. Two patients had recurrences after 12 days and 7 months, respectively, managed by endoscopic revision surgery resulting in a 100% closure rate after one revision (mean follow-up: 6.5 months). Persisting Sternberg's canal can be the source of spontaneous CSF-leaks and meningoencephaloceles in the lateral recess of sphenoid sinus especially when associated with extensive pneumatisation. Endoscopic management is technically challenging, nevertheless its advantages are a good view of the surgical field while being less traumatic than transcranial approaches.

SPHENOID SINUS (SS ANTERIOR MEDIAL TEMPORAL LOBE ENCEPHALOCELE (AMTLE WITH SPONTANEOUS CSF RHINORRHOEA : A CASE REPORT

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Laveena

2015-09-01

Full Text Available Cranial encephaloceles are the herniation of intracranial meninges and brain tissue through a defect in the cranium or skull base. These are rare conditions with an incidence of approximately 1 in 35,000 people, and are more common in the anterior cranial fossa than those in the middle one . 1,2 Temporal lobe herniation through a mid dle fossa defect into the lateral recess of the Sphenoid Sinus is even rarer than its medial representation. Intrasphenoidal encephaloceles are extremely rare findings 3 . Spontaneous, or primary, CSF fistula is a separate entity with no underlying cause of the CSF leak. Spontaneous CSF leaks are usually associated with a co - existing encephalocele of variable size 4 . We present a case of spontaneous CSF rhinorrhoea in a sphenoid sinus Anterior Medial Temporal lobe encephalocele herniating through a clinically silent lateral Craniopharyngeal canal.

Cavernous sinus thrombosis syndrome and brainstem involvement in patient with leptospirosis: Two rare complications of leptospirosis

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Shahriyar Alian

2014-01-01

Full Text Available Leptospirosis is a bacterial disease that is caused by pathogenic spirochetes of the genus Leptospira. It can affect humans and animals. In humans, it can lead to a wide spectrum of symptoms. It is known as the most common zoonosis in the world. The typical presentation of the disease is an acute biphasic febrile illness with or without jaundice. Less common clinical manifestations may result from involvement of different human body systems. In many places, this disease may be under-diagnosed, especially when associated with neurological complications. Moreover, without treatment, leptospirosis can lead to organ damages, and even death. Neurological complications are uncommon and are reported in a few cases. Cavernous sinus thrombosis syndrome and brainstem involvement are rare complications of leptospirosis and are associated with a high mortality risk. To our knowledge, no such cases have been reported in the literature.

Bilateral spontaneous internal carotid artery dissection managed with endovascular stenting – A case report

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Manoj Kumar Agarwala

2016-09-01

We describe a patient with ischemic stroke from spontaneous bilateral ICAD with completely occluded left ICA. Having failed medical therapy with antiplatelets and anticoagulants due to extensive loss of carotid vascular supply, he was managed successfully with endovascular stenting with good neurological recovery.

The effect of carotid sinus massage is independent of posture in patients with heart disease

DEFF Research Database (Denmark)

Mickley, H; Hansen, K N; Oxhøj, H

1989-01-01

unilateral right- and left-sided CSM performed in the supine and in the sitting position, while heart rate and systolic blood pressure were monitored. No statistically significant differences in the CSM-induced response in systolic blood pressure or heart rate were found between the two postures....... In the supine position the drop in heart rate was significantly greater after right-sided than after left-sided CSM (P less than 0.05). In only one patient (1%) was a significant carotid sinus reflex evoked. The response was cardioinhibitory with asystole for 3700 ms during right-sided, supine CSM...

Microscopic and endoscopic anatomical study of the extended transsphenoidal approach

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HUANG Xin-tao

2013-06-01

Full Text Available Background Traditional transsphenoidal approach has less treatment effect in invasive pituitary adenoma. To remove tumors growing outside the sella become one of the challenges in neurosurgery. This study aims to study anatomical characteristics of the extended transsphenoidal approach for clinical operation. Methods A mimetic surgery was performed on 10 adult cadaver heads through extended transsphenoidal approach by endoscopy. The study data of related anatomic structures were measured. Results The distance from sphenoidal ostium to anterior nasal spine is (59.68 ± 4.28 mm (52.62-63.16 mm, to posterior nasal aperture is (12.88 ± 1.46 mm (10.47-15.61 mm. The incidence of optic nerve and internal carotid artery protuberance in the lateral wall of sphenoidal sinus is 11/20 and 17/20, respectivly. The medial wall of the cavernous sinus is comprised of one dural layer. The incidence of anterior intercavernous sinus, posterior intercavernous sinus, inferior intercavernous sinus and basilar sinus is 17/20, 12/20, 11/20 and 20/20, respectively. The distance between the bilateral hidden segment of internal carotid artery is (15.30 ± 1.25 mm (12.42-21.76 mm, between the bilateral inferior horizontal segment midpoint is (14.03 ± 1.19 mm (10.42-18.43 mm, between the bilateral anterior vertical segment is (18.87 ± 1.44 mm (16.75-24.88 mm, and between the bilateral inner edge of tuberculum sellae is (12.73 ± 0.94 mm (9.97-16.18 mm. In 7 cases (7/20, the intracavernous carotid is in direct contact with the sellar part of the medial wall; in all cases (20/20, the venous plexus extends into the space between the intracavernous carotid and the sphenoidal part of the medial wall. The incidence of the intracavernous carotid coursing along the inferior one third of the pituitary gland is 9/20, along the inferior two thirds of the pituitary gland is 7/20, along the all the thirds of the pituitary gland is 3/20, while below the level of the sellar floor is

Successful treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV without arterial puncture: the transvenous triple-overlay embolization (TAILOREd) technique.

Science.gov (United States)

Huynh, Thien J; Morton, Ryan P; Levitt, Michael R; Ghodke, Basavaraj V; Wink, Onno; Hallam, Danial K

2017-08-18

We report successful transvenous treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV using a novel triple-overlay embolization (TAILOREd) technique without the need for arterial puncture, which is known to be highly risky in this patient group. The TAILOREd technique allowed for successful treatment using preoperative MR angiography as a three-dimensional overlay roadmap combined with cone beam CT and live fluoroscopy, precluding the need for an arterial puncture. 2017 BMJ Publishing Group Ltd.

Estudo micro-mesoscópico da parede lateral do seio cavernoso humano Human cavernous sinus: micro-mesoscopic study of the lateral wall

Directory of Open Access Journals (Sweden)

Renato Paulo Chopard

1996-12-01

Full Text Available Os autores estudam as estruturas contidas no seio cavernoso humano, tanto em seu interior como na sua parede lateral, através de cortes frontais seriados espessos. Mostram a importância desta parede que é freqüentemente usada como via de acesso cirúrgico às afecções presentes nesta estrutura venosa da dura-máterThe authors studied the structures of human cavernous sinus in its interior as well as on the lateral wall, utilizing thick, frontal, sequential sections. They show the significance of this wall, frequently used as surgical accessway to diseases encountered within this venous structure of the dura-mater.

Petrosal sinus sampling: technique and rationale.

Science.gov (United States)

Miller, D L; Doppman, J L

1991-01-01

Bilateral simultaneous sampling of the inferior petrosal sinuses is an extremely sensitive, specific, and accurate test for diagnosing Cushing disease and distinguishing between that entity and the ectopic ACTH syndrome. It is also valuable for lateralizing small hormone-producing adenomas within the pituitary gland. The inferior petrosal sinuses connect the cavernous sinuses with the ipsilateral internal jugular veins. The anatomy of the anastomoses between the inferior petrosal sinus, the internal jugular vein, and the venous plexuses at the base of the skull varies, but it is almost always possible to catheterize the inferior petrosal sinus. In addition, variations in size and anatomy are often present between the two inferior petrosal sinuses in a patient. Advance preparation is required for petrosal sinus sampling. Teamwork is a critical element, and each member of the staff should know what he or she will be doing during the procedure. The samples must be properly labeled, processed, and stored. Specific needles, guide wires, and catheters are recommended for this procedure. The procedure is performed with specific attention to the three areas of potential technical difficulty: catheterization of the common femoral veins, crossing the valve at the base of the left internal jugular vein, and selective catheterization of the inferior petrosal sinuses. There are specific methods for dealing with each of these areas. The sine qua non of correct catheter position in the inferior petrosal sinus is demonstration of reflux of contrast material into the ipsilateral cavernous sinus. Images must always be obtained to document correct catheter position. Special attention must be paid to two points to prevent potential complications: The patient must be given an adequate dose of heparin, and injection of contrast material into the inferior petrosal sinuses and surrounding veins must be done gently and carefully. When the procedure is performed as outlined, both inferior

Fulminant superior ophthalimic vein and cavermous sinus thrombophlebitis with intracranial extensions: A case report

International Nuclear Information System (INIS)

Hwang, Ji Sun; Hong, Hyun Sook; Park, Ji Sang; Lee, A Leum; Choo, Eun Ju; Chang, Kee Hyun

2015-01-01

Cavernous sinus thrombophlebitis (CST) is a rare and life-threatening disease without prompt diagnosis and treatment. Two cases of fulminant superior ophthalmic vein (SOV) and CST caused by maxillary periodontitis and sphenoid sinusitis are described. A 65-year-old woman presented with right proptosis, headache, and fever. A 74-year-old woman presented with left periorbital swelling. In both patients, MRI with gadolinium showed expansion of the bilateral cavernous sinus and diffuse dilatation of the SOV with non-enhancement of central thrombus, which indicated CST. The condition was complicated by brain abscess, meningitis, and ischemic stroke. These conditions were improved by antibiotic treatment, but one patient underwent exenteration of the orbit due to orbital rupture during hospitalization

Fulminant superior ophthalimic vein and cavermous sinus thrombophlebitis with intracranial extensions: A case report

Energy Technology Data Exchange (ETDEWEB)

Hwang, Ji Sun; Hong, Hyun Sook; Park, Ji Sang; Lee, A Leum; Choo, Eun Ju; Chang, Kee Hyun [Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of)

2015-06-15

Cavernous sinus thrombophlebitis (CST) is a rare and life-threatening disease without prompt diagnosis and treatment. Two cases of fulminant superior ophthalmic vein (SOV) and CST caused by maxillary periodontitis and sphenoid sinusitis are described. A 65-year-old woman presented with right proptosis, headache, and fever. A 74-year-old woman presented with left periorbital swelling. In both patients, MRI with gadolinium showed expansion of the bilateral cavernous sinus and diffuse dilatation of the SOV with non-enhancement of central thrombus, which indicated CST. The condition was complicated by brain abscess, meningitis, and ischemic stroke. These conditions were improved by antibiotic treatment, but one patient underwent exenteration of the orbit due to orbital rupture during hospitalization.

The subpetrous carotid wall hematoma. A sign of spontaneous dissection of the internal carotid artery on non-enhanced computed tomography. A retrospective study

International Nuclear Information System (INIS)

Jensen-Kondering, U.; Univ. Hospital Schleswig-Holstein, Kiel; Huhndorf, M.; Madjidyar, J.; Jansen, O.

2015-01-01

Spontaneous dissection of the internal carotid artery (CAD) is an increasingly recognized cause for stroke especially in young and middle-aged patients. We hypothesized that non-enhanced cranial computed tomography (NECCT) can visualize the subpetrous carotid wall hematoma and thus enable identification of patients with CAD. We retrospectively reviewed patients with confirmed CAD (n=21) and a control group with ischemic symptoms but without CAD (n=42) who received NECCT at admission. Two independent neuroradiologists rated the presence and shape of SPH, density and diameter of the subpetrous internal carotid artery. Additionally, we correlated the shape of the subpetrous carotid wall hematoma with the grade of stenosis on subsequent angiographic imaging. The subpetrous carotid wall hematoma was present in 14 of 21 patients (Cohen's k = 0.67). Mean diameter was 6.95 ± 1.05 mm in dissected vessels and 5.71 ± 1.52 mm in the contralateral vessel (p<0.05). Mean difference in vessel density was 15.05 ± 8.01 HU (p<0.01). Median grade of stenosis was significantly higher in patients with a full moon- shaped (n=11) than crescent-shaped (n=3) subpetrous carotid wall hematoma (21% vs. 80%, p<0.05). Two-thirds of patients with CAD were correctly identified on NECCT. The extracranial carotid artery should be evaluated in patients with symptoms of cerebral ischemia.

The subpetrous carotid wall hematoma. A sign of spontaneous dissection of the internal carotid artery on non-enhanced computed tomography. A retrospective study

Energy Technology Data Exchange (ETDEWEB)

Jensen-Kondering, U. [Univ. Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Radiology and Neuroradiology; Univ. Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Neurology; Huhndorf, M.; Madjidyar, J.; Jansen, O. [Univ. Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Radiology and Neuroradiology

2015-03-15

Spontaneous dissection of the internal carotid artery (CAD) is an increasingly recognized cause for stroke especially in young and middle-aged patients. We hypothesized that non-enhanced cranial computed tomography (NECCT) can visualize the subpetrous carotid wall hematoma and thus enable identification of patients with CAD. We retrospectively reviewed patients with confirmed CAD (n=21) and a control group with ischemic symptoms but without CAD (n=42) who received NECCT at admission. Two independent neuroradiologists rated the presence and shape of SPH, density and diameter of the subpetrous internal carotid artery. Additionally, we correlated the shape of the subpetrous carotid wall hematoma with the grade of stenosis on subsequent angiographic imaging. The subpetrous carotid wall hematoma was present in 14 of 21 patients (Cohen's k = 0.67). Mean diameter was 6.95 ± 1.05 mm in dissected vessels and 5.71 ± 1.52 mm in the contralateral vessel (p<0.05). Mean difference in vessel density was 15.05 ± 8.01 HU (p<0.01). Median grade of stenosis was significantly higher in patients with a full moon- shaped (n=11) than crescent-shaped (n=3) subpetrous carotid wall hematoma (21% vs. 80%, p<0.05). Two-thirds of patients with CAD were correctly identified on NECCT. The extracranial carotid artery should be evaluated in patients with symptoms of cerebral ischemia.

Angiographic findings of collateral vessels in cervicofacial vascular lesions with previously ligated carotid artery

International Nuclear Information System (INIS)

Na, Dong Gyu; Han, Moon Hee; Chang, Kee Hyun; Han, Gi Seok; Yeon, Kung Mo

1995-01-01

The purpose of this study is to describe the angiographic findings of collateral vessels in cervicofacial vascular lesions with previously ligated carotid arteries and to evaluate the extent of angiographic assessment needed before embolization. We retrospectively reviewed 10 cervicofacial vascular lesions with previously ligated carotid artery, which were 6 cases of arteriovenous malformation, 2 cases of carotid cavernous fistula, 1 case of hemangioma and 1 case of arteriovenous malformation with carotid cavernous fistula. The previously ligated arteries are proximal external carotid artery (n = 5), branches of external carotid artery (n = 2) and common carotid artery (n = 3). Common carotid artery or internal carotid artery (n = 9), vertebral artery (n = 5), ipsilateral external carotid artery (n = 4), contralateral external carotid artery (n = 5), costocervical trunk (n = 2), thyrocervical trunk (n = 2) were assessed by conventional angiography. Angiography of both carotid and vertebral arteries was performed in 5 cases. The collateral vascular channels were inferolateral trunk of internal carotid artery (n = 8), vertebral artery (n = 5), contralateral external carotid artery (n = 5), ipsilateral external carotid artery (n = 4), deep cervical artery (n = 2) and ascending cervical artery (n = 1). Embolization were performed in 9 cases with operative cannulation (n = 4), embolization via collateral branches of ipsilateral external carotid artery (n = 1), embolization via collateral branches of contralateral external carotid artery (n = 3) and balloon occlusion via direct puncture (n = 1). The collateral channels in cervicofacial vascular lesions with previously ligated carotid artery were inferolateral trunk of internal carotid artery, contralateral or ipsilateral external carotid artery, vertebral artery, deep cervical artery and ascending cervical artery on angiography. Complete angiographic assessment of possible collateral channels is mandatory for the

ORBITAL CELLULITIS COMPLICATING SINUSITIS: A 15-YEAR ...

African Journals Online (AJOL)

Dr. NWaorgu

cavernous sinus thrombosis, and brain abscess. 3, 4 In ... left orbit was involved in 55% and the right in 31% while it was bilateral ... Figure 1: Age and sex of patients with orbital cellulitis. 0. 5 ... However, Kenny et al and Child have suggested ...

The anterior medullary-anterior pontomesencephalic venous system and its bridging veins communicating to the dural sinuses: normal anatomy and drainage routes from dural arteriovenous fistulas

International Nuclear Information System (INIS)

Kiyosue, Hiro; Tanoue, Shuichi; Sagara, Yoshiko; Okahara, Mika; Kashiwagi, Junji; Mori, Hiromu; Hori, Yuzo; Nagatomi, Hirofumi

2008-01-01

We evaluated the normal venous anatomy of the anterior medullary/anterior pontomesencephalic venous (AMV/APMV) system and bridging veins connected to the dural sinuses using magnetic resonance (MR) imaging and demonstrated cases of dural arteriovenous fistulas (DAVFs) with bridging venous drainage. MR images obtained using a 3D gradient echo sequence in 70 patients without lesions affecting the deep or posterior venous channels were reviewed to evaluate the normal anatomy of the AMV/APMV system and bridging veins. MR images and digital subtraction angiography in 80 cases with intracranial or craniocervical junction DAVFs were reviewed to evaluate the bridging venous drainage from DAVFs. MR images clearly revealed AMV/APMV in 35 cases. Fifteen cases showed a direct connection between AMV and APMV, while 15 cases showed an indirect communication via the transverse pontine vein or the bridging vein. In the five remaining cases, the AMV and APMV end separately to the bridging vein or the transverse pontine vein. Bridging veins were identified in 34 cases, connecting to the cavernous sinus in 33, to the suboccipital cavernous sinus in 11, and the inferior petrosal sinus in five cases. In 80 DAVF cases, seven of 40 cavernous sinus DAVFs, two craniocervical junction DAVFs, and one inferior petrosal sinus DAVF drained via bridging veins to the brain stem. The AMV/APMV and bridging veins showed various anatomies and frequently showed a connection to the cavernous sinus. Knowledge of the venous anatomy is helpful for the diagnosis and intravascular treatment of DAVFs. (orig.)

Improvement in Visual Symptomatology after Endovascular Treatment of Cavernous Carotid Aneurysms: A Multicenter Study.

Science.gov (United States)

Drazin, Doniel; Choulakian, Armen; Nuño, Miriam; Gandhi, Ravi; Edgell, Randall C; Alexander, Michael J

2013-06-01

Aneurysms arising from the cavernous internal carotid artery (CCAs) pose technical challenges for surgical management and such patients are frequently referred for endovascular treatment. These aneurysms often produce a variety of neurological deficits, primarily those related to oculoparesis. Our purpose was to determine the visual and neurological outcome of patients with treated CCAs. We reviewed the medical records and angiograms for patients who underwent endovascular treatment for CCAs at three academic medical centers. The following outcomes were analyzed: angiographic assessment, visual improvement and outcome at 3 months using Glasgow Outcome Scale (GOS). Thirty-four patients (mean age 54.7 years) were treated for CCAs. The mean aneurysm size was 14.2 mm (range: 3-45 mm), and fourteen patients (41.2%) required stent assistance. Twenty-one aneurysms (61.8%) were completely occluded; nine aneurysms (26.6%) had near-complete occlusion; 4 aneurysms (11.8%) had partial occlusion. Seven patients (20.6%) required retreatment. Fifteen of the 34 patients (44.1%) presented with visual symptoms, while only eight patients had residual visual symptomatology at follow-up (44.1% vs. 23.5%; p=0.02). Patients that presented with visual symptoms (N=15) had a mean aneurysm size of 24.5 mm, while those without visual symptoms (N=19) had a size of 7.5 mm (p=0.001). Follow-up GOS was good (4-5) in 29 patients (90.6%). No thromboembolic complications were observed. One patient died (3.1%) of an unrelated cause. Most patients in this multicenter series improved or remained stable after treatment. The results of this study indicate that endovascular treatment may improve the outcome of visual symptoms in patients with large cavernous aneurysms with low periprocedural morbidity. MJA is a consultant for Stryker and Codman. AC receives a Cordis Endovascular Fellowship Training Grant and a Stryker Endovascular Neurosurgery Post-graduate Fellow Grant. Dr. Drazin: Conception and Design

Tolosa-Hunt syndrome in a patient with systemic lupus erythematosus

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Calistri, Valentina; Mostardini, Claudio; Pantano, Patrizia; Pierallini, Alberto [Department of Neurological Sciences, University of Rome (Italy); Colonnese, Claudio [IRCCS Neuromed, Pozzilli (Italy); Caramia, Francesca [Department of Neurological Sciences, University of Rome (Italy); IRCCS Neuromed, Pozzilli (Italy)

2002-02-01

We report a case of Tolosa-Hunt syndrome (THS) in a patient with systemic lupus erythematosus studied with MRI. Magnetic resonance showed enlargement of the cavernous sinus and compression of the carotid syphon by enhancing tissue. In particular, fat-suppressed T1-weighted images before and after contrast agent injection and MR angiography showed extension of the abnormal tissue to the apex of the orbit and narrowing of the internal carotid artery. A presumptive diagnosis of THS was made and steroid treatment was started with rapid relief of symptoms. Follow-up MR study after steroid therapy demonstrated sub-total resolution of the neuroradiological findings. Neuroradiological findings in THS are quite typical but they may be subtle; furthermore, the presence of a systemic disease may suggest secondary involvement of the cavernous sinus. Utilization of the appropriate MR techniques and follow-up exams may contribute to the diagnosis of THS even in the presence of other systemic diseases. (orig.)

Tolosa-Hunt syndrome in a patient with systemic lupus erythematosus

International Nuclear Information System (INIS)

Calistri, Valentina; Mostardini, Claudio; Pantano, Patrizia; Pierallini, Alberto; Colonnese, Claudio; Caramia, Francesca

2002-01-01

We report a case of Tolosa-Hunt syndrome (THS) in a patient with systemic lupus erythematosus studied with MRI. Magnetic resonance showed enlargement of the cavernous sinus and compression of the carotid syphon by enhancing tissue. In particular, fat-suppressed T1-weighted images before and after contrast agent injection and MR angiography showed extension of the abnormal tissue to the apex of the orbit and narrowing of the internal carotid artery. A presumptive diagnosis of THS was made and steroid treatment was started with rapid relief of symptoms. Follow-up MR study after steroid therapy demonstrated sub-total resolution of the neuroradiological findings. Neuroradiological findings in THS are quite typical but they may be subtle; furthermore, the presence of a systemic disease may suggest secondary involvement of the cavernous sinus. Utilization of the appropriate MR techniques and follow-up exams may contribute to the diagnosis of THS even in the presence of other systemic diseases. (orig.)

Inhibitory actions of methionine-enkephalin and morphine on the cat carotid chemoreceptors.

Science.gov (United States)

McQueen, D S; Ribeiro, J A

1980-01-01

1 The effects of intracarotid injections of methionine-enkephalin (Met-enkephalin) and morphine on chemoreceptor activity recorded from the peripheral end of a sectioned carotid sinus nerve have been studied in cats anaesthetized with pentobarbitone. 2 Met-enkephalin caused a rapid, powerful, inhibition of spontaneous chemoreceptor discharge, the intensity and duration of which was dose-dependent. 3 Morphine was a less potent inhibitor of spontaneous chemoreceptor discharge, and the inhibition it evoked was rather variable and tended to be biphasic. Low doses of morphine caused a slight increase in discharge. 4 Naloxone (0.2 mg i.c.) slightly increased spontaneous discharge, greatly reduced the chemo-inhibition caused by morphine, and reduced the inhibitory effect of Met-enkephalin. A higher dose of naloxone (0.8 mg) caused a substantial reduction of the Met-enkephalin effect. 5 Chemo-excitation evoked by intracarotid injections of acetylcholine, CO2-saturated Locke solution, and sodium cyanide were only slightly and somewhat variably reduced following injections of Met-enkephalin, whereas the inhibitory effect of dopamine was potentiated. Following morphine administration, response to acetylcholine and sodium cyanide were reduced slightly, whereas those to CO2 and dopamine were potentiated. 6 Responses to acetylcholine and CO2 were slightly potentiated during infusion of Met-enkephalin (50 micrograms/min, i.c.) and the response to sodium cyanide was slightly reduced. 7 It is concluded that naloxone-sensitive opiate receptors are present in the cat carotid body; when activated they cause inhibition of spontaneous chemoreceptor discharge. The physiological role of these receptors and the identity of any endogenous ligand remains to be established.

CURRENT APPROACH TO SINUSITIS

African Journals Online (AJOL)

Enrique

ment of bacterial resistance to the antibiotic.1. Very often antibiotics ... Acute sinusitis is a bacterial infection of one or more of the paranasal sinuses. It .... mathematical model of ABS is as fol- lows:1,8 ... The predicted spontaneous resolution.

Gamma radiosurgery combined with trans-sphenoidal surgery for pituitary tumor involved to the cavernous sinus

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Ikeda, Hidetoshi; Yoshimoto, Takashi; Shirokura, Hidefumi.

1995-01-01

Ten patients (2 males and 8 females with an average age of 39 years) were treated with combined trans-sphenoidal surgery and gamma radiosurgery for pituitary tumor involved to the cavernous sinus. A Follow-up period ranged from 7 to 29 months, with a mean of 21 months. Therapeutic effects were assessed using magnetic resonance imaging (MRI) every 3 months, endocrine examination, optical examination for visual field, and auditory test. Pituitary tumor after radiosurgery was shown as hypointensity on T1-weighted images and hyperintensity on T2-weighted images. Tumor response could be classified on MRI into (1) a remarkably decreased tumor in size with increased contrast enhancement (n=6), (2) a remarkably decreased tumor in size with unchanged contrast enhancement (n=one), (3) a slightly decreased tumor in size with increased spotted contrast enhancement (n=2), and (4) unchanged tumor in size with decreased contrast enhancement (n=one). Of 6 Type 1 patients, 5 had growth hormone production. Growth hormone production tended to be associated with favorable response to radiosurgery. In 3 patients who showed endocrinologically favorable response (such as increased growth hormone in blood and somatomedin C value), complete regression of tumor was achieved at a 20-month follow-up period. Radiosurgery also seemed to be useful for treating hormone active tumors. (N.K.)

Intracranial cavernous hemangiomas: a case report and bibliographic review

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Shiguihara, L.C.M.; Granero, P.C.; Gianotti, I.A.; Lederman, H.M.; Seixas, M.T.

1992-01-01

This is a case report of intracranial cavernous hemangioma that presented with macrocrania. A large, spontaneously hyperdense area with mass effect on CT was seen. This is a rare vascular malformation evolving the CNS in pediatrics. (author)

Anatomic and pathologic features of third cranial nerve disorders according to magnetic resonance studies

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Ruiz, Y.; Torres, J.; Ramos, M.; Caniego, J.L.; Manzanares, R.; Fresno, L.F.

1998-01-01

The objective of this report is to demonstrate the utility of magnetic resonance (MR) in the diagnosis of disorders involving the third cranial nerves. We have selected MR studies corresponding to patients with an anomaly affecting the third cranial nerves, whether alone or in combination with other cranial nerves. In order to better study the pathology of these cranial nerves, we considered four different segments of the nerves: mesencephalic, cisternal, cavernous and orbital. We present the MR features of the anatomy of the third cranial nerves and the most representative lesions affecting the different intracranial segments: infraction, multiple sclerosis, glioma and cavernoma in the mesencephalon; posterior communicating artery aneurysm, neuritis, neurinomas and meningioma in the cisternal segment; aneurysm of the internal carotid artery, cavernous carotid fistula, metastasis and meningioma in the cavernous sinus and Tolosa-Hunt syndrome in the orbital apex. (Author) 11 refs

[Involvement of cross interaction between central cholinergic and histaminergic systems in the nucleus tractus solitarius in regulating carotid sinus baroreceptor reflex].

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Hu, Li-Xun; Zhang, Guo-Xing; Zhang, Yu-Ying; Zhao, Hong-Fen; Yu, Kang-Ying; Wang, Guo-Qing

2013-12-25

The carotid sinus baroreceptor reflex (CSR) is an important approach for regulating arterial blood pressure homeostasis instantaneously and physiologically. Activation of the central histaminergic or cholinergic systems results in CSR functional inhibitory resetting. However, it is unclear whether two systems at the nucleus tractus solitarius (NTS) level display cross interaction to regulate the CSR or not. In the present study, the left or right carotid sinus region was isolated from the systemic circulation in Sprague-Dawley rats (sinus nerve was reserved) anesthetized with pentobarbital sodium. Respective intubation was conducted into one side isolated carotid sinus and into the femoral artery for recording the intracarotid sinus pressure (ISP) and mean arterial pressure (MAP) simultaneously with pressure transducers connection in vivo. ISP was set at the level of 0 mmHg to eliminate the effect of initial internal pressure of the carotid sinus on the CSR function. To trigger CSR, the ISP was quickly elevated from 0 mmHg to 280 mmHg in a stepwise manner (40 mmHg) which was added at every step for over 4 s, and then ISP returned to 0 mmHg in similar steps. The original data of ISP and corresponding MAP were fitted to a modified logistic equation with five parameters to obtain the ISP-MAP, ISP-Gain relationship curves and the CSR characteristic parameters, which were statistically compared and analyzed separately. Under the precondition of no influence on the basic levels of the artery blood pressure, the effects and potential regulatory mechanism of preceding microinjection with different cholinoceptor antagonists, the selective cholinergic M1 receptor antagonist, i.e., pirenzepine (PRZ), the M2 receptor antagonist, i.e., methoctramine (MTR) or the N1 receptor antagonist, i.e., hexamethonium (HEX) into the NTS on the changes in function of CSR induced by intracerebroventricular injection (i.c.v.) of histamine (HA) in rats were observed. Meanwhile, the actions and

CT and MR imaging of rhinocerebral mucormycosis

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Press, G.A.; Weindling, S.M.; Hesselink, J.R.

1987-01-01

Eight patients with biopsy-proven rhinocerebral mucormycosis had postcontrast CT. MR examination (1.5T) was also performed in two patients. Unilateral maxillary and ethmoid sinus disease with orbital apex extension was seen in five of six patients examined preoperatively. T2-weighted images showed intracranial extension as hyperintensity and mass effect in gray matter and white matter of frontal and temporal lobes, hypothalamus, thalamus, and pons in two patients. In the region of septic thrombosis of the cavernous sinus and internal carotid artery, MR detected inflammatory tissue of mixed signal intensity replacing the expected carotid signal void and petrous apex. Resolution of MR findings correlated with clinical improvement in one surviving patient

Dural sinus filling defect: intrasigmoid encephalocele

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Karatag, Ozan; Cosar, Murat; Kizildag, Betul; Sen, Halil Murat

2013-01-01

Filling defects of dural venous sinuses are considered to be a challenging problem especially in case of symptomatic patients. Many lesions have to be ruled out such as sinus thrombosis, arachnoid granulations and tumours. Encephalocele into dural sinus is also a rare cause of these filling defects of dural sinuses. Here, we report an extremely rare case with spontaneous occult invagination of temporal brain tissue into the left sigmoid sinus and accompanying cerebellar ectopia. PMID:24311424

Laser-Doppler Flowmetry and Horner’s Syndrome in Patients with Complete Unilateral Damage to the Parasellar Sympathetic Fibers During Cavernous Sinus Surgery

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Benedičič, Mitja; Debevc, David; Dolenc, Vinko V.; Bošnjak, Roman

2006-01-01

Aim To determine ocular, sudomotor, and vasomotor components of Horner’s syndrome resulting from complete unilateral intraoperative damage to the parasellar sympathetic fibers during cavernous sinus surgery. Methods Complete damage to the parasellar sympathetic fibers was found in four patients operated for central skull base lesions. Pupilometry, eyelid fissure measurement, Hertel’s exophthalmometry, starch iodine sweat test, and laser-Doppler perfusion assessment of bilaterally symmetrical forehead and cheek areas were performed. Results Pupil diameter was smaller and the eyelid fissure was >2 mm narrower on the affected side in all four patients. Exophthalmometry after the operation never revealed >1 mm difference. Anhydrosis was localized to the medial forehead in three and to the entire forehead in one patient. Average perfusion did not significantly differ between the affected and opposite side of the forehead or cheek. Conclusions The parasellar sympathetic fibers exclusively innervate the orbit and variably innervate the forehead sweat glands. No conclusion regarding their contribution to the facial vasomotor control could be established. PMID:16625695

The importance of venous hypertension in the formation of dural arteriovenous fistulas: a case report of multiple fistulas remote from sinus thrombosis

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Kusaka, N.; Sugiu, K.; Katsumata, A.; Nakashima, H.; Tamiya, T.; Ohmoto, T.

2001-01-01

Various hypotheses have been reported concerning the pathogenesis of dural arteriovenous fistulas (DAVFs). However, it is still controversial whether sinus thrombosis or venous hypertension has a greater influence on the formation of DAVFs. We present a rare case of multiple DAVFs that developed after sinus thrombosis. Chronic venous hypertension secondary to sinus thrombosis in the left transverse-sigmoid sinus induced the multiple DAVFs, including one in the right cavernous sinus, which was remote from the occluded sinus. This case indicates the importance of venous hypertension in the formation of DAVFs. (orig.)

Treatment of carotid artery aneurysms with covered stents; Aneurysmabehandlung der Arteria carotis interna mit gecoverten Stents

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Rohr, A.; Alfke, K.; Doerner, L.; Jansen, O. [UKSH Kiel (Germany). Neurochirurgie Neuroradiologie; Bartsch, T.; Stingele, R. [UKSH Kiel (Germany). Neurologie

2007-10-15

Purpose: Evaluation of the use of covered stents in treating pseudoaneurysms of the cervical and intracranial/extradural carotid artery and determination of the periprocedural and short- to mid-term complication rate. Materials and Methods: 8 patients with 9 spontaneous dissecting aneurysms of the cervical carotid artery - 5 of which were symptomatic - plus one patient with ofthalmoplegia due to an aneurysm of the cavernous carotid artery were studied. While the latter was treated with a PTFE-covered balloon-mounted stainless steel stent (Jostent/Graftmaster), a self-expanding PTFE-covered Nitonol Stent (Symbiot) was used in all other cases. Intervention was performed with local anesthesia. Aspirin and Clopidogrel were both used as antiplatelet drugs. Clinical signs and symptoms and vascular imaging with DS, MR, CT angiography and ultrasound were recorded during patient follow-up, with a mean follow-up period of 14.6 months (4 - 30). Results: We were able to treat 8 out of 10 aneurysms (80 %) using covered stents. The aneurysms were immediately occluded and the associated stenoses of the parent vessel were eliminated. No clinically relevant complications occurred during the procedure or in the follow-up interval. In two cases, elongation of the carotid artery prevented the stent from being positioned over the aneurysm neck. These cases were shown to be stable with the use of antiplatelet drugs. Conclusion: Covered stents can be used in the treatment of pseudoaneurysms of the carotid artery as an alternative to long-term antithrombotic medication or surgery. In our study treatment was effective (80 %) and free of complications in the short- and mid-term follow-up. Possible indications, technique and the use of imaging modalities for patient follow-up are discussed. (orig.)

Emergency embolization in the treatment of intractable epistaxis resulted from carotid arterial disease

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Sun Zengtao; Liu Yanjun; Chao Baoting; Tang Jun; Liu Zuoqin; Chen Jie; Shang Jianqiang; Zhang Lei; Li Jijun

2012-01-01

Objective: To evaluate the clinical value of internal carotid artery occlusion in treatment of intractable epistaxis caused by carotid artery siphon traumatic lesions. Methods: A total of 37 patients with intractable epistaxis caused by traumatic carotid artery siphon pseudoaneurysm or carotid cavernous fistula were retrospectively analyzed. All the patients underwent embolization from October 1998 to June 2010, including 34 men and 3 women with the age ranged from 25 to 65 years and a average of 40 years. Only lesions were occluded in 12 cases without involving the internal carotid artery, while occlusions of internal carotid artery were performed in the rest 25 cases. Results: Thirty-six patients were cured without recurrent hemorrhage after embolization. Only 1 patient with carotid artery occlusion died 48 hours after operation. Conclusion: For patients with carotid arterial intractable epistaxis, if the elimination of the lesions is not applicable and the collateral circulation of Willis ring has a good compensation, the use of detachable balloon or coil occlusion of ipsilateral internal carotid artery is a quick and easy method to save patients' lives. (authors)

Superior Sagittal Sinus Thrombosis Complicating Typhoid Fever in a Teenager

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P. O. Okunola

2012-01-01

Full Text Available Cerebral venous sinus (sinovenous thrombosis (CSVT is a rare life-threatening disorder in childhood that is often misdiagnosed. CSVT encompasses cavernous sinus thrombosis, lateral sinus thrombosis, and superior sagittal sinus thrombosis (SSST. We present an adolescent girl who was well until two weeks earlier when she had a throbbing frontal headache and fever with chills; she later had dyspnoea, jaundice, melena stool, multiple seizures, nuchal rigidity, and monoparesis of the right lower limb a day before admission. Urine test for Salmonella typhi Vi antigen was positive, and Widal reaction was significant. Serial cranial computerized tomography scans revealed an expanding hypodense lesion in the parafalcine region consistent with SSST or a parasagittal abscess. Inadvertent left parietal limited craniectomy confirmed SSST. She recovered completely with subsequent conservative management. Beyond neuropsychiatric complications of Typhoid fever, CSVT should be highly considered when focal neurologic deficits are present.

Diagnosis and interventional neuroradiology in cranial emergencies. Neuroradiologische Notfalldiagnostik und -therapie kranieller Erkrankungen

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Wakhloo, A.K.; Schumacher, M. (Freiburg Univ. (Germany, F.R.). Sektion Neuroradiologie)

1991-01-01

The most efficient diagnostic procedures are described for cases of intracranial mass, cerebral sinus and venous thrombosis, thrombosis of vertebral and basilar arteries, subarachnoid hemorrhage, carotid-cavernous fistulas, intractable epistaxis, Wernicke's encephalopathy and inflammatory cranial diseases. The importance of CT, MRI and angiography is discussed for these cranial emergencies. The different forms of interventional therapy possible are specified. (orig.).

High-resolution MR imaging of periarterial edema associated with biological inflammation in spontaneous carotid dissection

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Naggara, Olivier; Marsico, Rodolpho; Meder, Jean-Francois; Oppenheim, Catherine [Paris-Descartes University, Department of Neuroradiology, Paris (France); Touze, Emmanuel; Mas, Jean-Louis [Paris-Descartes University, Department of Neurology, Paris (France); Leclerc, Xavier; Pruvo, Jean-Pierre [University Hospital Roger Salengro, Department of Neuroradiology, Lille (France); Nguyen, Thanh [Boston University Medical Center, Department of Neurology, Neurosurgery, and Radiology, Boston, MA (United States)

2009-09-15

It has been suggested that spontaneous cervical carotid artery dissection (sCAD) may result from arterial inflammation. Periarterial edema (PAE), occasionally described in the vicinity of the mural hematoma in patients with sCAD, may support this hypothesis. Using cervical high-resolution magnetic resonance imaging, three readers, blinded to the mechanism of carotid artery dissection, searched for PAE, defined as periarterial T2-hyperintensity and T1-hypointensity, in 29 consecutive CAD patients categorized as spontaneous CAD (sCAD, n = 18) or traumatic CAD (tCAD, n = 11; i.e., major head or neck trauma within 2 weeks before the clinical onset). The relationships between PAE, inflammatory biological markers, history of infection and CAD mechanism were explored. Multiple CADs (n = 8) were found only in sCAD patients. Compared with tCAD, patients with sCAD were more likely to have a recent history of infection (OR = 12.5 [{sub 95%}CI = 1.3-119], p = 0.03), PAE (83% vs. 27%; OR = 13.3 [{sub 95%}CI = 2.2-82.0], p = 0.005) and to have elevated CRP (OR = 6.1 [{sub 95%}CI = 1.2-32.1], p = 0.0002) or ESR (OR = 8.8 [{sub 95%}CI = 1.5-50.1], p = 0.002) values. Interobserver agreement was 0.84 or higher for PAE identification. sCAD was associated with PAE and biological inflammation. Our results support the hypothesis of an underlying arterial inflammation in sCAD. (orig.)

High-resolution MR imaging of periarterial edema associated with biological inflammation in spontaneous carotid dissection

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Naggara, Olivier; Marsico, Rodolpho; Meder, Jean-Francois; Oppenheim, Catherine; Touze, Emmanuel; Mas, Jean-Louis; Leclerc, Xavier; Pruvo, Jean-Pierre; Nguyen, Thanh

2009-01-01

It has been suggested that spontaneous cervical carotid artery dissection (sCAD) may result from arterial inflammation. Periarterial edema (PAE), occasionally described in the vicinity of the mural hematoma in patients with sCAD, may support this hypothesis. Using cervical high-resolution magnetic resonance imaging, three readers, blinded to the mechanism of carotid artery dissection, searched for PAE, defined as periarterial T2-hyperintensity and T1-hypointensity, in 29 consecutive CAD patients categorized as spontaneous CAD (sCAD, n = 18) or traumatic CAD (tCAD, n = 11; i.e., major head or neck trauma within 2 weeks before the clinical onset). The relationships between PAE, inflammatory biological markers, history of infection and CAD mechanism were explored. Multiple CADs (n = 8) were found only in sCAD patients. Compared with tCAD, patients with sCAD were more likely to have a recent history of infection (OR = 12.5 [ 95% CI = 1.3-119], p = 0.03), PAE (83% vs. 27%; OR = 13.3 [ 95% CI = 2.2-82.0], p = 0.005) and to have elevated CRP (OR = 6.1 [ 95% CI = 1.2-32.1], p = 0.0002) or ESR (OR = 8.8 [ 95% CI = 1.5-50.1], p = 0.002) values. Interobserver agreement was 0.84 or higher for PAE identification. sCAD was associated with PAE and biological inflammation. Our results support the hypothesis of an underlying arterial inflammation in sCAD. (orig.)

Spontaneous intraorbital hematoma: case report

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Vinodan Paramanathan

2010-12-01

Full Text Available Vinodan Paramanathan, Ardalan ZolnourianQueen's Hospital NHS Foundation Trust, Burton on Trent, Staffordshire DE13 0RB, UKAbstract: Spontaneous intraorbital hematoma is an uncommon clinical entity seen in ophthalmology practice. It is poorly represented in the literature. Current evidence attributes it to orbital trauma, neoplasm, vascular malformations, acute sinusitis, and systemic abnormalities. A 65-year-old female presented with spontaneous intraorbital hematoma manifesting as severe ocular pains, eyelid edema, proptosis, and diplopia, without a history of trauma. Computer tomography demonstrated a fairly well defined extraconal lesion with opacification of the paranasal sinuses. The principal differential based on all findings was that of a spreading sinus infection and an extraconal tumor. An unprecedented finding of a spontaneous orbital hematoma was discovered when the patient was taken to theater. We discuss the rarity of this condition and its management.Keywords: hemorrhage, ophthalmology, spontaneous, intra-orbital, hematoma

Spontaneous bacterial coronary sinus septic thrombophlebitis treated successfully medically.

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Fournet, Maxime; Behaghel, Albin; Pavy, Carine; Flecher, Erwan; Thebault, Christophe

2014-03-01

A 38-year-old farmer was hospitalized for fever, chills, cough, and chest pain lasting for 7 days. Due to persistent symptoms, patient was referred to hospital. Blood cultures identified oxacillin-sensitive Staphylococcus aureus (OSSA). Transthoracic echocardiography (TTE) showed large pericardial effusion, a mobile heterogeneous mass originating from the coronary sinus ostium, no sign of valvular endocarditis. Pericardiocentesis was done carrying out purulent fluid, microbiological culture isolating an OSSA. Parenteral penicillin M was administered for 6 weeks. At the end of this antibiotherapy regimen, TTE showed no coronary sinus mass with complete vacuity of the coronary sinus vein and no pericardial effusion.

Introduction: surgery of the central skull base.

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Dolenc, Vinko V

2008-01-01

With his anatomical studies of the parasellar space, the so-called cavernous sinus (CS), Taptas opened Pandora's box more than 60 years ago. Parkinson continued the anatomical studies, and operated on vascular lesions in the CS with the help of extracorporeal circulation. The need for endovascular treatment of intracavernous internal carotid artery (ICA) aneurysms, as well as carotid-cavernous fistulas (CCFs), was obvious. Serbinenko started with the endovascular treatment of CCFs and ICA aneurysms using a balloon. At nearly the same time, Hakuba undertook surgical treatment of tumorous lesions in the region. Glascock studied the ICA in relation to the petrous bone, and with his studies of the ICA and this artery's relationship to the other structures, it became clear that further understanding of the pathological entities in the parasellar space hinged on additional microanatomical studies.

[Extensive tumor of the skull base: sphenoid sinus adenocarcinoma].

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Kallel, Souha; Sellami, Moncef

2017-01-01

We report a rare case of adenocarcinoma of the sphenoid sinus manifesting as extended skull base tumor. The patient included in the study was a 42-year old woman presenting with unilateral right symptomatology consisting of nasal obstruction, diplopia and hemifacial neuralgias. Clinical examination showed paralysis of the cranial nerve pairs V and VI. Brain scanner showed voluminous heterogeneous sphenoid and clival mass reaching the right cavernous sinus, with a peripheral tissue component at the level of the sphenoid sinus. Biopsy was performed under general anesthesia, through endonasal sphenoidotomy approach. Histological examination showed non-intestinal adenocarcinoma. The patient died due to impaired general condition occurred during examinations. Skull base adenocarcinomas mainly occur in the ethmoid bone. Sphenoid origin is exceptional. Radiological appearance is not specific and suggests malignancy. Diagnosis should be suspected in patients with aggressive tumor, even when it occurs in the midline skull base.

Cavernous sinus syndrome due to rhino-orbital-cerebral mucormycosis

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Vagner Moyses Vilela

2013-06-01

Full Text Available The present report describes the case of a 43-year-old diabetic patient with facial pain, protruding eyes, nasal congestion and decreased right vision (involvement of the ipsilateral cranial nerves III, IV and V. Computed tomography showed diffuse sinusitis at right, cribriform plate erosion and presence of a hypodense collection in the frontal lobe with peripheral enhancement. Magnetic resonance imaging confirmed the presence of a cerebral abscess. Samples were collected from the lesion, confirming hyphae compatible with mucormycosis.

ANTAGONISM OF PROGESTERONE RECEPTOR SUPPRESSES CAROTID BODY RESPONSES TO HYPOXIA AND NICOTINE IN RAT PUPS

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JOSEPH, V.; NIANE, L. M.; BAIRAM, A.

2012-01-01

We tested the hypothesis that antagonism of progesterone receptor (PR) in newborn rats alters carotid body and respiratory responses to hypoxia and nicotinic receptor agonists. Rats were treated with the PR antagonist mifepristone (daily oral gavage 40 μg/g/d) or vehicle between post-natal days 3 and 15. In 11–14-day-old rats, we used in vitro carotid body/carotid sinus nerve preparation and whole body plethysmography to assess the carotid body and ventilatory responses to hypoxia (65 mmHg in...

Endovascular stent-support angioplasty for cerebral venous sinus stenosis

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Xin-feng LI

2011-06-01

Full Text Available Objective To investigate the pathophysiological features of cerebral venous sinus stenosis,and the modus and therapeutic effect of stent-support angioplasty.Methods The clinical data of 36 patients with cerebral venous sinus stenosis,admitted to Neurosurgical Department of General Hospital of PLA from Dec.2001 to Jun.2010,were retrospectively analyzed.Of the 36 cases,10 were males and 26 females,aged from 14 to 57 years with a mean of 37.8 years,and the disease course ranged from 4 days to 9 years.The main clinical manifestations included headache,vomiting,optical visual blurring,and limb weakness with anesthesia in some patients.The diagnosis of all patients was confirmed by digital subtraction angiography,and the results showed that the local stenosis located in right transverse-sigmoid sinus in 21 cases,left transverse-sigmoid sinus in 12 cases,and on both sides in 3 cases.All patients received thrombolytic therapy via carotid artery or a microcatheter inserted in the venous sinus,followed by stent angioplasty of venous sinus.Meanwhile,general anticoagulant and antiplatelet therapy were essential.Results All the 36 patients were successively treated with balloon dilatation and stent angioplasty of venous sinus with exception of 3 cases,who failed because of the circuitous jugular foramen preventing the insertion of the stent.The successful rate was 91.7%.The cerebrospinal fluid pressure of the patients was lowered from 374.7±82.9mmH2O before operation to 230.3±48.1mmH2O after operation.Thirty-three patients were followed-up for 1 month to 8 years by brain angiography and examinations in the outpatient clinic.Among them 32 showed persistent relief of clinical symptoms.The remaining patient presented severe headache and optical visual blurring 1 month after stent implantation,however the symptoms were alleviated obviously after thrombolytic therapy via the carotid artery with adequate anticoagulation.Conclusions Stent angioplasty of venous

Laser Doppler anemometer measurements of pulsatile flow in a model carotid bifurcation.

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Ku, D N; Giddens, D P

1987-01-01

Hemodynamics at the human carotid bifurcation is important to the understanding of atherosclerotic plaque initiation and progression as well as to the diagnosis of clinically important disease. Laser Doppler anemometry was performed in a large scale model of an average human carotid. Pulsatile waveforms and physiologic flow divisions were incorporated. Disturbance levels and shear stresses were computed from ensemble averages of the velocity waveform measurements. Flow in the common carotid was laminar and symmetric. Flow patterns in the sinus, however, were complex and varied considerably during the cycle. Strong helical patterns and outer wall flow separation waxed and waned during each systole. The changing flow patterns resulted in an oscillatory shear stress at the outer wall ranging from -13 to 9 dyn cm-2 during systole with a time-averaged mean of only -0.5 dyn cm-2. This contrasts markedly with an inner wall shear stress range of 17-50, (mean 26) dyn cm-2. The region of transient separation was confined to the carotid sinus outer wall with no reverse velocities detected in the distal internal carotid. Notable disturbance velocities were also time-dependent, occurring only during the deceleration phase of systole and the beginning of diastole. The present pulsatile flow studies have aided in identifying hemodynamic conditions which correlate with early intimal thickening and predict the physiologic level of flow disturbances in the bulb of undiseased internal carotid arteries.

Analysis of pneumatization and neurovascular structures of the sphenoid sinus using cone-beam tomography (CBT)

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Gueldner, Christian; Pistorius, Sarah M.; Diogo, Isabell; Sesterhenn, Andreas; Werner, Jochen A. (Department of Otorhinolaryngology, Head and Neck Surgery, UKGM, Marburg (Germany)), Email: gueldner@staff.uni-marburg.de; Bien, Siegfried (Department of Neuroradiology, UKGM, Marburg (Germany))

2012-03-15

Background. The sphenoid sinus is a frequent target of paranasal sinus surgery. Because of the high risk of injuring the surrounding structures (e.g. internal carotid artery, optical nerve) a preoperative imaging is absolutely necessary. Purpose. To analyze the possibilities of cone-beam computed tomography (CBCT), which is especially quite a new technique in ENT, in the evaluation of the sphenoid sinus, its surrounding structures, and the corresponding anatomical variations. Material and Methods. This was a retrospective, single-centre study of 580 patients (1160 sides = cases). The Accu-I-Tomo-F17 was used. Pneumatization of sphenoid sinus, course of internal artery, course of optical nerve, and dehiscence of the bony canals were evaluated. Results. In the case of pneumatization a type I (completely missing or minimal sphenoid sinus) was found in two patients (0.3%), type II (posterior wall of sphenoid sinus is in front of the anterior wall of the sella) in 38 patients (6.6%), type III (posterior wall is between anterior and posterior wall of sella) in 332 patients (57,2%), type IVa (posterior wall is behind the posterior wall of sella without air dorsal the sella) in 104 patients (17.9%), and type IVb (similar to type IVa but with air dorsal the sella) in 104 patients (17.9%). In 1025 cases (89.5%) a smooth course of the internal carotid artery was found whereas a free course could be detected in 120 cases (10.5%). Defects of the bony canal of the optical nerve were found in 16.7% and of the internal carotid artery in 2.7% of the cases. The optical nerve showed a free course through the sphenoid in 151 cases (13.7%) and a smooth course in 1007 cases (87.0%). Conclusion. CBCT could evaluate all relevant anatomic structures and answer the questions of different anatomical variants. A modified classification of the pneumatization of the sphenoid sinus could be described. Frequencies of anatomical variations are in accordance with the current literature of CT

Analysis of pneumatization and neurovascular structures of the sphenoid sinus using cone-beam tomography (CBT)

International Nuclear Information System (INIS)

Gueldner, Christian; Pistorius, Sarah M.; Diogo, Isabell; Sesterhenn, Andreas; Werner, Jochen A.; Bien, Siegfried

2012-01-01

Background. The sphenoid sinus is a frequent target of paranasal sinus surgery. Because of the high risk of injuring the surrounding structures (e.g. internal carotid artery, optical nerve) a preoperative imaging is absolutely necessary. Purpose. To analyze the possibilities of cone-beam computed tomography (CBCT), which is especially quite a new technique in ENT, in the evaluation of the sphenoid sinus, its surrounding structures, and the corresponding anatomical variations. Material and Methods. This was a retrospective, single-centre study of 580 patients (1160 sides = cases). The Accu-I-Tomo-F17 was used. Pneumatization of sphenoid sinus, course of internal artery, course of optical nerve, and dehiscence of the bony canals were evaluated. Results. In the case of pneumatization a type I (completely missing or minimal sphenoid sinus) was found in two patients (0.3%), type II (posterior wall of sphenoid sinus is in front of the anterior wall of the sella) in 38 patients (6.6%), type III (posterior wall is between anterior and posterior wall of sella) in 332 patients (57,2%), type IVa (posterior wall is behind the posterior wall of sella without air dorsal the sella) in 104 patients (17.9%), and type IVb (similar to type IVa but with air dorsal the sella) in 104 patients (17.9%). In 1025 cases (89.5%) a smooth course of the internal carotid artery was found whereas a free course could be detected in 120 cases (10.5%). Defects of the bony canal of the optical nerve were found in 16.7% and of the internal carotid artery in 2.7% of the cases. The optical nerve showed a free course through the sphenoid in 151 cases (13.7%) and a smooth course in 1007 cases (87.0%). Conclusion. CBCT could evaluate all relevant anatomic structures and answer the questions of different anatomical variants. A modified classification of the pneumatization of the sphenoid sinus could be described. Frequencies of anatomical variations are in accordance with the current literature of CT

Non-Hodgkin's lymphoma of the sphenoid sinus presenting as isolated oculomotor nerve palsy

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Huh Ji

2007-08-01

Full Text Available Abstract Background Solitary involvement of the sphenoid sinus has rarely been reported in non-Hodgkin's lymphoma. Isolated oculomotor nerve palsy is uncommon as an initial presentation of malignant tumors of the sphenoid sinus. Case presentation A 53-year-old woman presented with a three-month history of headache and diplopia. Neurological examination revealed complete left oculomotor nerve palsy. Magnetic Resonance Imaging (MRI demonstrated a homogenous soft-tissue lesion occupying the left sphenoid sinus and invading the left cavernous sinus. The patient underwent transsphenoidal biopsy and the lesion was histologically diagnosed as non-Hodgkin's lymphoma, diffuse large B-cell type. Tumor cells were positive for CD20 and negative for CD3. Following six cycles of chemotherapy, the left oculomotor nerve palsy that had been previously observed was completely resolved. There was no enhancing lesion noted on follow-up MRI. Conclusion It is important to recognize that non-Hodgkin's lymphoma of the sphenoid sinus can present with isolated oculomotor nerve palsy, although it is extremely rare. The cranial nerve deficits can resolve dramatically after chemotherapy.

Thrombosis of internal carotid artery following blunt neck injuries

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Houdek, M.; Klaus, E.

1986-01-01

Complicated problems of nonpenetrating injuries of the internal carotid artery, their pathophysiological mechanisms, clinical picture, diagnosis and therapy are analyzed. The possible surgical management is considered. Attention was paid to angiographic diagnosis of traumatic and spontaneous lesions of internal carotid arteries. (author). 87 refs

Spontaneous regression of two supraophthalmic internal cerebral artery aneurysms following flow pattern alteration

International Nuclear Information System (INIS)

Hans, F.J.; Reinges, M.H.T.; Krings, T.; Mull, M.

2004-01-01

We report on a patient with fibromuscular dysplasia who presented with a right-sided giant calcified cavernous internal carotid artery (ICA) aneurysm and two additional supraophthalmic ICA aneurysms. Endovascular closure of the right ICA using detachable balloons was performed with collateralisation of the right hemisphere via the right-sided posterior communicating and the anterior communicating arteries. Repeat angiography after 6 months demonstrated spontaneous complete regression of the two supraophthalmic aneurysms, although the parent vessel was still perfused. In comparison to the former angiography, the flow within the parent vessel was reversed due to the proximal ICA balloon occlusion. MRI demonstrated that the aneurysms were not obliterated by thrombosis alone, but showed a real regression in size. This case report demonstrates that changes in cerebral hemodynamics potentially lead to plastic changes in the vessel architecture in adults and that aneurysms can be flow-related, even if not associated with high flow fistulas or arteriovenous malformations, especially in cases with an arterial wall disease. (orig.)

Central retinal and posterior ciliary artery occlusion after particle embolization of the external carotid artery system.

Science.gov (United States)

Mames, R N; Snady-McCoy, L; Guy, J

1991-04-01

A 15-year-old boy underwent neuroradiologic embolization of the left internal maxillary artery with polyvinyl alcohol to stop traumatic epistaxis after failure of surgical clipping and nasal packing. Selective catheterization of the external carotid artery before embolization showed a faint choroidal blush. Although the procedure provided hemostasis, embolization to the central retinal artery and ciliary arteries resulted in loss of vision. The route of the emboli to the eye was via the anastomotic network of the lacrimal artery supplied by the external carotid artery system. Neuroradiologic embolization of the external carotid artery is an effective mode of therapy for dural-cavernous fistulas when fed by the external carotid artery system. Because the blood flow to the brain and eye is predominantly supplied by the internal carotid artery, embolization of the external carotid artery is considered relatively safe. The authors document the importance of recognition of the choroidal blush during selective external carotid artery angiography as a sign of collateral blood flow to the eye. Physicians and patients need to be aware of the risk of blindness as a complication of external carotid artery embolization when this sign is present.

Feasibility of Using Intravascular Ultrasonography for Assessment of Giant Cavernous Aneurysm after Endovascular Treatment: A Technical Report

Science.gov (United States)

Majidi, Shahram; Grigoryan, Mikayel; Tekle, Wondwossen G; Watanabe, Masaki; Qureshi, Adnan I

2012-01-01

Introduction Intravascular ultrasonography (IVUS) has been shown as a valuable adjunct imaging tool during endovascular procedures but its value in detection of any recurrence during follow up after endovascular coil embolization of large and giant intracranial aneurysms is not reported. Methods A 41 years old man who had been treated using stent assisted coil embolization for cavernous segment aneurysm of the left internal carotid artery underwent 60 month angiographic follow up. Concurrently, IVUS catheter was advanced under fluoroscopic guidance inside the cavernous portion of the left internal carotid artery. Then IVUS images were used to visualize the stent, coil loops, and aneurysm neck. Results The angiographic images were limited because of superimposition of the aneurysm on the parent vessel in all projections. IVUS images demonstrated that the stent was patent along its whole length and there was no sign of stent deformity or in-stent thrombosis. Loops of the coil were visualized as hyperechoic signals inside the aneurysm and there was no sign of herniated loops of coil inside the stent. Conclusion In this case report, we observed that adjunct use of IVUS can provide valuable information not ascertained by angiography during follow up assessment of coil embolized aneurysm. PMID:22737259

Basilar expansion of the human sphenoidal sinus: an integrated anatomical and computerized tomography study

International Nuclear Information System (INIS)

Haetinger, Rainer G.; Navarro, Joao A.C.; Liberti, Edson A.

2006-01-01

Basilar expansion of the sphenoidal sinus (BESS) was studied in order to demonstrate its critical relevance in endoscopic or microscopic endonasal surgical interventions, including access to the sphenoidal sinus itself or in transsphenoidal pituitary approaches. Direct evaluation of anatomical specimens (25 dry skulls and 25 formalin-fixed hemi heads) and the use of computerized tomography (CT) (50 dry skulls and 750 patients) showed a high BESS frequency (69%). The authors considered BESS to be critical when the posterior wall of the clivus was 2-mm thick and found a high incidence of this important anatomical variation (44%). This study also evaluated the relationship between the sinonasal septa, the clivus, and the internal carotid arteries, and a considerable regularity in the location of these structures was seen. The septa were anatomically related to the internal carotid arteries in 55% and to the clivus in 33% of the cases. In conclusion, the high frequency of critical BESS here described is relevant to endoscopic or microscopic endonasal surgical interventions, including access to the sphenoidal sinus itself or in transsphenoidal pituitary approaches. (orig.)

Resolution of carotid stenosis pre-carotid intervention: A case for selective preoperative duplex ultrasound.

Science.gov (United States)

Ali, Abid; Ashrafi, Mohammed; Zeynali, Iraj

2015-01-01

Spontaneous resolution of carotid stenosis is a phenomenon that has been described in literature in the past. At present it is not routine practise to scan patients prior to carotid endarterectomy surgery within the UK. A 58 year old female presented to hospital with a history of sudden onset headache and left sided weakness. CT head showed findings in keeping with an acute right MCA territory infarct. A duplex ultrasound scan showed echolucent material in the right internal carotid artery forming a greater than 95% stenosis. The scan was unable to visualise the patency of the vessel distally due to the position of the mandible. The patient was provisionally listed for carotid endarterectomy. An MRA was requested prior to surgery to assess the patency of the distal internal carotid artery. The MRA of the carotids showed normal appearance of the common carotid, internal and vertebral arteries with no definite stenosis. A repeat duplex ultrasound confirmed there was no significant stenosis. The finding of complete resolution of stenosis on MRA was an unexpected event. Had the initial duplex imaging allowed visualisation of the distal vessel patency, our patient would have undergone unnecessary carotid surgery with the associated morbidity and mortality. This case report draws attention to the benefits of selective preoperative scanning, in sparing patients from unnecessary surgery as a result of finding occlusion or resolution of a previously diagnosed carotid stenosis. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Extension and origin of parasellar meningiomas. Evaluation on MRI

International Nuclear Information System (INIS)

Hara, Yoshie; Nakamura, Mitsugu; Asada, Masahiro; Tamaki, Norihiko

1997-01-01

We evaluated MRI of forty patients who had histologically confirmed meningiomas around the sella turcica. Coronal section of the spin-echo/fast spin-echo T 1 weighted imaging (with and without GD-DTPA enhancement) were mainly investigated. We precisely examined two points; the location of the bulk of tumor mass, the anatomical relationship between the tumor and the anterior clinoid process, superior orbital fissure, optic nerve, and the internal carotid artery (ICA). Based on MRI findings, we recognized five different tumor origins. Meningiomas originating lateral to the anterior clinoid process never extended medially into the cavernous sinus or the sella turcica, while tumors originating medial to the anterior clinoid process did not migrate laterally beyond the process. Tumors originating from the cavernous sinus tended to invade though the dura into the superior orbital fissure and involved the anterior clinoid process. Based upon the tumor origin and their extension investigated as revealed by MRI, we speculated that the anterior clinoid process and the tough dural folds attached to it (the anterior and posterior petroclinoid ligaments, and the interclinoid ligament) played important roles as barriers against the extension of meningiomas. These dural folds may be the unique part of the dura that most resists invasion of meningiomas from extracavernous regions. Meningiomas originated from the inferomedial surface of the anterior clinoid process may have been misdiagnosed as tuberculum sellae meningiomas; however, the close anatomical relation of the tumor origin and the distal carotid suggests their potential to directly invade the internal carotid artery. (K.H.)

Preoperative Lateralization Modalities for Cushing Disease: Is Dynamic Magnetic Resonance Imaging or Cavernous Sinus Sampling More Predictive of Intraoperative Findings?

Science.gov (United States)

Sun, Hai; Yedinak, Chris; Ozpinar, Alp; Anderson, Jim; Dogan, Aclan; Delashaw, Johnny; Fleseriu, Maria

2015-06-01

Objective To analyze whether cavernous sinus sampling (CSS) and dynamic magnetic resonance imaging (dMRI) are consistent with intraoperative findings in Cushing disease (CD) patients. Design Retrospective outcomes study. Setting Oregon Health & Science University; 2006 and 2013. Participants A total of 37 CD patients with preoperative dMRI and CSS to confirm central adrenocorticotropic hormone (ACTH) hypersecretion. Patients were 78% female; mean age was 41 years (at diagnosis), and all had a minimum of 6 months of follow-up. Main Outcome Measures Correlations among patient characteristics, dMRI measurements, CSS results, and intraoperative findings. Results All CSS indicated presence of CD. Eight of 37 patients had no identifiable tumor on dMRI. Three of 37 patients had no tumor at surgery. dMRI tumor size was inversely correlated with age (rs = - 0.4; p = 0.01) and directly correlated to intraoperative lateralization (rs = 0.3; p < 0.05). Preoperative dMRI was directly correlated to intraoperative lateralization (rs = 0.5; p < 0.002). CSS lateralization showed no correlation with intraoperative findings (rs = 0.145; p = 0.40) or lateralization observed on preoperative dMRI (rs = 0.17; p = 0.29). Postoperative remission rate was 68%. Conclusion dMRI localization was most consistent with intraoperative findings; CSS results were less reliable. Results suggest that small ACTH-secreting tumors continue to pose a challenge to reliable preoperative localization.

Vascular Complications of Intercavernous Sinuses during Transsphenoidal Surgery: An Anatomical Analysis Based on Autopsy and Magnetic Resonance Venography.

Science.gov (United States)

Deng, Xuefei; Chen, Shijun; Bai, Ya; Song, Wen; Chen, Yongchao; Li, Dongxue; Han, Hui; Liu, Bin

2015-01-01

Vascular complications induced by intercavernous sinus injury during dural opening in the transsphenoidal surgery may contribute to incomplete tumour resections. Preoperative neuro-imaging is of crucial importance in planning surgical approach. The aim of this study is to correlate the microanatomy of intercavernous sinuses with its contrast-enhanced magnetic resonance venography (CE-MRV). Eighteen human adult cadavers and 24 patients were examined based on autopsy and CE-MRV. Through dissection of the cadavers and CE-MRV, the location, shape, number, diameter and type of intercavernous sinuses were measured and compared. Different intercavernous sinuses were identified by their location and shape in all the cadavers and CE-MRV. Compared to the cadavers, CE-MRV revealed 37% of the anterior intercavernous sinus, 48% of the inferior intercavernous sinus, 30% of the posterior intercavernous sinus, 30% of the dorsum sellae sinus and 100% of the basilar sinus. The smaller intercavernous sinuses were not seen in the neuro-images. According to the presence of the anterior and inferior intercavernous sinus, four types of the intercavernous sinuses were identified in cadavers and CE-MRV, and the corresponding operative space in the transsphenoidal surgical approach was implemented. The morphology and classification of the cavernous sinus can be identified by CE-MRV, especially for the larger vessels, which cause bleeding more easily. Therefore, CE-MRV provides a reliable measure for individualized preoperative planning during transsphenoidal surgery.

Models of experimental saccular aneurysms of carotid arteries in canine

International Nuclear Information System (INIS)

Zhang Haixia; Cheng Yingsheng; Li Minghua

2006-01-01

Objective: To study the availability by making experimental saccular aneurysm models of carotid arteries in canine similar to human intracranial aneurysms. Methods: Twenty healthy canines with experimental saccular side-wall aneurysms of carotid arteries were created successfully by surgery. Results: Forty experimental saccular side-wall aneurysms of carotid arteries were created successfully with 36 aneurysms and parent arteries maintaining patency with each other and four spontaneously occluded confirmed by angiography. Model successful rate reached 90%. Conclusions: Experimental saccular side-wall aneurysms of carotid arteries in canines were one of best models created for simulating human intracranial aneurysms. (authors)

Schwann cell seeded guidance tubes restore erectile function after ablation of cavernous nerves in rats.

Science.gov (United States)

May, F; Weidner, N; Matiasek, K; Caspers, C; Mrva, T; Vroemen, M; Henke, J; Lehmer, A; Schwaibold, H; Erhardt, W; Gänsbacher, B; Hartung, R

2004-07-01

Dissection of the cavernous nerves eliminates spontaneous erections. We evaluated the ability of Schwann cell seeded nerve guidance tubes to restore erections after bilateral cavernous nerve resection in rats. Sections (5 mm) of the cavernous nerve were excised bilaterally, followed by immediate bilateral microsurgical reconstruction. In 10 animals per group (20 study nerves) reconstruction was performed by genitofemoral nerve interposition, interposition of silicone tubes or interposition of silicone tubes seeded with homologous Schwann cells. As the control 10 animals (20 study nerves) underwent sham operation (positive control) and bilateral nerve ablation (without reconstruction) was performed in a further 10 (negative control). Erectile function was evaluated 3 months postoperatively by relaparotomy, electrical nerve stimulation and intracavernous pressure recording. After 3 months neurostimulation resulted in an intact erectile response in 90% (18 of 20) of Schwann cell grafts, while treatment with autologous nerves (30% or 6 of 20) or tubes only (50% or 10 of 20) was less successful (p Schwann cell grafts compared to results in the other treatment groups (p Schwann cell grafts. Schwann cell seeded guidance tubes restore erectile function after the ablation of cavernous nerves in rats and they are superior to autologous nerve grafts.

Vascular Complications of Intercavernous Sinuses during Transsphenoidal Surgery: An Anatomical Analysis Based on Autopsy and Magnetic Resonance Venography.

Directory of Open Access Journals (Sweden)

Xuefei Deng

Full Text Available Vascular complications induced by intercavernous sinus injury during dural opening in the transsphenoidal surgery may contribute to incomplete tumour resections. Preoperative neuro-imaging is of crucial importance in planning surgical approach. The aim of this study is to correlate the microanatomy of intercavernous sinuses with its contrast-enhanced magnetic resonance venography (CE-MRV.Eighteen human adult cadavers and 24 patients were examined based on autopsy and CE-MRV. Through dissection of the cadavers and CE-MRV, the location, shape, number, diameter and type of intercavernous sinuses were measured and compared.Different intercavernous sinuses were identified by their location and shape in all the cadavers and CE-MRV. Compared to the cadavers, CE-MRV revealed 37% of the anterior intercavernous sinus, 48% of the inferior intercavernous sinus, 30% of the posterior intercavernous sinus, 30% of the dorsum sellae sinus and 100% of the basilar sinus. The smaller intercavernous sinuses were not seen in the neuro-images. According to the presence of the anterior and inferior intercavernous sinus, four types of the intercavernous sinuses were identified in cadavers and CE-MRV, and the corresponding operative space in the transsphenoidal surgical approach was implemented.The morphology and classification of the cavernous sinus can be identified by CE-MRV, especially for the larger vessels, which cause bleeding more easily. Therefore, CE-MRV provides a reliable measure for individualized preoperative planning during transsphenoidal surgery.

Study of mined storage caverns

International Nuclear Information System (INIS)

1975-06-01

All available information concerning 75 mined storage caverns as well as the investigative techniques utilized to determine the feasibility of a cavern site is presented. Potential new storage caverns may be for products such as high or low vapor pressure petroleum products, other chemical products, aid industrial or nuclear waste

Successful endoscopic management with Mitomycin C application for sinusitis with orbital cellulitis

Directory of Open Access Journals (Sweden)

Anil S Harugop

2013-01-01

Full Text Available Background: Sinusitis with orbital complication is a potentially fatal disease that has been known since the days of Hippocrates. Primary sinus infection is the most common cause of orbital cellulitis. It is an emergency that threatens not only vision but also life from complications such as meningitis, cavernous sinus thrombosis, and brain abscess. Surgical intervention is mandatory whenever antibiotic treatment fails. There are two surgical options for the drainage, an external approach via a Lynch incision and an intranasal endoscopic procedure. Materials and Methods: Five patients with orbital cellulitis secondary to acute on chronic rhinosinusitis were included in the study from the period of 2010 - 2011. All five patients did not respond to medical management and hence underwent endoscopic sinus surgery with treatment of orbital pathology. At the end of the surgical procedure Mitomycin C in a concentration of 0.4mg/ml was applied with a cottonoid for a period of 4 minutes to prevent chance of adhesion formation. Results: In this series 3 females and 2 male patient with orbital cellulitis secondary to acute on chronic rhinosinusitis underwent endoscopic sinus surgery with treatment of orbital pathology. All 5 patients showed subjective and objective improvement within one week of endoscopic management. Conclusion: Though antibiotics have altered the course of sinusitis, its grave complications still persist in our environment. The excellent results and the absence of any major complications of endoscopic sinus surgery and drainage of abscess with application of Mitomycin C can be recommended as the preferred surgical technique.

Spontaneous low-frequency oscillations in cerebral vessels

DEFF Research Database (Denmark)

Schytz, Henrik W; Hansson, Andreas; Phillip, Dorte

2010-01-01

). Analysis of CA by measurement of spontaneous oscillations in the low-frequency spectrum in cerebral vessels might be a useful tool for assessing risk and investigating different treatment strategies in carotid artery disease (CAD) and stroke. We reviewed studies exploring spontaneous oscillations...

"Tepid" Geysers above salt caverns

Science.gov (United States)

Bérest, Pierre; Brouard, Benoît; Zakharov, Vassily

2018-06-01

The formation of a brine geyser erupting from the wellhead of a large underground salt cavern is described. In most cases, the brine outflow from an opened cavern is slow; it results from the cavern creep closure and the thermal expansion of the cavern brine. These two processes are smooth; however, the brine outflow often is bumpy, as it is modulated by atmospheric pressure variations that generate an elastic increase (or decrease) of both cavern and brine volumes. In addition, when the flow is fast enough, the brine thermodynamic behavior in the wellbore is adiabatic. The cold brine expelled from the cavern wellhead is substituted with warm brine entering the borehole bottom, resulting in a lighter brine column. The brine outflow increases. In some cases, the flow becomes so fast that inertia terms must be taken into account. A geyser forms, coming to an end when the pressure in the cavern has dropped sufficiently. A better picture is obtained when head losses are considered. A closed-form solution can be reached. This proves that two cases must be distinguished, depending on whether the cold brine initially contained in the wellbore is expelled fully or not. It can also be shown that geyser formation is a rare event, as it requires both that the wellbore be narrow and that the cavern be very compressible. This study stemmed from an actual example in which a geyser was observed. However, scarce information is available, making any definite interpretation difficult. xml:lang="fr"

Diagnosis and endovascular treatment of multiple cerebral venous and venous sinuses thrombosis

International Nuclear Information System (INIS)

Li Baomin; Zhang Ji; Yin Ling; Huang Xusheng; Jiang Jinli; Liu Jun; Lang Senyang; Zhou Dingbiao; Zhu Ke

2000-01-01

Objective: Eighty-five cases with multiple cerebral venous and venous sinuses thrombosis including the diagnosis and endovascular therapy were reported. Methods: The long T2 and short T1 signals in the related regions of multiple venous sinuses on MRI and prolonged blood circulation time of the brain with tortuous dilatation of vein in angiography were the important characteristics for the diagnosis. Of the 85 cases, the treatment procedures were consisted of injecting urokinase intermittently via common carotid artery and intra-sinus contact thrombolysis as well as warfarin intake orally. Results: Intracranial pressure of 80 cases reduced down between 230 and 300 mm H 2 O, and clinical deficits were markedly improved within 10 days. Re-angiography of 18 cases revealed recanalization partly in 5 cases and circulation time appeared near normal i 8 cases during one week after therapy. Conclusions: Combined intraarterial thrombolysis consecutively with general anticoagulation for the treatment of multiple thrombosis in cerebral venous sinuses may be one of the effective means

Comparison of objective methods to classify the pattern of respiratory sinus arrhythmia during mechanical ventilation and paced spontaneous breathing

International Nuclear Information System (INIS)

Carvalho, N C; Beda, A; Granja-Filho, P; Jandre, F C; Giannella-Neto, A; De Abreu, M G; Spieth, P M

2009-01-01

Respiratory sinus arrhythmia (RSA) is a fluctuation of heart period that occurs during a respiratory cycle. It has been suggested that inspiratory heart period acceleration and expiratory deceleration during spontaneous ventilation (henceforth named positive RSA) improve the efficiency of gas exchange compared to the absence or the inversion of such a pattern (negative RSA). During mechanical ventilation (MV), for which maximizing the efficiency of gas exchange is of critical importance, the pattern of RSA is still the object of debate. In order to gain a better insight into this matter, we compared five different methods of RSA classification using the data of five mechanically ventilated piglets. The comparison was repeated using the data of 15 volunteers undergoing a protocol of paced spontaneous breathing, which is expected to result in a positive RSA pattern. The results showed that the agreement between the employed methods is limited, suggesting that the lack of a consensus about the RSA pattern during MV is, at least in part, of methodological origin. However, independently of the method used, the pattern of RSA within the respiratory cycle was not consistent among the subjects and conditions of MV considered. Also, the outcomes showed that even during paced spontaneous breathing a negative RSA pattern might be present, when a low respiratory frequency is imposed

Delayed effect of radiation therapy on extracerebral cavernous angioma in the middle fossa

International Nuclear Information System (INIS)

Shibata, Shobu; Mori, Kazuo

1988-01-01

This is a report of a case with extracerebral cavernous angioma in the middle fossa which had received radiation therapy. Follow-up study with serial computed tomography during and after irradiation were presented. A 62-year-old housewife complained of vertigo. CT scan revealed a slightly high density area in the left middle cranial fossa which was markedly enhanced with contrast media. Left carotid angiography demonstrated a large avascular mass in the left middle fossa and no feeding artery or draining vein was visualized except a faint irregular stain in the venous phase. Irradiation with a total dose of 50 Gy was delivered. At the end of radiation, CT scan revealed a slight decrease in size and CT number of the tumor. Follow-up CT scans 5 months later showed 50 % regression of the tumor and 19 months later were negative for tumor. It is concluded that in case of an extracerebral cavernous angioma with massive hemorrhage, radiation of up to 30 - 50 Gy was a method of choice. The treatment results in the possibility of eliminating surgery and the benefit of irradiation may not become evident until the first year. (author)

Stereotactic Radiosurgery for Benign (World Health Organization Grade I) Cavernous Sinus Meningiomas-International Stereotactic Radiosurgery Society (ISRS) Practice Guideline: A Systematic Review.

Science.gov (United States)

Lee, Cheng-Chia; Trifiletti, Daniel M; Sahgal, Arjun; DeSalles, Antonio; Fariselli, Laura; Hayashi, Motohiro; Levivier, Marc; Ma, Lijun; Álvarez, Roberto Martínez; Paddick, Ian; Regis, Jean; Ryu, Samuel; Slotman, Ben; Sheehan, Jason

2018-03-15

Stereotactic radiosurgery (SRS) has become popular as a standard treatment for cavernous sinus (CS) meningiomas. To summarize the published literature specific to the treatment of CS meningioma with SRS found through a systematic review, and to create recommendations on behalf of the International Stereotactic Radiosurgery Society. Articles published from January 1963 to December 2014 were systemically reviewed. Three electronic databases, PubMed, EMBASE, and The Cochrane Central Register of Controlled Trials, were searched. Publications in English with at least 10 patients (each arm) were included. Of 569 screened abstracts, a total of 49 full-text articles were included in the analysis. All studies were retrospective. Most of the reports had favorable outcomes with 5-yr progression-free survival (PFS) rates ranging from 86% to 99%, and 10-yr PFS rates ranging from 69% to 97%. The post-SRS neurological preservation rate ranged from 80% to 100%. Resection can be considered for the treatment of larger (>3 cm in diameter) and symptomatic CS meningioma in patients both receptive to and medically eligible for open surgery. Adjuvant or salvage SRS for residual or recurrent tumor can be utilized depending on factors such as tumor volume and proximity to adjacent critical organs at risk. The literature is limited to level III evidence with respect to outcomes of SRS in patients with CS meningioma. Based on the observed results, SRS offers a favorable benefit to risk profile for patients with CS meningioma.

Rock cavern storage of spent fuel

Energy Technology Data Exchange (ETDEWEB)

Cho, Won Jin; Kim, Kyung Soo [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); Kwon, Sang Ki [Inha University, Incheon (Korea, Republic of)

2015-12-15

The rock cavern storage for spent fuel has been assessed to apply in Korea with reviewing the state of the art of the technologies for surface storage and rock cavern storage of spent fuel. The technical feasibility and economic aspects of the rock cavern storage of spent fuel were also analyzed. A considerable area of flat land isolated from the exterior are needed to meet the requirement for the site of the surface storage facilities. It may, however, not be easy to secure such areas in the mountainous region of Korea. Instead, the spent fuel storage facilities constructed in the rock cavern moderate their demands for the suitable site. As a result, the rock cavern storage is a promising alternative for the storage of spent fuel in the aspect of natural and social environments. The rock cavern storage of spent fuel has several advantages compared with the surface storage, and there is no significant difference on the viewpoint of economy between the two alternatives. In addition, no great technical difficulties are present to apply the rock cavern storage technologies to the storage of domestic spent fuel.

Chapter 8: Invasive fungal rhinosinusitis.

Science.gov (United States)

Duggal, Praveen; Wise, Sarah K

2013-01-01

Invasive fungal rhinosinusitis (IFRS) is a disease of the paranasal sinuses and nasal cavity that typically affects immunocompromised patients in the acute fulminant form. Early symptoms can often mimic rhinosinusitis, while late symptoms can cause significant morbidity and mortality. Swelling and mucosal thickening can quickly progress to pale or necrotic tissue in the nasal cavity and sinuses, and the disease can rapidly spread and invade the palate, orbit, cavernous sinus, cranial nerves, skull base, carotid artery, and brain. IFRS can be life threatening if left undiagnosed or untreated. While the acute fulminant form of IFRS is the most rapidly progressive and destructive, granulomatous and chronic forms also exist. Diagnosis of IFRS often mandates imaging studies in conjunction with clinical, endoscopic, and histopathological examination. Treatment of IFRS consists of reversing the underlying immunosuppression, antifungal therapy, and aggressive surgical debridement. With early diagnosis and treatment, IFRS can be treated and increase patient survival.

Characteristics and treatment of cavernous malformations

International Nuclear Information System (INIS)

Takagi, Kenji; Ishida, Mitsuaki; Okabe, Hidetoshi; Nozaki, Kazuhiko

2013-01-01

Cavernous malformations are clusters of dilated sinusoidal channels with thin walls devoid of elastin and smooth muscle. They have no intervening brain tissue. They occur both in sporadic and familial forms. The genes responsible for cavernous malformations have been identified. Recent reports show that mutations of these responsible genes are involved not only in familial but also in sporadic forms. Germline and somatic mutations may occur before cavernous malformations develop (two-hit mechanism). Two patterns, with mulberry-like and hematoma-like appearances, are seen intraoperatively, and from histological findings, mulberry-like appearance may change into hematoma-like one by intralesional hemorrhage. Cavernous malformation treatments include open surgery and radiosurgery. Open surgery is usually chosen for the treatment of symptomatic hemorrhagic cavernous malformations because post-radiosurgical annual bleeding risks at the early phase seem to be higher than those of open surgery. If open surgery has a high risk because of lesion location, radiosurgery becomes an effective alternative treatment. Brainstem cavernous malformations have high annual bleeding and re-bleeding incidence, so if the lesion is accessible with low risk, open surgery is recommended. (author)

Comparison of carotid and cerebrovascular disease between diabetic and non-diabetic patients using dual-source CT

International Nuclear Information System (INIS)

He Ci; Yang Zhigang; Chu Zhigang; Dong Zhihui; Li Yunming; Shao Heng; Deng Wen

2011-01-01

Purpose: To clarify the differences of the carotid and cerebrovascular disease between patients with and without type 2 diabetes using dual-source CT angiography. Materials and methods: Dual-source CT angiography of the carotid and cerebrovascular arteries was performed in 79 type 2 diabetic patients and 207 non-diabetic patients. The type, extent and distribution of plaques, and luminal stenosis were compared. Results: Compared with non-diabetic patients, diabetic patients had a higher overall incidence of plaque (p 0.05), as well as for the number of diseased segments and the distribution of plaques; both mainly involved the bilateral cavernous segment of the internal carotid artery. As for the stenosis, non-obstructive lesions were more common in diabetic patients (p 0.05). Conclusion: Diabetes is associated with a higher incidence of plaque and non-obstructive stenosis. However, no significant differences were observed in the type, extent and distribution of involved plaques between diabetic and non-diabetic patients.

Preoperative irradiation of an extracerebral cavernous hemangioma in the middle fossa

International Nuclear Information System (INIS)

Shibata, Shobu; Kurihara, Masaki; Mori, Kazuo; Amamoto, Yuhei.

1981-01-01

This is a report of case with the extracerebral cavernous hemangioma in the middle fossa in which total removal was carried out after radiotherapy. Follow-up study with computed tomography during and after irradiation are presented. A 44-year-old house-wife complained of a decreased vision of the both eyes and paresis of the left upper and lower limbs. CT scan revealed a slightly high density area in the right middle cranial fossa which was markedly enhanced with contrast media. Right carotid angio-graphy demonstrated a large avascular mass in the right middle fossa and no feeding artery or draining vein was visualized except a faint irregular stain in the venous phase. An attempt to total removal of the tumor had failed to success because of extensive hemorrhage from the tumor. Histological examination revealed a cavernous hemangioma. Irradiation with a total dose of 5000 rads was delivered. After irradiation. CT scan revealed a marked decrease of size and EMI number of the tumor. At this stage, hypervascular mass lesion with feeding arteries was noted in conventional angiography. Tumor stain in prolonged injection angiography was also visualized. In the second operation, removal of the tumor was performed without any difficulty and hemorrhage was controlled easily by electrocoagulation. Histology revealed a marked narrowing of vessels with an increase in the connective tissues. In the central part of specimen, there noted findings of coagulation necrosis, intraluminal thrombus formations and so on, which were attributed to the influence of radiation. It is concluded that in case of a extracerebral cavernous hemangioma with massive hemorrhage, radiation of up to 3000 - 5000 rads was a method of choice. The treatment results in an increase of probability of total removal of the tumor. (author)

Numerical estimation of structural integrity of salt cavern wells.

NARCIS (Netherlands)

Orlic, B.; Thienen-Visser, K. van; Schreppers, G.J.

2016-01-01

Finite element analyses were performed to estimate axial deformation of cavern wells due to gas storage operations in solution-mined salt caverns. Caverns shrink over time due to salt creep and the cavern roof subsides potentially threatening well integrity. Cavern deformation, deformation of salt

Cerebral Cavernous Malformation and Hemorrhage

Science.gov (United States)

... Text Size: SMALL • LARGE Cerebral Cavernous Angioma and Hemorrhage By Jack Hoch; Reviewed by Dr. Issam Awad ... for years, the mechanism by which these lesions hemorrhage remains poorly understood. Hemorrhage Types Since cavernous angiomas ...

Hydrocarbon storage caverns overhaul: A case study

Energy Technology Data Exchange (ETDEWEB)

McDougall, N. [Bayer Inc., Sarnia, ON (Canada)

1998-09-01

Case studies of four hydrocarbon storage cavern overhauls by Bayer Inc., of Sarnia during the period 1993 to 1997 were reviewed and the lessons learned were discussed. Discussions included inspection requirements for each of the caverns, the logistics and planning plant production around the cavern outages, site and cavern preparation, including removal of the casing slips from the well heads. It was emphasized that cavern overhauls can be expensive operations, unless preceded by proper planning. The largest variable cost is likely to be rig time at about $ 2,000 per day. Planning for the unexpected with thoughtful contingencies can reduce costs and avoid expensive delays.

Endovascular treatment with a stent-graft for internal carotid artery laceration during trans sphenoidal surgery: a case report

International Nuclear Information System (INIS)

Choe, Eun Hwa; Ko, Ji Ho; Lee, Tae Hong; Rho, Myung Ho

2008-01-01

An internal carotid artery (ICA) tear during or after trans-sphenoidal surgery (TSS) is rare but may cause potentially lethal complications. A 23-year-old female patient visited our hospital for treatment of a Rathke's cleft cyst. The patient had massive hemorrhage during surgery and angiography performed after surgery showed laceration of the cavernous ICA. We successfully controlled the hemorrhage with emergency placement of an endovascular stent-graft

Historical Cavern Floor Rise for All SPR Sites

Energy Technology Data Exchange (ETDEWEB)

Moriarty, Dylan Michael [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2016-09-01

The Strategic Petroleum Reserve (SPR) contains the largest supply is the largest stockpile of government-owned emergency crude oil in the world. The oil is stored in multiple salt caverns spread over four sites in Louisiana and Texas. Cavern infrastructure near the bottom of the cavern can be damaged from vertical floor movement. This report presents a comprehensive history of floor movements in each cavern. Most of the cavern floor rise rates ranged from 0.5-3.5 ft/yr, however, there were several caverns with much higher rise rates. BH103, BM106, and BH105 had the three highest rise rates. Information from this report will be used to better predict future vertical floor movements and optimally place cavern infrastructure. The reasons for floor rise are not entirely understood and should be investigated.

ANTAGONISM OF PROGESTERONE RECEPTOR SUPPRESSES CAROTID BODY RESPONSES TO HYPOXIA AND NICOTINE IN RAT PUPS

Science.gov (United States)

JOSEPH, V.; NIANE, L. M.; BAIRAM, A.

2013-01-01

We tested the hypothesis that antagonism of progesterone receptor (PR) in newborn rats alters carotid body and respiratory responses to hypoxia and nicotinic receptor agonists. Rats were treated with the PR antagonist mifepristone (daily oral gavage 40 μg/g/d) or vehicle between post-natal days 3 and 15. In 11–14-day-old rats, we used in vitro carotid body/carotid sinus nerve preparation and whole body plethysmography to assess the carotid body and ventilatory responses to hypoxia (65 mmHg in vitro, 10% O2 in vivo) and to nicotinic receptor agonists (as an excitatory modulator of carotid body activity—nicotine 100 μM for in vitro studies, and epibatidine 5 μg/kg, i.p., which mainly acts on peripheral nicotinic receptors, for in vivo studies). The carotid body responses to hypoxia and nicotine were drastically reduced by mifepristone. Compared with vehicle, mifepristone-treated rats had a reduced body weight. The ventilatory response to epibatidine was attenuated; however, the hypoxic ventilatory response was similar between vehicle and mifepristone-treated pups. Immunohistochemical staining revealed that mifepristone treatment did not change carotid body morphology. We conclude that PR activity is a critical factor ensuring proper carotid body function in newborn rats. PMID:22326965

MRI findings in Tolosa-Hunt syndrome before and after systemic corticosteroid therapy

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Cakirer, Sinan E-mail: scakirer@yahoo.com

2003-02-01

Tolosa-Hunt syndrome (THS) is characterized by painful ophthalmoplegia due to a granulomatous inflammation in the cavernous sinus. Corticosteroid therapy dramatically resolves both the clinical and radiological findings of THS. We present MRI findings of six patients with a clinical history of at least one episode of unilateral or bilateral orbital-periorbital pain, clinical findings of associated paresis of one or more of 3rd, 4th, 5th or 6th cranial nerves. All of the patients revealed an enlargement of the symptomatic cavernous sinus on magnetic resonance imaging (MRI) scans. Five patients revealed total resolution of the clinical findings within 1-8 weeks, following systemic corticosteroid treatment. One patient revealed only minor regression of clinical findings within 2 weeks after the initiation of the treatment, so the cavernous sinus lesion was reevaluated as meningioma on MRI, and the patient underwent surgical resection of the mass with resultant histopathological finding of cavernous sinus meningioma. A follow-up MRI scan was performed for five patients at the end of 8-weeks of steroid therapy. Three of these five patients showed total resolution of the cavernous sinus lesions whereas two of them revealed a partial regression of the cavernous sinus lesions. MRI findings before and after systemic corticosteroid therapy are important diagnostic criteria to put the definitive diagnosis of THS and to differentiate it from other cavernous sinus lesions that simulate THS both clinically and radiologically.

A 12-year cavern abandonment test

Directory of Open Access Journals (Sweden)

Brouard B.

2010-06-01

Full Text Available In 1997-1998, an abandonment test was performed in a 950-m deep, 8000-m3 salt cavern operated by GDF SUEZ at Etrez, France. In this relatively small brine-filled cavern, which had been kept idle for 15 years before the test, thermal equilibrium was reached. A special system was designed to monitor leaks, which proved to be exceedingly small. In these conditions, brine permeation and cavern creep closure are the only factors to play significant roles in pressure evolution. This test strongly suggested that obtaining an equilibrium pressure such that the effects of these two factors were exactly equal would be reached in the long term. Four years later, pressure monitoring in the closed cavern resumed. Pressure evolution during the 2002-2009 period confirmed that cavern brine pressure will remain constant and significantly smaller than geostatic pressure in the long term, precluding any risk of fracturing and brine seepage to the overburden layers.

Spontaneous intracranial arterial dissection in the young: diagnosis by CT angiography

Directory of Open Access Journals (Sweden)

Given Curtis A

2006-04-01

Full Text Available Abstract Background Spontaneous carotid artery dissections have been rarely reported in children. Diagnosis has traditionally been confirmed by catheter arteriography. More recently diagnosis has been made by magnetic resonance imaging and magnetic resonance angiography; however the sensitivity of these techniques has yet to be determined. The authors are unaware of reports of carotid dissection confirmed by dynamic computed tomography (computerized tomographic arteriography in the young. Case presentation We recently evaluated a fourteen year-old male following the development of transient neurologic symptoms. There was no antecedent illness or trauma. Dynamic computed tomography revealed an intracranial dissection involving the supraclinoid segment of the left internal carotid artery (confirmed by catheter arteriography. Studies for vasculitis, pro-thrombotic states, and defects of collagen were negative. Conclusion Spontaneous carotid artery dissection is a potential cause of transient neurological symptoms and ischemic stroke in the pediatric population. Dynamic computed tomography appears to be a reliable diagnostic tool which can lead to early diagnosis.

Genetics Home Reference: cerebral cavernous malformation

Science.gov (United States)

... Additional NIH Resources (1 link) National Institute of Neurological Disorders and Stroke Educational Resources (7 links) Boston Children's Hospital: Cavernous Malformations Disease InfoSearch: Cerebral Cavernous Malformation ...

Surgery for juvenile nasopharyngeal angiofibroma with lateral extension to the infratemporal fossa.

Science.gov (United States)

Yamada, Masato; Tsunoda, Atsunobu; Tokumaru, Takao; Aoyagi, Masaru; Kawano, Yoshihisa; Yano, Tomoyuki; Kishimoto, Seiji

2014-08-01

The study aimed to assess the usefulness of skull base surgery for large juvenile nasopharyngeal angiofibroma (JNA) with lateral extension to the infratemporal fossa. Eleven cases were enrolled for this study, and the mean age was 17.7 years old (range: 8-32). Six out of 11 cases underwent surgery as an initial treatment, and the other five underwent secondary surgery after initial surgery or radiotherapy in other institutions. The range of extension of tumor, feeding arteries, surgical approach, and treatment outcome were estimated. All tumors originated from the sphenopalatine foramen. Based on the imaging study, there was extension to the cavernous sinus observed in eight cases, as well as to the middle cranial fossa (8), orbit (4), and anterior cranial fossa (1). These tumors were diagnosed as Andrews' Stage IVa (3) and IVb (8). However, infiltration into the cavernous sinus was observed in one case only during surgery. Ten tumors were separated carefully from the cavernous sinus or dura and were accurately diagnosed as Stage IIIb. In all cases, the main arterial feeders of the JNAs were branches of the external carotid artery, which were embolized prior to surgery. However, 10 cases were also fed by branches of the internal carotid artery (branches of the ophthalmic artery), in which these arteries could not be embolized. Coronal skin incision (1) and a facial dismasking flap (9) were used, and in one case, wide lateral skin incision with temporary incision of the facial nerve was applied. The orbito-zygomatic approach and its modification was applied to all the cases. Fronto-lateral craniotomy was applied in four cases and lateral craniotomy in seven cases. Total resection was achieved in 10 cases and subtotal resection in one case. No mortality was noted in this series. Temporal trismus was observed in all cases which subsided gradually. Cheek numbness and facial palsy were observed in three and two cases, respectively. Coupled with craniotomy, tumor removal

Analysis of cavern stability at the West Hackberry SPR site.

Energy Technology Data Exchange (ETDEWEB)

Ehgartner, Brian L.; Sobolik, Steven Ronald

2009-05-01

This report presents computational analyses that simulate the structural response of caverns at the Strategic Petroleum Reserve (SPR) West Hackberry site. The cavern field comprises 22 caverns. Five caverns (6, 7, 8, 9, 11) were acquired from industry and have unusual shapes and a history dating back to 1946. The other 17 caverns (101-117) were leached according to SPR standards in the mid-1980s and have tall cylindrical shapes. The history of the caverns and their shapes are simulated in a three-dimensional geomechanics model of the site that predicts deformations, strains, and stresses. Future leaching scenarios corresponding to oil drawdowns using fresh water are also simulated by increasing the volume of the caverns. Cavern pressures are varied in the model to capture operational practices in the field. The results of the finite element model are interpreted to provide information on the current and future status of subsidence, well integrity, and cavern stability. The most significant results in this report are relevant to Cavern 6. The cavern is shaped like a bowl with a large ceiling span and is in close proximity to Cavern 9. The analyses predict tensile stresses at the edge of the ceiling during repressuization of Cavern 6 following workover conditions. During a workover the cavern is at low pressure to service a well. The wellhead pressures are atmospheric. When the workover is complete, the cavern is repressurized. The resulting elastic stresses are sufficient to cause tension around the edge of the large ceiling span. With time, these stresses relax to a compressive state because of salt creep. However, the potential for salt fracture and propagation exists, particularly towards Cavern 9. With only 200 ft of salt between the caverns, the operational consequences must be examined if the two caverns become connected. A critical time may be during a workover of Cavern 9 in part because of the operational vulnerabilities, but also because dilatant damage is

Treatment of Cervical Internal Carotid Artery Spontaneous Dissection with Pseudoaneurysm and Unilateral Lower Cranial Nerves Palsy by Two Silk Flow Diverters

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Zelenak, Kamil, E-mail: zelenak@unm.sk [University Hospital, Department of Radiology (Slovakia); Zelenakova, Jana [University Hospital, Department of Neurology (Slovakia); DeRiggo, Julius [University Hospital, Department of Neurosurgery (Slovakia); Kurca, Egon; Kantorova, Ema [University Hospital, Department of Neurology (Slovakia); Polacek, Hubert [University Hospital, Department of Radiology (Slovakia)

2013-08-01

Internal carotid artery (ICA) lesions in the parapharyngeal space (a dissection and a pseudoaneurysm) may present as isolated lower cranial nerves (IX, X, XI, and XII) palsy (Collet-Sicard syndrome). Some arteriopathies such as fibromuscular dysplasia and tortuosity make a vessel predisposed to dissection. Extreme vessel tortuosity makes the treatment by a stent graft impossible. Two Silk stents were used in a 46 year-old man with left lower cranial nerves (IX-XII) palsy for the treatment of left ICA spontaneous dissection with pseudoaneurysm. A follow-up angiogram 5 months later confirmed pseudoaneurysm thrombosis and patency of the left ICA. The patient recovered completely from the deficits.

Treatment of Cervical Internal Carotid Artery Spontaneous Dissection with Pseudoaneurysm and Unilateral Lower Cranial Nerves Palsy by Two Silk Flow Diverters

International Nuclear Information System (INIS)

Zeleňák, Kamil; Zeleňáková, Jana; DeRiggo, Július; Kurča, Egon; Kantorová, Ema; Poláček, Hubert

2013-01-01

Internal carotid artery (ICA) lesions in the parapharyngeal space (a dissection and a pseudoaneurysm) may present as isolated lower cranial nerves (IX, X, XI, and XII) palsy (Collet–Sicard syndrome). Some arteriopathies such as fibromuscular dysplasia and tortuosity make a vessel predisposed to dissection. Extreme vessel tortuosity makes the treatment by a stent graft impossible. Two Silk stents were used in a 46 year-old man with left lower cranial nerves (IX–XII) palsy for the treatment of left ICA spontaneous dissection with pseudoaneurysm. A follow-up angiogram 5 months later confirmed pseudoaneurysm thrombosis and patency of the left ICA. The patient recovered completely from the deficits

Preoperative cellulose porous beads for therapeutic embolization of meningioma: provocation test and technical considerations

International Nuclear Information System (INIS)

Kai, Yutaka; Morioka, Motohiro; Yano, Shigetoshi; Nakamura, Hideo; Makino, Keishi; Mizuno, Takamasa; Takeshima, Hideo; Kuratsu, Jun-ichi; Hamada, Jun-ichiro

2007-01-01

Cellulose porous beads (CPBs) are exceptionally uniform in size and nonabsorbable and they provide highly effective tumor devascularization. The risk of cranial nerve palsy must not be overlooked when embolization with CPBs is considered in meningioma patients. We attempted to identify patients at risk of cranial nerve palsy after meningioma embolization. Prior to preoperative superselective embolization with 200 μm diameter CPBs, 141 patients with meningioma underwent provocation test with lidocaine and amytal. They were divided into two groups on the basis of whether they were or were not considered eligible for embolization. We evaluated the differences between the two groups with respect to tumor anatomy, angiographic findings, and clinical presentation and recorded complications associated with the embolization of the meningioma. Of the 141 patients, 128 underwent CPB embolization (group 2); 13 were not embolized because their provocation test results were positive (group 1, n = 11) or because they showed vasospasm (n = 2). Group 1 patients had meningioma in the cavernous sinus or petroclival region. Characteristically, the feeders were of middle meningeal artery origin and exhibited a posteromedial course toward the petrous apex or cavernous sinus. In group 2 patients the middle meningeal artery was the feeder, but it lacked branches coursing posteromedially. Three of these patients experienced complications which included intratumoral hemorrhage (n 2) and post-embolization hearing disturbance (n = 1). Patients with meningioma whose tumor-feeding arteries run posteromedially toward the petrous apex or cavernous sinus are at increased risk of post-embolization cranial nerve palsy. Appropriate protocols, including lidocaine and amytal provocation tests, may reduce the risk of complications after CPB embolization of the external carotid territory in this group of patients. (orig.)

Preoperative cellulose porous beads for therapeutic embolization of meningioma: provocation test and technical considerations

Energy Technology Data Exchange (ETDEWEB)

Kai, Yutaka; Morioka, Motohiro; Yano, Shigetoshi; Nakamura, Hideo; Makino, Keishi; Mizuno, Takamasa; Takeshima, Hideo; Kuratsu, Jun-ichi [Kumamoto University, Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto (Japan); Hamada, Jun-ichiro [Kanazawa University, Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa (Japan)

2007-05-15

Cellulose porous beads (CPBs) are exceptionally uniform in size and nonabsorbable and they provide highly effective tumor devascularization. The risk of cranial nerve palsy must not be overlooked when embolization with CPBs is considered in meningioma patients. We attempted to identify patients at risk of cranial nerve palsy after meningioma embolization. Prior to preoperative superselective embolization with 200 {mu}m diameter CPBs, 141 patients with meningioma underwent provocation test with lidocaine and amytal. They were divided into two groups on the basis of whether they were or were not considered eligible for embolization. We evaluated the differences between the two groups with respect to tumor anatomy, angiographic findings, and clinical presentation and recorded complications associated with the embolization of the meningioma. Of the 141 patients, 128 underwent CPB embolization (group 2); 13 were not embolized because their provocation test results were positive (group 1, n = 11) or because they showed vasospasm (n = 2). Group 1 patients had meningioma in the cavernous sinus or petroclival region. Characteristically, the feeders were of middle meningeal artery origin and exhibited a posteromedial course toward the petrous apex or cavernous sinus. In group 2 patients the middle meningeal artery was the feeder, but it lacked branches coursing posteromedially. Three of these patients experienced complications which included intratumoral hemorrhage (n = 2) and post-embolization hearing disturbance (n = 1). Patients with meningioma whose tumor-feeding arteries run posteromedially toward the petrous apex or cavernous sinus are at increased risk of post-embolization cranial nerve palsy. Appropriate protocols, including lidocaine and amytal provocation tests, may reduce the risk of complications after CPB embolization of the external carotid territory in this group of patients. (orig.)

Endovascular treatment in proximal and intracranial carotid occlusion 9 hours after symptom onset

International Nuclear Information System (INIS)

Jakubowska, Malgorzata M.; Michels, Peter; Mueller-Jensen, Axel; Leppien, Andreas; Eckert, Bernd

2008-01-01

A debate is emerging over whether the treatment time window in acute stroke can be extended beyond 6 h if penumbral tissue can be identified. Treatment decisions are very difficult in cases of tandem proximal carotid occlusion with arterioarterial intracranial embolism. We enter this debate with the present report on a case of atherosclerotic proximal carotid occlusion and resulting periocclusional carotid T embolism that was successfully treated 9 h after symptom onset. The case of a 68-year-old man with fluctuating symptoms of right-hemispheric stroke is presented (NIHSS score 12-20 on admission). CT angiography demonstrated proximal carotid occlusion and periocclusional embolism of the entire internal carotid artery (ICA) including the carotid T segment. Penumbral tissue was diagnosed by nonenhanced and perfusion CT imaging 7.5 h after symptom onset. Treatment was initiated 9 h after symptom onset by passing the proximal occlusion with a microcatheter and local administration of recombinant tissue plasminogen activator (rt-PA) into the carotid T segment at the level of posterior communicating artery (PCoA) origin. Recanalization of the ICA and middle cerebral artery was accomplished within 1 h by flow establishment via the PCoA. The atherosclerotic proximal ICA occlusion was not stented due to the risk of embolism from remnant thrombi in the petrous and cavernous ICA segments. Follow-up MRI showed only mild haemorrhagic infarct transformation of the initial infarct core. The patient was discharged from hospital 18 days after treatment with NIHSS score 5. If penumbral tissue can be conclusively identified, endovascular treatment in proximal and intracranial tandem occlusion can be successful, even in treatments initiated 6-9 h after stroke onset. If the intracranial flow after recanalization can be established via the circle of Willis, the underlying proximal ICA occlusion may not require treatment. (orig.)

Endovascular treatment in proximal and intracranial carotid occlusion 9 hours after symptom onset

Energy Technology Data Exchange (ETDEWEB)

Jakubowska, Malgorzata M.; Michels, Peter; Mueller-Jensen, Axel [Asklepios Clinic Altona, Department of Neurology, Hamburg (Germany); Leppien, Andreas; Eckert, Bernd [Asklepios Clinic Altona, Department of Neuroradiology, Hamburg (Germany)

2008-07-15

A debate is emerging over whether the treatment time window in acute stroke can be extended beyond 6 h if penumbral tissue can be identified. Treatment decisions are very difficult in cases of tandem proximal carotid occlusion with arterioarterial intracranial embolism. We enter this debate with the present report on a case of atherosclerotic proximal carotid occlusion and resulting periocclusional carotid T embolism that was successfully treated 9 h after symptom onset. The case of a 68-year-old man with fluctuating symptoms of right-hemispheric stroke is presented (NIHSS score 12-20 on admission). CT angiography demonstrated proximal carotid occlusion and periocclusional embolism of the entire internal carotid artery (ICA) including the carotid T segment. Penumbral tissue was diagnosed by nonenhanced and perfusion CT imaging 7.5 h after symptom onset. Treatment was initiated 9 h after symptom onset by passing the proximal occlusion with a microcatheter and local administration of recombinant tissue plasminogen activator (rt-PA) into the carotid T segment at the level of posterior communicating artery (PCoA) origin. Recanalization of the ICA and middle cerebral artery was accomplished within 1 h by flow establishment via the PCoA. The atherosclerotic proximal ICA occlusion was not stented due to the risk of embolism from remnant thrombi in the petrous and cavernous ICA segments. Follow-up MRI showed only mild haemorrhagic infarct transformation of the initial infarct core. The patient was discharged from hospital 18 days after treatment with NIHSS score 5. If penumbral tissue can be conclusively identified, endovascular treatment in proximal and intracranial tandem occlusion can be successful, even in treatments initiated 6-9 h after stroke onset. If the intracranial flow after recanalization can be established via the circle of Willis, the underlying proximal ICA occlusion may not require treatment. (orig.)

Assessment of shear stress related parameters in the carotid bifurcation using mouse-specific FSI simulations.

Science.gov (United States)

De Wilde, David; Trachet, Bram; Debusschere, Nic; Iannaccone, Francesco; Swillens, Abigail; Degroote, Joris; Vierendeels, Jan; De Meyer, Guido R Y; Segers, Patrick

2016-07-26

The ApoE(-)(/)(-) mouse is a common small animal model to study atherosclerosis, an inflammatory disease of the large and medium sized arteries such as the carotid artery. It is generally accepted that the wall shear stress, induced by the blood flow, plays a key role in the onset of this disease. Wall shear stress, however, is difficult to derive from direct in vivo measurements, particularly in mice. In this study, we integrated in vivo imaging (micro-Computed Tomography-µCT and ultrasound) and fluid-structure interaction (FSI) modeling for the mouse-specific assessment of carotid hemodynamics and wall shear stress. Results were provided for 8 carotid bifurcations of 4 ApoE(-)(/)(-) mice. We demonstrated that accounting for the carotid elasticity leads to more realistic flow waveforms over the complete domain of the model due to volume buffering capacity in systole. The 8 simulated cases showed fairly consistent spatial distribution maps of time-averaged wall shear stress (TAWSS) and relative residence time (RRT). Zones with reduced TAWSS and elevated RRT, potential indicators of atherosclerosis-prone regions, were located mainly at the outer sinus of the external carotid artery. In contrast to human carotid hemodynamics, no flow recirculation could be observed in the carotid bifurcation region. Copyright © 2015 Elsevier Ltd. All rights reserved.

Neurosymptomatic carvenous sinus meningioma: a 15-years experience with fractionated stereotactic radiotherapy and radiosurgery

International Nuclear Information System (INIS)

Correa, Sebastião Francisco Miranda; Marta, Gustavo Nader; Teixeira, Manoel Jacobsen

2014-01-01

The tumor removal of Cavernous Sinus Meningiomas usually results in severe neurological deficits. Stereotactic radiosurgery (SRS) and fractionated Stereotactic radiotherapy (SRT) are advanced modalities of radiotherapy for treatment of patients with inoperable and symptomatic CSMs. The authors evaluated the long term symptomatology, the image findings, and the toxicity of patients with CSMs treated with SRS or SRT. From 1994 to 2009, 89 patients with symptomatic CSMs were treated with SRS or SRT. The indication was based on tumour volume and or proximity to the optic chiasm. The median single dose of SRS was 14 Gy, while the SRT total dose, ranged from 50.4 to 54 Gy fractionated in 1.8-2 Gy/dose. The median follow-up period lasted 73 months. The clinical and radiological improvement was the same despite the method of radiotherapy; 41.6% (SRS) and 48.3% (SRT) of patients treated. The disease-free survivals were 98.8%, 92.3% and 92.3%, in 5, 10, and 15 years, respectively. There was no statistical difference in relation to the symptoms and image findings between both methods. According to the Common Toxicity Criteria, 7% of the patients presented transient optic neuropathy during 3 months (grade 2) and recovered with dexamethasone, 2 patients had trigeminal neuropathy (grade 2) and improved rapidly, and one patient presented total occlusion of the internal carotid artery without neurological deficit (grade 2). Temporary lethargy and headache (grade 1) were the most frequent immediate complications. No severe complications occurred. Stereotactic Radiosurgery and fractionated Stereotactic Radiotherapy were equally safe and effective in the management of symptomatic CSMs

Persistent dorsal ophthalmic artery arising from the internal carotid artery: Report of three cases

Energy Technology Data Exchange (ETDEWEB)

Shin, Jae Hwan; Lee, Ghi Jai; Shim, Jae Chan; Lee, Kyoung Eun; Kim, Ho Kyun; Suh, Jung Ho [Dept. of Radiology, Seoul Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

2016-12-15

Normally, the ophthalmic artery (OA) arises from the supraclinoid segment of the internal carotid artery (ICA) and enters the orbit via the optic canal. A persistent dorsal OA is a rare variation that originates from the cavernous segment of the ICA and enters the orbit via the superior orbital fissure. To the best of our knowledge, persistent dorsal OA has not been described in the Korean literature. In this paper, we report three cases of persistent dorsal OA with review of the literature on embryogenesis and other origins of the OA.

High fat diet blunts the effects of leptin on ventilation and on carotid body activity.

Science.gov (United States)

Ribeiro, Maria J; Sacramento, Joana F; Gallego-Martin, Teresa; Olea, Elena; Melo, Bernardete F; Guarino, Maria P; Yubero, Sara; Obeso, Ana; Conde, Silvia V

2017-12-22

Leptin plays a role in the control of breathing, acting mainly on central nervous system; however, leptin receptors have been recently shown to be expressed in the carotid body (CB), and this finding suggests a physiological role for leptin in the regulation of CB function. Leptin increases minute ventilation in both basal and hypoxic conditions in rats. It increases the frequency of carotid sinus nerve discharge in basal conditions, as well as the release of adenosine from the CB. However, in a metabolic syndrome animal model, the effects of leptin in ventilatory control, carotid sinus nerve activity and adenosine release by the CB are blunted. Although leptin may be involved in triggering CB overactivation in initial stages of obesity and dysmetabolism, resistance to leptin signalling and blunting of responses develops in metabolic syndrome animal models. Leptin plays a role in the control of breathing, acting mainly on central nervous system structures. Leptin receptors are expressed in the carotid body (CB) and this finding has been associated with a putative physiological role of leptin in the regulation of CB function. Since, the CBs are implicated in energy metabolism, here we tested the effects of different concentrations of leptin administration on ventilatory parameters and on carotid sinus nerve (CSN) activity in control and high-fat (HF) diet fed rats, in order to clarify the role of leptin in ventilation control in metabolic disease states. We also investigated the expression of leptin receptors and the neurotransmitters involved in leptin signalling in the CBs. We found that in non-disease conditions, leptin increases minute ventilation in both basal and hypoxic conditions. However, in the HF model, the effect of leptin in ventilatory control is blunted. We also observed that HF rats display an increased frequency of CSN discharge in basal conditions that is not altered by leptin, in contrast to what is observed in control animals. Leptin did not

Dynamic MR imaging in Tolosa-Hunt syndrome

Energy Technology Data Exchange (ETDEWEB)

Haque, Tabassum Laz; Miki, Yukio; Kashii, Satoshi; Yamamoto, Akira; Kanagaki, Mitsunori; Takahashi, Takahiro; Fushimi, Yasutaka; Asato, Reinin; Murase, Nagako; Shibasaki, Hiroshi; Konishi, Junji

2004-09-01

Objective: To evaluate the cavernous sinuses with dynamic magnetic resonance (MR) imaging in patients with Tolosa-Hunt syndrome (THS). Methods: The sellar and parasellar regions of five patients with THS and 12 control subjects were examined with dynamic MR (1.5 T) imaging in the coronal plane. Dynamic images were obtained with spin-echo (SE) sequences in three patients, and with fast spin-echo (FSE) sequences in two patients and control subjects. Conventional MR images of the cranium including sellar and parasellar regions were also obtained on T1-weighted pre- and post-contrast SE, and T2-weighted FSE sequences in the coronal plane. Results: MR images revealed affected cavernous sinus with bulged convex lateral wall in three patients and concave lateral wall in two patients. In all control subjects, cavernous sinuses were observed with concave lateral wall. The signal intensity on T1- and T2-weighted images and contrast enhancement on post-contrast images of the affected cavernous sinuses in patients were similar to those of the unaffected cavernous sinuses in patients and control subjects. The dynamic images in all patients disclosed small areas adjacent to the cranial nerve filling-defects within the enhanced venous spaces of the affected cavernous sinus, which showed slow and gradual enhancement from the early to the late dynamic images. No such gradually enhancing area was observed in control subjects except one. The follow-up dynamic MR images after corticosteroid therapy revealed complete resolution of the gradually enhancing areas in the previously affected cavernous sinus. Conclusion: Dynamic MR imaging may facilitate the diagnosis of THS.

Dynamic MR imaging in Tolosa-Hunt syndrome

International Nuclear Information System (INIS)

Haque, Tabassum Laz; Miki, Yukio; Kashii, Satoshi; Yamamoto, Akira; Kanagaki, Mitsunori; Takahashi, Takahiro; Fushimi, Yasutaka; Asato, Reinin; Murase, Nagako; Shibasaki, Hiroshi; Konishi, Junji

2004-01-01

Objective: To evaluate the cavernous sinuses with dynamic magnetic resonance (MR) imaging in patients with Tolosa-Hunt syndrome (THS). Methods: The sellar and parasellar regions of five patients with THS and 12 control subjects were examined with dynamic MR (1.5 T) imaging in the coronal plane. Dynamic images were obtained with spin-echo (SE) sequences in three patients, and with fast spin-echo (FSE) sequences in two patients and control subjects. Conventional MR images of the cranium including sellar and parasellar regions were also obtained on T1-weighted pre- and post-contrast SE, and T2-weighted FSE sequences in the coronal plane. Results: MR images revealed affected cavernous sinus with bulged convex lateral wall in three patients and concave lateral wall in two patients. In all control subjects, cavernous sinuses were observed with concave lateral wall. The signal intensity on T1- and T2-weighted images and contrast enhancement on post-contrast images of the affected cavernous sinuses in patients were similar to those of the unaffected cavernous sinuses in patients and control subjects. The dynamic images in all patients disclosed small areas adjacent to the cranial nerve filling-defects within the enhanced venous spaces of the affected cavernous sinus, which showed slow and gradual enhancement from the early to the late dynamic images. No such gradually enhancing area was observed in control subjects except one. The follow-up dynamic MR images after corticosteroid therapy revealed complete resolution of the gradually enhancing areas in the previously affected cavernous sinus. Conclusion: Dynamic MR imaging may facilitate the diagnosis of THS

Analysis of cavern stability at the Bryan Mound SPR site.

Energy Technology Data Exchange (ETDEWEB)

Ehgartner, Brian L.; Sobolik, Steven Ronald

2009-04-01

This report presents computational analyses that simulate the structural response of caverns at the Strategic Petroleum Reserve Bryan Mound site. The cavern field comprises 20 caverns. Five caverns (1, 2, 4, and 5; 3 was later plugged and abandoned) were acquired from industry and have unusual shapes and a history dating back to 1946. The other 16 caverns (101-116) were leached according to SPR standards in the mid-1980s and have tall cylindrical shapes. The history of the caverns and their shapes are simulated in a 3-D geomechanics model of the site that predicts deformations, strains, and stresses. Future leaching scenarios due to oil drawdowns using fresh water are also simulated by increasing the volume of the caverns. Cavern pressures are varied in the model to capture operational practices in the field. The results of the finite element model are interpreted to provide information on the current and future status of subsidence, well integrity, and cavern stability. The most significant result in this report is relevant to caverns 1, 2, and 5. The caverns have non-cylindrical shapes and have potential regions where the surrounding salt may be damaged during workover procedures. During a workover the normal cavern operating pressure is lowered to service a well. At this point the wellhead pressures are atmospheric. When the workover is complete, the cavern is repressurized. The resulting elastic stresses are sufficient to cause tension and large deviatoric stresses at several locations. With time, these stresses relax to a compressive state due to salt creep. However, the potential for salt damage and fracturing exists. The analyses predict tensile stresses at locations with sharp-edges in the wall geometry, or in the case of cavern 5, in the neck region between the upper and lower lobes of the cavern. The effects do not appear to be large-scale, however, so the only major impact is the potential for stress-induced salt falls in cavern 5, potentially leading to

Preliminary evaluation of 3D TOF MRA fly-around advantages in the diagnosis of internal carotid artery aneurysms

International Nuclear Information System (INIS)

Zhu Yusen; Zhang Lina; Xu Ke; Li Songbai; Huang Yanling; Sun Wenge; Jin Anyu; Qi Xixun; Li Yanliang

2004-01-01

TOF MRA and MS 3D-CTA only. All of the 22 Aneurysms were detected by 3D TOF MRA fly-around, with the body's diameter ranging from 2.5 mm to 24 mm. Seven of those aneurysms were less than 4 mm in diameter (31.8%,7/22). Detecting rate of 3D TOF MRA was 100%. On images of 3D TOF MRA, aneurysm's body, neck, source vessel, and the relationship between the aneurysms and the surrounding structures were clearly and surely displayed. Conclusion: 3D TOF MRA fly-around should be a very effective procedure in diagnosing internal carotid artery aneurysms, especially in those who are close to the bony structures of the skull base and the cavernous sinus

Reinforcement of the concrete base slab of the ATLAS cavern

CERN Multimedia

Maximilien Brice

2002-01-01

Photo 02: UX15 cavern, preparation for concreting of base slab first lift. Photo 05: UX15 cavern, placing of reinforcement for base slab first lift. Photo 07: UX15 cavern, preparation for concreting of base slab first lift. Photo 09: UX15 cavern, placing of reinforcement for base slab first lift. Photo 10: UX15 cavern, view into PX14 shaft above. Photo 12: UX15 cavern, temporary access platform of RB16 tunnel. Photo 15: UJ17 chamber, invert excavation.

Bilateral segmental regression of the carotid and vertebral arteries with rete compensation in a Western patient

Energy Technology Data Exchange (ETDEWEB)

Mahadevan, J.; Batista, L.; Alvarez, H.; Lasjaunias, P. [Service de Neuroradiologie Diagnostique et Therapeutique, Hopital de Bicetre, 94275 Le Kremlin Bicetre, 94275, Le Kremlin Bicetre (France); Bravo-Castro, E. [Instituto De Neurocirugia Asenjo, c/Jose Manuel Infante, Santiago (Chile)

2004-06-01

We report a case of symptomatic symmetrical, bilateral absence of the cavernous internal carotid (ICA) and transdural vertebral artery (VA) segments with formation of a rete mirabile. There have been similar reports in Asian patients; ours is the first in the Western population. A 29- year-old woman presented with recurrent temporary blindness and an episode of minor subarachnoid haemorrhage. Angiography demonstrated absence of the C5 and C6 segments of the ICA and the C1/2 segments of the VA bilaterally, with typical carotid rete mirabile formation to reconstitute the distal flow. Comparative anatomy and embryology show retia in several species and point to their secondary origin. The anomalies of the ICA cannot be called agenesis but rather absence since they are likely to result from perinatal disappearance of the artery rather its failure to develop. (orig.)

Allowable pillar to diameter ratio for strategic petroleum reserve caverns.

Energy Technology Data Exchange (ETDEWEB)

Ehgartner, Brian L.; Park, Byoung Yoon

2011-05-01

This report compiles 3-D finite element analyses performed to evaluate the stability of Strategic Petroleum Reserve (SPR) caverns over multiple leach cycles. When oil is withdrawn from a cavern in salt using freshwater, the cavern enlarges. As a result, the pillar separating caverns in the SPR fields is reduced over time due to usage of the reserve. The enlarged cavern diameters and smaller pillars reduce underground stability. Advances in geomechanics modeling enable the allowable pillar to diameter ratio (P/D) to be defined. Prior to such modeling capabilities, the allowable P/D was established as 1.78 based on some very limited experience in other cavern fields. While appropriate for 1980, the ratio conservatively limits the allowable number of oil drawdowns and hence limits the overall utility and life of the SPR cavern field. Analyses from all four cavern fields are evaluated along with operating experience gained over the past 30 years to define a new P/D for the reserve. A new ratio of 1.0 is recommended. This ratio is applicable only to existing SPR caverns.

Spontaneous Resolution of a Fetal Dural Sinus Thrombosis: One Case Report and Review of the Literatures

Directory of Open Access Journals (Sweden)

Chen Wang

2012-01-01

Full Text Available Fetal dural sinus thrombosis is a rare finding. Most cases have been terminated without long-term follow-ups. Recently some reports have indicated the potentially favorable evolution of fetal dural sinus thrombosis. Most of the fetuses showing symptoms have been delivered with normal neurologic outcome. We report a case of fetal dural sinus thrombosis. Serial ultrasound and magnetic resonance images (MRI showed the shrinkage of the thrombosis which indicated good prognosis. No physical or neurological abnormality was observed at 8-months follow-up. Conservative treatment is appropriate to prenatally diagnosed dural sinus thrombosis with favorable prognostic factors. Serial MRI or ultrasound should be taken every 1-2 months to monitor the thrombosis development and fetal well-beings.

Strategic petroleum reserve caverns casing damage update 1997

Energy Technology Data Exchange (ETDEWEB)

Munson, D.E.; Molecke, M.A.; Neal, J.T. [and others

1998-01-01

Hanging casing strings are used for oil and brine transfer in the domal salt storage caverns of the Strategic Petroleum Reserve (SPR). Damage to these casings is of concern because hanging string replacement is costly and because of implications on cavern stability. Although the causes of casing damage are not always well defined, many events leading to damage are assumed to be the result of salt falls impacting the hanging strings. However, in some cases, operational aspects may be suspected. The history of damage to hanging strings is updated in this study to include the most recent events. Potential general domal and local operational and material factors that could influence the tendency for caverns to have salt falls are examined in detail. As a result of this examination, general factors, such as salt dome anomalies and crude type, and most of the operational factors, such as geometry, location and depressurizations, are not believed to be primary causes of casing damage. Further analysis is presented of the accumulation of insolubles during cavern solutioning and accumulation of salt fall material on the cavern floor. Inaccuracies in sump geometry probably make relative cavern insolubles contents uncertain. However, determination of the salt fall accumulations, which are more accurate, suggest that the caverns with the largest salt fall accumulations show the greatest number of hanging string events. There is good correlation between the accumulation rate and the number of events when the event numbers are corrected to an equivalent number for a single hanging string in a quiescent, operating cavern. The principal factor that determines the propensity for a cavern to exhibit this behavior is thought to be the effect of impurity content on the fracture behavior of salt.

Comparison of the sagittal sinus cross-sectional area between patients with multiple sclerosis, hydrocephalus, intracranial hypertension and spontaneous intracranial hypotension: a surrogate marker of venous transmural pressure?

Science.gov (United States)

Bateman, Grant A; Lechner-Scott, Jeannette; Copping, Ross; Moeskops, Christopher; Yap, Swee Leong

2017-07-06

There is evidence that patients with multiple sclerosis (MS) and hydrocephalus share some common pathophysiological mechanisms. Alterations in CSF pressure are known to affect cerebral venous sinus geometry. To further explore these mechanisms, we measured the superior sagittal sinus (SSS) cross-sectional area 3 cm above the torcular using T2 images in 20 MS, 10 spontaneous intracranial hypotension (SIH), 21 hydrocephalus and 20 idiopathic intracranial hypertension (IIH) patients and compared with 20 matched controls. The SSS area was reduced by 25% in hydrocephalus (p = 0.0008), increased by 22% (p = 0.037) in SIH and unchanged in IIH compared to matched controls. In MS there was a 16% increase in SSS area (p = 0.01).The findings suggest that changes in SSS cross-sectional are common between MS and SIH patients, while in hydrocephalus and IIH these are different.

Surveying the ATLAS cavern

CERN Multimedia

Laurent Guiraud

2000-01-01

The cathedral-like cavern into which the ATLAS experiment will be lowered and installed forms a vital part of the engineering work at CERN in preparation for the new LHC accelerator. This cavern, being measured by surveyors in these images, will have one of the largest spans of any man-made underground structure. The massive 46X25X25 cubic metre detector will be the largest of its type in the world when it is completed for the LHC start-up in 2008.

Endovascular treatment for arterial injuries of skull base

International Nuclear Information System (INIS)

Li Tianxiao; Bai Weixing; Zai Suiting; Wang Ziliang; Xue Jiangyu

2008-01-01

Objective: To explore the role of endovascular techniques in treatment for arterial injuries of skull base. Methods: A total of 53 consecutive cases suffered from skull base arterial injuries were enrolled in our hospital from Oct 2004 to May 2007, including 44 male and 9 female cases with average age of 23.3 years. Thirty-nine cases presented with pulsatile exophthalmos and intracranial vascular murmur, cerchnus and dysphagia in another 9, epistaxis in the remaining 5 cases. Diagnosis of 39 carotid cavernous fistulae (CCF)and 14 carotid pseudoaneurysm were performed by angiography (DSA). Alternative endovascular procedures were performed depending on lesions characteristics and follow-up was done by telephone and outpatient work up. Results: Procedures were performed involving 56 carotid arteries in all 53 cases including 34 CCF with embolization of detachable balloon(33 cases), 3 with balloon and coils, and 3 by stent-graft placement. 8 carotid pseudoaneurysms were cured by parent artery occlusion with balloon, 2 experienced endovascular isolation with balloon and coils, and 4 with stent-graft. Follow-up for mean 9.5 months (range from 2 to 25 months) revealed that the chief symptoms of 45 cases (85%) were relieved within 6 months after the procedure but ocular movement and visual disorder remained in 8 cases (15%)till 12 months. Six pseudoaneurysms and 3 residual leak were found in reexamination, of which 2 cases underwent intervention again 2 and 3 months later due to dural arterial-venous fistula in cavernous sinus, respectively. Conclusions: Endovascular treatment is safe and effective therapeutic option with minimal invasion for skull base arterial injuries. Detachable balloon embolization is the first choice for CCF and carotid pseudoaneurysm. Spring coil packing and stent-graft implantation should be in alternation as combination for special cases. (authors)

Pilot abandonment test of a very deep gas storage salt cavern

International Nuclear Information System (INIS)

Durup, J.G.; Vidal, F.; Rolin, C.

2007-01-01

As a result of knowledge gained initially from a series of succinct sealed well and cavern field tests performed in the late 1980's and early 1990's by Gaz de France (EZ58; EZ53), issues related to the long term abandonment of salt caverns became more focused. The tests were performed in cooperation with Ecole Polytechnique (France) and were partially funded by the Solution Mining Research Institute (USA). The long-term abandonment (sealing or plugging) of a solution-mined cavern in a salt formation that has been used for mineral production, hydrocarbon storage, or waste disposal has been a contemporary topic for many years. Sealing and abandonment of caverns in salt formations differs from sealing of an oil and gas well principally for two reasons: - cavern wells are generally completed with much larger casings than oil and gas exploration and production wells; - the cavern fluid pressure rises after sealing. The first difference is not a significant deterrent to effective cavern sealing and abandonment. Essentially all of the uncertainties and complexities associated with cavern sealing and abandonment are a direct result of the second difference - the fact that the cavern fluid pressure rises through time. After a short introduction to solution mining of salt caverns and their use as underground gas storages, the paper will first discuss the factors affecting cavern fluid pressure increase after sealing. The second part of the paper will highlight the practical impacts of these factors on a deep salt cavern abandonment experiment (Cavern TE02; 1500 meters deep), currently being performed on the natural gas storage of Tersanne operated for over 35 years by Gaz de France. (authors)

Sequestration of CO2 in salt caverns

International Nuclear Information System (INIS)

Dusseault, M.B.; Rothenburg, L.; Bachu, S.

2002-01-01

The greenhouse effect is thought to be greatly affected by anthropogenic and naturally generated gases, such as carbon dioxide. The reduction of greenhouse gas emissions in the atmosphere could be effected through the permanent storage of carbon dioxide in dissolved salt caverns. A large number of suitable salt deposits are located in Alberta, especially the Lotsberg Salt of east-central Alberta. A major advantage of this deposit is its proximity to present and future point sources of carbon dioxide associated with fossil fuel development projects. Using the perspective of the long term fate of the stored carbon dioxide, the authors presented the characteristics of the Lotsberg Salt and the overlying strata. A high level of security against leakage and migration of the gas back to the biosphere is ensured by several features discussed in the paper. The authors propose a procedure that would be applicable for the creation, testing, and filling of a salt cavern. Achieving a long term prediction of the behavior of the cavern during slow closure, coupled to the pressure and volume behavior of the gas within the cavern represents the critical factor. The authors came up with an acceptable prediction by using a semi-analytical model. The use of salt caverns for the permanent sequestration of carbon dioxide has not yet faced technical obstacles that would prevent it. The authors argue that sequestration of carbon dioxide in salt caverns represents an environmentally acceptable option in Alberta. 11 refs., 3 figs

Purines and Carotid Body: New Roles in Pathological Conditions

Directory of Open Access Journals (Sweden)

Silvia V. Conde

2017-12-01

Full Text Available It is known that adenosine and adenosine-5′-triphosphate (ATP are excitatory mediators involved in carotid body (CB hypoxic signaling. The CBs are peripheral chemoreceptors classically defined by O2, CO2, and pH sensors. When hypoxia activates the CB, it induces the release of neurotransmitters from chemoreceptor cells leading to an increase in the action potentials frequency at the carotid sinus nerve (CSN. This increase in the firing frequency of the CSN is integrated in the brainstem to induce cardiorespiratory compensatory responses. In the last decade several pathologies, as, hypertension, diabetes, obstructive sleep apnea and heart failure have been associated with CB overactivation. In the first section of the present manuscript we review in a concise manner fundamental aspects of purine metabolism. The second section is devoted to the role of purines on the hypoxic response of the CB, providing the state-of-the art for the presence of adenosine and ATP receptors in the CB; for the role of purines at presynaptic level in CB chemoreceptor cells, as well as, its metabolism and regulation; at postsynaptic level in the CSN activity; and on the ventilatory responses to hypoxia. Recently, we have showed that adenosine is involved in CB hypersensitization during chronic intermittent hypoxia (CIH, which mimics obstructive sleep apnea, since caffeine, a non-selective adenosine receptor antagonist that inhibits A2A and A2B adenosine receptors, decreased CSN chemosensory activity in animals subjected to CIH. Apart from this involvement of adenosine in CB sensitization in sleep apnea, it was recently found that P2X3 ATP receptor in the CB contributes to increased chemoreflex hypersensitivity and hypertension in spontaneously hypertension rats. Therefore the last section of this manuscript is devoted to review the recent findings on the role of purines in CB-mediated pathologies as hypertension, diabetes and sleep apnea emphasizing the potential

Subdural hematoma from a cavernous malformation.

Science.gov (United States)

Schmitt, Anne J; Mitha, Alim P; Germain, Rasha; Eschbacher, Jennifer; Spetzler, Robert F

2014-01-01

To present a case of a cavernous malformation presenting with a subdural hematoma. A 27-year-old woman was admitted with progressively worsening headache, vomiting, weakness, and word-finding difficulties 1 week after she was discharged from an outside hospital, where she was managed conservatively for a presumed traumatic subdural hematoma. Computed tomography revealed an enlarging subacute left hemispheric subdural hematoma for which she underwent drill craniostomy. Postprocedural magnetic resonance imaging showed a posterior left temporal lobe mass consistent with a cavernous malformation juxtaposed with the subdural hematoma. Craniotomy for resection of the lesion was performed. She had an uncomplicated postoperative course and experienced a good recovery. The signs and symptoms, diagnostic imaging, and intraoperative findings suggest that the subdural hematoma was caused by extralesional hemorrhage of the cavernous malformation, which is a rare finding associated with these malformations. The clinical course, radiologic, and intraoperative findings suggest that the subdural hemorrhage was caused by extralesional hemorrhage of the cavernous malformation. Copyright © 2014 Elsevier Inc. All rights reserved.

Special people visit the ATLAS cavern

CERN Multimedia

Muriel

ATLAS has been host to many important visitors lately. Here are a selected few: Professor Stephen Hawking visits the ATLAS cavern On Tuesday 26 September 2006 the ATLAS Collaboration was honoured by a very special visit to the detector in the underground cavern. We were pleased to guide Professor Stephen Hawking, the famous cosmologist holding the post of Lucasian Professor of Mathematics at Cambridge University (position held by Isaac Newton in the 17th century), on a tour of the ATLAS pit and the LHC tunnel. The visit was accompanied by a few colleagues from the CERN Theory group, and was only possible thanks to the professional assistance of Olga Beltramello and Bernard Lebegue, who had also taken care of all the necessary preparatory work in the cavern. Professor Hawking was very keen to check for himself the status of the detector installation, and he admired, in particular, the spectacular TGC big wheel on side C. (left) Stephen Hawking in the ATLAS cavern side-C (right) and in the LHC tunnel...

The huge ATLAS cavern now fully excavated

CERN Multimedia

2002-01-01

Excavation of the ATLAS cavern is now complete! At the end of two years' work involving a tremendous technical challenge, the civil engineering contractors have succeeded in digging out one of the biggest experimental caverns in the world. Bravo!

Spontaneous pneumocephalus after commercial air travel complicated by meningitis.

Science.gov (United States)

Javan, Ramin; Duszak, Richard; Eisenberg, Alan D; Eggers, Frank M

2011-12-01

Pneumocephalus usually results from trauma, infection, neoplasm, or iatrogenic causes. Barotrauma-induced spontaneous pneumocephalus is extremely rare, usually seen in divers or occassionally with air travel. We report a case of a 61-yr-old female presenting with confusion, fever, and respiratory failure one day after developing sudden nausea, vomiting, and headache during descent on a commercial airliner. Pneumocephalus and meningitis were present on admission. Sinus computed tomography (CT) showed pansinusitis and a tiny bone defect in the posterior wall of the right sphenoid sinus, through which a cisternogram later showed free communication with the prepontine cistern. An orbital CT 2 yr earlier after a fall showed the bone defect, with no other areas of abnormality or fracture. After repair of defects by otolaryngology and appropriate antibiotics, she did well and was eventually discharged. Changes in aircraft cabin pressure likely resulted in rupture of dura and arachnoid layers beneath the pre-existing bony defect, predisposed by existing sinus disease. The pathophysiology, implications, and potential sources of spontaneous pneumocephalus, as well as risks of postcraniotomy and post-trauma air-travel, are discussed.

Spontaneous conversion of first onset atrial fibrillation

DEFF Research Database (Denmark)

Lindberg, Søren Østergaard; Hansen, Sidsel; Nielsen, Tonny

2011-01-01

Background  We studied all patients admitted to hospital with first onset atrial fibrillation (AF) to determine the probability of spontaneous conversion to sinus rhythm and to identify factors predictive of such a conversion. Methods and Results  We retrospectively reviewed charts of 438...

[A case of traumatic middle meningeal arteriovenous fistula on the side of the head opposite to the injured side].

Science.gov (United States)

Takeuchi, Satoru; Takasato, Yoshio; Masaoka, Hiroyuki; Hayakawa, Takanori; Otani, Naoki; Yoshino, Yoshikazu; Yatsushige, Hiroshi; Sugawara, Takashi; Aoyagi, Chikashi; Suzuki, Go

2009-10-01

A rare case of a traumatic middle meningeal arteriovenous fistula on the side of the head opposite to the injured side was reported. A 21-year-old man was admitted to our hospital after a traffic accident in which the right side of his head was hit. CT scans and MR images on admission showed a right temporal bone fracture, traumatic subarachnoid hemorrhage, and a left frontal lobe contusion. Three months after the head injury, he complained of tinnitus and exophthalmos. One year after the head injury, left external carotid angiograms showed a dural arteriovenous fistula fed by the left dilated middle meningeal artery and draining into the middle meningeal vein. Early filling of the sphenoparietal sinus, cavernous sinus, superior ophthalmic vein, and the cortical vein were also detected. Transarterial embolization of the left middle meningeal fistula was performed, resulting in the disappearance of the lesion. The postoperative course was uneventful.

Tolosa-Hunt syndrome. A CT demonstration of a high-density lesion

Energy Technology Data Exchange (ETDEWEB)

Hirata, Kazuhiro; Muramoto, Masato; Chiba, Yasuhiro; Yagishita, Saburo

1987-08-01

CT scan studies of the Tolosa-Hunt syndrome have seldom been reported; positive abnormal findings are especially rare. A 36-year-old man suffered from steady, boring pain behind the left eye for one year. On admission he complained of diplopia on the right lateral gaze and hypesthesea of the first and second divisions of the left trigeminal nerve. A CT scan demonstrated a slightly high-density lesion, which was homogeneously enhanced, in the left cavernous portion and the superior orbital fissure. Carotid angiograms demonstrated no abnormal finding, and the cavernous sinus venography revealed no filling of the left cavernous sinus. A left front-temporal craniotomy was performed for the purpose of biopsy. A histological examination revealed non-specific focal granulomatous pachymeningitis. He responded dramatically to systemic steroid therapy, and he became pain-free by the fourth post-operative day. This diagnosis of the Tolosa-Hunt syndrome was confirmed both clinically and etiologically; however, the CT scan after the treatment demonstrated no definitive change in the lesion. The CT scan is useful for the diagnosis of this syndrome. Considering the stage of the illness, it is possible that the high-resolution CT scan can demonstrate this lesion with an advanced technique. The clinical diagnosis is almost easy, and surgical exploration is not always necessary if there is a prompt remission upon systemic steroid therapy. However, this syndrome should be differentiated from the other causes by appropriate examinations. Some cases similar to ours, especially suspected tumors, need surgical exploration because these angiographic findings are not specific.

Pseudoaneurysm of the Internal Carotid Artery: Treatment with a Covered Stent

International Nuclear Information System (INIS)

Scavee, Vincent; Wispelaere, Jean-Francois de; Mormont, Eric; Coulier, Bruno; Trigaux, Jean-Paul; Schoevaerdts, Jean-Claude

2001-01-01

Dissection of the cervical segment of the internal carotid artery may occur spontaneously or after trauma. We report the management of a 53-year-old right-handed man with progressive dizziness and neck pain 6 weeks after a motor vehicle collision. The clinical and neurologic examinations were normal. The CT scan led to the diagnosis of a pseudoaneurysm of the right internal carotid artery near the skull base. We successfully treated this post-traumatic lesion with a covered stent. The patient underwent the endovascular procedure under general anesthesia and transcranial Doppler monitoring. No neurologic event was observed. Obliteration of the pseudoaneurysm with preservation of the carotid artery was achieved. The patient was discharged from the hospital 72 hr later with no complications. Clinical and imaging follow-up at 6 months was unremarkable

Risk assessment of nonhazardous oil-field waste disposal in salt caverns.

Energy Technology Data Exchange (ETDEWEB)

Elcock, D.

1998-03-05

In 1996, Argonne National Laboratory (ANL) conducted a preliminary technical and legal evaluation of disposing of nonhazardous oil-field wastes (NOW) into salt caverns. Argonne determined that if caverns are sited and designed well, operated carefully, closed properly, and monitored routinely, they could be suitable for disposing of oil-field wastes. On the basis of these findings, Argonne subsequently conducted a preliminary evaluation of the possibility that adverse human health effects (carcinogenic and noncarcinogenic) could result from exposure to contaminants released from the NOW disposed of in domal salt caverns. Steps used in this evaluation included the following: identifying potential contaminants of concern, determining how humans could be exposed to these contaminants, assessing contaminant toxicities, estimating contaminant intakes, and calculating human cancer and noncancer risk estimates. Five postclosure cavern release scenarios were assessed. These were inadvertent cavern intrusion, failure of the cavern seal, failure of the cavern through cracks, failure of the cavern through leaky interbeds, and a partial collapse of the cavern roof. Assuming a single, generic, salt cavern and generic oil-field wastes, potential human health effects associated with constituent hazardous substances (arsenic, benzene, cadmium, and chromium) were assessed under each of these scenarios. Preliminary results provided excess cancer risk and hazard index (referring to noncancer health effects) estimates that were well within the US Environmental Protection Agency (EPA) target range for acceptable exposure risk levels. These results led to the preliminary conclusion that from a human health perspective, salt caverns can provide an acceptable disposal method for nonhazardous oil-field wastes.

Risk assessment of nonhazardous oil-field waste disposal in salt caverns

International Nuclear Information System (INIS)

Elcock, D.

1998-01-01

In 1996, Argonne National Laboratory (ANL) conducted a preliminary technical and legal evaluation of disposing of nonhazardous oil-field wastes (NOW) into salt caverns. Argonne determined that if caverns are sited and designed well, operated carefully, closed properly, and monitored routinely, they could be suitable for disposing of oil-field wastes. On the basis of these findings, Argonne subsequently conducted a preliminary evaluation of the possibility that adverse human health effects (carcinogenic and noncarcinogenic) could result from exposure to contaminants released from the NOW disposed of in domal salt caverns. Steps used in this evaluation included the following: identifying potential contaminants of concern, determining how humans could be exposed to these contaminants, assessing contaminant toxicities, estimating contaminant intakes, and calculating human cancer and noncancer risk estimates. Five postclosure cavern release scenarios were assessed. These were inadvertent cavern intrusion, failure of the cavern seal, failure of the cavern through cracks, failure of the cavern through leaky interbeds, and a partial collapse of the cavern roof. Assuming a single, generic, salt cavern and generic oil-field wastes, potential human health effects associated with constituent hazardous substances (arsenic, benzene, cadmium, and chromium) were assessed under each of these scenarios. Preliminary results provided excess cancer risk and hazard index (referring to noncancer health effects) estimates that were well within the US Environmental Protection Agency (EPA) target range for acceptable exposure risk levels. These results led to the preliminary conclusion that from a human health perspective, salt caverns can provide an acceptable disposal method for nonhazardous oil-field wastes

Risk assessment of nonhazardous oil-field waste disposal in salt caverns.

Energy Technology Data Exchange (ETDEWEB)

Elcock, D.

1998-03-10

Salt caverns can be formed in underground salt formations incidentally as a result of mining or intentionally to create underground chambers for product storage or waste disposal. For more than 50 years, salt caverns have been used to store hydrocarbon products. Recently, concerns over the costs and environmental effects of land disposal and incineration have sparked interest in using salt caverns for waste disposal. Countries using or considering using salt caverns for waste disposal include Canada (oil-production wastes), Mexico (purged sulfates from salt evaporators), Germany (contaminated soils and ashes), the United Kingdom (organic residues), and the Netherlands (brine purification wastes). In the US, industry and the regulatory community are pursuing the use of salt caverns for disposal of oil-field wastes. In 1988, the US Environmental Protection Agency (EPA) issued a regulatory determination exempting wastes generated during oil and gas exploration and production (oil-field wastes) from federal hazardous waste regulations--even though such wastes may contain hazardous constituents. At the same time, EPA urged states to tighten their oil-field waste management regulations. The resulting restrictions have generated industry interest in the use of salt caverns for potentially economical and environmentally safe oil-field waste disposal. Before the practice can be implemented commercially, however, regulators need assurance that disposing of oil-field wastes in salt caverns is technically and legally feasible and that potential health effects associated with the practice are acceptable. In 1996, Argonne National Laboratory (ANL) conducted a preliminary technical and legal evaluation of disposing of nonhazardous oil-field wastes (NOW) into salt caverns. It investigated regulatory issues; the types of oil-field wastes suitable for cavern disposal; cavern design and location considerations; and disposal operations, closure and remediation issues. It determined

Risk assessment of nonhazardous oil-field waste disposal in salt caverns

International Nuclear Information System (INIS)

Elcock, D.

1998-01-01

Salt caverns can be formed in underground salt formations incidentally as a result of mining or intentionally to create underground chambers for product storage or waste disposal. For more than 50 years, salt caverns have been used to store hydrocarbon products. Recently, concerns over the costs and environmental effects of land disposal and incineration have sparked interest in using salt caverns for waste disposal. Countries using or considering using salt caverns for waste disposal include Canada (oil-production wastes), Mexico (purged sulfates from salt evaporators), Germany (contaminated soils and ashes), the United Kingdom (organic residues), and the Netherlands (brine purification wastes). In the US, industry and the regulatory community are pursuing the use of salt caverns for disposal of oil-field wastes. In 1988, the US Environmental Protection Agency (EPA) issued a regulatory determination exempting wastes generated during oil and gas exploration and production (oil-field wastes) from federal hazardous waste regulations--even though such wastes may contain hazardous constituents. At the same time, EPA urged states to tighten their oil-field waste management regulations. The resulting restrictions have generated industry interest in the use of salt caverns for potentially economical and environmentally safe oil-field waste disposal. Before the practice can be implemented commercially, however, regulators need assurance that disposing of oil-field wastes in salt caverns is technically and legally feasible and that potential health effects associated with the practice are acceptable. In 1996, Argonne National Laboratory (ANL) conducted a preliminary technical and legal evaluation of disposing of nonhazardous oil-field wastes (NOW) into salt caverns. It investigated regulatory issues; the types of oil-field wastes suitable for cavern disposal; cavern design and location considerations; and disposal operations, closure and remediation issues. It determined

Transient behaviour of deep underground salt caverns

International Nuclear Information System (INIS)

Karimi-Jafari, M.

2007-11-01

This work deals with the transient behaviour of deep underground salt caverns. It has been shown that a cavern is a complex system, in which there are mechanical, thermal, chemical and hydraulic evolutions. The importance of the transient evolutions, particularly the role of the 'reverse' creep in the interpretation of the tightness test in a salt cavern is revealed. Creep is characterized by a formulation of the behaviour law which presents the advantage, in a practical point of view, to only have a reduced number of parameters while accounting of the essential of what it is observed. The initiation of the rupture in the effective traction in a salt cavern rapidly pressurized is discussed. A model fitted to a very long term behaviour (after abandonment) is developed too. In this case too, a lot of phenomena, more or less coupled, occur, when the existing literature took only into account some phenomena. (O.M.)

Multidetector computerized tomographic fistulography in the evaluation of congenital branchial cleft fistulae and sinuses.

Science.gov (United States)

Sun, Zhipeng; Fu, Kaiyuan; Zhang, Zuyan; Zhao, Yanping; Ma, Xuchen

2012-05-01

The aim of this study was to primarily investigate the usefulness of computerized tomographic (CT) fistulography in the diagnosis and management of branchial cleft fistulae and sinuses. Fifteen patients with confirmed branchial fistulae or sinuses who had undergone CT fistulography were included. The diagnoses were confirmed by clinical, radiologic, or histopathologic examinations. The internal openings, distribution, and neighboring relationship of the lesions presented by CT fistulography were analyzed to evaluate the usefulness in comparison with x-ray fistulography. Nine patients were diagnosed with first branchial fistulae or sinuses, 2 with second branchial fistulae, and 4 with third or fourth branchial fistulae. The presence and location of the lesions could be seen on x-ray fistulography. The distribution of the lesions, internal openings, and neighboring relationship with parotid gland, carotid sheath, and submandibular gland could be clearly demonstrated on CT cross-sectional or volume-rendering images. CT fistulography could provide valuable information and benefit surgical planning by demonstrating the courses of branchial anomalies in detail. Copyright © 2012 Elsevier Inc. All rights reserved.

Conjunctival-corneal melt in association with carotid artery stenosis

Directory of Open Access Journals (Sweden)

Rosalind MK Stewart

2008-10-01

Full Text Available Rosalind MK Stewart1, Say Aun Quah1, Dan Q Nguyen2, Stephen B Kaye11Royal Liverpool University Hospital, Liverpool, UK; 2Bristol Eye Hospital, Bristol, UKPurpose: To report a case of severe conjunctival-corneal melt in association with carotid artery stenosis.Methods: Observational case report.Results: A 76-year-old man with a history of bilateral severe carotid artery occlusion and nonarteritic ischemic optic neuropathy developed a spontaneous bulbar conjunctival defect. Despite intensive lubrication, and attempts at surgical closure including an amniotic membrane patch graft, it progressed with subsequent adjacent corneal perforation. Thorough investigations revealed no underlying disease, except markedly delayed episcleral vessel filling on anterior segment fluorescein angiography.Conclusions: Neovascularisation is a known factor in the inhibition of ulceration. In light of the findings in this report, ocular ischemia should be considered as a cause or contributing factor in the differential diagnosis of conjunctival-corneal melt.Keywords: conjunctival melt, corneal melt, ocular ischemia, carotid artery stenosis

Giant intracranial aneurysm with fistula to the paranasal sinuses - a case report; Aneurisma gigante intracraniano com fistula para os seios paranasais - relato de um caso

Energy Technology Data Exchange (ETDEWEB)

Cabral, Luciano Gusmao; Monteiro, Soraya Silveira; Rossi, Luiz Antonio; Araujo, Marcelo Antonio Nobrega; Iagarachi, Celso Kendy; Oliveira, Luiz Antonio Nunes de [Hospital do Servidor Publico Estadual de Sao Paulo, SP (Brazil). Serv. de Radiologia

1998-09-01

The authors present a case of giant aneurysm of internal carotid artery with extensive bone erosion, which led to a fistula to the paranasal sinuses. The clinical aspects, radiological findings and differential diagnosis of giant intracranial aneurysms are discussed. (author) 9 refs., 5 figs.

Carotid artery aneurysm resulting in myxedema coma

Directory of Open Access Journals (Sweden)

Elizabeth M. Lamos

2015-06-01

Full Text Available Intra-sellar aneurysms are a rare, but important consideration when evaluating pituitary masses. Identification of aneurysms is critical to appropriate treatment and avoiding perilous consequences. These vascular aneurysms can result in severe endocrine dysfunction due to mass effect, stripping of the vascular supply to the pituitary, or hemorrhage. Here we describe a novel case of spontaneous myxedema coma and pituitary apoplexy secondary to a large internal carotid artery aneurysm.

Tolosa-Hunt syndrome: MRI appearances

International Nuclear Information System (INIS)

Jain, R.; Sawhney, S.; Koul, R. L.; Chand, P.

2008-01-01

Full text: A review of MRI findings in seven patients with Tolosa-Hunt syndrome was carried out. Seven patients presented with unilateral painful ophthalmoplegia. Magnetic resonance imaging studies were carried out to evaluate the cavernous sinuses and orbits. Coronal fast spin-echo T 2 -weighted images and fat-saturated T 1 -weighted coronal and transverse images with and without contrast enhancement were obtained for the cavernous sinuses and orbits. All patients showed focal-enhancing masses expanding the ipsilateral cavernous sinus. In one patient the mass was extending to the orbital apex and intraorbital. All patients recovered on corticosteroid therapy and resolution of the masses was documented on follow-up MRI studies in five patients. One patient had a relapse of symptoms after discontinuing therapy. Magnetic resonance imaging studies of the cavernous sinus and orbital apex show high sensitivity for the detection and follow up of inflammatory mass lesions in Tolosa-Hunt syndrome. Magnetic resonance imaging should be the initial screening study in these patients.

Digging a cavern for a titan

CERN Multimedia

Patrice Loiez

1999-01-01

Civil engineers work 100 m underground near the France-Swiss border on the cavern that will soon house ATLAS, one of the experiments on CERN's new LHC accelerator. All personnel and equipment must be lowered by crane down the access shaft. When completed this cavern will have one of the largest spans constructed at 35 m, which required the roof to be supported by large steel anchors buried in concrete.

Civil Engineering in the ATLAS cavern

CERN Multimedia

Laurent Guiraud

2000-01-01

Ghostly figures can be seen wandering the cavern that will eventually house the ATLAS experiment, part of the LHC at CERN. Quite fitting since the detector will hunt the illusive 'ghostly' particles, such as the Higgs boson and dark matter. These engineers are excavating the huge cavern that has to be anchored from above as the detector will fill so much space that there is no room for support pillars.

The Pedicled Buccal Fat Pad: Anatomical Study of the New Flap for Skull Base Defect Reconstruction After Endoscopic Endonasal Transpterygoid Surgery

Science.gov (United States)

Golbin, Denis A.; Lasunin, Nikolay V.; Cherekaev, Vasily A.; Polev, Georgiy A.

2016-01-01

Objectives To evaluate the efficacy and safety of using a buccal fat pad for endoscopic skull base defect reconstruction. Design Descriptive anatomical study with an illustrative case presentation. Setting Anatomical study was performed on 12 fresh human cadaver specimens with injected arteries (24 sides). Internal carotid artery was exposed in the coronal plane via the endoscopic transpterygoid approach. The pedicled buccal fat pad was used for reconstruction. Participants: 12 human cadaver head specimens; one patient operated using the proposed technique. Main outcome measures: Proximity of the buccal fat pad flap to the defect, compliance of the flap, comfort and safety of harvesting procedure, and compatibility with the Hadad–Bassagasteguy nasoseptal flap. Results: Harvesting procedure was performed using anterior transmaxillary corridor. The pedicled buccal fat pad flap can be used to pack the sphenoid sinus or cover the internal carotid artery from cavernous to upper parapharyngeal segment. Conclusion The buccal fat pad can be safely harvested through the same approach without external incisions and is compliant enough to conform to the skull base defect. The proposed pedicled flap can replace free abdominal fat in central skull base reconstruction. The volume of the buccal fat pad allows obliteration of the sphenoid sinus or upper parapharyngeal space. PMID:28180047

Metastases in the cavernous synus

International Nuclear Information System (INIS)

Victoria Fernandez, C.; Gonzalez Patino, E.; Pereiro Zabala, I.; Lopez Vazquez, M.D.; Cascallar Caneda, L.; Porto Vazquez, M.C.

1993-01-01

We report four cases of metastases in the cavernous synus in patients with primary tumors of parotid gland, lymphatic system, breast and colon. In spite of the similarity in the presentation clinic, the diagnosis wasn't carried out in all the cases with the required celerity, specially in the case of the first presentation of metastasis disease. Three of them response. We analyze the clinic and radiologic data characteristical in cavernous synus metastases, highliting the importance of diagnostic techniques, facilitating as soon as possible the suitable treatment. (Author)

Pediatric Sinusitis

Science.gov (United States)

... ENTCareers Marketplace Find an ENT Doctor Near You Pediatric Sinusitis Pediatric Sinusitis Patient Health Information News media interested in ... sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms of ...

A new shape design method of salt cavern used as underground gas storage

International Nuclear Information System (INIS)

Wang, Tongtao; Yan, Xiangzhen; Yang, Henglin; Yang, Xiujuan; Jiang, Tingting; Zhao, Shuai

2013-01-01

Graphical abstract: Safety factor contours of four salt cavern gas storages after running 10 years. Highlights: ► We propose a new model to design the shape of salt cavern gas storage. ► The concepts of slope instability and pressure arch are introduced into the shape design. ► The max. gas pressure determines the shapes and dimensions of cavern lower structure. ► The min. gas pressure decides the shapes and dimensions of cavern upper structure. - Abstract: A new model used to design the shape and dimension of salt cavern gas storage is proposed in the paper. In the new model, the cavern is divided into two parts, namely the lower and upper structures, to design. The concepts of slope instability and pressure arch are introduced into the shape design of the lower and upper structures respectively. Calculating models are established according to the concepts. Field salt cavern gas storage in China is simulated as examples, and its shape and dimension are proposed. The effects of gas pressure, friction angle and cohesion of rock salt on the cavern stability are discussed. Moreover, the volume convergence, displacement, plastic volume rate, safety factor, and effective strain are compared with that of three other existing shapes salt caverns to validate the performance of newly proposed cavern. The results show that the max. gas pressure determines the shape and dimension of cavern lower structure, while the min. gas pressure decides that of cavern upper structure. With the increase of friction angle and cohesion of rock salt, the stability of salt cavern is increased. The newly proposed salt cavern gas storage has more notable advantages than the existing shapes of salt cavern in volume convergence, displacement, plastic volume rate, safety factor, and effective strain under the same conditions

Air quality in the Carlsbad cavern

International Nuclear Information System (INIS)

Cheng, Yung-Seng; Chen, Tou-Rong; Wasiolek, P.T.

1994-01-01

The air quality in the Carlsbad Cavern has been investigated, but there are no reports on radon progeny and aerosols. The purpose of this experiment was to determine the activity size distribution of radon progeny and the air exchange rate inside the Cavern. Teams from ITRI and New Mexico Institute of Mining and Technology (NMT) conducted the field study in July 1994. The ITRI graded diffusion battery (GDB) was used to determine the activity size distribution, progeny concentration, equilibrium factor, and unattached fraction of the radon progeny. The design, calibration, and performance of the GDB have been described. For this study, each stage of the GDB contained one stainless steel screen, with the mesh sizes arranged in a series of 30, 50, 145, 200, and 635 mesh from the air inlet to the outlet. A 47-nm type A/E glass fiber filter was used to collect all particles that penetrated the screens. The flow rate was 5 L/min. The average ventilation rate in the cavern is 0.0026 V/hr. Our results showed that the cavern atmosphere may be quite different from other underground environments. The atmosphere in the summer is stable and relatively free of airborne particles, partly due to the extremely slow air exchange rate

Spontaneous Intracranial Hypotension

International Nuclear Information System (INIS)

Joash, Dr.

2015-01-01

Epidemiology is not only rare but an important cause of new daily persistent headaches among young & middle age individuals. The Etiology & Pathogenesis is generally caused by spinal CSF leak. Precise cause remains largely unknown, underlying structural weakness of spinal meninges is suspected. There are several MR Signs of Intracranial Hypotension that include:- diffuse pachymeningeal (dural) enhancement; bilateral subdural, effusion/hematomas; Downward displacement of brain; enlargement of pituitary gland; Engorgement of dural venous sinuses; prominence of spinal epidural venous plexus and Venous sinus thrombosis & isolated cortical vein thrombosis. The sum of volumes of intracranial blood, CSF & cerebral tissue must remain constant in an intact cranium. Treatment in Many cases can be resolved spontaneously or by use Conservative approach that include bed rest, oral hydration, caffeine intake and use of abdominal binder. Imaging Modalities for Detection of CSF leakage include CT myelography, Radioisotope cisternography, MR myelography, MR imaging and Intrathecal Gd-enhanced MR

Features of Bayou Choctaw SPR caverns and internal structure of the salt dome.

Energy Technology Data Exchange (ETDEWEB)

Munson, Darrell E.

2007-07-01

The intent of this study is to examine the internal structure of the Bayou Choctaw salt dome utilizing the information obtained from graphical representations of sonar survey data of the internal cavern surfaces. Many of the Bayou Choctaw caverns have been abandoned. Some existing caverns were purchased by the Strategic Petroleum Reserve (SPR) program and have rather convoluted histories and complex cavern geometries. In fact, these caverns are typically poorly documented and are not particularly constructive to this study. Only two Bayou Choctaw caverns, 101 and 102, which were constructed using well-controlled solutioning methods, are well documented. One of these was constructed by the SPR for their use while the other was constructed and traded for another existing cavern. Consequently, compared to the SPR caverns of the West Hackberry and Big Hill domes, it is more difficult to obtain a general impression of the stratigraphy of the dome. Indeed, caverns of Bayou Choctaw show features significantly different than those encountered in the other two SPR facilities. In the number of abandoned caverns, and some of those existing caverns purchased by the SPR, extremely irregular solutioning has occurred. The two SPR constructed caverns suggest that some sections of the caverns may have undergone very regular solutioning to form uniform cylindrical shapes. Although it is not usually productive to speculate, some suggestions that point to the behavior of the Bayou Choctaw dome are examined. Also the primary differences in the Bayou Choctaw dome and the other SPR domes are noted.

Penile cavernous hemangioma

Directory of Open Access Journals (Sweden)

Abdelmoughit ECHCHAOUI

2015-06-01

Full Text Available Hemangiomas are benign lesions that occur in any part of the body in newborns or in young patients, they are typically capillary or cavernous. Cavernous hemangioma of the penis is extremely rare; and its etiology is not completely understood. Treatment options (surgical excision, laser therapy or sclerotherapy… are controversial and are required if pain, cosmetic defect and/or bleeding during intercourse.                                                  We report a case of a 26 years old man presented with a five years history of a painless lesion on his penis. Physical examination showed an ovoid, solid, 1 x 2 mm in size on the dorsum of penis (Panel A and two elevated irregular lesions on the ventral side (Panel B. The lesions were compressive, nonpulsatile and bluish-red in color with strawberry like appearance. Biopsy and histopathological examination of the lesion revealed a gaping and communicating vessels proliferated in the superficial and medium dermis which is pathognomonic for cavernous hemangioma (Panel C and D. Given the small size, the large number of the lesions, the young age, and the ulceration risk during intercourse if skin graft after excision, Neodymium: YAG laser coagulation was recommended to get a good cosmetic results and sexual function satisfaction.

Newer techniques for intravascular and intraoperative neurointerventional procedures

International Nuclear Information System (INIS)

Higashida, R.T.; Halbach, V.V.; Hieshima, G.B.; Yang, P.

1987-01-01

A videotape demonstrating newer techniques used in intravascular and intraoperative embolization procedures will be presented. The authors discuss the use of some of the newer embolic agents, real-time digital subtraction angiography, roadmapping techniques, and the use of microcatheters and steerable micro guide wires, which has greatly facilitated neurovascullar embolization procedures and enhanced patient safety. A number of actual intraoperative and intravascular cases will be shown demonstrating treatment of vascular malformations of the brain and spinal cord, carotid cavernous sinus fistulas, aneurysms and dural arteriovenous malformations. The indications for treatment, patient selection, technical preparation and newer methodologies and approaches to complex vascular lesions of the brain and spinal cord are discussed in detail

Geomechanical Analysis and Design Considerations for Thin-Bedded Salt Caverns. Final Report

International Nuclear Information System (INIS)

Michael S. Bruno

2005-01-01

The bedded salt formations located throughout the United States are layered and interspersed with non-salt materials such as anhydrite, shale, dolomite and limestone. The salt layers often contain significant impurities. GRI and DOE have initialized this research proposal in order to increase the gas storage capabilities by providing operators with improved geotechnical design and operating guidelines for thin bedded salt caverns. Terralog has summarized the geologic conditions, pressure conditions, and critical design factors that may lead to: (1) Fracture in heterogeneous materials; (2) Differential deformation and bedding plane slip; (3) Propagation of damage around single and multiple cavern; and (4) Improved design recommendations for single and multiple cavern configurations in various bedded salt environments. The existing caverns within both the Permian Basin Complex and the Michigan and Appalachian Basins are normally found between 300 m to 1,000 m (1,000 ft to 3,300 ft) depth depending on local geology and salt dissolution depth. Currently, active cavern operations are found in the Midland and Anadarko Basins within the Permian Basin Complex and in the Appalachian and Michigan Basins. The Palo Duro and Delaware Basins within the Permian Basin Complex also offer salt cavern development potential. Terralog developed a number of numerical models for caverns located in thin bedded salt. A modified creep viscoplastic model has been developed and implemented in Flac3D to simulate the response of salt at the Permian, Michigan and Appalachian Basins. The formulation of the viscoplastic salt model, which is based on an empirical creep law developed for Waste Isolation Pilot Plant (WIPP) Program, is combined with the Drucker-Prager model to include the formation of damage and failure. The Permian salt lab test data provided by Pfeifle et al. 1983, are used to validate the assumptions made in the material model development. For the actual cavern simulations two

Preoperative irradiation of an extracerebral cavernous hemangioma in the middle fossa. Follow-up study with computed tomography

Energy Technology Data Exchange (ETDEWEB)

Shibata, S; Kurihara, M; Mori, K [Nagasaki Univ. (Japan). School of Medicine; Amamoto, Y

1981-02-01

This is a report of case with the extracerebral cavernous hemangioma in the middle fossa in which total removal was carried out after radiotherapy. Follow-up study with computed tomography during and after irradiation are presented. A 44-year-old house-wife complained of a decreased vision of the both eyes and paresis of the left upper and lower limbs. CT scan revealed a slightly high density area in the right middle cranial fossa which was markedly enhanced with contrast media. Right carotid angio-graphy demonstrated a large avascular mass in the right middle fossa and no feeding artery or draining vein was visualized except a faint irregular stain in the venous phase. An attempt to total removal of the tumor had failed to succeed because of extensive hemorrhage from the tumor. Histological examination revealed a cavernous hemangioma. Irradiation with a total dose of 5000 rads was delivered. After irradiation CT scan revealed a marked decrease of size and EMI number of the tumor. At this stage, hypervascular mass lesion with feeding arteries was noted in conventional angiography. Tumor stain in prolonged injection angiography was also visualized. In the second operation, removal of the tumor was performed without any difficulty and hemorrhage was controlled easily by electrocoagulation. Histology revealed a marked narrowing of vessels with an increase in the connective tissues. In the central part of specimen, there noted findings of coagulation necrosis, intraluminal thrombus formations and so on, which were attributed to the influence of radiation. It is concluded that in case of an extracerebral cavernous hemangioma with massive hemorrhage, radiation of up to 3000 - 5000 rads was a method of choice. The treatment results in an increase of probability of total removal of the tumor.

Treatment of complex internal carotid artery aneurysms using radial artery grafts. Surgical technique, perioperative complications, and results in 17 patients

International Nuclear Information System (INIS)

Murai, Yasuo; Teramoto, Akira; Mizunari, Takayuki; Kobayashi, Shiro; Kamiyama, Hiroyasu

2007-01-01

cavernous internal carotid artery aneurysms. Radial artery grafting was a reliable way to bypass the parent segment just prior to its occlusion. (author)

Cavernous transformation of the portal vein

International Nuclear Information System (INIS)

Lehotska, V.; Dostalova, K.; Durkovsky, A.; Samal, V.

1995-01-01

In this contribution, the authors give an account of a rare case of a cavernous transformation of the portal vein that may have originated secondarily in a proliferative hematogenous disease with a polyglobulia and thrombosis in the periferal blood count as well as development of portal hypertension of a prehepatal type. The state of hyper-coagulation in a myeloproliferative disease may have lead to a chronic thrombosis of the portal vein with a subsequent malformation of the portal vein in terms of a cavernous transformation of the portal vein. The case is an interesting one because of the discrepancy between the gravity of the thrombotic complication and slightness of the symptoms in the clinical picture. The authors point out the importance of ultrasonography and computed tomography examination following the intravenous application of a water solution of a contrast medium in a morphologic diagnosing of a rare complication of a chronic thrombotic clot of the portal vein - the cavernous transformation. (authors)

Systematic Evaluation of Salt Cavern Well Integrity

Science.gov (United States)

Roberts, B. L.; Lord, D. L.; Lord, A. S.; Bettin, G.; Sobolik, S. R.; Park, B. Y.

2017-12-01

The U.S. Strategic Petroleum Reserve (SPR) holds a reserve of crude oil ( 700 million barrels) to help ease any interruptions in oil import to the United States. The oil is stored in a set of 63 underground caverns distributed across four sites along the U.S. Gulf Coast. The caverns were solution mined into salt domes at each of the four sites. The plastic nature of the salt is beneficial for the storage of crude oil as it heals any fractures that may occur in the salt. The SPR is responsible for operating and maintaining the nearly 120 wells used to access the storage caverns over operational lifetimes spanning decades. Salt creep can induce deformation of the well casing which must be remediated to insure cavern and well integrity. This is particularly true at the interface between the plastic salt and the rigid caprock. The Department of Energy, the SPR Management and Operations contractor, and Sandia National Laboratories has developed a multidimensional well-grading system for the salt cavern access wells. This system is designed to assign numeric grades to each well indicating its risk of losing integrity and remediation priority. The system consists of several main components which themselves may consist of sub-components. The main components consider such things as salt cavern pressure history, results from geomechanical simulations modeling salt deformation, and measurements of well casing deformation due to salt creep. In addition, the geology of the salt domes and their overlying caprock is also included in the grading. These multiple factors are combined into summary values giving the monitoring and remediation priority for each well. Sandia National Laboratories is a multimission laboratory managed and operated by National Technology and Engineering Solutions of Sandia LLC, a wholly owned subsidiary of Honeywell International Inc. for the U.S. Department of Energy's National Nuclear Security Administration under contract DE-NA0003525.

Transcranial and Epidural Approach for Spontaneous Cerebrospinal Fluid Leakage Due to Meningoencephalocele of the Lateral Sphenoid Sinus.

Science.gov (United States)

Shintoku, Ryosuke; Tosaka, Masahiko; Shimizu, Tatsuya; Yoshimoto, Yuhei

2018-01-01

We experienced a case of sphenoid sinus type meningoencephalocele manifesting as severe cerebrospinal fluid (CSF) rhinorrhea. A 35-year-old man became aware of serous nasal discharge 1 year previously, which had gradually worsened. The nasal discharge was diagnosed as CSF rhinorrhea. Head computed tomography (CT) showed several small depressions in the bone of the left middle cranial fossa, and the largest depression extended through the bone to the lateral sphenoid sinus. Head magnetic resonance imaging revealed that the meningoencephalocele projected to the lateral sphenoid sinus, through this small bone defect of the middle cranial fossa. We performed a combined craniotomy and epidural approach without intradural procedures using neuronavigation. Multiple meningoencephaloceles protruded into small depressions in the middle skull base. The small protrusions not passing through the sphenoid sinus were coagulated. The largest protrusion causing the CSF leakage was identified by neuronavigation. This meningoencephalocele was cut. Both the dural and bone sides were closed with double layers to prevent CSF leakage. The CSF rhinorrhea completely stopped after the surgery. In our case, identification of the leak site was easy with neuronavigation based on bone window CT. The epidural approach also has significant advantages with double layer closure, including both the dural and bone sides. If the site of CSF leakage is outside the foramen rotundum (as with the most common type of lateral sphenoid sinus meningoencephalocele), we recommend the epidural approach using neuronavigation for surgical treatment.

Brain MRI findings of spontaneous intracranial hypotension

Energy Technology Data Exchange (ETDEWEB)

Park, Won Kyu; Byun, Woo Mok; Cho, Jae Ho; Cho Kil Ho; Hwang, Mi Soo; Park, Bok Hwan [Yeungnam Univ. College of Medicine, Taegu (Korea, Republic of); Joo, Yang Gu [Keimyoung Univ. College of Medicine, Taegu (Korea, Republic of); Lee, Sang Jin [Soonchunhyang Univ. College of Medicine, Seoul (Korea, Republic of)

1997-09-01

To evaluate brain MRI findings of spontaneous intracranial hypotension. A retrospective review of MRI findings was conducted on six patients with clinically proven spontaneous intracranial hypotension; no patient had a history of previous spinal puncture. Follow-up MRI was available in two patients, and to detect CSF leakage, radio-nuclide cisternography(n=3D5), myelography(n=3D1), and MR myelography(n=3D1) were performed. On contrast-enhanced T1WI, diffuse dural enhancement was seen in all cases, subdural hematoma or hygroma was seen in four cases, pituitary gland prominence in four, dural sinus dilatation in four, downward displacement of the cerebellar tonsil in two, downward displacement of the iter in one, and suprasellar and prepontine cistern effacement in two. In no patient was abnormal CSF leakage found. Although dural enhancement, as seen on MRI, is not specific, diffuse enhancement of the dura mater accompanied by subdural hematoma, hygroma, pituitary gland prominence, dural sinus dilatation, downward displacement of the cerebellar tonsil, or suprasellar and prepontine cistern effacement can strongly suggest intracranial hypotension.=20.

Incidence of enhancement of the optic nerve/sheath complex in fat-suppression orbit MRI

Energy Technology Data Exchange (ETDEWEB)

Lee, Ho Kyu; Yoon, Kwon Ha; Choi, Choong Gon; Suh, Dae Chul [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

1995-04-15

To elucidate the incidence of Gd-DTPA enhancement of the optic nerve/sheath complex (ONC) in patients with various ophthalmopathies using fat-suppression MRI. Orbit MRI with fat-suppression technique (ChemSat) was performed in 58 patients with normal and various orbital lesions. The fat-suppression MR was done with and without Gd-DTPA injection in all cases. MR findings were reviewed retrospectively in a blind fashion with respect to presence or absence of contrast enhancement of the ONC. Contrast enhancement of the ONC was seen in 86% (6/7) of cavernous sinus lesions, 80% (8/10) of intraconal lesions excluding the ONC, 57% (16/28) of ONC lesions, 38% (3/8) of ocular lesions, and 2% (1/55) of normal orbits. The ONC enhancement was the most common in optic nerve/sheath tumors (10/10), and pseudotumors (6/6), cavernous sinus dural arteriovenous malformations (3/3) and cavernous sinus thrombosis (2/2), and less frequently seen in optic neuritis (3/14). Enhancement of the ONC may be seen in lesions of the cavernous sinus and orbit other than optic nerve/sheath lesion.

Multiple Vascular Accidents Including Rupture of a Sinus of Valsalva Aneurysm, a Minor Ischemic Stroke and Intracranial Arterial Anomaly in a Patient with Systemic Congenital Abnormalities: A Case Report

Directory of Open Access Journals (Sweden)

Masataka Nakajima

2013-11-01

Full Text Available A 39-year-old man with a history of rupture of a sinus of Valsalva aneurysm experienced an ischemic stroke. Although the patient presented left-sided hemiparesis for a week, no abnormal signals were indicated on diffusion-weighted imaging with repeated magnetic resonance scans. Carotid ultrasound and cerebral angiography were conducted, and they revealed hypoplasty of the left internal carotid artery with a low-lying carotid bifurcation at the level of the C6 vertebra. In addition, he was diagnosed with intellectual disabilities, evaluated by the Wechsler Adult Intelligence Scale-III, and congenital velopharyngeal insufficiency. We herein present the first report of a patient with cardio-cerebrovascular abnormalities, intellectual disabilities, and an otorhinolaryngological abnormality.

Carotid body denervation prevents fasting hyperglycemia during chronic intermittent hypoxia.

Science.gov (United States)

Shin, Mi-Kyung; Yao, Qiaoling; Jun, Jonathan C; Bevans-Fonti, Shannon; Yoo, Doo-Young; Han, Woobum; Mesarwi, Omar; Richardson, Ria; Fu, Ya-Yuan; Pasricha, Pankaj J; Schwartz, Alan R; Shirahata, Machiko; Polotsky, Vsevolod Y

2014-10-01

Obstructive sleep apnea causes chronic intermittent hypoxia (IH) and is associated with impaired glucose metabolism, but mechanisms are unknown. Carotid bodies orchestrate physiological responses to hypoxemia by activating the sympathetic nervous system. Therefore, we hypothesized that carotid body denervation would abolish glucose intolerance and insulin resistance induced by chronic IH. Male C57BL/6J mice underwent carotid sinus nerve dissection (CSND) or sham surgery and then were exposed to IH or intermittent air (IA) for 4 or 6 wk. Hypoxia was administered by decreasing a fraction of inspired oxygen from 20.9% to 6.5% once per minute, during the 12-h light phase (9 a.m.-9 p.m.). As expected, denervated mice exhibited blunted hypoxic ventilatory responses. In sham-operated mice, IH increased fasting blood glucose, baseline hepatic glucose output (HGO), and expression of a rate-liming hepatic enzyme of gluconeogenesis phosphoenolpyruvate carboxykinase (PEPCK), whereas the whole body glucose flux during hyperinsulinemic euglycemic clamp was not changed. IH did not affect glucose tolerance after adjustment for fasting hyperglycemia in the intraperitoneal glucose tolerance test. CSND prevented IH-induced fasting hyperglycemia and increases in baseline HGO and liver PEPCK expression. CSND trended to augment the insulin-stimulated glucose flux and enhanced liver Akt phosphorylation at both hypoxic and normoxic conditions. IH increased serum epinephrine levels and liver sympathetic innervation, and both increases were abolished by CSND. We conclude that chronic IH induces fasting hyperglycemia increasing baseline HGO via the CSN sympathetic output from carotid body chemoreceptors, but does not significantly impair whole body insulin sensitivity. Copyright © 2014 the American Physiological Society.

CMS cavern inspection robot

CERN Document Server

Ibrahim, Ibrahim

2017-01-01

Robots which are immune to the CMS cavern environment, wirelessly controlled: -One actuated by smart materials (Ionic Polymer-Metal Composites and Macro Fiber Composites) -One regular brushed DC rover -One servo-driven rover -Stair-climbing robot

Epistaxis and pituitary apoplexy due to ruptured internal carotid artery aneurysm embedded within pituitary adenoma.

Science.gov (United States)

Peng, Zesheng; Tian, Daofeng; Wang, Hongliu; Kong, Derek Kai; Zhang, Shenqi; Liu, Baohui; Deng, Gang; Xu, Zhou; Wu, Liquan; Ji, Baowei; Wang, Long; Cai, Qiang; Li, Mingchang; Wang, Junmin; Zhang, Aimin; Chen, Qianxue

2015-01-01

Epistaxis due to ruptured internal carotid artery (ICA) aneurysm embedded within a pituitary adenoma (PA) has seldom been reported in the literature. Here we want to elaborate the incidence, mechanisms, clinical manifestations, and treatment strategy for this condition. The first survived case of a patient with epistaxis and pituitary apoplexy due to ruptured aneurysm embedded within PA was reported and the literature was reviewed. A 53-year-old male patient presented to our institution with sudden onset epistaxis and progressive vision loss. Neurological examination revealed bilateral ptosis and dilated unresponsive pupils. A CT scan showed a large mass in the pituitary fossa with bony erosion. MRI revealed a large pituitary tumor and abnormal signal intensity in the tumor. No aneurysm was noted during the pre-operative MR angiography. Abundant arterial bleeding suddenly occurred during urgent transsphenoidal surgery. Digital subtraction angiography confirmed the presence of a 14 mm unexpected saccular aneurysm of right ICA in the cavernous sinus with the dome protruding into the sella turcica. Balloon test occlusion of the right ICA was undertaken and permanent occlusion was performed. The patient recovered well and received bromocriptine and thyroid hormone replacement therapy during the follow-up period. At 14-month followup, the patient had no neurological deficits, no features of ischaemia relating to the right ICA therapeutic occlusion. Our case indicated that epistaxis and pituitary apoplexy could be due to the rupture of an ICA aneurysm embedded in a PA. Clinical suspicion should remain high when evaluating any case of epistaxis and pituitary apoplexy. Optimal treatment should take into consideration individual features of the tumor, aneurysm, and patient. Making the correct diagnosis as well as identifying an appropriate management strategy is critical in the care of such patients.

Internal Carotid Artery Hypoplasia: Role of Color-Coded Carotid Duplex Sonography.

Science.gov (United States)

Chen, Pei-Ya; Liu, Hung-Yu; Lim, Kun-Eng; Lin, Shinn-Kuang

2015-10-01

The purpose of this study was to determine the role of color-coded carotid duplex sonography for diagnosis of internal carotid artery hypoplasia. We retrospectively reviewed 25,000 color-coded carotid duplex sonograms in our neurosonographic database to establish more diagnostic criteria for internal carotid artery hypoplasia. A definitive diagnosis of internal carotid artery hypoplasia was made in 9 patients. Diagnostic findings on color-coded carotid duplex imaging include a long segmental small-caliber lumen (52% diameter) with markedly decreased flow (13% flow volume) in the affected internal carotid artery relative to the contralateral side but without intraluminal lesions. Indirect findings included markedly increased total flow volume (an increase of 133%) in both vertebral arteries, antegrade ipsilateral ophthalmic arterial flow, and a reduced vessel diameter with increased flow resistance in the ipsilateral common carotid artery. Ten patients with distal internal carotid artery dissection showed a similar color-coded duplex pattern, but the reductions in the internal and common carotid artery diameters and increase in collateral flow from the vertebral artery were less prominent than those in hypoplasia. The ipsilateral ophthalmic arterial flow was retrograde in 40% of patients with distal internal carotid artery dissection. In addition, thin-section axial and sagittal computed tomograms of the skull base could show the small diameter of the carotid canal in internal carotid artery hypoplasia and help distinguish hypoplasia from distal internal carotid artery dissection. Color-coded carotid duplex sonography provides important clues for establishing a diagnosis of internal carotid artery hypoplasia. A hypoplastic carotid canal can be shown by thin-section axial and sagittal skull base computed tomography to confirm the final diagnosis. © 2015 by the American Institute of Ultrasound in Medicine.

Silent sinus syndrome an acquired condition and the essential role of otorhinolaryngologist consultation: a retrospective study.

Science.gov (United States)

Martínez-Capoccioni, Gabriel; Varela-Martínez, Ernesto; Martín-Martín, Carlos

2016-10-01

The silent sinus syndrome (SSS) is a rare clinical entity characterized by painless spontaneous enophthalmos, hypoglobus, and facial deformities secondary to chronic maxillary sinus atelectasis. The aim of this study was to present an SSS diagnostic feature and evaluate the relationship between nasal septum deviation and maxillary sinus volume. A retrospective chart review of the clinical characteristics of 20 patients diagnosed with SSS between January 2013 and July 2014 were analyzed by the Department of Otorhinolaryngology of University Hospital Complex of Santiago de Compostela. 14 patients were females and six males. The mean age was 43 years (range 28-67 years). The right maxillary sinus was involved in 12 patients and the left maxillary sinus in eight patients. There was no statistical difference between gender and the presence of SSS. Maxillary sinus sizes were significantly smaller on the same side as the deviation (p craneo-caudal photographs. The present study demonstrates that, in adult patients, SSS generally presents a septal deviation to the affected maxillary sinus. We recommend performing a paranasal sinus CT scan when the patient has a deviated nasal septum, retraction of the malar eminence (evidenced from the viewpoint cranio-caudal facial) and hypoglobus. FESS performing postero-anterior uncinectomy and enlargement of the maxillary ostium is recommended to restore sinus pressure and prevent progression of the enophthalmos, hypoglobus and facial deformities.

Valuation of gas stored in salt cavern facilities

Energy Technology Data Exchange (ETDEWEB)

Bond, Michael A. [St. Mary' s University, TX (United States); Grant, Floyd H. [Purdue University, IN (United States)

2008-07-01

Since natural gas production is relatively inelastic towards demand in the short term, underground storage is used as a buffer against periods of high demand. Of the three most common storage facility types, depleted reservoirs, aquifers and manmade salt caverns, the latter is the most costly to develop. The challenge then is to maximize profits through efficient operation, well-timed injection and withdrawal of gas. The valuation of a commodity in storage is a challenging problem and has been the subject of study for decades. We investigate selected existing valuation approaches and look for ways to leverage salt-cavern-specific physical characteristics for financial advantage. The basis for our valuation is the Black-Scholes model for pricing options. Then, applying Monte-Carlo methods and simulation, we model combinations of characteristics in multi-cavern facilities and their impact on profitability. We describe the theory behind our work and our analytical framework and provide numerical results of our analysis. Our approach offers increased efficiency in salt-cavern gas storage facility operations. (author)

MRI findings of intracranial cavernous malformations

International Nuclear Information System (INIS)

Han, Byoung Hee; Kim, Dong Ik; Cho, Yong Kuk

1995-01-01

To analyze the variable MRI features and clinical significance of intracranial cavernous malformations. Forty patients(mean age 35.4) with cavernous malformation were evaluated by MRI. Eleven patients were surgically confirmed. Cavernous malformations were divided into four categories on the basis of the MR imaging characteristics, especially on T2-weighted image. Type I lesion was defined as an extralesional subacute hemorrhage outside the low signal rim, type II as an intralesional hemorrhage surrounded by low signal rim, type III lesion as an intralesional thrombosis with variegated central core surrounded by low signal rim, and type IV lesion as a focal old hemorrhagic core with small low signal intensity. Type IV was further divided into IVa and IVb, whether the lesion has small iso-or hypersignal central core (IVa) or not (IVb). Follow-up MRI was evaluated in 12 patients who were managed conservatively. Follow-up intervals ranged from 2 weeks to 29 months (mean 6 months). Total 80 lesions were detected in 40 patients. Multiple lesions were noted in 10 patients. The topography of the cavernous malformations was supratentorial in 75% and infratentorial in 23%. There were 10 lesions in type I, 15 in type II, 21 in type III, 14 in type IVa, and 20 in type IVb. Type I lesions mainly showed mass effect and edema. Type III lesions showed minimal contrast enhancements in 7 lesions on delayed images. Type II lesions showed the characteristics of both type I and type III lesions. On follow up images, decrease in size in 5, change of type in 7, rebleeding in 2 and no change in 12 lesions were demonstrated. Hemorrhage, edema and mass effect were combined in the cases of rebleeding. On follow-up study, the estimated risk of bleeding was 32.3%/person-year and 13.7%/lesion-year. Cavernous malformations show as variable appearance, on MR imaging suggesting variable stages of evolution. The MR morphologic classification and evaluation of secondary findings are helpful to

Sinus Anatomy

Science.gov (United States)

... Caregivers Contact ARS HOME ANATOMY Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ... Size + - Home > ANATOMY > Sinus Anatomy Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ...

Carotid artery surgery

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Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

Spontaneous sphenopalatine pseudoaneurysm: recurrent epistaxis in a patient with cryptogenic vasculopathy

Science.gov (United States)

Goh, Samantha; Ritchie, Louisa; Joseph, Theo; Brookes, Jocelyn

2015-01-01

We present a unique case of recurrent epistaxis secondary to a spontaneous sphenopalatine artery aneursym in a young woman. This was investigated with an external carotid artery angiogram and subsequently treated successfully with endovascular embolisation of the aneurysm. PMID:26113592

Therapeutic surprise! Photodynamic therapy for cavernous haemangioma of the disc

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Mahesh P Shanmugam

2017-01-01

Full Text Available Purpose: To report the response of cavernous haemangioma of the disc to PDT. Methods and Patients: A 32 years old lady presented to us with complaints of sudden onset of blurry vision in her right eye. What seemed initially as polypoidal choroidal vasculopathy turned out as cavernous haemangioma of the disc after pneumatic displacement of the sub-retinal haeme. She was treated with PDT as she was prone to recurrent haemorrhage from the lesion due to her low platelet count. Results: Complete regression of the cavernous haemangioma was noted as early as the second week itself and remained regressed for 4 months. Conclusion: PDT can be safe option for patients presenting with symptomatic cavernous haemangioma of the disc or retina.

The microbiology of ethmoid and maxillary sinuses in patients with chronic sinusitis.

Science.gov (United States)

Aral, Murat; Keles, Erol; Kaygusuz, Irfan

2003-01-01

To investigate aerob-anaerob microorganisms growth in maxillary and ethmoid sinuses by evaluating aspiration materials from patients with chronic sinusitis. The study was performed prospectively, and there were 31 patients (23 men, 8 women; mean age, 31.4+/-14.15, between 18-65 years) who had endoscopic sinus surgery because of chronic sinusitis. During the operation, when the maxillary sinus ostium and ethmoid sinus were opened, readily aspirated materials from sinuses were evaluated regarding aerob and anaerob bacteria. Nose and throat swap samples were collected preoperatively to determine the upper respiratory tract flora and also to understand the relationship between the flora and the microorganisms aspirated from sinuses. Total aerob bacteria count, which was isolated from preoperative nasal swab cultures, was 36, and aerob-anaerob bacteria count that included cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery was 42. For each 2 samples, the most common isolated aerob bacteria were coagulase (-) staphylococci. Microorganisms were isolated in 87.0% of 27 patients, in which cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery were included. It is determined that the isolated aerob bacteria rate was 90.4%, and the isolated anaerob bacteria rate was 14.2%. All of the 6 samples in which anaerob bacteria isolated were all maxillary sinus aspiration materials. Microorganisms that isolated from the nose and the sinuses were similar with the rate of 25.8%, and microorganisms that isolated from the throat cultures and sinuses were similar with the rate of 22.5%. This study reveals the aerob and anaerob microbiology of the maxillary and ethmoid sinuses so the treatment of chronic sinusitis will be easier.

Risk analyses for disposing nonhazardous oil field wastes in salt caverns

Energy Technology Data Exchange (ETDEWEB)

Tomasko, D.; Elcock, D.; Veil, J.; Caudle, D.

1997-12-01

Salt caverns have been used for several decades to store various hydrocarbon products. In the past few years, four facilities in the US have been permitted to dispose nonhazardous oil field wastes in salt caverns. Several other disposal caverns have been permitted in Canada and Europe. This report evaluates the possibility that adverse human health effects could result from exposure to contaminants released from the caverns in domal salt formations used for nonhazardous oil field waste disposal. The evaluation assumes normal operations but considers the possibility of leaks in cavern seals and cavern walls during the post-closure phase of operation. In this assessment, several steps were followed to identify possible human health risks. At the broadest level, these steps include identifying a reasonable set of contaminants of possible concern, identifying how humans could be exposed to these contaminants, assessing the toxicities of these contaminants, estimating their intakes, and characterizing their associated human health risks. The contaminants of concern for the assessment are benzene, cadmium, arsenic, and chromium. These were selected as being components of oil field waste and having a likelihood to remain in solution for a long enough time to reach a human receptor.

Cerebral cavernous malformations. Serial magnetic resonance imaging findings in patients with and without gamma knife surgery

International Nuclear Information System (INIS)

Yoon Pyeong-Ho; Kim, Dong-Ik; Jeon Pyoung; Ryu, Young-Hoon; Hwang, Geum-Joo; Park, Sang-Joon

1998-01-01

To classify the cerebral cavernous malformations and to investigate the natural history of cavernous malformations according to the classification, 41 patients with 61 cavernous malformations (40 cavernous malformations from 22 patients treated with gamma knife surgery) were regularly followed up using MR imaging for a mean period of 25.5 months in treated cavernous malformations and 20.7 months in untreated cavernous malformations, respectively. Cavernous malformations were classified into four types. Follow-up MR images were analyzed to evaluate changes in size, signal intensity, rebleeding, and perilesional adverse reaction of irradiation. A total of 61 cavernous malformations including 17 in type I, 23 in type II, 10 in type III, and 11 in type IV showed usual degradation of blood product in 22 cavernous malformations, no change in shape and signal intensity in 31 cavernous malformations, and eight cavernous malformations with rebleedings in the serial MR images. In these eight cavernous malformations with rebleedings, six occurred in type II and two in type III, but none in type I or IV. Rebleedings were more frequent in type II than in other types. Adverse reaction of irradiation was observed in five of 22 patients treated with gamma knife surgery. Although most cerebral cavernous malformations showed evolution of hemorrhage or no change in size or shape on follow-up MR images, cerebral cavernous malformations represented as mixture of subacute and chronic hemorrhage with hemosiderin rim (type II) have a higher frequency to rebleed than other types of cerebral cavernous malformations. Cerebral cavernous malformations represented as hemosiderin deposition without central core (type IV) have a lower tendency to rebleed than other types and do not need any treatment. Most of the adverse reaction of irradiation after gamma knife surgery around cavernous malformations are transient findings and are considered to be perilesional edema. (K.H)

Analysis of SPR salt cavern remedial leach program 2013.

Energy Technology Data Exchange (ETDEWEB)

Weber, Paula D.; Gutierrez, Karen A.; Lord, David L.; Rudeen, David Keith

2013-09-01

The storage caverns of the US Strategic Petroleum Reserve (SPR) exhibit creep behavior resulting in reduction of storage capacity over time. Maintenance of oil storage capacity requires periodic controlled leaching named remedial leach. The 30 MMB sale in summer 2011 provided space available to facilitate leaching operations. The objective of this report is to present the results and analyses of remedial leach activity at the SPR following the 2011 sale until mid-January 2013. This report focuses on caverns BH101, BH104, WH105 and WH106. Three of the four hanging strings were damaged resulting in deviations from normal leach patterns; however, the deviations did not affect the immediate geomechanical stability of the caverns. Significant leaching occurred in the toes of the caverns likely decreasing the number of available drawdowns until P/D ratio criteria are met. SANSMIC shows good agreement with sonar data and reasonably predicted the location and size of the enhanced leaching region resulting from string breakage.

Clinical significance of balloon dilatation angiography during cerebral venous sinus stenosis stenting

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Xiang-yu CAO

2016-12-01

Full Text Available Objective To explore the clinical significance of balloon dilatation angiography during cerebral venous sinus stenosis stenting to predict the reflux of perforator veins after operation. Methods A total of 93 patients (including 51 with cerebral venous sinus stenosis and intracranial hypertension and 42 with intractable pulsatile tinnitus caused by cerebral venous sinus stenosis who were treated by stent implantation were analyzed retrospectively. Among those patients, the diameter of transverse and sigmoid sinuses of 63 cases were measured based on angiography, and stent was selected according to the measurement result. The other 30 cases were given angiography on ipsilateral carotid artery or vertebral artery when the balloon was dilated in the venous sinus to confirm the reflux of perforator veins. If the venous reflux decreased in the angiography, stent with diameter 1-2 mm less than that of venous sinus could be selected.  Results The success rate of stenting was 100% (93/93. In 63 cases, 45 cases were planted 9 mm × 40 mm stents, 15 were planted 8 mm × 40 mm stents, 3 were planted 7 mm × 40 mm stents. The average diameter of stents was (8.67 ± 0.68 mm. There were 11 cases (17.46% with slow perforator venous reflux after operation. In the other 30 cases, 3 cases were planted 8 mm × 40 mm stents, 11 were planted 7 mm × 40 mm stents, and 16 were planted 6 mm × 40 mm stents. The average diameter of stents was (7.57 ± 0.67 mm. There was only one case (3.33% with slow perforator venous reflux after operation. The difference of stent diameter between 2 groups was statistically significant (t = 15.632, P = 0.001. The occurrence rate of perforator vein occlusion after operation between 2 groups was significantly different (adjusted χ 2 = 60.065, P = 0.001.  Conclusions Perforator vein occlusion after cerebral venous sinus stenting is common complication. Balloon dilatation angiography could predict the possibility of perforator vein

Trigemino-cardiac reflex: occurrence of asystole during trans-sphenoidal adenomectomy: a case report.

Science.gov (United States)

Jeon, Dae Geun; Kang, Bong Jin; Hur, Tae Won

2014-09-01

The trigemino-cardiac reflex has been reported to occur during various craniofacial surgeries or procedures including manipulation of the trigeminal ganglion, tumor resection in the cerebellopontine angle, various facial reconstructions and trans-sphenoidal adenomectomy. Regarding risk factors during trans-sphenoidal adenomectomy, invasiveness closely related to the size of tumor and the degree of manipulation of cavernous sinus wall have been reported. We report the case of a 40-year-old female patient who had a relatively small-sized (trans-sphenoidal operation of the wall of the cavernous sinus, which strongly suggests the importance of careful manipulation of the cavernous sinus wall. In addition to reporting this rare complication of trans-sphenoidal adenomectomy, we reviewed its clinical management by performing a literature search.

Effects of maxillary sinus floor elevation surgery on maxillary sinus physiology

NARCIS (Netherlands)

Timmenga, NM; Raghoebar, GM; Liem, RSB; van Weissenbruch, R; Manson, WL; Vissink, A

In a prospective study, the effects of elevation surgery of the maxillary sinus floor on maxillary sinus physiology were assessed. Seventeen consecutive patients without preoperative anamnestic, clinical and radiological signs of maxillary sinusitis underwent sinus floor elevation surgery with iliac

Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils

Energy Technology Data Exchange (ETDEWEB)

Jansen, O.; Doerfler, A.; Forsting, M.; Hartmann, M.; Kummer, R. von; Tronnier, V.; Sartor, K. [Dept. of Neuroradiology, University of Heidelberg Medical School (Germany)

1999-12-01

We report our experience in using Guglielmi electrolytically detachable coils (GDC) alone or in combination with other materials in the treatment of intracranial or cervical high-flow fistulae. We treated 14 patients with arteriovenous fistulae on brain-supplying vessels - three involving the external carotid or the vertebral artery, five the cavernous sinus and six the dural sinuses - by endovascular occlusion using electrolytically detachable platinum coils. The fistula was caused by trauma in six cases. In one case Ehlers-Danlos syndrome was the underlying disease, and in the remaining seven cases no aetiology could be found. Fistulae of the external carotid and vertebral arteries and caroticocavernous fistulae were reached via the transarterial route, while in all dural fistulae a combined transarterial-transvenous approach was chosen. All fistulae were treated using electrolytically detachable coils. While small fistulae could be occluded with electrolytically detachable coils alone, large fistulae were treated by using coils to build a stable basket for other types of coil or balloons. In 11 of the 14 patients, endovascular treatment resulted in complete occlusion of the fistula; in the remaining three occlusion was subtotal. Symptoms and signs were completely abolished by this treatment in 12 patients and reduced in 2. On clinical and neuroradiological follow-up (mean 16 months) no reappearance of symptoms was recorded. (orig.)

Taila Dāha (Cauterization with Oil an innovative approach in pilonidal sinus

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Rabinarayan Tripathy

2016-01-01

Full Text Available Pilonidal sinus is a chronic inflammatory track in mid gluteal cleft usually associated with hairs with an incidence rate of twenty six per one lakh population. It is more prevalently seen in the natal cleft of hairy middle aged obese, males. Such type of non-healing tracts may be considered as Nāḍivraṇa (Sinuses and can either be treated by the conventional Kṣārasūtra (medicated seton therapy or contemporary treatment methods. Irrespective of whatsoever management protocol adopted, it inevitably needs long term hospitalisation and is associated with complications. A case of a 28 year old male patient, presenting with pain (within tolerable limits in the natal cleft and frequent occurrence of a pustule which burst out spontaneously on and off, diagnosed as pilonidal sinus (nāḍi vraṇa was treated with excision of tract and Tailadāha (thermal cauterization with hot oil with a combination of yaṣṭimadhu taila and powdered Copper Sulphate (CuSO4. Good haemostasis and uneventful wound healing with a minimally invasive and cost effective treatment was the outcome of study. This study represents an innovative treatment modality in pilonidal sinus.

Imaging Evaluation of the Location and Fenestration of Sellar Floor during Endonasal Transsphenoidal Surgery in Patients with Pituitary Adenomas.

Science.gov (United States)

Wang, Shousen; Qin, Yong; Xiao, Deyong; Wu, Zhifeng; Wei, Liangfeng

2018-05-03

To evaluate the clinical value of three-dimensional (3D) CT reconstruction of the sphenoidal sinus separation in localizing sellar floor during endonasal transsphenoidal surgery, and determine the size and location of sellar floor fenestration. After exclusion,51 patients were eligible for study inclusion. A pre-operative CT scan of the paranasal sinus and CT scan and MRI of the pituitary gland were obtained. Sphenoidal sinus separation was reconstructed using Mimics 15.0 software and the quantity, shape, and orientation were observed and compared with intra-operative data, the purpose of which was to guide the localization of sellar floor. Anatomic variation of the sphenoidal sinus and adjacent structures, tumor and sella turcica morphology, minimal distance between the cavernous segment of the internal carotid artery（CSICA） bilaterally, and the shortest distance from the midline were measured. Based upon the shape of the sphenoidal sinus separation, sellar floor was accurately localized in all cases. Intra-operative sphenoidal sinus separation was consistent with pre-operative 3D CT reconstruction images. The sellar floor was extremely small in two patients, and insufficient fenestration of the sellar floor negatively affected tumor resection. Pre-operative 3D CT reconstruction is helpful for accurate and rapid localization of the saddle floor. The anatomic variation of sphenoidal sinus and adjacent structures, the characteristics of tumor and Sella, the minimum distance between bilateral CSICA and the shortest distance from the midline are helpful for the establishment of individualized Sellar bottom fenestration. Copyright © 2018. Published by Elsevier Inc.

Low-energy cardioversion of spontaneous atrial fibrillation. Immediate and long-term results.

Science.gov (United States)

Lévy, S; Ricard, P; Gueunoun, M; Yapo, F; Trigano, J; Mansouri, C; Paganelli, F

1997-07-01

Recent studies have suggested that induced atrial fibrillation (AF) could be successfully terminated by using a two-catheter electrode system and low energy (energy cardioversion in spontaneous chronic and paroxysmal AF. Forty-two consecutive patients with spontaneous AF underwent low-energy electrical cardioversion. AF was chronic (> or = 1 month) with a mean duration of 9 +/- 19 months in 28 patients (group I) or paroxysmal with a history of recurrent attacks and a mean duration of the present episode of 7 +/- 16 days in 14 patients (group II). An underlying heart disease was present in 28 patients. A 3/3-ms biphasic shock was delivered between catheters positioned in the right atrium and the coronary sinus in 32 patients. In 10 patients, the left pulmonary artery branch was used. The catheters were connected to a custom external defibrillator. The shocks were synchronized to the R wave. Following a test shock of 60 V, the energy was increased in 40-V steps until a maximum of 400 V or restoration of sinus rhythm. Sinus rhythm was restored in 22 of the 28 patients (78%) of group I by using a mean leading-edge voltage of 297 +/- 57 V (mean energy 3.3 +/- 1.3 J) and in 11 of 14 patients (78%) of group II by using a mean leading-edge voltage of 223 +/- 41 V (mean energy, 1.8 +/- 0.7 J). The energy required for terminating chronic AF was significantly (P energy between two intracardiac catheters with an electrical field between the right and left atria and the protocol used is feasible in patients with persistent spontaneous AF. The technique is safe provided synchronization to the R wave is achieved. A low recurrence rate of AF was seen in patients in whom sinus rhythm was restored.

Venous sinus stenting for pseudotumour cerebri with venous sinus stenosis

International Nuclear Information System (INIS)

Chen Huairui; Bai Rulin; Wu Xiaojun; Qi Xiangqian; Mei Qiyong; Lu Yicheng

2011-01-01

Objective: To explore the relation between venous sinus stenosis and pseduotumour cerebri and to discuss the efficacy and strategy of venous sinus stenting for its treatment. Methods: Venous sinus stenting was performed in a total of 9 patients with pseudotumour cerebri accompanied by dural sinus stenosis. The clinical data, including the clinical presentations, intracranial pressure, angiographic findings, pressure of dural sinus,methods of treatment and the therapeutic results, were retrospectively analyzed. Results: Bilateral disc edema was seen in all patients. The pressure gradient in the lateral sinuses was obviously high before stenting (22.67±7.25)mmHg in all patients and a reduction in intra-sinus pressure and pressure gradient was also found (5.78±3.77)mmHg. The symptoms associated with intracranial hypertension were gradually improved or disappeared in two weeks after the placement of the stent in all cases, and the intracranial pressure dropped evidently (12.78±5.97)cm H 2 O. Vision was improved in 7 cases at three months, whereas it remained poor in 2 cases despite normalized intracranial pressure. There was no other permanent procedure-related morbidity. The patients were followed up for 3 months to 5 years, and no recurrence developed. Conclusion: Lateral sinus stenting is an effective method for the treatment of pseudotumour cerebri with dural sinus stenosis. (authors)

Preliminary long-term stability criteria for compressed air energy storage caverns in salt domes

Energy Technology Data Exchange (ETDEWEB)

Thoms, R.L.; Martinez, J.D.

1978-08-01

Air storage caverns, which are an essential and integral component of a CAES plant, should be designed and operated so as to perform satisfactorily over the intended life of the overall facility. It follows that the long-term ''stability'' of air storage caverns must be considered as a primary concern in projecting the satisfactory operation of CAES facilities. As used in the report, ''stability'' of a storage cavern implies the extent to which an acceptable amount of cavern storage volume can be utilized with routine maintenance for a specified time interval, e.g., 35 years. In this context, cavern stability is relative to both planned utilization and time interval of operation. The objective of the study was to review the existing literature and consult knowledgeable workers in the storage industry, and then report state-of-the-art findings relative to long-term stability of compressed air energy storage caverns in salt domes. Further, preliminary cavern stability criteria were to be presented in a form consistent with the amount of information available on cavern performance in salt domes. Another objective of the study was to outline a methodology for determining the long-term stability of site-specific CAES cavern systems in salt domes.

Perforation of the sinus membrane during sinus floor elevation

DEFF Research Database (Denmark)

von Arx, Thomas; Fodich, Ivo; Bornstein, Michael M

2014-01-01

PURPOSE: To analyze the frequency of perforation of the sinus membrane during maxillary sinus floor elevation (SFE) and to assess possible risk factors. MATERIALS AND METHODS: Seventy-seven cases of SFE performed with a lateral window approach were evaluated retrospectively. Clinical and radiogra......PURPOSE: To analyze the frequency of perforation of the sinus membrane during maxillary sinus floor elevation (SFE) and to assess possible risk factors. MATERIALS AND METHODS: Seventy-seven cases of SFE performed with a lateral window approach were evaluated retrospectively. Clinical...

Sinusitis

Science.gov (United States)

... cause. Acute viral sinusitis does not benefit from antibiotics, but may be treated using pain relievers, steroid nasal sprays, or salt water irrigation in the nose. These treatments are good options for acute bacterial sinusitis too, but in ...

A Rare Case of Spontaneous Pneumocephalus Associated with Nontraumatic Cerebrospinal Fluid Leak

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Murad Baba

2016-01-01

Full Text Available Introduction. Spontaneous nontraumatic pneumocephalus (PNC and cerebrospinal fluid (CSF leaks are both very uncommon conditions. We report a rare case of spontaneous pneumocephalus associated with CSF leak secondary to right sphenoid sinus bony defect without history of trauma. Case Description. 51-year-old Hispanic female with past medical history of hypertension and idiopathic intracranial hypertension (Pseudotumor Cerebri presented to the emergency room complaining of headache and clear discharge from the right nostril. Physical examination was significant for right frontal sinus tenderness and clear discharge from right nostril. Computed Tomography (CT scan of the brain showed moderate amount of extra-axial air within the right cerebral hemisphere indicative of pneumocephalus. CT scan of facial bones showed bony defect along the right sphenoid sinus with abnormal CSF collection. The patient was started on intravenous antibiotics for meningitis prophylaxis and subsequently underwent transsphenoidal repair of cerebrospinal fluid leak with abdominal fat graft. CSF rhinorrhea stopped completely after the surgery with near complete resolution of pneumocephalus before discharge. Conclusions. Early identification of pneumocephalus and surgical intervention can help decrease the morbidity and avoid possible complications. Idiopathic intracranial hypertension, although rare, can lead to CSF leak and pneumocepahlus.

Subgaleal Retention Sutures: Internal Pressure Dressing Technique for Dolenc Approach.

Science.gov (United States)

Burrows, Anthony M; Rayan, Tarek; Van Gompel, Jamie J

2017-08-01

Extradural approach to the cavernous sinus, the "Dolenc" approach recognizing its developing Dr. Vinko Dolenc, is a critically important skull base approach. However, resection of the lateral wall of the cavernous sinus, most commonly for cavernous sinus meningiomas, results commonly in a defect that often cannot be reconstructed in a water-tight fashion. This may result in troublesome pseudomeningocele postoperatively. To describe a technique designed to mitigate the development of pseudomeningocele. We found the Dolenc approach critical for resection of cavernous lesions. However, a number of pseudomeningoceles were managed with prolonged external pressure wrapping in the early cohort. Therefore, we incorporated subgaleal to muscular sutures, which were designed to close this potential space and retrospectively analyzed our results. Twenty-one patients treated with a Dolenc approach and resection of the lateral wall of the cavernous sinus over a 2-year period were included. Prior to incorporation of this technique, 12 patients were treated and 3 (25%) experienced postoperative pseudomeningoceles requiring multiple clinic visits and frequent dressing. After incorporation of subgaleal retention sutures, no patient (0%) experienced this complication. Although basic, subgaleal to temporalis muscle retention sutures likely aid in eliminating this potential dead space, thereby preventing patient distress postoperatively. This technique is simple and further emphasizes the importance of dead space elimination in complex closures. Copyright © 2017 by the Congress of Neurological Surgeons

Columellar sinus: A rare congenital isolated sinus

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Anindita Datta

2016-07-01

Full Text Available Midline congenital malformation of the nose is a very rare presentation and it's midline situation seems curious and is very difficult to explain on the basis of the present day conception of the embryology of the nose. The prevalence of lower lip sinuses has been estimated to be about 0.001 % of the general population. Upper lip sinuses are even more uncommon. We herein report a case of a 13 years old girl having congenital sinus affecting the upper part of the columella.

Magnetic resonance imaging of intracavernous pathology

Energy Technology Data Exchange (ETDEWEB)

Komiyama, Masaki; Yasui, Toshihiro; Yagura, Hisatsugu; Fu, Yoshihiko; Baba, Mitsuru [Baba Memorial Hospital, Sakai, Osaka (Japan); Hakuba, Akira; Nishimura, Shuro

1989-07-01

To evaluate the usefulness of magnetic resonance (MR) imaging of intracavernous pathology, T{sub 1}-weighted spin echo images of four vascular lesions and 10 neoplastic lesions with surgically confirmed cavernous sinus (CS) invasion were reviewed retrospectively. In one case of traumatic carotid-cavernous fistula (CCF) and one of dural arteriovenous malformation (AVM), the internal carotid artery (ICA) and rapid shunted flow were depicted as signal voids, and the relationship between the ICA and shunted flow was clearly shown. Normal venous flow appeared as a low-intensity area and was observed even in the presence of the CCF and dural AVM. In two cases of thrombosed aneurysms, the thrombosis was clearly demonstrated, along with patent arterial flow in one case; in the other case, however, it was impossible to differentiate patent arterial flow from calcification. The intensity of all neoplastic lesions was similar to that of the cerebral cortex. The relationship between the ICA and the tumors was clearly demonstrated. The visual pathways were also plainly shown unless they were involved, or markedly compressed, by tumor. CS invasion was strongly associated with four findings: (1) encasement of the ICA by the tumor; (2) marked displacement of the ICA; (3) absence of low intensity, which reflects normal venous flow, in the CS; and (4) extension of extrasellar tumors to the medial wall or of intrasellar tumors to the lateral wall. MR imaging was judged promising in the evaluation of intracavernous pathology. (author).

Thermo-mechanical modelling of salt caverns due to fluctuating loading conditions.

Science.gov (United States)

Böttcher, N.

2015-12-01

This work summarizes the development and application of a numerical model for the thermo-mechanical behaviour of salt caverns during cyclic gas storage. Artificial salt caverns are used for short term energy storage, such as power-to-gas or compressed air energy storage. Those applications are characterized by highly fluctuating operation pressures due to the unsteady power levels of power plants based on renewable energy. Compression and expansion of the storage gases during loading and unloading stages lead to rapidly changing temperatures in the host rock of the caverns. This affects the material behaviour of the host rock within a zone that extends several meters into the rock mass adjacent to the cavern wall, and induces thermo-mechanical stresses and alters the creep response.The proposed model features the thermodynamic behaviour of the storage medium, conductive heat transport in the host rock, as well as temperature dependent material properties of rock salt using different thermo-viscoplastic material models. The utilized constitutive models are well known and state-of-the-art in various salt mechanics applications. The model has been implemented into the open-source software platform OpenGeoSys. Thermal and mechanical processes are solved using a finite element approach, coupled via a staggered coupling scheme. The simulation results allow the conclusion, that the cavern convergence rate (and thus the efficiency of the cavern) is highly influenced by the loading cycle frequency and the resulting gas temperatures. The model therefore allows to analyse the influence of operation modes on the cavern host rock or on neighbouring facilities.

Cavernous haemangioma mimicking as clitoral hypertrophy

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Sajid Nayyar

2014-01-01

Full Text Available Haemangioma is the most common benign neoplasm of infantile age. It is most commonly located in head and neck region, trunk and extremities but very rarely it can be located at clitoris. However, it is very important to differentiate clitoral haemangioma from enlargement of the clitoris secondary to androgen excess. Only four cases of clitoromegaly caused by cavernous haemangioma have been reported in the literature so far. Herein, we report our experience with a 10-year-old girl who presented with clitoromegaly and normal hormonal assay that turned out to be clitoral cavernous haemangioma after histopathological examination of the clitoral mass.

MRI of normal pituitary glands and their surrounding structures

International Nuclear Information System (INIS)

Sato, Yoshiyuki

1991-01-01

Normal MRI appearances of the pituitary glands and their surrounding structures were evaluated in 332 patients without sellar and parasellar diseases. The height of the pituitary gland was maximum at 10-19 years of age reflecting hormonal activity. The width of the pituitary gland decreased, while that of the cavernous sinus increased with aging. This is probably due to atherosclerotic change of the internal carotid artery. Females younger than 30 years of age tended to show a convex upper surface of the pituitary gland and the displacement of the pituitary stalk was common after 50 years of age. Almost all of the anterior lobe of the pituitary gland showed isointensity relative to the pons or cerebral cortex and the majority (85.1%) of the posterior lobe showed hyperintensity. However, the anterior lobe in 2 newborns showed hyperintensity similar to the normal posterior lobe in adults. The posterior lobe was located off the midline in 19.1% of the subjects. One case of pars intermedia cyst was discovered among 14 subjects who were administered Gd-DTPA. The dural membrane between the pituitary gland and cavernous sinus was recognizable only in 8.6% on the right side and 7.5% on the left side. Primary empty sella was identified in 4.5%. Knowledge of the above normal ranges and variations of the pituitary gland and its surrounding structures is important in diagnosing sellar and parasellar lesions. (author) 52 refs

Analysis of cavern and well stability at the West Hackberry SPR site using a full-dome model.

Energy Technology Data Exchange (ETDEWEB)

Sobolik, Steven R. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2015-08-01

This report presents computational analyses that simulate the structural response of caverns at the Strategic Petroleum Reserve (SPR) West Hackberry site. The cavern field comprises 22 caverns. Five caverns (6, 7, 8, 9, 11) were acquired from industry and have unusual shapes and a history dating back to 1946. The other 17 caverns (101-117) were leached according to SPR standards in the mid-1980s and have tall cylindrical shapes. The history of the caverns and their shapes are simulated in a three-dimensional geomechanics model of the site that predicts deformations, strains, and stresses. Future leaching scenarios corresponding to oil drawdowns using fresh water are also simulated by increasing the volume of the caverns. Cavern pressures are varied in the model to capture operational practices in the field. The results of the finite element model are interpreted to provide information on the current and future status of subsidence, well integrity, and cavern stability. The most significant results in this report are relevant to Cavern 6. The cavern is shaped like a bowl with a large ceiling span and is in close proximity to Cavern 9. The analyses predict tensile stresses at the edge of the ceiling during repressurization of Cavern 6 following workover conditions. During a workover the cavern is at low pressure to service a well. The wellhead pressures are atmospheric. When the workover is complete, the cavern is repressurized. The resulting elastic stresses are sufficient to cause tension around the edge of the large ceiling span. With time, these stresses relax to a compressive state because of salt creep. However, the potential for salt fracture and propagation exists, particularly towards Cavern 9. With only 200 feet of salt between the caverns, the operational consequences must be examined if the two caverns become connected. A critical time may be during a workover of Cavern 9 in part because of the operational vulnerabilities, but also because dilatant damage

Sinusitis

Science.gov (United States)

... sinuses: Apply a warm, moist washcloth to your face several times a day. Drink plenty of fluids to thin ... do help, they may only slightly reduce the time it takes for the ... the face Severe swelling around the eyes Acute sinusitis should ...

Japan's exploration of vertical holes and subsurface caverns on the Moon and Mars

Science.gov (United States)

Haruyama, J.; Kawano, I.; Kubota, T.; Yoshida, K.; Kawakatsu, Y.; Kato, H.; Otsuki, M.; Watanabe, K.; Nishibori, T.; Yamamoto, Y.; Iwata, T.; Ishigami, G.; Yamada, T. T.

2013-12-01

Recently, gigantic vertical holes exceeding several tens of meters in diameter and depth were discovered on the Moon and Mars. Based on high-resolution image data, lunar holes and some Martian pits (called 'holes' hereafter) are probably skylights of subsurface caverns such as lava tubes or magma chambers. We are starting preparations for exploring the caverns through the vertical holes. The holes and subsurface caverns have high potential as resources for scientific studies. Various important geological and mineralogical processes could be uniquely and effectively observed inside these holes and subsurface caverns. The exposed fresh lava layers on the vertical walls of the lunar and Martian holes would provide information on volcanic eruption histories. The lava layers may also provide information on past magnetic fields of the celestial bodies. The regolith layers may be sandwiched between lava layers and may preserve volatile elements including solar wind protons that could be a clue to understanding past solar activities. Water molecules from solar winds or cometary/meteorite impacts may be stored inside the caverns because of mild temperatures there. The fresh lava materials forming the walls and floors of caverns might trap endogenic volatiles from magma eruptions that will be key materials for revealing the formation and early evolution of the Moon and Mars. Furthermore, the Martian subsurface caverns are highly expected to be life cradles where the temperatures are probably stable and that are free from ultra-violet and other cosmic rays that break chemical bonds, thus avoiding polymerization of molecules. Discovering extraterrestrial life and its varieties is one of our ultimate scientific purposes for exploring the lunar and Martian subsurface caverns. In addition to scientific interests, lunar and Martian subsurface caverns are excellent candidates for future lunar bases. We expect such caverns to have high potential due to stable temperatures; absence

A NOVEL PROCESS TO USE SALT CAVERNS TO RECEIVE SHIP BORNE LNG

Energy Technology Data Exchange (ETDEWEB)

Michael M. McCall; William M. Bishop; Marcus Krekel; James F. Davis; D. Braxton Scherz

2005-05-31

This cooperative research project validates use of man made salt caverns to receive and store the cargoes of LNG ships in lieu of large liquid LNG tanks. Salt caverns will not tolerate direct injection of LNG because it is a cryogenic liquid, too cold for contact with salt. This research confirmed the technical processes and the economic benefits of pressuring the LNG up to dense phase, warming it to salt compatible temperatures and then directly injecting the dense phase gas into salt caverns for storage. The use of salt caverns to store natural gas sourced from LNG imports, particularly when located offshore, provides a highly secure, large scale and lower cost import facility as an alternative to tank based LNG import terminals. This design can unload a ship in the same time as unloading at a tank based terminal. The Strategic Petroleum Reserve uses man made salt caverns to securely store large quantities of crude oil. Similarly, this project describes a novel application of salt cavern gas storage technologies used for the first time in conjunction with LNG receiving. The energy industry uses man made salt caverns to store an array of gases and liquids but has never used man made salt caverns directly in the importation of LNG. This project has adapted and expanded the field of salt cavern storage technology and combined it with novel equipment and processes to accommodate LNG importation. The salt cavern based LNG receiving terminal described in the project can be located onshore or offshore, but the focus of the design and cost estimates has been on an offshore location, away from congested channels and ports. The salt cavern based terminal can provide large volumes of gas storage, high deliverability from storage, and is simplified in operation compared to tank based LNG terminals. Phase I of this project included mathematical modeling that proved a salt cavern based receiving terminal could be built at lower capital cost, and would have significantly higher

Optical Coherence Tomography Angiography of Retinal Cavernous Hemangioma.

Science.gov (United States)

Pierro, Luisa; Marchese, Alessandro; Gagliardi, Marco; Bandello, Francesco

2017-08-01

Retinal cavernous hemangioma is a rare, benign, retinal tumor characterized by angiomatous proliferation of vessels within the inner retina or the optic disc.1 Here we report a case of retinal cavernous hemangioma on the margin of the optic disc in the right eye of a 61-year-old asymptomatic female. The lesion was studied with multimodal imaging which included structural optical coherence tomography, fluorescein angiography, blue fundus auto-fluorescence, optical coherence tomography angiography (OCTA) (DRI OCT Triton; Topcon, Tokyo, Japan) and visual field examination. Blood circulation inside retinal cavernous hemangioma lesion is typically low-stagnant.2 However, OCTA demonstrated blood flow inside the lesion, illustrating its vascular circulation.3 Visual field was within the normal limits, except from a slight enlargement of the blind spot. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:684-685.]. Copyright 2017, SLACK Incorporated.

Bioelectronic modulation of carotid sinus nerve activity in the rat: a potential therapeutic approach for type 2 diabetes.

Science.gov (United States)

Sacramento, Joana F; Chew, Daniel J; Melo, Bernardete F; Donegá, Matteo; Dopson, Wesley; Guarino, Maria P; Robinson, Alison; Prieto-Lloret, Jesus; Patel, Sonal; Holinski, Bradley J; Ramnarain, Nishan; Pikov, Victor; Famm, Kristoffer; Conde, Silvia V

2018-03-01

A new class of treatments termed bioelectronic medicines are now emerging that aim to target individual nerve fibres or specific brain circuits in pathological conditions to repair lost function and reinstate a healthy balance. Carotid sinus nerve (CSN) denervation has been shown to improve glucose homeostasis in insulin-resistant and glucose-intolerant rats; however, these positive effects from surgery appear to diminish over time and are heavily caveated by the severe adverse effects associated with permanent loss of chemosensory function. Herein we characterise the ability of a novel bioelectronic application, classified as kilohertz frequency alternating current (KHFAC) modulation, to suppress neural signals within the CSN of rodents. Rats were fed either a chow or high-fat/high-sucrose (HFHSu) diet (60% lipid-rich diet plus 35% sucrose drinking water) over 14 weeks. Neural interfaces were bilaterally implanted in the CSNs and attached to an external pulse generator. The rats were then randomised to KHFAC or sham modulation groups. KHFAC modulation variables were defined acutely by respiratory and cardiac responses to hypoxia (10% O 2  + 90% N 2 ). Insulin sensitivity was evaluated periodically through an ITT and glucose tolerance by an OGTT. KHFAC modulation of the CSN, applied over 9 weeks, restored insulin sensitivity (constant of the insulin tolerance test [K ITT ] HFHSu sham, 2.56 ± 0.41% glucose/min; K ITT HFHSu KHFAC, 5.01 ± 0.52% glucose/min) and glucose tolerance (AUC HFHSu sham, 1278 ± 20.36 mmol/l × min; AUC HFHSu KHFAC, 1054.15 ± 62.64 mmol/l × min) in rat models of type 2 diabetes. Upon cessation of KHFAC, insulin resistance and glucose intolerance returned to normal values within 5 weeks. KHFAC modulation of the CSN improves metabolic control in rat models of type 2 diabetes. These positive outcomes have significant translational potential as a novel therapeutic modality for the purpose of treating metabolic

Changes in gonadotropin-releasing hormone and gonadotropin-releasing hormone receptor gene expression after an increase in carbon monoxide concentration in the cavernous sinus of male wild boar and pig crossbread.

Science.gov (United States)

Romerowicz-Misielak, M; Tabecka-Lonczynska, A; Koziol, K; Gilun, P; Stefanczyk-Krzymowska, S; Och, W; Koziorowski, M

2016-06-01

Previous studies indicate that there are at least a few regulatory systems involved in photoperiodic synchronisation of reproductive activity, which starts with the retina and ends at the gonadotropin-releasing hormone (GnRH) pulse generator. Recently we have shown indicated that the amount of carbon monoxide (CO) released from the eye into the ophthalmic venous blood depends on the intensity of sunlight. The aim of this study was to test whether changes in the concentration of carbon monoxide in the ophthalmic venous blood may modulate reproductive activity, as measured by changes in GnRH and GnRH receptor gene expression. The animal model used was mature male swine crossbred from wild boars and domestic sows (n = 48). We conducted in vivo experiments to determine the effect of increased CO concentrations in the cavernous sinus of the mammalian perihypophyseal vascular complex on gene expression of GnRH and GnRH receptors as well as serum luteinizing hormone (LH) levels. The experiments were performed during long photoperiod days near the summer solstice (second half of June) and short photoperiod days near the winter solstice (second half of December). These crossbred swine demonstrated a seasonally-dependent marked variation in GnRH and GnRH receptor gene expression and systemic LH levels in response to changes in CO concentration in ophthalmic venous blood. These results seem to confirm the hypothesis of humoral phototransduction as a mechanism for some of bright light's effects in animal chronobiology and the effect of CO on GnRH and GnRH receptor gene expression.

Instability risk analysis and risk assessment system establishment of underground storage caverns in bedded salt rock

Science.gov (United States)

Jing, Wenjun; Zhao, Yan

2018-02-01

Stability is an important part of geotechnical engineering research. The operating experiences of underground storage caverns in salt rock all around the world show that the stability of the caverns is the key problem of safe operation. Currently, the combination of theoretical analysis and numerical simulation are the mainly adopts method of reserve stability analysis. This paper introduces the concept of risk into the stability analysis of underground geotechnical structure, and studies the instability of underground storage cavern in salt rock from the perspective of risk analysis. Firstly, the definition and classification of cavern instability risk is proposed, and the damage mechanism is analyzed from the mechanical angle. Then the main stability evaluating indicators of cavern instability risk are proposed, and an evaluation method of cavern instability risk is put forward. Finally, the established cavern instability risk assessment system is applied to the analysis and prediction of cavern instability risk after 30 years of operation in a proposed storage cavern group in the Huai’an salt mine. This research can provide a useful theoretical base for the safe operation and management of underground storage caverns in salt rock.

Novel Technique for the UX15 Cavern Vault Support System

CERN Document Server

Rammer, H

2000-01-01

The overall LHC project schedule requires the civil engineering work to begin before the final LEP shutdown. The new caverns for the ATLAS experiment will be built in and around the existing underground structures at point 1. In order to make the best possible use of the time available for the LHC civil engineering before the shutdown of LEP, a particular arrangement for the construction of the UX15 cavern vault has been developed. The basic concept of this arrangement consists of the excavation of the cavern top heading and the installation of the concrete vault immediately afterwards, prior to the subsequent bench excavation after LEP shutdown. A temporary support of the dead weight of the concrete roof will be achieved by the suspension of the roof by 38 no. pre-stressed ground anchors of 225 tons capacity each. This support system will work up to the construction of the cavern base slab and walls and the completion of the permanent concrete lining.

Maxillary sinus function after sinus lifts for the insertion of dental implants

NARCIS (Netherlands)

Timmenga, NM; Raghoebar, GM; Boering, G; VanWeissenbruch, R

Purpose: The influence of bone augmentation of the floor of the maxillary sinus for the insertion of denial implants on sinus function has not been well investigated, In this study, the influence of the sinus lift on the development of maxillary sinus pathology was evaluated using generally accepted

Computed Tomography (CT) -- Sinuses

Medline Plus

Full Text Available ... Physician Resources Professions Site Index A-Z Computed Tomography (CT) - Sinuses Computed tomography (CT) of the sinuses ... CT of the Sinuses? What is CT (Computed Tomography) of the Sinuses? Computed tomography, more commonly known ...

Endoscopic repair of an injured internal carotid artery utilizing femoral endovascular closure devices.

Science.gov (United States)

Van Rompaey, Jason; Bowers, Greg; Radhakrishnan, Jay; Panizza, Benedict; Solares, C Arturo

2014-06-01

Injury to the internal carotid artery is a feared complication of endoscopic endonasal surgery of the skull base. Such an event, although rare, is associated with high morbidity and mortality. Even if bleeding is controlled, permanent neurological defects frequently persist. Many techniques have been developed to manage internal carotid artery rupture with varying degrees of success. The purpose of this study was to explore endoscopic management of arterial damage with endovascular closure devices used for a femoral arteriotomy. The ability to remotely suture a damaged artery permits the possible adaptation of this technology in managing endoscopic arterial complications. Technical note. After the creation of an endoscopic endonasal corridor in a cadaveric specimen, an arteriotomy was created at the cavernous portion of the internal carotid artery. The Angio-Seal, StarClose, and MynxGrip vascular closure devices were utilized under endoscopic guidance to repair the arteriotomy. Angiography was then done on a cadaver sutured with the StarClose. Both the Angio-Seal and StarClose were deployed quickly and appeared to provide sufficient closure of the arteriotomy. The Angio-Seal required the use of a guidewire and was longer to deploy when compared with the StarClose. The StarClose deployment was quick and facile. The MynxGrip also deployed without difficulty. The Angio-Seal and StarClose systems were both successfully deployed utilizing an endoscopic endonasal approach. The MynxGrip was the easiest to deploy and has the greatest potential to be of benefit in this application. Further studies with hemodynamic models are required to properly assess the appropriateness in this setting. NA. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Sensitivity of storage field performance to geologic and cavern design parameters in salt domes.

Energy Technology Data Exchange (ETDEWEB)

Ehgartner, Brian L. (Sandia National Laboratories, Albuquerque, NM); Park, Byoung Yoon

2009-03-01

A sensitivity study was performed utilizing a three dimensional finite element model to assess allowable cavern field sizes for strategic petroleum reserve salt domes. A potential exists for tensile fracturing and dilatancy damage to salt that can compromise the integrity of a cavern field in situations where high extraction ratios exist. The effects of salt creep rate, depth of salt dome top, dome size, caprock thickness, elastic moduli of caprock and surrounding rock, lateral stress ratio of surrounding rock, cavern size, depth of cavern, and number of caverns are examined numerically. As a result, a correlation table between the parameters and the impact on the performance of storage field was established. In general, slower salt creep rates, deeper depth of salt dome top, larger elastic moduli of caprock and surrounding rock, and a smaller radius of cavern are better for structural performance of the salt dome.

Simultaneous and sequential hemorrhage of multiple cerebral cavernous malformations: a case report.

Science.gov (United States)

Louis, Nundia; Marsh, Robert

2016-02-09

The etiology of cerebral cavernous malformation hemorrhage is not well understood. Causative physiologic parameters preceding hemorrhagic cavernous malformation events are often not reported. We present a case of an individual with sequential simultaneous hemorrhages in multiple cerebral cavernous malformations with a new onset diagnosis of hypertension. A 42-year-old white man was admitted to our facility with worsening headache, left facial and tongue numbness, dizziness, diplopia, and elevated blood pressure. His past medical history was significant for new onset diagnosis of hypertension and chronic seasonal allergies. Serial imaging over the ensuing 8 days revealed sequential hemorrhagic lesions. He underwent suboccipital craniotomy for resection of the lesions located in the fourth ventricle and right cerebellum. One month after surgery, he had near complete resolution of his symptoms with mild residual vertigo but symptomatic chronic hypertension. Many studies have focused on genetic and inflammatory mechanisms contributing to cerebral cavernous malformation rupture, but few have reported on the potential of hemodynamic changes contributing to cerebral cavernous malformation rupture. Systemic blood pressure changes clearly have an effect on angioma pressures. When considering the histopathological features of cerebral cavernous malformation architecture, changes in arterial pressure could cause meaningful alterations in hemorrhage propensity and patterns.

Coronal CT of the paranasal sinuses before and after functional endoscotic sinus surgery

International Nuclear Information System (INIS)

Mantoni, M.; Larsen, P.; Hansen, H.; Tos, M.; Berner, B.; Oerntoft, S.

1996-01-01

Coronal CT of the paranasal sinuses and the ostiomeatal complex (OMC) was performed before and 12 months after bilateral functional endoscopic sinus surgery (FESS) in 30 patients with sinusitis and 12 patients with nasal polyposis. The extent of sinus mucosal thickening was graded, and the patency of the OMC was evaluated. After FESS, the percentage of open OMCs had increased from 42% to 83% in the sinusitis group, and from 8% to 45% in the polyposis group. There was only a small improvement in mucosal score in sinuses with opened OMC, so that the overall extent of sinus opacification before and after FESS was almost the same. Despite this, 91% of the patients reported clinical relief of symptoms. Preoperative coronal CT of the paranasal sinuses serves as an anatomical map for the surgeon, but there is no benefit of routine postoperative CT. (orig.)

Added value of contrast-enhanced CISS imaging in relation to conventional MR images for the evaluation of intracavernous cranial nerve lesions

Energy Technology Data Exchange (ETDEWEB)

Yagi, Akiko; Takahashi, Ayako; Morita, Hideo; Amanuma, Makoto; Endo, Keigo [Gunma University School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Gunma (Japan); Sato, Noriko [National Center Hospital of Neurology and Psychiatry, Department of Radiology, Kodaira, Tokyo (Japan); Takeuchi, K. [Takasaki University of Health and Welfare, Department of Health and Welfare, Gunma (Japan)

2010-12-15

The normal cranial nerves (CNs) of the cavernous sinus can be clearly demonstrated using contrast-enhanced constructive interference in steady-state (CISS) magnetic resonance imaging (MRI). This study used the method to evaluate pathological CNs III, IV, V{sub 1}, V{sub 2}, and VI in cavernous sinuses affected by inflammatory and neoplastic diseases. MR images from 17 patients with diseases involving the cavernous sinuses and/or causing neuropathy in CNs III-VI were retrospectively evaluated. The patients were divided into inflammatory (n = 11) and neoplastic (n = 6) groups. We defined CNs as abnormal when they exhibited enlargement or enhancement. CNs were evaluated using both contrast-enhanced CISS and T1-weighted MRI. In the inflammatory group, abnormal CNs were identified by contrast-enhanced CISS MRI in 13 of 25 symptomatic CNs (52%) in eight patients, but in only two CNs (8%) in two patients by contrast-enhanced T1-weighted MRI. In the neoplastic group, both sequences of contrast-enhanced CISS and T1-weighted MRI detected abnormalities in the same three of eight symptomatic CNs (37.5%), i.e., the three CNs were all in the same patient with adenoid cystic carcinoma. Contrast-enhanced CISS MRI is useful for detecting CN abnormalities in inflammatory pathological conditions of the cavernous sinuses. (orig.)

Computed Tomography (CT) -- Sinuses

Medline Plus

Full Text Available ... about tumors of the nasal cavity and sinuses. plan for surgery by defining anatomy. top of page How should ... for sinusitis. CT of the sinuses can help plan the safest and most effective surgery. CT of the sinuses is now widely available ...

Lined rock caverns for the storage of hazardous waste

International Nuclear Information System (INIS)

Semprich, S.; Speidel, S.R.; Schneider, H.J.

1987-01-01

For reasons of environmental protection the storage of hazardous waste in unlined rock caverns is possible to a very limited extent only. Therefore, the authors have recently developed technologies for the lining and sealing of rock caverns. In the process, sealing systems of synthetic materials or metals have proved suitable. Synthetic materials can be used in the form of either sheets or coatings with various materials such as epoxy resins, polyethylenes etc. being used. Metal sealings consist of thin sheets or foils which are either welded or bonded. In either case, the structural design must provide for a leakage control possibility. The article describes the design principles, the structural and operational aspects as well as the control measures with regard to the planning and execution of lined rock caverns for the storage of hazardous waste

Crestal Sinus Augmentation in the Presence of Severe Sinus Mucosal Thickening: A Report of 3 Cases.

Science.gov (United States)

Fang, Yiqin; An, Xueyin; Jeong, Seung-Mi; Choi, Byung-Ho

2018-06-01

In the presence of severe sinus mucosal thickening, the ostium can be blocked when the sinus membrane is lifted, causing drainage disturbances and sinusitis. Here, we present 3 cases in which maxillary sinus floor elevation was performed using a crestal approach in the presence of severe sinus mucosal thickening (>10 mm). The effects of maxillary sinus floor elevation using the crestal approach technique on sinus mucosal thickening and bone formation in the sinus were evaluated using cone beam computed tomography. None of the patients exhibited an increase in sinus membrane thickness. No complications were encountered during the follow-up periods, and bone formation was observed around the implants at the sinus floor. All implants were functioning successfully. Maxillary sinus floor elevation using the crestal approach technique in the presence of severe sinus mucosal thickening allows for minimally invasive sinus grafting and simultaneous implant placement and does not increase sinus membrane thickness.

Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study) : an interim analysis of a randomised controlled trial

NARCIS (Netherlands)

Ederle, Joerg; Dobson, Joanna; Featherstone, Roland L.; Bonati, Leo H.; van der Worp, H. Bart; de Borst, Gert J.; Lo, T. Hauw; Gaines, Peter; Dorman, Paul J.; Macdonald, Sumaira; Lyrer, Philippe A.; Hendriks, Johanna M.; McCollum, Charles; Nederkoorn, Paul J.; Brown, Martin M.; Algra, A.; Bamford, J.; Beard, J.; Bland, M.; Bradbury, A. W.; Brown, M. M.; Clifton, A.; Gaines, P.; Hacke, W.; Halliday, A.; Malik, I.; Mas, J. L.; McGuire, A. J.; Sidhu, P.; Venables, G.; Bradbury, A.; Brown, M. M.; Clifton, A.; Gaines, P.; Collins, R.; Molynewc, A.; Naylor, R.; Warlow, C.; Ferro, J. M.; Thomas, D.; Bonati, L. H.; Coward, L.; Dobson, J.; Ederle, J.; Featherstone, R. F.; Tindall, H.; McCabe, D. J. H.; Wallis, A.; Hendriks, J. M. H.; Hendriks, J. M.

2010-01-01

Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid

Carotid angioplasty with stenting for chronic internal carotid artery occlusion: technical note

Energy Technology Data Exchange (ETDEWEB)

Kobayashi, Nozomu; Tanasawa, Toshihiko; Okada, Takeshi; Endo, Otone; Yamamoto, Naohito [Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Department of Neurosurgery, Aichi (Japan); Miyachi, Shigeru; Hattori, Kenichi [Nagoya University Graduate School of Medicine, Department of Neurosurgery, Nagoya (Japan)

2006-11-15

Carotid angioplasty with stenting (CAS) is becoming accepted as an effective and reliable treatment option for severe carotid artery stenosis. However, it is rarely applied for carotid occlusion, especially in its chronic stage. We report our experience of CAS for chronic internal carotid artery occlusion representing compromised cerebral blood flow using various protection methods. A 77-year-old woman, who was already diagnosed with severe left internal carotid artery stenosis, suddenly had right hemiparesis and aphasia. At that time, she was treated conservatively because her neurological status was quite good, in spite of left carotid artery occlusion. Her symptoms improved in the short term, except slight aphasia, but deteriorated again 18 days from the onset, and magnetic resonance imaging (MRI) showed new ischemic lesions. CAS was then performed for the occluded carotid artery on the 23rd day from the first onset. Using the proximal protection technique, the occluded lesion was crossed carefully with a microguidewire. Stents were also placed successfully with the distal protection technique. The occluded carotid artery was completely recanalized without any unfavorable events or neurological deterioration. In this patient, CAS was successfully to treat chronic carotid artery occlusion. These procedures and techniques are reviewed and discussed. (orig.)

Carotid angioplasty with stenting for chronic internal carotid artery occlusion: technical note

International Nuclear Information System (INIS)

Kobayashi, Nozomu; Tanasawa, Toshihiko; Okada, Takeshi; Endo, Otone; Yamamoto, Naohito; Miyachi, Shigeru; Hattori, Kenichi

2006-01-01

Carotid angioplasty with stenting (CAS) is becoming accepted as an effective and reliable treatment option for severe carotid artery stenosis. However, it is rarely applied for carotid occlusion, especially in its chronic stage. We report our experience of CAS for chronic internal carotid artery occlusion representing compromised cerebral blood flow using various protection methods. A 77-year-old woman, who was already diagnosed with severe left internal carotid artery stenosis, suddenly had right hemiparesis and aphasia. At that time, she was treated conservatively because her neurological status was quite good, in spite of left carotid artery occlusion. Her symptoms improved in the short term, except slight aphasia, but deteriorated again 18 days from the onset, and magnetic resonance imaging (MRI) showed new ischemic lesions. CAS was then performed for the occluded carotid artery on the 23rd day from the first onset. Using the proximal protection technique, the occluded lesion was crossed carefully with a microguidewire. Stents were also placed successfully with the distal protection technique. The occluded carotid artery was completely recanalized without any unfavorable events or neurological deterioration. In this patient, CAS was successfully to treat chronic carotid artery occlusion. These procedures and techniques are reviewed and discussed. (orig.)

Sinus Tumors

Science.gov (United States)

... RESOURCES Medical Societies Patient Education About this Website Font Size + - Home > CONDITIONS > Sinus Tumors Adult Sinusitis Pediatric ... and they vary greatly in location, size and type. Care for these tumors is individualized to each ...

Literature Survey Concerning the Feasibility of Remedial Leach for Select Phase I Caverns

Energy Technology Data Exchange (ETDEWEB)

Weber, Paula D. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Flores, Karen A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Lord, David L. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2015-09-01

Bryan Mound 5 ( BM5 ) and West Hackberry 9 ( WH9 ) have the potential to create a significant amount of new storage space should the caverns be deemed "leach - ready". This study discusses the original drilling history of the caverns, surrounding geology, current stability, and, based on this culmination of data, makes a preliminary assessment of the leach potential for the cavern. The risks associated with leaching BM5 present substantial problems for the SPR . The odd shape and large amount of insoluble material make it difficult to de termine whether a targeted leach would have the desired effect and create useable ullage or further distort the shape with preferential leaching . T he likelihood of salt falls and damaged or severed casing string is significant . In addition, a targeted le ach would require the relocation of approximately 27 MMB of oil . Due to the abundance of unknown factors associated with this cavern, a targeted leach of BM5 is not recommended. A targeted leaching of the neck of WH 9 could potentially eliminate or diminis h the mid - cavern ledge result ing in a more stable cavern with a more favorable shape. A better understanding of the composition of the surrounding salt and a less complicated leaching history yields more confidence in the ability to successfully leach this region. A targeted leach of WH9 can be recommended upon the completion of a full leach plan with consideration of the impacts upon nearby caverns .

Sinus Surgery

Science.gov (United States)

... sinus computed tomography (CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected ... altered anatomical landmarks, or where a patient’s sinus anatomy is very unusual, making typical surgery difficult. Image ...

Spontaneous non aneurysmal subarachnoid hemorrhage

International Nuclear Information System (INIS)

Bian Jieyong; Wang Zhong; Zhou Dai

2000-01-01

Objective: To study the etiology and the treatment of spontaneous non-aneurysmal subarachnoid hemorrhage. Methods: Twenty five cases of cerebral vessel angiography negative patients were analysed retrospectively, the majority of them had been undergone CT, DSA, MRI examination in order to define the etiological factor. Results: Among them, there was 1 case of spinal arteria-vena malformation, 1 case of hemorrhagic blood and 2 cases according to the revealing of MRI could be explained as bled vascular-occult malformation or cavernous angioma. Conclusion: The management and prognosis of patients in whom non-aneurysm is founded on the initial angiogram depends on the pattern of hemorrhage of the initial CT scanning, repeated angiography should be avoided for the case of premise encephalic non-aneurysmal SAH and MRI examination may be indicated to defining of etiological factors

The value of paramagnetic contrast agent gadolinium-DTPA in the diagnosis of pituitary adenomas

International Nuclear Information System (INIS)

Nakamura, T.; Schoerner, W.; Bittner, R.C.; Felix, R.

1988-01-01

The purpose of this study was to assess the role of MR imaging and the paramagnetic contrast agent Gadolinium-DYPA(Gd-DTPA) in the diagnosis of pituitary macroadenomas. 44 macroadenomas were examined with MRI before and after intravenous application of Gd-DTPA. Gd-DTPA produced excellent enhancement of solid adenoma. The best contrast between adenoma and surrounding structures could be gained on post-Gd T1-weighted images. Post-Gd images were equivalent to pre-Gd images in the evaluation of supra- and infrasellar extensions of macroadenomas. Post-Gd images had advantages in the evaluation of cavernous sinus invasion by adenoma. The difference in degree of contrast enhancement between adenoma and cavernous sinus facilitated the exact evaluation of lateral extension by adenoma in 18 cases. Almost equal degree of enhancement of both structures impaired tumor-sinus contrast in 2 cases. In the other 24 cases the tumor filled the cavernous sinus completely. It is our opinion that Gd-DTPA can be used on a widerspread basis because of its excellent capability to highlight and delineate pituitary adenomas. (orig.)

Mathematical model of salt cavern leaching for gas storage in high-insoluble salt formations.

Science.gov (United States)

Li, Jinlong; Shi, Xilin; Yang, Chunhe; Li, Yinping; Wang, Tongtao; Ma, Hongling

2018-01-10

A mathematical model is established to predict the salt cavern development during leaching in high-insoluble salt formations. The salt-brine mass transfer rate is introduced, and the effects of the insoluble sediments on the development of the cavern are included. Considering the salt mass conservation in the cavern, the couple equations of the cavern shape, brine concentration and brine velocity are derived. According to the falling and accumulating rules of the insoluble particles, the governing equations of the insoluble sediments are deduced. A computer program using VC++ language is developed to obtain the numerical solution of these equations. To verify the proposed model, the leaching processes of two salt caverns of Jintan underground gas storage are simulated by the program, using the actual geological and technological parameters. The same simulation is performed by the current mainstream leaching software in China. The simulation results of the two programs are compared with the available field data. It shows that the proposed software is more accurate on the shape prediction of the cavern bottom and roof, which demonstrates the reliability and applicability of the model.

Correlation between presumed sinusitis-induced pain and paranasal sinus computed tomographic findings.

Science.gov (United States)

Mudgil, Shikha P; Wise, Scott W; Hopper, Kenneth D; Kasales, Claudia J; Mauger, David; Fornadley, John A

2002-02-01

The correlation between facial and/or head pain in patients clinically suspected of having sinusitis and actual localized findings on sinus computed tomographic (CT) imaging are poorly understood. To prospectively evaluate the relationship of paranasal sinus pain symptoms with CT imaging. Two hundred consecutive patients referred by otolaryngologists and internists for CT of the paranasal sinuses participated by completing a questionnaire immediately before undergoing CT. Three radiologists blinded to the patients' responses scored the degree of air/fluid level, mucosal thickening, bony reaction, and mucus retention cysts using a graded scale of severity (0 to 3 points). The osteomeatal complexes and nasolacrimal ducts were also evaluated for patency. Bivariate analysis was performed to evaluate the relationship between patients' localized symptoms and CT findings in the respective sinus. One hundred sixty-three patients (82%) reported having some form of facial pain or headache. The right temple/forehead was the most frequently reported region of maximal pain. On CT imaging the maxillary sinus was the most frequently involved sinus. Bivariate analysis failed to show any relationship between patient symptoms and findings on CT. Patients with a normal CT reported a mean 5.88 sites of facial or head pain versus 5.45 sites for patients with an abnormal CT. Patient-based responses of sinonasal pain symptoms fail to correlate with findings in the respective sinuses. CT should therefore be reserved for delineating the anatomy and degree of sinus disease before surgical intervention.

Carotid angiography in the diagnosis and treatment planning of juvenile angiofibroma

International Nuclear Information System (INIS)

Szymanska, A.; Pietura, R.; Krzyzanowski, W.; Szczerbo-Trojanowska, M.

2005-01-01

Juvenile nasopharyngeal angiofibroma is a benign, hyper vascular neoplasm, which affects almost exclusively young males. Although histologically benign it shows malignant clinical course with episodes of severe epistaxis due to marked tendency to spontaneous bleeding. It also leads to serious surgical complications like massive intraoperative bleeding resulting in incomplete resection and high rate of recurrence. The aim of the study was to discuss angiographical findings of the juvenile angiofibroma, evaluate its vascular composition and main feeding vessels, and assess the usefulness of carotid angiography in treatment planning. Typical angiographical findings: rich vascularity and the internal maxillary artery as the main feeding vessel confirm the clinical diagnosis of the juvenile nasopharyngeal angiofibroma. In patients with abundant blood supply from the internal carotid artery a nonsurgical treatment modality may be recommended. Visualisation of the course of the internal maxillary artery facilitates its identification and ligation during surgery. There were 40 patients with angiofibroma juvenile. All patients underwent carotid angiography. We assessed vascularity of the tumour, main feeding vessels and displacement of the internal maxillary artery due to the lateral tumour spread to the infra temporal and pterygopalatine fossa. The relationship between tumour extension and the presence of the internal carotid artery blood supply was also evaluated. In all patients angiography revealed the presence of pathological vessels and defined tumour blood supply. The internal maxillary artery was the main feeding vessel in 97,5% of tumours. In a group of 27 patients 33% showed dislocation of the internal maxillary artery due to the involvement of the infratemporal and pterygopalatine fossa. The relationship between tumour extension and the presence of the internal carotid artery blood supply was statistically significant. (author)

Hazard assessment of the stability of a cavern roof along the coastline

Science.gov (United States)

Reina, A.; Lollino, P.

2009-04-01

This work concerns the hazard assessment about the stability of a large shallow depth cavern, located along the coastline rocky sector of Polignano town (Apulia, Southern Italy) under an intensely urbanised area. This cavern, which lies at the sea level, has been created by a prolonged process of sea erosion within a rock mass formed of a lower stratified limestone mass and an upper Gravina Calcarenite mass. The thickness of the cavern roof, which has a dome shape, is less than 10 metres in the centre. Important buildings, as hotels and private houses, are located just above the top of the roof. Erosion processes have been observed to be still active along the whole cavern due to climate factors and, in particular, to sea salt weathering and sea spray effects. In 2007 a large calcarenite block, 3 m large, fell down from the cavern roof and consequently a field investigation campaign was carried out for a rational stabilization plan in order to understand the current stability conditions of the roof and the potential failure mechanism. Therefore, a thorough geo-structural survey has firstly been carried out, together with laboratory and in-situ testing for measuring the physical and mechanical properties of the calcarenite rock and of the corresponding joints. A monitoring system has also been planned and installed in order to measure the erosional rate and the block displacements in the cavern.

Acute presentation of solitary spinal epidural cavernous angioma in a child

International Nuclear Information System (INIS)

Khalatbari, M.R.; Moharamzad, Y.; Hamidi, M.

2013-01-01

Solitary spinal epidural cavernous angiomas are rare lesions, especially in paediatric age group. They are infrequently considered in the differential diagnosis of spinal epidural masses in children. We report a case of solitary epidural cavernous angioma of the thoracic spine in a child presenting with acute onset of back pain and myelopathy. Magnetic resonance imaging of the thoracic spine demonstrated a posterior epidural mass at T6-T8 levels with compression of the spinal cord. Using microsurgical technique and bipolar coagulation, total excision of the lesion was achieved. Histopathological examination confirmed the diagnosis of cavernous angioma. At the five-year follow-up, there was no recurrence of the tumour. (author)

Research progress in hepatic cavernous hemangiomas: a comprehensive review with graphics

International Nuclear Information System (INIS)

Ouyang Yong; Zhang Xuejun; Ouyang Xuehui; Chao Lumeng

2012-01-01

The common benign tumor of the liver, cavernous hemangioma, has already been confirmed, both embryologically and pathologically, to be not a neoplasm, but a congenital vascular malformation of the liver which is resulted from the arrested development of hepatic sinusoids at embryologic stage. This paper aims to make a comprehensive description of the cavernous hemangiomas of the liver, including the lesion's blood supply, the hemodynamics, the imaging features, the classification and its interventional therapy. The relevant example illustrations, figures and graphics are accompanied with the text in order to provide the readers with an complete and up-to-date understanding of the hepatic cavernous hemangiomas. (authors)

Intracranial carotid anastomosis and partial aplasia of an internal carotid artery

International Nuclear Information System (INIS)

Huber, G.

1980-01-01

A rare arterial anastomosis between the right and left interal carotid arteries at the base at the skull, with aplasia of the cervical part of the left internal carotid artery is reported. The case is unusual because, in addition to the vascular anomaly of the carotid artery, there is an aneurysm of the anterior communicating artery and bilateral renal cysts. The condition is a complex malformation syndrome caused by defective regression of the third branchial artery. Because of the characteristic angiographic aspects such a case should be called transverse carotid anastomosis. (orig.)

Intracranial carotid anastomosis and partial aplasia of an internal carotid artery

Energy Technology Data Exchange (ETDEWEB)

Huber, G.

1980-12-01

A rare arterial anastomosis between the right and left internal carotid arteries at the base at the skull, with aplasia of the cervical part of the left internal carotid artery is reported. The case is unusual because, in addition to the vascular anomaly of the carotid artery, there is an aneurysm of the anterior communicating artery and bilateral renal cysts. The condition is a complex malformation syndrome caused by defective regression of the third branchial artery. Because of the characteristic angiographic aspects such a case should be called transverse carotid anastomosis.

Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial.

LENUS (Irish Health Repository)

Ederle, Jörg

2010-03-20

Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy.

Assessment of maxillary sinus wall thickness with paranasal sinus digital tomosynthesis and CT

Energy Technology Data Exchange (ETDEWEB)

Byun, Ji Eun; Shim, Sung Shine; Kim, Yoo Kyung; Kong, Kyoung Ae [Mokdong Hospital, Ewha Womans University School of Medicine, Seoul (Korea, Republic of)

2017-05-15

This study was performed to compare paranasal sinus tomosynthesis with computed tomography (CT) imaging as a radiologic tool to evaluate the paranasal sinuses, using measurement of the soft tissue thickness of the maxillary sinus. A total of 114 patients with sinusitis who underwent both paranasal sinus digital tomosynthesis (DT) and CT were enrolled in this retrospective study. Two observers independently assessed soft tissue thickness in both maxillary sinus chambers using both DT and CT images. The mean difference in soft tissue thickness measured by each observer was −0.31 mm on CT and 0.15 mm on DT. The mean differences in soft tissue thickness measured with DT and CT were −0.15 by observer 1 and −0.31 by observer 2. Evaluation of the agreement in measurement of soft tissue thickness in the maxillary sinus using DT and CT showed a high intraclass correlation, with the 95% limit of agreement ranging from −3.36 mm to 3.06 mm [intraclass correlation coefficient (ICC), 0.994: p<0.01] for observer 1 and from −5.56 mm to 4.95 mm (ICC, 0.984: p<0.01) for observer 2. As an imaging tool, DT is comparable to CT for assessing the soft tissue thickness of maxillary sinuses in patients with sinusitis.

Clinical consideration of fungal paranasal sinusitis

International Nuclear Information System (INIS)

Okuni, Tsuyoshi; Asakura, Koji; Homma, Tomo; Kawaguchi, Ryuichi; Ishikawa, Tadataka; Yamazaki, Norikazu; Himi, Tetsuo

2008-01-01

Fungal paranasal sinusitis is included in the differential diagnosis of unilateral paranasal lesion. Recently the incidence of fungal paranasal sinusitis has been increasing. We reviewed 24 patients (9 males and 15 females) with fungal paranasal sinusitis treated at Muroran City Hospital between January 2001 and May 2006, and clinical presentation and CT findings with those of 56 patients (36 males and 20 females) with chronic unilateral sinusitis. Fungal sinusitis patients ranged in age from 45 to 87, and the average age was 65.9 years old. In contrast, the age of chronic sinusitis patients ranged from 24 to 83, and the average age was 54.4 years old. The chief complaint of both fungal sinusitis and chronic sinusitis included rhinorrhea, nasal obstruction and post nasal discharge. CT exam was performed in all patients. In 23 cases of paranasal fungal sinusitis and 54 cases of chronic sinusitis the findings involved the maxillary sinus. The most common observation (69.6%) was bone density within the affected sinus in fungal sinusitis. However, only 2 cases of chronic sinusitis (3.9%) showed calcification. All cases of fungal sinusitis were diagnosed by pathological examinations. Most cases were proved to be aspergillus, while only one case was mucor. We treated all cases surgically, 18 cases underwent Caldwell-Luc's procedure and 5 cases underwent endoscopic sinus surgery under local anesthesia. (author)

Review of applicable technology: solution mining of caverns in salt domes to serve as repositories for radioactive wastes

International Nuclear Information System (INIS)

1976-01-01

There is an abundance of salt domes in the Gulf Coastal region. Advances in leaching technology and cavern shape control make it possible to build large caverns with configurations approaching teardrops, cylinders, and spheres. Fenix and Scisson has designed and constructed several dozen caverns in sizes up to three million barrels (16.8 million cubic feet). It is now within current technological bounds to evacuate the brine left in the cavern following construction, dehumidify the cavern atmosphere and supply conditioned cavern ventilation. The state-of-the-art in drilling large diameter holes has advanced to the point that it is now possible to drill 120-in. holes as deep as 6,000 ft and 144-in. holes to lesser depths. Additional research is needed in the area of cavern stability. Cavern shrinkage rates are known to increase with depth because of lower salt strengths at higher pressures and temperatures

How does nose blowing effect the computed tomography of paranasal sinuses in chronic sinusitis?

International Nuclear Information System (INIS)

Savranlar, Ahmet; Uzun, Lokman; Ugur, Mehmet Birol; Mahmutyazicioglu, Kamran; Ozer, Tulay; Gundogdu, Sadi

2005-01-01

Objective: Our aim was to determine whether inward or outward movement of the secretions in the paranasal sinuses due to nose blowing after nasal decongestion has any effect on the paranasal sinus computed tomography (CT) images in patients with sinusitis and to asses whether nose blowing may result in misdiagnosis or overdiagnosis in radiological evaluation of sinusitis. Materials and methods: Twenty-four patients with chronic sinusitis were evaluated in an academic tertiary care hospital and data were collected prospectively. After coronal sinus computed tomography scans were performed at 100 mA setting which was half the value of the standard radiation dose suggested by the manufacturer, topical decongestion was applied to each nostril followed by nose blowing 10 min later. Sinus CT scans were then repeated at the same setting. We evaluated the mucosal thickness of medial, lateral, superior and inferior maxillary and frontal sinus walls and the maximal thickness in anterior ethmoidal cells. The measurements prior to and following nose blowing were compared with Wilcoxon signed ranks test. The obtained images were also staged using Lund-McKay staging system separately and the scores were compared with Student's t-test. Results: We observed a tendency towards reduction in mucosal thickness after nose blowing. There were statistically significant differences between maxillary sinus inferior wall and frontal sinus inferior wall mucosal thickness values prior to and after nose blowing. The difference however was very small, about 0.5 mm in magnitude and Lund-McKay score did not change in any of the patients after nose blowing. Conclusion: Nose blowing and topical nasal decongestion does not have any effect on the diagnostic accuracy of sinus CT in chronic sinusitis patients

Computed Tomography (CT) -- Sinuses

Medline Plus

Full Text Available ... diagnose sinusitis . evaluate sinuses that are filled with fluid or thickened sinus membranes . detect the presence of ... other in a ring, called a gantry. The computer workstation that processes the imaging information is located ...

Computed Tomography (CT) -- Sinuses

Medline Plus

Full Text Available ... CT of the sinuses is primarily used to: help diagnose sinusitis . evaluate sinuses that are filled with ... elevated. Straps and pillows may be used to help the patient maintain the correct position and to ...

Computed Tomography (CT) -- Sinuses

Medline Plus

Full Text Available ... about tumors of the nasal cavity and sinuses. plan for surgery by defining anatomy. top of page ... for sinusitis. CT of the sinuses can help plan the safest and most effective surgery. CT of ...

Radiodense concrements in sinus maxillaris-CT diagnosis of sinus aspergillosis

International Nuclear Information System (INIS)

Krennmair, G.; Lugmayr, H.; Lenglinger, F.

1993-01-01

11 patients with radiodense concrements in the sinus maxillaris underwent a preoperative computertomographic examination of the sinus maxillaris and the sinus concrements. 8 patients (72.7%) with the occurrence of radiodense concrements presented postoperative a histological and microbiological infection with aspergillus fumigatus. The CT-numbers of radiodense concrements in patients with aspergillus were 2802±302.4 HU (Hounsfield Unit). Concrements of patients without aspergillus infection (n=3) had lower density (368.6±149.1 HU; p [de

Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial.

NARCIS (Netherlands)

Ederle, J.; Dobson, J.; Featherstone, R.L.; Bonati, L.H.; Worp, H.B. van der; Borst, G.J. de; Lo, T.H.; Gaines, P.; Dorman, P.J.; Macdonald, S.; Lyrer, P.A.; Hendriks, J.M.; McCollum, C.; Nederkoorn, P.J.; Brown, M.M.; Blankensteijn, J.D.; Leeuw, F.E. de; Schultze Kool, L.J.; Vliet, J.A. van der; et al.,

2010-01-01

BACKGROUND: Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. METHODS: The International

Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial

NARCIS (Netherlands)

Ederle, Jörg; Dobson, Joanna; Featherstone, Roland L.; Bonati, Leo H.; van der Worp, H. Bart; de Borst, Gert J.; Lo, T. Hauw; Gaines, Peter; Dorman, Paul J.; Macdonald, Sumaira; Lyrer, Philippe A.; Hendriks, Johanna M.; McCollum, Charles; Nederkoorn, Paul J.; Brown, Martin M.; Algra, A.; Bamford, J.; Beard, J.; Bland, M.; Bradbury, A. W.; Brown, M. M.; Clifton, A.; Gaines, P.; Collins, R.; Molyneux, A.; Naylor, R.; Warlow, C.; Ferro, J. M.; Thomas, D.; Bonati, L. H.; Coward, L.; Dobson, J.; Ederle, J.; Featherstone, R. F.; Tindall, H.; McCabe, D. J. H.; Wallis, A.; Brooks, M.; Chambers, B.; Chan, A.; Chu, P.; Clark, D.; Dewey, H.; Donnan, G.; Fell, G.; Hoare, M.; Molan, M.; Roberts, A.; Roberts, N.; Beiles, B.; Bladin, C.; Clifford, C.; Grigg, M.; New, G.; Bell, R.; Bower, S.; Chong, W.; Holt, M.; Saunder, A.; Than, P. G.; Gett, S.; Leggett, D.; McGahan, T.; Quinn, J.; Ray, M.; Wong, A.; Woodruff, P.; Foreman, R.; Schultz, D.; Scroop, R.; Stanley, B.; Allard, B.; Atkinson, N.; Cambell, W.; Davies, S.; Field, P.; Milne, P.; Mitchell, P.; Tress, B.; Yan, B.; Beasley, A.; Dunbabin, D.; Stary, D.; Walker, S.; Cras, P.; d'Archambeau, O.; Hendriks, J. M. H.; van Schil, P.; St Blasius, A. Z.; Bosiers, M.; Deloose, K.; van Buggenhout, E.; de Letter, J.; Devos, V.; Ghekiere, J.; Vanhooren, G.; Astarci, P.; Hammer, F.; Lacroix, V.; Peeters, A.; Verbist, J.; Blair, J.-F.; Caron, J. L.; Daneault, N.; Giroux, M.-F.; Guilbert, F.; Lanthier, S.; Lebrun, L.-H.; Oliva, V.; Raymond, J.; Roy, D.; Soulez, G.; Weill, A.; Hill, M.; Hu, W.; Hudion, M.; Morrish, W.; Sutherland, G.; Wong, J.; Albäck, A.; Harno, H.; Ijäs, P.; Kaste, M.; Lepäntalo, M.; Mustanoja, S.; Paananen, T.; Porras, M.; Putaala, J.; Railo, M.; Sairanen, T.; Soinne, L.; Vehmas, A.; Vikatmaa, P.; Goertler, M.; Halloul, Z.; Skalej, M.; Brennan, P.; Kelly, C.; Leahy, A.; Moroney, J.; Thornton, J.; Koelemay, M. J. W.; Reekers, J. A. A.; Roos, Y. B. W. E. M.; Hendriks, J. M.; Koudstaal, P. J.; Pattynama, P. M. T.; van der Lugt, A.; van Dijk, L. C.; van Sambeek, M. R. H. M.; van Urk, H.; Verhagen, H. J. M.; Bruijninckx, C. M. A.; de Bruijn, S. F.; Keunen, R.; Knippenberg, B.; Mosch, A.; Treurniet, F.; van Dijk, L.; van Overhagen, H.; Wever, J.; de Beer, F. C.; van den Berg, J. S. P.; van Hasselt, B. A. A. M.; Zeilstra, D. J.; Boiten, J.; van Otterloo, J. C. A. de Mol; de Vries, A. C.; Lycklama a Nijeholt, G. J.; van der Kallen, B. F. W.; Blankensteijn, J. D.; de Leeuw, F. E.; Kool, L. J. Schultze; van der Vliet, J. A.; de Borst, G. J.; de Kort, G. A. P.; Kapelle, L. J.; Lo, T. H.; Mali, W. P. Th M.; Moll, F.; van der Worp, H. B.; Verhagen, H.; Barber, P. A.; Bourchier, R.; Hill, A.; Holden, A.; Stewart, J.; Bakke, S. J.; Krohg-Sørensen, K.; Skjelland, M.; Tennøe, B.; Bialek, P.; Biejat, Z.; Czepiel, W.; Czlonkowska, A.; Dowzenko, A.; Jedrzejewska, J.; Kobayashi, A.; Lelek, M.; Polanski, J.; Kirbis, J.; Milosevic, Z.; Zvan, B.; Blasco, J.; Chamorro, A.; Macho, J.; Obach, V.; Riambau, V.; San Roman, L.; Branera, J.; Canovas, D.; Estela, Jordi; Gaibar, A. Gimenez; Perendreu, J.; Björses, K.; Gottsater, A.; Ivancev, K.; Maetzsch, T.; Sonesson, B.; Berg, B.; Delle, M.; Formgren, J.; Gillgren, P.; Kall, T.-B.; Konrad, P.; Nyman, N.; Takolander, R.; Andersson, T.; Malmstedt, J.; Soderman, M.; Wahlgren, C.; Wahlgren, N.; Binaghi, S.; Hirt, L.; Michel, P.; Ruchat, P.; Engelter, S. T.; Fluri, F.; Guerke, L.; Jacob, A. L.; Kirsch, E.; Lyrer, P. A.; Radue, E.-W.; Stierli, P.; Wasner, M.; Wetzel, S.; Bonvin, C.; Kalangos, A.; Lovblad, K.; Murith, M.; Ruefenacht, D.; Sztajzel, R.; Higgins, N.; Kirkpatrick, P. J.; Martin, P.; Varty, K.; Adam, D.; Bell, J.; Crowe, P.; Gannon, M.; Henderson, M. J.; Sandler, D.; Shinton, R. A.; Scriven, J. M.; Wilmink, T.; D'Souza, S.; Egun, A.; Guta, R.; Punekar, S.; Seriki, D. M.; Thomson, G.; Brennan, J. A.; Enevoldson, T. P.; Gilling-Smith, G.; Gould, D. A.; Harris, P. L.; McWilliams, R. G.; Nasser, H.-C.; White, R.; Prakash, K. G.; Serracino-Inglott, F.; Subramanian, G.; Symth, J. V.; Walker, M. G.; Clarke, M.; Davis, M.; Dixit, S. A.; Dorman, P.; Dyker, A.; Ford, G.; Golkar, A.; Jackson, R.; Jayakrishnan, V.; Lambert, D.; Lees, T.; Louw, S.; Macdonald, S.; Mendelow, A. D.; Rodgers, H.; Rose, J.; Stansby, G.; Wyatt, M.; Baker, T.; Baldwin, N.; Jones, L.; Mitchell, D.; Munro, E.; Thornton, M.; Baker, D.; Davis, N.; Hamilton, G.; McCabe, D.; Platts, A.; Tibballs, J.; Cleveland, T.; Dodd, D.; Lonsdale, R.; Nair, R.; Nassef, A.; Nawaz, S.; Venables, G.; Belli, A.; Cloud, G.; Halliday, A.; Markus, H.; McFarland, R.; Morgan, R.; Pereira, A.; Thompson, A.; Chataway, J.; Cheshire, N.; Gibbs, R.; Hammady, M.; Jenkins, M.; Malik, I.; Wolfe, J.; Adiseshiah, M.; Bishop, C.; Brew, S.; Brookes, J.; Jäger, R.; Kitchen, N.; Ashleigh, R.; Butterfield, S.; Gamble, G. E.; McCollum, C.; Nasim, A.; O'Neill, P.; Edwards, R. D.; Lees, K. R.; MacKay, A. J.; Moss, J.

2010-01-01

BACKGROUND: Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. METHODS: The International

Computed Tomography (CT) -- Sinuses

Medline Plus

Full Text Available ... equipment to evaluate the paranasal sinus cavities – hollow, air-filled spaces within the bones of the face ... paranasal sinus cavities. The paranasal sinuses are hollow, air-filled spaces located within the bones of the ...

Geotechnical issues and guidelines for storage of compressed air in excavated hard rock caverns

Energy Technology Data Exchange (ETDEWEB)

Allen, R.D.; Doherty, T.J.; Fossum, A.F.

1982-04-01

The results of a literature survey on the stability of excavated hard rock caverns are presented. The objective of the study was to develop geotechnical criteria for the design of compressed air energy storage (CAES) caverns in hard rock formations. These criteria involve geologic, hydrological, geochemical, geothermal, and in situ stress state characteristics of generic rock masses. Their relevance to CAES caverns, and the identification of required research areas, are identified throughout the text. This literature survey and analysis strongly suggests that the chief geotechnical issues for the development and operation of CAES caverns in hard rock are impermeability for containment, stability for sound openings, and hydrostatic balance.

Analysis of the flow in stenosed carotid artery bifurcation models--hydrogen-bubble visualisation.

Science.gov (United States)

Palmen, D E; van de Vosse, F N; Janssen, J D; van Dongen, M E

1994-05-01

This paper deals with the effect of geometric changes of mild stenoses on large-scale flow disturbances in the carotid artery bifurcation. Hydrogen-bubble visualisation experiments have been performed in Plexiglas models of a non-stenosed and a 25% stenosed carotid artery bifurcation. The flow conditions approximate physiological flow. The experiments show that shortly after the onset of the diastolic phase vortex formation occurs in the plane of symmetry. This vortex formation is found in a shear layer, which is formed in the carotid sinus. The shear layer is located between a region with low shear rates at the non-divider wall and a region with high shear rates at the divider wall. In order to gain insight into the parameters that are important with respect to the stability of the shear layer, experiments have been performed in which the influence of the shape of the flow pulse, the Reynolds number (Re), the Womersley parameter (alpha) and the flow division ratio (gamma) on the flow phenomena is studied. From these experiments it appears that the flow phenomena in the carotid artery bifurcation are significantly influenced by Re, alpha the systolic acceleration (sa) and deceleration (sd) and the duration of the peak-systolic flow (Tmax). With these results a simplified flow pulse is chosen, with which the experiments in the non-stenosed and the 25% stenosed bifurcation are performed. Comparison of the hydrogen-bubble profiles in the 0 and 25% stenosed models with similar flow conditions shows that the geometric change of the 25% stenosis only slightly influences the flow phenomena. The most striking influences are found in the stability of the shear layer. Quantitative experiments by means of laser Doppler anemometry measurements and numerical computations are needed to analyse the influence of the stenosis of the flow field more accurately.

[Damage to cranial and peripheral nerves following patency restoration of the internal carotid artery].

Science.gov (United States)

Myrcha, P; Ciostek, P; Szopiński, P; Noszczyk, W

2001-01-01

The aim of the study was an assessment of the incidence of injury to cranial and peripheral nerves as complication of patency restoration of the internal carotid artery, and analysis of the effect of peripheral nerve injury on the results of carotid patency restoration. From Oct 1987 to Sept 1999 543 procedures were carried out for restoration of patency of the internal carotid artery. After the operation hypoglossus nerve injury was found in 7 cases (1.4%), vagus injury in 9 (1.8%). Signs of exclusively recurrent laryngeal nerve damage were found in 6 cases (1.2%). Glossopharyngeus nerve was damaged in 2 cases (0.4%), transient phrenic nerve palsy as a result of conduction anaesthesia was noted in 2 cases (0.4%). Damage to the transverse cervical nerve was found in 96 cases (60%). In 2 patients (1.2%) lower position of mouth angle was due to section of the mandibular ramus of the facial nerve. In another 2 cases skin sensation disturbances were a consequence of lesion of the auricularis magnus nerve and always they coexisted with signs of transverse cervical nerve damage. damage to the cranial nerves during operation for carotid patency restoration are frequent but mostly they are not connected with any health risks and often they regress spontaneously.

Maxillary Sinus Floor Augmentation

DEFF Research Database (Denmark)

Starch-Jensen, Thomas; Jensen, Janek Dalsgaard

2017-01-01

, radiological and histomorphometric outcome as well as complications are presented after maxillary sinus floor augmentation applying the lateral window technique with a graft material, maxillary sinus membrane elevation without a graft material and osteotome-mediated sinus floor elevation with or without...

Role of carotid duplex imaging in carotid screening programmes – an overview

Directory of Open Access Journals (Sweden)

Gillard Jonathan H

2008-07-01

Full Text Available Abstract Background Stroke is the third most common cause of death in the UK and the largest single cause of severe disability. Each year more than 110,000 people in England suffer from a stroke which costs the National Health Service (NHS over GBP2.8 billion. Thus, it is imperative that patients at risk be screened for underlying carotid artery atherosclerosis. Aim To assess the role of carotid ultrasound in different carotid screening programmes. Methods A literature overview was carried out by using PubMed search engine, to identify different carotid screening programmes that had used ultrasound scan as a screening tool. Results It appears that the carotid ultrasound is an effective method for screening carotid artery disease in community as it effectively predicts the presence of stenosis with high accuracy. There is a need for primary care to recommend high risk patients for regular screening, to reduce stroke and transient ischemic attack (TIA related morbidity and mortality. Conclusion Screening programmes using carotid ultrasonography contribute to public health awareness and promotion which in long term could potentially benefit in disease prevention and essentially promote better standards of healthcare.

How does nose blowing effect the computed tomography of paranasal sinuses in chronic sinusitis?

Energy Technology Data Exchange (ETDEWEB)

Savranlar, Ahmet; Uzun, Lokman; Ugur, Mehmet Birol; Mahmutyazicioglu, Kamran; Ozer, Tulay; Gundogdu, Sadi

2005-02-01

Objective: Our aim was to determine whether inward or outward movement of the secretions in the paranasal sinuses due to nose blowing after nasal decongestion has any effect on the paranasal sinus computed tomography (CT) images in patients with sinusitis and to asses whether nose blowing may result in misdiagnosis or overdiagnosis in radiological evaluation of sinusitis. Materials and methods: Twenty-four patients with chronic sinusitis were evaluated in an academic tertiary care hospital and data were collected prospectively. After coronal sinus computed tomography scans were performed at 100 mA setting which was half the value of the standard radiation dose suggested by the manufacturer, topical decongestion was applied to each nostril followed by nose blowing 10 min later. Sinus CT scans were then repeated at the same setting. We evaluated the mucosal thickness of medial, lateral, superior and inferior maxillary and frontal sinus walls and the maximal thickness in anterior ethmoidal cells. The measurements prior to and following nose blowing were compared with Wilcoxon signed ranks test. The obtained images were also staged using Lund-McKay staging system separately and the scores were compared with Student's t-test. Results: We observed a tendency towards reduction in mucosal thickness after nose blowing. There were statistically significant differences between maxillary sinus inferior wall and frontal sinus inferior wall mucosal thickness values prior to and after nose blowing. The difference however was very small, about 0.5 mm in magnitude and Lund-McKay score did not change in any of the patients after nose blowing. Conclusion: Nose blowing and topical nasal decongestion does not have any effect on the diagnostic accuracy of sinus CT in chronic sinusitis patients.

The ATLAS cavern in the spotlight

CERN Multimedia

On Wednesday, 4th June, the President of the Swiss Confederation, Pascal Couchepin, inaugurated the world's largest experimental cavern, which is to house the ATLAS detector in 2007, and announced Switzerland's gift to CERN of the "Palais de l'Equilibre".

A structural behavior study of rock caverns considering the effects of discontinuities

International Nuclear Information System (INIS)

Kim, Jhin Wung; Kim, Sun Hoon; Seo, Jeong Moon; Choi, Kyu Seop; Kim, Dae Hong; Lee, Kyung Jin; Choi, In Gil; Lee, Dong Yong

1990-06-01

The objective of this study is to understand the effects of discontinuities within rock masses on the structural behavior of underground rock caverns for radioactive waste disposal, and then develop a computer program for the structural analysis of rock caverns considering these effect of discontinuities. The behavior of rock masses, such as strength, deformation modes, ect., is very difficult to predict because discontinuities in the form of microcracks or joints are randomly distributed within rock masses. Discontinuties existing around the rock cavern for underground radioactive waste disposal may become the main transport pathways of radionuclides, and reduce the strength of rock masses eventually causing the rock cavern structure unstable. Therefore, a comprehensive understanding of the mechanical properties and behavior of discontinuous rock masses and an improvement of structural analysis methods are essential in order to understand the behavior of underground rock cavern structures properly in order to design safe and economic understanding the behavior of discontinuous rock masses is essential. Therfore, this study includes literature review on mechanical properties of and computational models for discontinuous rock masses, and on structures. Then, bases on the engineering judgement a suitable selection and slight modifications on computational models and analysis methods have been made before developing the structural analysis computer program for underground radioactive waste disposal structures. (author)

Familial cerebral cavernous haemangioma diagnosed in an infant with a rapidly growing cerebral lesion

International Nuclear Information System (INIS)

Ng, B.H.K.; Pereira, J.K.; Ghedia, S.; Pinner, J.; Mowat, D.; Vonau, M.

2006-01-01

Cavernous haemangiomas of the central nervous system are vascular malformations best imaged by MRI. They may present at any age, but to our knowledge only 39 cases in the first year of life have previously been reported. A familial form has been described and some of the underlying genetic mutations have recently been discovered. We present the clinical features and serial MRI findings of an 8-week-old boy who presented with subacute intracranial haemorrhage followed by rapid growth of a surgically proven cavernous haemangioma, mimicking a tumour. He also developed new lesions. A strong family history of neurological disease was elucidated. A familial form of cavernous haemangioma was confirmed by identification of a KRIT 1 gene mutation and cavernous haemangiomas in the patient and other family members. We stress the importance of considering cavernous haemangiomas in the context of intracerebral haemorrhage and in the differential diagnosis of rapidly growing lesions in this age group. The family history is also important in screening for familial disease

Current Approaches for Carotid Endarterectomy

Directory of Open Access Journals (Sweden)

Cengiz Köksal

2010-12-01

Full Text Available Permanent neurologic injuries and death following stroke, necessitates more vigorous treatment of carotid disease. Carotid stenting and carotid endarterectomy are treatment options in many centers besides medical treatment. Whether the patient is symptomatic or asymtomatic, indications and management strategies for treatment remain controversial. Despite the debate, carotid endarterectomy is still accepted to be the most efficientintervention to decrease risk of stroke due to carotid artery stenosis.

Evaluation of the factors predicting the outcome of transsphenoidal microsurgery in patients with premenopausal microprolactinoma

International Nuclear Information System (INIS)

Tsugu, Hitoshi; Emoto, Makoto; Oshiro, Shinya; Komatsu, Fuminari; Sakamoto, Seisaburo; Ohta, Mika; Fukushima, Takeo

2008-01-01

Although cabergoline is an effective first-line treatment for prolactinoma, transsphenoidal microsurgery remains useful for the treatment of microprolactinoma. We investigated the factors that predict the outcome of transsphenoidal microsurgery and also evaluated indications for this method in patients with prolactinoma. We reviewed the cases of 21 premenopausal patients with prolactinoma, who had undergone magnetic resonance imaging (MRI). The clinical characteristics, preoperative prolactin level, adenoma size, MIB-1 labeling index, and cavernous sinus invasion were evaluated. Cavernous sinus invasion was graded according to Knosp's MRI classification. The preoperative prolactin level (P=0.0268) and grade of cavernous sinus invasion (P=0.0284) were statistically significant predictors of a surgical cure for patients with prolactinoma. As a result, transsphenoidal microsurgery is considered to be an effective therapy for appropriately selected premenopausal patients with prolactinoma. We believe that patients with either low Knosp's grade (0 or 1) and/or a preoperative prolactin level of <100 ng/ml would benefit most from transsphenoidal microsurgery as a first-line treatment. (author)

Trigeminofacial reflex: a means of detecting proximity to ophthalmic and maxillary divisions of the trigeminal nerve during surgery.

Science.gov (United States)

AlMasri, Omar A; Brown, Emma E; Forster, Alan; Kamel, Mahmoud H

2014-11-01

The aim in this paper was to localize and detect incipient damage to the ophthalmic and maxillary branches of the trigeminal nerve during tumor surgery. This was an observational study of patients with skull base, retroorbital, or cavernous sinus tumors warranting dissection toward the cavernous sinus at a university hospital. Stimuli were applied as normal during approach to the cavernous sinus to localize cranial nerves (CNs) III, IV, and VI. Recordings were also obtained from the facial muscles to localize CN VII. The trigeminofacial reflex was sought simply by observing a longer time base routinely. Clear facial electromyography responses were reproduced when stimuli were applied to the region of V1, V2, and V3. Response latency was increased compared with direct CN VII stimuli seen in some cases. Responses gave early warning of approach to these sensory trigeminal branches. The authors submit this as a new technique, which may improve the chances of preserving trigeminal sensory branches during surgery in this region.

Fractal Prediction of Grouting Volume for Treating Karst Caverns along a Shield Tunneling Alignment

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Wen-Chieh Cheng

2017-06-01

Full Text Available Karst geology is common in China, and buried karst formations are widely distributed in Guangdong province. In the process of shield tunneling, the abundant water resources present in karst caverns could lead to the potential for high water ingress, and a subsequent in situ stress change-induced stratum collapse. The development and distribution of karst caverns should therefore be identified and investigated prior to shield tunnel construction. Grouting is an efficient measure to stabilize karst caverns. The total volume of karst caverns along the shield tunneling alignment, and its relationship with the required volume of grouts, should be evaluated in the preliminary design phase. Conventionally, the total volume of karst caverns is empirically estimated based on limited geological drilling hole data; however, accurate results are rarely obtained. This study investigates the hydrogeology and engineering geology of Guangzhou, the capital of Guangdong province, and determines the fractal characteristics of the karst caverns along the tunnel section of Guangzhou metro line no. 9. The karst grouting coefficients (VR were found to vary from 0.11 in the case of inadequate drilling holes to 1.1 in the case where adequate drilling holes are provided. A grouting design guideline was furthermore developed in this study for future projects in karst areas.

Carotid angioplasty and stenting for symptomatic carotid kinking combined with stenosis

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JIANG Xue-li

2013-03-01

Full Text Available Background Carotid endarterectomy (CEA is currently the preferred treatment for severe carotid kinking and stenosis. Kinking is generally believed to be a relative contraindication for endovascular stent placement. This article aims to study the necessity, feasibility and security of carotid angioplasty and stenting (CAS for symptomatic carotid kinking combined with stenosis, and summarize clinical experience of this disease according to therapeutic results. Methods Twenty-two cases with symptomatic carotid kinking and high-grade stenosis demonstrated by digital subtraction angiography (DSA were performed CAS. Their clinical manifestations, imaging features, procedure safety and follow-up data were collected and retrospectively analyzed. All patients understood CEA and voluntarily received CAS. Results Twenty-two cases with carotid kinking and stenosis were all successfully performed CAS (the success rate was 100% without stent-related disability or mortality. Twenty-four self-expandable stents were implanted. The mean degree of stenosis was reduced from 85.63%before stenting to 11.25% after stenting and the angles of kinking were improved from 120° (Metz' category. During the period of hospitalization, no transient ischemic attack (TIA or cerebral infarction occurred, and the clinical symptoms and signs of ischemia, such as dizziness and headache, were improved or disappeared. Besides, no permenant complications or deaths happened. All cases were followed up from 6 to 72 months, among whom 1 patient experienced contralateral carotid TIA, and 2 patients experienced ipsilateral carotid TIA (one indicated aspirin resistance in platelet aggregation test and the other showed restenosis in DSA. Computed tomography angiography (CTA of 10 patients and Duplex scan of 7 patients during the follow-up demonstrated carotid in good morphology and fluent blood flow, without kinking or restenosis. Conclusion CAS is a feasible and safe therapeutic method and

Absence of pulmonary aspiration of sinus contents in patients with asthma and sinusitis

International Nuclear Information System (INIS)

Bardin, P.G.; Van Heerden, B.B.; Joubert, J.R.

1990-01-01

The frequent association of asthma and paranasal sinusitis has been ascribed to a nasobronchial reflex, aspiration of sinus secretions, or enhanced beta-adrenergic blockade. We investigated possible pulmonary aspiration in a pilot study (eight patients) and follow-up study (13 patients) by means of a radionuclide technique. In the pilot study, the aim was to demonstrate aspiration as well as visibility of the radionuclide in the thorax during a period of 24 hours. The radionuclide was initially placed bronchoscopically in the bronchial tree in four patients and was still clearly visible in the same position after 24 hours in three patients. Aspiration from the nasopharynx was unequivocally demonstrated in two of four patients with depressed consciousness. The follow-up study population consisted of four patients with maxillary sinusitis only and nine patients with sinusitis and asthma. The radionuclide was placed in a maxillary sinus during therapeutic puncture. In the patients with only sinusitis as well as patients with asthma and sinusitis the radionuclide could be demonstrated in the maxillary sinus, nasopharynx, esophagus, and lower gastrointestinal tract during a 24-hour period. However, no pulmonary aspiration of radionuclide could be demonstrated in any patient. We conclude that seeding of the lower airways by mucopurulent secretions is unlikely to account for coexistent pulmonary disease. The association is probably related to generalized mucosal disease affecting both upper and lower airways

Prevalence of paranasal sinus opacification in infants and children without overt sinusitis using computed tomography

International Nuclear Information System (INIS)

Choi, Pil YouB; Kim, Hyung Jin; Park, Eui Dong; Kim, Jae Hyoung; Chung, Sung Hoon

1994-01-01

To evaluate the prevalence of the opacification of paranasal sinuses and to correlate the prevalence and severity of the sinus opacification with presence of upper respiratory infection (URI) in infants and children using CT. We analyzed CT scans of 162 children aged under 16 who have no signs and symptoms of paranasal sinusitis. Both sides of maxillary and ethmoidal sinuses were evaluated. We scored from 0 to 3 according to the degree of soft tissue opacification of each sinus and then summed up the scores of each sinus. We divided the children into 5 groups according to their age. We paid particular attention to the following respects: 1) the prevalence of the opacification of the paranasal sinuses in each group; 2) the difference in the prevalence between the children with and without URI; 3) the correlation between the severity of the sinus opacification and the presence of URI. Of 162 children, one or more paranasal sinus opacification was noted in 76(47%): 31(65%) less than 1 year old; 11(52%) between 1 and 2 years old; 16(53%) between 2 and 6 years old; 15(28%) between 6 and 12 years old; and 3(33%) above 12 years old. In children less than 1 year old, no significant difference in the prevalence of the sinus opacification was found between URI-positive(71%) and URI-negative(58%) subgroups. In children between 1 and 12 years old, although the prevalence of the sinus opacification in URI-positive subgroups was much greater than that in URI-negative subgroup, statistically significant difference was noted only in children between 2 and 6 years old. As to the correlation between the severity of the sinus opacification and the presence of URI, these was a statistically significant difference in children between 2 and 6 years old and between 6 and 12 years old. Although the exact pathophysiology is not fully understood, the opacification of the paranasal sinuses is not an uncommon finding at CT in children without the signs and symptoms of sinusitis. We thick that

VACUUM THERAPY – PREVENTION OF HYPOXIA OF CAVERNOUS TISSUE PATIENTS AFTER RADICAL PROSTATECTOMY

Directory of Open Access Journals (Sweden)

A. E. Osadchinskii

2018-01-01

Full Text Available Patients, after radical prostatectomy with the use of nerve-sparing techniques, without carrying out penile rehabilitation, are at risk of forming cavernous fibrosis with the emergence of subsequent persistent erectile dysfunction. In order to minimize damage to cavernous tissue and early restoration of erectile function during the period of neuropraxia, it is necessary to ensure a sufficient level of oxygenation. The role of applying vacuum in penile rehabilitation for the prevention of hypoxia of cavernous tissue is not fully understood, due to the lack of data on the gaseous composition of the blood at the time of reaching the vacuum of erection. The purpose of this work was to review the scientific studies devoted to the study of vacuum induced penile erection in animals or humans, which indicates high results due to increased oxygenation of cavernous tissue.

Chronic Granulomatous Tolosa-Hunt Syndrome (Case Report

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Dewa Purwa Samatra

2016-04-01

Full Text Available Background: Tolosa-Hunt syndrome is a rare case, characterized by tenderness, persistent around the affected eye and ophthalmoplegia /paresis caused by granulomatous inflammation in the cavernous sinus region, supra orbital or orbital fissure. Although spontaneous remission may occur, even corticosteroid therapy has a very satisfactory effect. However, relapse can occur after remission. We report a case of granulomatous Tolosa-Hunt syndrome in women aged 47 years who suffer from recurrent Tolosa-Hunt syndrome attacks for 4 years on his left eye, there was a significant recovery after receiving steroid therapy. Case:  We report A 47 years old with recurrent pain in the left eye since 4 years, pain episode duration of 1-2 weeks, accompanied by double vision when having long or short distance viewing, and when climbing stairs. The patient left eye was protruded with blurred vision and difficulty in distinguishing green color. Left eye examination vision 1/300, green color discromatopsia, normal funduscopic, ptosis, with paresis eye movement toward the superior, inferior, nasal and temporal. C-reactive protein and erythrocyte sedimentation rate were slightly elevated. ANA test was positive. In visual evoked potential, it showed latency elongation of the left face. Head MRI with contrast showed a isointense protrusion on the left cavernous sinus in axial cuts in T1 and T2. Head MRI T1 with contrast on coronal, axial cuts showed the appearance of convex lesions around the left cavernous sinus that enhanced with contrast. Conclusions: The result was clinically and radiographically diagnosed as Tolosa-Hunt Syndrome (THS. Therefore, 10 mg dexamethasone therapy, 4 times a day for 3 days was lowered to three times on day 4, 2 times on the fifth day and one time at day 6. The patient showed clinical improvement. The patient continued 48 mg oral methylprednisolone therapy up to 3 weeks which then gradually decreased and planned head MRI 3 months later.

Fracture and Healing of Rock Salt Related to Salt Caverns

International Nuclear Information System (INIS)

Chan, K.S.; Fossum, A.F.; Munson, D.E.

1999-01-01

In recent years, serious investigations of potential extension of the useful life of older caverns or of the use of abandoned caverns for waste disposal have been of interest to the technical community. All of the potential applications depend upon understanding the reamer in which older caverns and sealing systems can fail. Such an understanding will require a more detailed knowledge of the fracture of salt than has been necessary to date. Fortunately, the knowledge of the fracture and healing of salt has made significant advances in the last decade, and is in a position to yield meaningful insights to older cavern behavior. In particular, micromechanical mechanisms of fracture and the concept of a fracture mechanism map have been essential guides, as has the utilization of continuum damage mechanics. The Multimechanism Deformation Coupled Fracture (MDCF) model, which is summarized extensively in this work was developed specifically to treat both the creep and fracture of salt, and was later extended to incorporate the fracture healing process known to occur in rock salt. Fracture in salt is based on the formation and evolution of microfractures, which may take the form of wing tip cracks, either in the body or the boundary of the grain. This type of crack deforms under shear to produce a strain, and furthermore, the opening of the wing cracks produce volume strain or dilatancy. In the presence of a confining pressure, microcrack formation may be suppressed, as is often the case for triaxial compression tests or natural underground stress situations. However, if the confining pressure is insufficient to suppress fracture, then the fractures will evolve with time to give the characteristic tertiary creep response. Two first order kinetics processes, closure of cracks and healing of cracks, control the healing process. Significantly, volume strain produced by microfractures may lead to changes in the permeability of the salt, which can become a major concern in

Establishing experimental model of human internal carotid artery siphon segment in canine common carotid artery

International Nuclear Information System (INIS)

Cui Xuee; Li Minghua; Wang Yongli; Cheng Yingsheng; Li Wenbin

2005-01-01

Objective: To study the feasibility of establishing experimental model of human internal carotid artery siphon segment in canine common carotid artery (CCA) by end-to-end anastomoses of one side common carotid artery segment with the other side common carotid artery. Methods: Surgical techniques were used to make siphon model in 8 canines. One side CCA was taken as the parent artery and anastomosing with the cut off contra-lateral CCA segment which has passed through within the S-shaped glass tube. Two weeks after the creation of models angiography showed the model siphons were patent. Results: Experimental models of human internal carotid artery siphon segment were successfully made in all 8 dogs. Conclusions: It is practically feasible to establish experimental canine common carotid artery models of siphon segment simulating human internal carotid artery. (authors)

Laterally situated sinus pericranii

International Nuclear Information System (INIS)

Koshu, K.; Takahashi, S.

1981-01-01

Sinus pericranii has been reported to be situated usually along the midline. Two cases of laterally situated sinus pericranii are presented. Venous blood was obtained by puncturing the tumors directly. Injection of contrast medium into the tumors demonstrated a communication between the tumors and the intracranial venous sinuses through marked diploic veins. (orig.)

Associations between inflammatory cells infiltrating the ethmoid sinus mucosa, and nasal polyp size and grade of ethmoid sinus opacification on CT images in chronic sinusitis

International Nuclear Information System (INIS)

Imajima, Naotoshi; Watanabe, So; Furuta, Atsuko; Shimizu, Toshiyuki; Yamada, Naohiro; Mochizuki, Yuichiro; Suzaki, Harumi

2009-01-01

We investigated the types and numbers of inflammatory cells that infiltrated the ethmoid sinus mucosa in cases of chronic sinusitis in order to identify any associations with nasal polyp size and the grade of ethmoid sinus opacification on computer tomography images. The subjects were patients with chronic sinusitis who underwent endoscopic sinus surgery. Seventeen subjects also had bronchial asthma as a complication (six with aspirin-induced asthma, 11 with another form of asthma) and 24 did not have bronchial asthma as a complication (16 with allergic rhinitis, 8 with chronic sinusitis alone). The nasal polyps in the patients with bronchial asthma were significantly larger than those in the patients without bronchial asthma. Investigation of the numbers of infiltrating inflammatory cells according to polyp size revealed significantly more eosinophils as polyp size increased. In addition, infiltration of significantly more mast cells was observed when the polyps were large. Assessment of the grade of opacification of the ethmoid sinuses on computer tomography images showed a significantly higher grade of opacification in the patients with bronchial asthma than in the patients without bronchial asthma. Comparisons between the grade of opacification of the ethmoid sinuses and the number of infiltrating inflammatory cells revealed significantly more infiltrating eosinophils and mast cells in the patients with intense ethmoid sinus opacification. The above findings suggest that eosinophils and mast cells play a major role in forming the persistent inflammation of the sinus mucosa and nasal polyp tissue of patients with chronic sinusitis complicated by bronchial asthma. (author)

Simulation of Mechanical Processes in Gas Storage Caverns for Short-Term Energy Storage

Science.gov (United States)

Böttcher, Norbert; Nagel, Thomas; Kolditz, Olaf

2015-04-01

In recent years, Germany's energy management has started to be transferred from fossil fuels to renewable and sustainable energy carriers. Renewable energy sources such as solar and wind power are subjected by fluctuations, thus the development and extension of energy storage capacities is a priority in German R&D programs. This work is a part of the ANGUS+ Project, funded by the federal ministry of education and research, which investigates the influence of subsurface energy storage on the underground. The utilization of subsurface salt caverns as a long-term storage reservoir for fossil fuels is a common method, since the construction of caverns in salt rock is inexpensive in comparison to solid rock formations due to solution mining. Another advantage of evaporate as host material is the self-healing behaviour of salt rock, thus the cavity can be assumed to be impermeable. In the framework of short-term energy storage (hours to days), caverns can be used as gas storage reservoirs for natural or artificial fuel gases, such as hydrogen, methane, or compressed air, where the operation pressures inside the caverns will fluctuate more frequently. This work investigates the influence of changing operation pressures at high frequencies on the stability of the host rock of gas storage caverns utilizing numerical models. Therefore, we developed a coupled Thermo-Hydro-Mechanical (THM) model based on the finite element method utilizing the open-source software platform OpenGeoSys. The salt behaviour is described by well-known constitutive material models which are capable of predicting creep, self-healing, and dilatancy processes. Our simulations include the thermodynamic behaviour of gas storage process, temperature development and distribution on the cavern boundary, the deformation of the cavern geometry, and the prediction of the dilatancy zone. Based on the numerical results, optimal operation modes can be found for individual caverns, so the risk of host rock damage

Vascular permeability in cerebral cavernous malformations

DEFF Research Database (Denmark)

Mikati, Abdul G; Khanna, Omaditya; Zhang, Lingjiao

2015-01-01

Patients with the familial form of cerebral cavernous malformations (CCMs) are haploinsufficient for the CCM1, CCM2, or CCM3 gene. Loss of corresponding CCM proteins increases RhoA kinase-mediated endothelial permeability in vitro, and in mouse brains in vivo. A prospective case-controlled observ...

Assessment of the Available Drawdowns for Oil Storage Caverns at the West Hackberry SPR Site

Energy Technology Data Exchange (ETDEWEB)

Sobolik, Steven R. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Geotechnology and Engineering Dept.

2016-03-01

The Department of Energy, in response to requests from the U.S. Congress, wishes to maintain an up-to-date table documenting the number of available full drawdowns of each of the caverns owned by the Strategic Petroleum Reserve. This information is important for assessing the SPR’s ability to deliver oil to domestic oil companies expeditiously if national or world events dictate a rapid sale and deployment of the oil reserves. What factors go into assessing available drawdowns? The evaluation of drawdown risks require the consideration of several factors regarding cavern and wellbore integrity and stability, including stress states caused by cavern geometry and operations, salt damage caused by dilatant and tensile stresses, the effect on enhanced creep on wellbore integrity, the sympathetic stress effect of operations on neighboring caverns. Based on the work over the past several months, a consensus has been built regarding the assessment of drawdown capabilities and risks for the SPR caverns. This paper draws upon the recently West Hackberry model upgrade and analyses to reevaluate and update the available drawdowns for each of those caverns. Similar papers for the Bryan Mound, Big Hill, and Bayou Choctaw papers will be developed as the upgrades to those analyses are completed. The rationale and documentation of the methodology is described in the remainder of this report, as are the updated estimates of available drawdowns for the West Hackberry caverns.

Strains and stresses in the rock around and unlined hot water cavern

Science.gov (United States)

Rehbinder, Göran

1984-07-01

Hot water stored in an unlined rock cavern is an efficient energy storage. A research program has been carried out with a test plant at the city of Avesta, Sweden. The plant consists of a rock cavern, the volume of which is 15000 m3, which serves as an energy buffer in the district heating system of the city. The water is heated from a garbage incinerator located close to the cavern. During the first test period the temperature of the stored water has varied between 40°C and 95°C. The heating of the rock causes strains and stresses in the rock. The measurements show that the state in the rock does mainly respond to the average temperature and not to the fluctuations. The maximum thermal stress is 9 MPa occurring at the wall of the cavern. The heave of the ground is less than 5 mm. The development of stress and strain will continue after the first test period since thermal equilibrium was not reached during this period.

Anomalous external carotid artery-internal carotid artery anastomosis in two patients with proximal internal carotid arterial remnants

Energy Technology Data Exchange (ETDEWEB)

Kim, Chang Hun [Dept. of Neurology, Stroke Center, Myongji Hospital, Goyang (Korea, Republic of); Cho, Young Dae; Kang, Hyun Seung; Kim, Jeong Eun; Han, Moon Hee [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Jung, Seung Chai [Dept. of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Ahn, Jun Hyong [Dept. of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of)

2015-08-15

Two angiographic instances of anomalous external carotid artery (ECA) and internal carotid artery (ICA) anastomosis are described, each occurring at the C2-3 level and bearing remnants of proximal ICA. The ICA remnant of one patient (identifiable immediately upon bifurcation of the common carotid artery) was hypoplastic, and that of the other patient was an occluded arterial stump. These features are not typical of non-bifurcating ICA. The occipital artery originated from an anomalous connection in one instance and from the main trunk of the ECA (just past the ECA-ICA connection) in the other.

Intracranial intrasellar kissing carotid arteries: case report Artérias carótidas intracranianas intra-selares "que se beijam": relato de caso

Directory of Open Access Journals (Sweden)

Arthur de Azambuja Pereira Filho

2007-06-01

Full Text Available Intracranial "kissing" carotid arteries are a rare variant of the carotid arteries, where both internal carotid arteries deviate medially and touch each other near the midline within the sphenoid sinus or the sphenoid bone, including the sella. This anomaly is particularly important since it may cause or mimic pituitary disease and also may complicate transsphenoidal surgery. We report a rare case of intracranial intrasellar kissing carotid arteries in a 57-years-old woman that was submitted to a computed tomography angiography during investigation of a sudden headache, and to discuss the clinical relevance of this radiological finding.Artérias carótidas intracranianas "que se beijam" representam rara variação da anatomia arterial, onde ambas as artérias carótidas internas desviam-se medialmente e tocam-se próximo à linha media dentro do seio esfenoidal ou do osso esfenóide, incluindo a sela túrcica. Essa anomalia é particularmente importante, pois pode causar ou simular doença pituitária e ainda pode complicar uma cirurgia transesfenoidal. Relatamos um raro caso de artérias carótidas intracranianas "que se beijam" em mulher de 57 anos, a qual foi investigada por angiotomografia por quadro de cefaléia súbita. Discutimos a relevância clínica desse achado radiológico.

[A case of multiple cavernous angioma with dementia].

Science.gov (United States)

Kariya, S; Kawahara, M; Suzumura, A

2000-10-01

We reported a 65-year-old man who developed dementia since 50 years of age. His consciousness was clear but he was indifferent to his illness. Also, the luck of attention was recognized when we underwent examinations and the result of intellectual test varied every time we performed. His memory function was almost normal on the examination which was performed when he was cooperative. Magnetic resonance imaging (MRI) disclosed multiple tiny lesions (more than 130 in all) in cerebrum, brainstem, cerebellum and spinal cord. These lesions were compatible with multiple cavernous angioma. Most of lesions manifested high-density area on cranial CT. Though the multiplicity of foci indicated the possibility of familial occurrence, he was considered to be a sporadic case on his lineage investigation and the brain MRI of his only son. In this case, neither headache nor seizures which were known as the major clinical features of intracerebral cavernous angioma was observed. He was diagnosed as having white matter dementia characterized by attentional dysfunction, decrement of volition and less memory disturbance. We speculated that he developed symptomatic dementia by the sum of multiple minor degeneration, especially in frontal lobe white matter, caused by repeated minor bleeding from cavernous angiomas.

Transient behaviour of deep underground salt caverns; Comportement transitoire des cavites salines profondes

Energy Technology Data Exchange (ETDEWEB)

Karimi-Jafari, M

2007-11-15

This work deals with the transient behaviour of deep underground salt caverns. It has been shown that a cavern is a complex system, in which there are mechanical, thermal, chemical and hydraulic evolutions. The importance of the transient evolutions, particularly the role of the 'reverse' creep in the interpretation of the tightness test in a salt cavern is revealed. Creep is characterized by a formulation of the behaviour law which presents the advantage, in a practical point of view, to only have a reduced number of parameters while accounting of the essential of what it is observed. The initiation of the rupture in the effective traction in a salt cavern rapidly pressurized is discussed. A model fitted to a very long term behaviour (after abandonment) is developed too. In this case too, a lot of phenomena, more or less coupled, occur, when the existing literature took only into account some phenomena. (O.M.)

Recurrent Syncope due to Esophageal Squamous Cell Carcinoma

OpenAIRE

Casini, Alessandro; Tschanz, Elisabeth; Dietrich, Pierre-Yves; Nendaz, Mathieu

2011-01-01

Syncope is caused by a wide variety of disorders. Recurrent syncope as a complication of malignancy is uncommon and may be difficult to diagnose and to treat. Primary neck carcinoma or metastases spreading in parapharyngeal and carotid spaces can involve the internal carotid artery and cause neurally mediated syncope with a clinical presentation like carotid sinus syndrome. We report the case of a 76-year-old man who suffered from recurrent syncope due to invasion of the right carotid sinus b...

EXAMINE AND EVALUATE A PROCESS TO USE SALT CAVERNS TO RECEIVE SHIP BORNE LIQUEFIED NATURAL GAS

Energy Technology Data Exchange (ETDEWEB)

Michael M. McCall; William M. Bishop; D. Braxton Scherz

2003-04-24

The goal of the U.S. Department of Energy cooperative research project is to define, describe, and validate, a process to utilize salt caverns to receive and store the cargoes of LNG ships. The project defines the process as receiving LNG from a ship, pumping the LNG up to cavern injection pressures, warming it to cavern compatible temperatures, injecting the warmed vapor directly into salt caverns for storage, and distribution to the pipeline network. The performance of work under this agreement is based on U.S. Patent 5,511,905, and other U.S. and Foreign pending patent applications. The cost sharing participants in the research are The National Energy Technology Laboratory (U.S. Department of Energy), BP America Production Company, Bluewater Offshore Production Systems (U.S.A.), Inc., and HNG Storage, L.P. Initial results indicate that a salt cavern based receiving terminal could be built at about half the capital cost, less than half the operating costs and would have significantly higher delivery capacity, shorter construction time, and be much more secure than a conventional liquid tank based terminal. There is a significant body of knowledge and practice concerning natural gas storage in salt caverns, and there is a considerable body of knowledge and practice in handling LNG, but there has never been any attempt to develop a process whereby the two technologies can be combined. Salt cavern storage is infinitely more secure than surface storage tanks, far less susceptible to accidents or terrorist acts, and much more acceptable to the community. The project team developed conceptual designs of two salt cavern based LNG terminals, one with caverns located in Calcasieu Parish Louisiana, and the second in Vermilion block 179 about 50 miles offshore Louisiana. These conceptual designs were compared to conventional tank based LNG terminals and demonstrate superior security, economy and capacity. The potential for the development of LNG receiving terminals

Sinusitis with eosinophilic otitis media

International Nuclear Information System (INIS)

Kawano, Toshiro; Ishitoya, Junichi; Tsukuda, Mamoru

2007-01-01

Eosinophilic otitis media is an intractable inflammation of the middle ear combined with bronchial asthma. According to a national epidemiological investigation on eosinophilic otitis media, it is assumed that eosinophilic otitis media are combined with sinusitis in about 74% of their cases. On the other hand, organizational images of eosinophilic otitis media and eosinophilic sinusitis are similar, and steroid therapy is effective together, and it is thought that they are involved in the idea of one airway one disease, but the details of sinusitis combined with the eosinophilic otitis media are unidentified. Therefore, we examined the kinds of the sinusitis combined with eosinophilic otitis media. We diagnosed 18 cases (male: 2 cases, female: 16 cases) (average age: 54.6 years old) as eosinophilic otitis media according to the diagnostic criteria. And, by the CT views of a paranasal sinus, blood tests, existence of the nasal polyp, etc, we investigated the kinds of sinusitis combined with eosinophilic otitis media. It turned out that bronchial asthma was combined with eosinophilic otitis media in 17 of 18 cases (airway hypersensitivity did sthenia of one case, but the asthma did not yet developed), and 6 cases were combined with aspirin induced asthma (AIA), and 3 cases were combined with Churg-Strauss syndromes (CSS). 10 case (55.6%) of 17 eosinophilic otitis media were combined with eosinophilic sinusitis. And 4 cases (22.2%) of 17 eosinophilic otitis media were combined with chronic sinusitis, 4 cases (22.2%) of 17 eosinophilic otitis media were not combined with sinusitis. We concluded that eosinophilic otitis media was not always combined with eosinophilic sinusitis. The idea of one airway one disease was not applied to this examination. (author)

Sinusitis with eosinophilic otitis media

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Kawano, Toshiro; Ishitoya, Junichi [Yokohama City Univ., Medical Center, Yokohama, Kanagawa (Japan); Tsukuda, Mamoru [Yokohama City Univ., Graduate School of Medicine, Yokohama, Kanagawa (Japan)

2007-09-15

Eosinophilic otitis media is an intractable inflammation of the middle ear combined with bronchial asthma. According to a national epidemiological investigation on eosinophilic otitis media, it is assumed that eosinophilic otitis media are combined with sinusitis in about 74% of their cases. On the other hand, organizational images of eosinophilic otitis media and eosinophilic sinusitis are similar, and steroid therapy is effective together, and it is thought that they are involved in the idea of one airway one disease, but the details of sinusitis combined with the eosinophilic otitis media are unidentified. Therefore, we examined the kinds of the sinusitis combined with eosinophilic otitis media. We diagnosed 18 cases (male: 2 cases, female: 16 cases) (average age: 54.6 years old) as eosinophilic otitis media according to the diagnostic criteria. And, by the CT views of a paranasal sinus, blood tests, existence of the nasal polyp, etc, we investigated the kinds of sinusitis combined with eosinophilic otitis media. It turned out that bronchial asthma was combined with eosinophilic otitis media in 17 of 18 cases (airway hypersensitivity did sthenia of one case, but the asthma did not yet developed), and 6 cases were combined with aspirin induced asthma (AIA), and 3 cases were combined with Churg-Strauss syndromes (CSS). 10 case (55.6%) of 17 eosinophilic otitis media were combined with eosinophilic sinusitis. And 4 cases (22.2%) of 17 eosinophilic otitis media were combined with chronic sinusitis, 4 cases (22.2%) of 17 eosinophilic otitis media were not combined with sinusitis. We concluded that eosinophilic otitis media was not always combined with eosinophilic sinusitis. The idea of one airway one disease was not applied to this examination. (author)

Spontaneous acute subdural hematoma as an initial presentation of choriocarcinoma: A case report

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Rocque Brandon G

2008-06-01

Full Text Available Abstract Introduction Diverse sequelae of central nervous system metastasis of choriocarcinoma have been reported, including infarction, intra or extra axial hemorrhages, aneurysm formation and carotid-cavernous fistula. Here we report a case of subdural hematoma as the first presentation of choriocarcinoma. Case presentation The patient is a 34-year-old woman whose initial presentation of widely metastatic choriocarcinoma was an acute subdural hematoma, requiring decompressive craniectomy. Histopathologic examination of the tissue showed no evidence of choriocarcinoma, but the patient was found to have diffuse metastatic disease and cerebrospinal fluid indices highly suggestive of intracranial metastasis. Conclusion Choriocarcinoma frequently metastasizes intracranially. We review the diverse possible manifestations of this process. In addition, the cerebrospinal fluid:serum beta-human chorionic gonadotropin ratio is an important factor in diagnosing these cases. Finally, the role of the neurosurgeon is discussed.

Pilonidal Sinus of the Penis

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Hugh F. O'Kane

2004-01-01

Full Text Available A pilonidal sinus is a subcutaneous sinus containing hair. It is most commonly found in the natal cleft of hirsute men. Here we describe the unusual finding of a pilonidal sinus arising on the male foreskin.

Intracranial melanocytic meningeal tumours and melanosis oculi: case report and literature review

International Nuclear Information System (INIS)

Doglietto, Francesco; Colosimo, Cesare; Lauriola, Libero; Balducci, Mario; De Bonis, Pasquale; Montano, Nicola; Zadeh, Gelareh; Maira, Giulio; Pallini, Roberto

2012-01-01

Melanocytic meningeal tumours are rare extra-axial neoplasms of the nervous system, with only three reported cases in the cavernous sinus. Herein we describe for the first time the association of ocular melanosis and multiple intracranial melanocytic meningeal tumours, with the presenting lesion being in the cavernous sinus. The importance of this association is discussed together with the diagnostic and therapeutic challenges of the case. A 20-year-old man presented with a left sixth cranial nerve deficit; general examination documented only congenital melanosis of the homolateral eye. MRI examination showed a space occupying lesion in the left cavernous sinus, which was followed conservatively for 2 years, until a new space occupying lesion was evident at the level of the right frontal convexity: both lesions presented with neuroradiological characteristics suggestive of melanin content. The frontal convexity lesion was removed: intraoperatively the dura was markedly and diffusely melanotic. Histological examination documented a melanocytic meningeal tumour, with a proliferative index of 3 %. The patient underwent 3D-Conformal Radiation Therapy on the lesion of the cavernous sinus (total dose 5040 cGy), with initial tumour reduction. Three years later, due to a symptomatic growth, he underwent partial removal of the lesion in the cavernous sinus. Histological examination was unchanged. He then received adjuvant Temozolomide with Low Dose Fractionated Radiation Therapy (LD-FRT). Due to further disease progression cisplatin plus fotemustine were administered, concomitant with LD-FRT: after two cycles MRI documented significant disease regression. After a period of apparent disease control, the patient presented with persistent cough and evidence of multiple thoracic metastases, which lead to his death, seven years after presentation. Intracranial melanocytic meningeal tumours are challenging lesions, both from a diagnostic and therapeutic point of view; though rare

Mixing in the human carotid artery during carotid drug infusion studied with PET

International Nuclear Information System (INIS)

Junck, L.; Koeppe, R.A.; Greenberg, H.S.

1989-01-01

The safety and efficacy of drug infusion into the carotid artery require adequate mixing of the infused solution with carotid blood. Using positron emission tomography (PET), we studied the mixing of solutions infused into the human carotid artery in seven patients by analyzing the distribution of [15O]H2O infused into the carotid artery and by vein. At four infusion rates ranging from 0.5 to 10 ml/min, the variability in distribution averaged 16.5-17.8% among the pixels in a large volume of interest, without dependence on the infusion rate. The overall correlation between [15O]H2O influx with arterial infusion and [15O]H2O influx with venous injection was 0.78-0.82 at the four infusion rates, with no trend toward higher correlations at the faster infusion rates. The distribution into the anterior, middle, and posterior cerebral artery territories differed from distribution throughout the entire carotid territory by an average of 6.2-9.6% at the four infusion rates, with no trend toward smaller differences at the faster infusion rates. Infusions performed into a vinyl tube simulating the carotid artery indicated that at 0.5 ml/min, the velocity of fluid exiting the catheter makes no apparent contribution to mixing. We conclude that with infusions at the carotid bifurcation, mixing in the human carotid artery is complete or nearly complete over a wide range of infusion rates. The mixing appears to result from the patterns of blood flow within the artery, and not from jet effects at the catheter tip

Maxillary sinus augmentation

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A B Tarun Kumar

2015-01-01

Full Text Available Placing dental implants in the maxillary posterior region can be both challenging and un-nerving for a regular implant dentist who is not well versed with advanced surgical procedures. It is vital for a general dentist to understand the fundamentals of bone grafting the maxillary sinus if he/she is really committed to providing the best health care for their patients. The dental practice is seeing an increasing group of patients who are living longer, and this group of older baby boomers often has an edentulous posterior maxilla either unilateral or bilateral. When edentulous, the posterior maxilla more likely has diminished bone height, which does not allow for the placement of dental implants without creating additional bone. Through grafting the maxillary sinus, bone of ideal quality can be created (allowing for placement of dental implants, which offer many advantages over other tooth replacement modalities. The sinus graft offers the dental patient a predictable procedure of regenerating lost osseous structure in the posterior maxilla. This offers the patient many advantages for long-term success. If dentists understand these concepts, they can better educate their patients and guide them to have the procedure performed. This article outlines bone grafting of the maxillary sinus for the purpose of placing dental implants. This review will help the readers to understand the intricacies of sinus augmentation. They can relate their patient's condition with the available literature and chalk out the best treatment plan for the patient, especially by using indirect sinus augmentation procedures which are less invasive and highly successful if done using prescribed technique.

Acrolein inhalation alters arterial blood gases and triggers carotid body-mediated cardiovascular responses in hypertensive rats.

Science.gov (United States)

Perez, Christina M; Hazari, Mehdi S; Ledbetter, Allen D; Haykal-Coates, Najwa; Carll, Alex P; Cascio, Wayne E; Winsett, Darrell W; Costa, Daniel L; Farraj, Aimen K

2015-01-01

Air pollution exposure affects autonomic function, heart rate, blood pressure and left ventricular function. While the mechanism for these effects is uncertain, several studies have reported that air pollution exposure modifies activity of the carotid body, the major organ that senses changes in arterial oxygen and carbon dioxide levels, and elicits downstream changes in autonomic control and cardiac function. We hypothesized that exposure to acrolein, an unsaturated aldehyde and mucosal irritant found in cigarette smoke and diesel exhaust, would activate the carotid body chemoreceptor response and lead to secondary cardiovascular responses in rats. Spontaneously hypertensive (SH) rats were exposed once for 3 h to 3 ppm acrolein gas or filtered air in whole body plethysmograph chambers. To determine if the carotid body mediated acrolein-induced cardiovascular responses, rats were pretreated with an inhibitor of cystathionine γ-lyase (CSE), an enzyme essential for carotid body signal transduction. Acrolein exposure induced several cardiovascular effects. Systolic, diastolic and mean arterial blood pressure increased during exposure, while cardiac contractility decreased 1 day after exposure. The cardiovascular effects were associated with decreases in pO2, breathing frequency and expiratory time, and increases in sympathetic tone during exposure followed by parasympathetic dominance after exposure. The CSE inhibitor prevented the cardiovascular effects of acrolein exposure. Pretreatment with the CSE inhibitor prevented the cardiovascular effects of acrolein, suggesting that the cardiovascular responses with acrolein may be mediated by carotid body-triggered changes in autonomic tone. (This abstract does not reflect EPA policy.).

Diseases of the nose and paranasal sinuses in child.

Science.gov (United States)

Stenner, Markus; Rudack, Claudia

2014-01-01

Diseases of the pediatric nose and nasal sinuses as well as neighboring anatomical structures encompass a variety of pathologies, especially of inflammatory nature. Congenital disease, such as malformations and structural deviations of the nasal septum, as well as systemic metabolic pathologies affecting the nose and sinuses, rarely require medical therapy from an Otolaryngologist. The immunological function of the mucosa and genetic factors play a role in the development of disease in the pediatric upper airway tract, especially due to the constantly changing anatomy in this growth phase. Disease description of the nose and nasal sinuses due to mid-facial growth must also take developmental age differences (infant, toddler, preschool, and school age) into account. Epidemiological examinations and evidence based studies are often lacking in the pediatric population. The wide range of inflammatory diseases of the nose and paranasal sinuses, such as the acute and chronic rhinosinusitis, the allergic rhinitis, and adenoid disease, play a role in the susceptibility of a child to infection. The susceptibility to infection depends on the pediatric age structure (infant, young child) and has yet to be well defined. The acute rhinosinusitis in children develops after a viral infection of the upper airways, also referred to as the "common cold" in the literature. It usually spontaneously heals within ten days without any medical therapy. Antibiotic therapy is prudent in complicated episodes of ARS. The antibiotic therapy is reserved for children with complications or associated disease, such as bronchial asthma and/or chronic bronchitis. A chronic rhinosinusitis is defined as the inflammatory change in the nasal mucosa and nasal sinus mucosa, in which the corresponding symptoms persist for over 12 weeks. The indication for CT-imaging of the nasal sinuses is reserved for cases of chronic rhinosinusitis that have been successfully treated with medication. A staged therapeutic

MR imaging of carotid webs

International Nuclear Information System (INIS)

Boesen, Mari E.; Eswaradass, Prasanna Venkatesan; Singh, Dilip; Mitha, Alim P.; Menon, Bijoy K.; Goyal, Mayank; Frayne, Richard

2017-01-01

We propose a magnetic resonance (MR) imaging protocol for the characterization of carotid web morphology, composition, and vessel wall dynamics. The purpose of this case series was to determine the feasibility of imaging carotid webs with MR imaging. Five patients diagnosed with carotid web on CT angiography were recruited to undergo a 30-min MR imaging session. MR angiography (MRA) images of the carotid artery bifurcation were acquired. Multi-contrast fast spin echo (FSE) images were acquired axially about the level of the carotid web. Two types of cardiac phase resolved sequences (cineFSE and cine phase contrast) were acquired to visualize the elasticity of the vessel wall affected by the web. Carotid webs were identified on MRA in 5/5 (100%) patients. Multi-contrast FSE revealed vessel wall thickening and cineFSE demonstrated regional changes in distensibility surrounding the webs in these patients. Our MR imaging protocol enables an in-depth evaluation of patients with carotid webs: morphology (by MRA), composition (by multi-contrast FSE), and wall dynamics (by cineFSE). (orig.)

MR imaging of carotid webs

Energy Technology Data Exchange (ETDEWEB)

Boesen, Mari E. [University of Calgary, Department of Biomedical Engineering, Calgary (Canada); Foothills Medical Centre, Seaman Family MR Research Centre, Calgary (Canada); Eswaradass, Prasanna Venkatesan; Singh, Dilip; Mitha, Alim P.; Menon, Bijoy K. [University of Calgary, Department of Clinical Neurosciences, Calgary (Canada); Foothills Medical Centre, Calgary Stroke Program, Calgary (Canada); Goyal, Mayank [Foothills Medical Centre, Calgary Stroke Program, Calgary (Canada); University of Calgary, Department of Radiology, Calgary (Canada); Frayne, Richard [Foothills Medical Centre, Seaman Family MR Research Centre, Calgary (Canada); University of Calgary, Hotchkiss Brain Institute, Calgary (Canada)

2017-04-15

We propose a magnetic resonance (MR) imaging protocol for the characterization of carotid web morphology, composition, and vessel wall dynamics. The purpose of this case series was to determine the feasibility of imaging carotid webs with MR imaging. Five patients diagnosed with carotid web on CT angiography were recruited to undergo a 30-min MR imaging session. MR angiography (MRA) images of the carotid artery bifurcation were acquired. Multi-contrast fast spin echo (FSE) images were acquired axially about the level of the carotid web. Two types of cardiac phase resolved sequences (cineFSE and cine phase contrast) were acquired to visualize the elasticity of the vessel wall affected by the web. Carotid webs were identified on MRA in 5/5 (100%) patients. Multi-contrast FSE revealed vessel wall thickening and cineFSE demonstrated regional changes in distensibility surrounding the webs in these patients. Our MR imaging protocol enables an in-depth evaluation of patients with carotid webs: morphology (by MRA), composition (by multi-contrast FSE), and wall dynamics (by cineFSE). (orig.)

Treatment of a spontaneous intracranial dissecting aneurysm with stent-assisted coil embolization

International Nuclear Information System (INIS)

Irie, Keiko; Negoro, Makoto; Hayakawa, Motoharu; Hayashi, Junichi; Kanno, Tetsuo

2003-01-01

Arterial dissection is now recognized as an important cause of stroke. Most reported dissections involve the extracranial portion of the internal carotid artery (ICA) and vertebral arteries. Spontaneous dissecting aneurysms of the intracranial ICA are uncommon. Endovascular treatment for cerebral aneurysms has become widespread; however, the dissecting aneurysm is still difficult to treat if the parent artery has to be preserved. More recently, stenting has been advocated for use with endosaccular coiling, with the coils held in place by the stent. We herein report a spontaneous intracranial ICA dissecting aneurysm in a 51-year-old woman who was treated using a new technique of combined stent and coils. (orig.)

Classification of temporal bone pneumatization based on sigmoid sinus using computed tomography

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Han, S.-J. [Department of Otorhinolaryngology, National Health Insurance Corporation Ilsan Hospital, Seoul (Korea, Republic of); Song, M.H. [Department of Otorhinolaryngology, Yonsei University College of Medicine, Kang-nam Gu, Do-gok Dong, 146-92, Seoul, Republic of Korea 135-720 (Korea, Republic of); Kim, J. [Department of Radiology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, W.-S. [Department of Otorhinolaryngology, Yonsei University College of Medicine, Kang-nam Gu, Do-gok Dong, 146-92, Seoul, Republic of Korea 135-720 (Korea, Republic of); Lee, H.-K. [Department of Otorhinolaryngology, Yonsei University College of Medicine, Kang-nam Gu, Do-gok Dong, 146-92, Seoul, Republic of Korea 135-720 (Korea, Republic of)], E-mail: hoki@yuhs.ac

2007-11-15

Aim: To analyse several reference structures using axial computed tomography (CT) imaging of the temporal bone, which may reflect pneumatization of the entire temporal bone by statistical correlation to the actual volume of the temporal bone measured using three-dimensional reconstruction. Materials and methods: One hundred and sixteen temporal bones were studied, comprising 48 with normal findings and 68 sides showing chronic otitis media or temporal bone fracture. After measuring the volume of temporal bone air cells by the volume rendering technique using three-dimensional reconstruction images, classification of temporal bone pneumatization was performed using various reference structures on axial images to determine whether significant differences in the volume of temporal bone air cells could be found between the groups. Results: When the sigmoid sinus at the level of the malleoincudal complex was used in the classification, there were statistically significant differences between the groups that correlated with the entire volume of the temporal bone. Grouping based on the labyrinth and the ascending carotid artery showed insignificant differences in volume. Furthermore, there was no significant correlation between the cross-sectional area of the antrum and the entire volume of the temporal bone. Conclusion: The degree of pneumatization of temporal bone can be estimated easily by the evaluation of the air cells around the sigmoid sinus on axial CT images.

Anatomical variations and morphometric study of the optic strut and the anterior clinoid process

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Eldan Kapur

2012-05-01

Full Text Available The optic strut and the anterior clinoid process represent bony structures that are closely related to anatomically and clinically significant elements such as the cavernous sinus, the internal carotid artery, the optic nerve and the pituitary gland. The objective of our study was to quantify dimensions of the optic strut and anterior clinoid process, and to determine variations in positions and forms of these structures. A descriptive anatomical study was performed on 200 dry human skulls. We analyzed dimensions and variations in position of the optic strut, dimensions of the anterior clinoid process as well as the incidence and forms of the caroticoclinoid foramen. The average thickness of the optic strut on skulls belonging to males was 3 mm and 2.8 mm on those belonging to females. The optic strut was most commonly attached to the anterior two fifths on the lower side of the anterior clinoid process. On the male skulls the average width of the anterior clinoid process was 9.4 mm (right and 9.1 mm (left. Its length was 9.9 and 9.3 mm. On female skulls the average width of the process was 8.7 mm (right and 8.3 mm (left, while the length measured 9.3 mm on the right and 8.9 mm on the opposite side. In our sample, a complete caroticoclinoid foramen appeared in 4.25%, a contact form in 2.75%. At last, an incomplete form of the foramen was observed in 9.75%. The anatomic variations of the investigated structures must be considered during the approaches to the cavernous sinus and neurovascular elements of the sellar region.

Four cases of intracranial AVM successfully treated by radiation therapy

International Nuclear Information System (INIS)

Chen, Mau-Nan; Imaya, Hisatoshi; Nakazawa, Shozo.

1990-01-01

We have treated three patients with conventional radiotherapy and one with stereotactic radiosurgery and report the follow-up results. A 63-year-old woman had a dural arteriovenous malformation (AVM) in the right cavernous sinus. She was irradiated using 10 MV X-ray with a total of 30 Gy. Post irradiation angiography showed a complete absence of dural AVM. A 62-year-old woman had a dural AVM fed by the left external carotid artery in the right cavernous sinus. Embolization by gelfoam was performed before irradiation. The irradiation was given with a total dose of 30 Gy. Post irradiation angiography showed disappearance of the dural AVM. A 26-year-old woman had a small AVM (about 20 x 15 x 15 mm) in the posterior corpus callosum. An operation was performed but the AVM was not excised completely. We irradiated to the residual AVM with a total of 30 Gy. The follow-up angiography one year after treatment, showed disappearance of the AVM. She had no neurological deficit two years after the treatment. A 14-year-old boy had a small AVM (about 20 x 15 x 10 mm) in the left anterior wall of the fourth ventricle. The AVM was located deeply, so an operation was not performed. Radiosurgery was undertaken four months after onset in Buenos Aires. The total dose was 36 Gy. The follow-up angiography one year after treatment, showed disappearance of the AVM. He also had no neurological deficit two years after the treatment. These four cases of AVM (two dural AVMs) were successfully treated by radiation therapy. No side effect was observed. (author)

Long-term results after carotid artery stenting. Restenosis after carotid artery stenting using self-expandable stent

International Nuclear Information System (INIS)

Matsumoto, Yasushi; Furui, Eisuke; Tsuboi, Ken; Takahashi, Akira; Ezura, Masayuki

2008-01-01

Carotid artery stenting has emerged as an acceptable treatment alternative in patients with carotid artery stenosis. Although early clinical results of carotid artery stenting have shown promise, long, term clinical results remain less certain. We report the frequency, management, and clinical results of in-stent restenosis after carotid artery stenting using a self-expandable stent. Between August 1998 and September 2004, 80 carotid artery stenting procedures in 78 patients were performed. We evaluated 76 of the 80 procedures in 75 of the 78 patients treated during this period who had a minimum 6-month clinical and imaging (ultrasound and/or magnetic resonance angiography) follow-up. Recurrent stenosis (≥50%) after carotid artery stenting occurred in 3 (3.9%) patients. The recurrent stenosis occurred within one year after the procedure in all cases. The low rate of in-stent restenosis using self-expandable stent suggested that carotid artery stenting may be an effective alternative treatment for carotid artery stenosis, but more data of long-term follow-up are required. (author)

Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings

Energy Technology Data Exchange (ETDEWEB)

Singh, Sumit; Ramakrishnaiah, Raghu H.; Hegde, Shilpa V.; Glasier, Charles M. [University of Arkansas for Medical Sciences, Pediatric Radiology, Little Rock, AR (United States)

2016-01-15

Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage. (orig.)

Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings

International Nuclear Information System (INIS)

Singh, Sumit; Ramakrishnaiah, Raghu H.; Hegde, Shilpa V.; Glasier, Charles M.

2016-01-01

Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage. (orig.)

Stent-Graft Repair of a Large Cervical Internal Carotid Artery Pseudoaneurysm Causing Dysphagia

International Nuclear Information System (INIS)

Gupta, Vivek; Niranjan, Khandelwal; Rawat, Lokesh; Gupta, A. K.

2009-01-01

Pseudoaneurysms of the cervical internal carotid artery (ICA) are rare and most frequently result from trauma, infection, or sometimes spontaneously. They have the potential to cause life-threatening hemorrhage; thus, their immediate management is necessary. Endovascular treatment by stent graft placement in the affected artery appears to be a safe and effective treatment option. We present a case of a child who presented with neck swelling and dysphagia caused by a ruptured cervical ICA pseudoaneurysm which was managed by stent graft placement.

Sigmoid Sinus Diverticulum, Dehiscence, and Venous Sinus Stenosis: Potential Causes of Pulsatile Tinnitus in Patients with Idiopathic Intracranial Hypertension?

Science.gov (United States)

Lansley, J A; Tucker, W; Eriksen, M R; Riordan-Eva, P; Connor, S E J

2017-09-01

Pulsatile tinnitus is experienced by most patients with idiopathic intracranial hypertension. The pathophysiology remains uncertain; however, transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence have been proposed as potential etiologies. We aimed to determine whether the prevalence of transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence was increased in patients with idiopathic intracranial hypertension and pulsatile tinnitus relative to those without pulsatile tinnitus and a control group. CT vascular studies of patients with idiopathic intracranial hypertension with pulsatile tinnitus ( n = 42), without pulsatile tinnitus ( n = 37), and controls ( n = 75) were independently reviewed for the presence of severe transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence according to published criteria. The prevalence of transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence in patients with idiopathic intracranial hypertension with pulsatile tinnitus was compared with that in the nonpulsatile tinnitus idiopathic intracranial hypertension group and the control group. Further comparisons included differing degrees of transverse sinus stenosis (50% and 75%), laterality of transverse sinus stenosis/sigmoid sinus diverticulum/dehiscence, and ipsilateral transverse sinus stenosis combined with sigmoid sinus diverticulum/dehiscence. Severe bilateral transverse sinus stenoses were more frequent in patients with idiopathic intracranial hypertension than in controls ( P tinnitus within the idiopathic intracranial hypertension group. Sigmoid sinus dehiscence (right- or left-sided) was also more common in patients with idiopathic intracranial hypertension compared with controls ( P = .01), but there was no significant association with pulsatile tinnitus within the idiopathic intracranial hypertension group. While our data corroborate previous studies demonstrating increased prevalence of sigmoid sinus diverticulum

Modeling deformation processes of salt caverns for gas storage due to fluctuating operation pressures

Science.gov (United States)

Böttcher, N.; Nagel, T.; Goerke, U.; Khaledi, K.; Lins, Y.; König, D.; Schanz, T.; Köhn, D.; Attia, S.; Rabbel, W.; Bauer, S.; Kolditz, O.