Intraoperative Ultrasound Navigation with Doppler Function to Guide Arteriovenous Malformation Resection: 3-Dimensional Operative Video

2019 ◽  
Vol 17 (4) ◽  
pp. E162-E163
Author(s):  
Marcos Dellaretti ◽  
Daniel Espindola Ronconi
Keyword(s):  
Arteriovenous Malformation ◽  
Doppler Ultrasound ◽  
Superior Sagittal Sinus ◽  
Intraoperative Ultrasound ◽  
Complete Resection ◽  
Sensory Cortex ◽  
Cortical Mapping ◽  
3 Dimensional ◽  
Sagittal Sinus ◽  
The Right

Abstract Intraoperative ultrasound navigation was initially introduced in the neurosurgical field for brain tumor surgery and was then extended to arteriovenous malformation surgery with good success. This tool provides real-time intraoperative images.1 Moreover, Doppler ultrasound permits early identification of feeding arteries and supplies the surgeon with a global impression of the flow dynamics.2 A further use of doppler is to check for residual nidus. Other advantages are the capacity to identify intracerebral hemorrhage.2 In this video, we demonstrate the case of a 15-yr-old patient who presented intracranial hemorrhage. Magnetic resonance imaging revealed the presence of left frontoparietal hematoma associated with an image suggestive of cerebral arteriovenous malformation (AVM). Arteriography confirmed the diagnosis of AVM fed by branches of the anterior cerebral and superficial drainage for the superior sagittal sinus. The patient was placed in dorsal decubitus with his head turned to the right and a left parietal-frontal craniotomy was performed. After the dura mater was opened, cortical mapping was performed to locate the motor and sensory cortex. After the mapping, ultrasound with doppler was performed to locate the AVM and the hematoma and determine its relation to the motor and sensory cortex. At the end of the surgery, doppler ultrasound was used again to ensure complete resection of the AVM. Intraoperative Ultrasound navigation with doppler is an inexpensive technology that can be used in the treatment of AVMs, especially in the subcortex, as it assists in locating the nidus and confirms its complete resection.

Resection of Right Frontal Arteriovenous Malformation: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (1) ◽  
pp. 111-111
Author(s):  
William T Couldwell
Keyword(s):  
Arteriovenous Malformation ◽  
Venous Drainage ◽  
Complete Resection ◽  
Institutional Review Board ◽  
3 Dimensional ◽  
Bone Removal ◽  
Institutional Review ◽  
Brain Interface ◽  
Grade Ii ◽  
The Right

Abstract The video demonstrates resection of a Grade II Spetzler-Martin unruptured, medium-sized arteriovenous malformation (AVM). A young woman presented with headaches and seizures. The right frontal lesion measured 4.5 cm in largest dimension and had superficial venous drainage. Partial Onyx embolization, primarily of the anterior cerebral feeding arteries, was performed. Bone removal for exposure allowed identification of indentation from the large superficial draining vein. The video demonstrates careful microsurgical dissection on the AVM/brain interface, with selective interruption of feeding arteries circumferentially. The lesion was removed after ligation of the large superficial draining vein. Postoperative day 1 and 1-yr angiography demonstrated complete resection. The patient's symptoms abated after resection. This case is presented with a waiver of informed consent as per the Institutional Review Board.

scholarly journals A peculiar case of dural venous sinuses with resulting atypical bony markings in posterior cranial fossa

2017 ◽  
Vol 5 (6) ◽  
pp. 2830
Author(s):  
Gitanjali Khorwal ◽  
Sunita Kalra
Keyword(s):  
Right Hemisphere ◽  
Superior Sagittal Sinus ◽  
Transverse Sinus ◽  
Posterior Cranial Fossa ◽  
Undergraduate Medical Students ◽  
Venous Sinuses ◽  
Sagittal Sinus ◽  
Cranial Fossa ◽  
The Right ◽  
Dural Venous Sinuses

A paramedian or midline suboccipital approach for craniotomies and craniectomies is commonly employed for decompression or tumour resections from posterior cranial fossa. The reference for midline is taken as the line joining the nasion and inion on the surface of the skull which is the estimated position of superior sagittal sinus. In the interior, the internal occipital protuberance is the site of confluence of sinuses which presents a spectrum of variations. An unusual pattern of drainage of dural venous sinuses was observed at the site of customary confluence during routine dissection of head region for undergraduate medical students in a sixty-year-old female cadaver. The superior sagittal sinus continued as right transverse sinus as usual but it was connected to the left transverse sinus through a venous channel. There was no appreciable confluence of sinuses at this site. A prominent and atypical cerebellar process emerged from right hemisphere of cerebellum and projected between right transverse sinus and the venous channel connecting right and left transverse sinuses. In the posterior cranial fossa, the internal occipital crest was present on the left of midline separated from internal occipital protuberance. Another small ridge was present to the right of midline. A triangular fossa thus formed on the right side of internal occipital crest was occupied by the unusual prominent process emerging from the right hemisphere of cerebellum.Pre-operative assessment of dural venous sinuses is imperative before any surgical intervention especially around the confluence of the sinuses.

scholarly journals Cerebral Venous Air Embolism due to a Hidden Skull Fracture Secondary to Head Trauma

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Ai Hosaka ◽  
Tetsuto Yamaguchi ◽  
Fumiko Yamamoto ◽  
Yasuro Shibagaki
Keyword(s):  
Head Trauma ◽  
Superior Sagittal Sinus ◽  
Skull Fracture ◽  
Air Embolism ◽  
Skull Fractures ◽  
Venous Air Embolism ◽  
Sagittal Sinus ◽  
The Right ◽  
Head Computed Tomography

Cerebral venous air embolism is sometimes caused by head trauma. One of the paths of air entry is considered a skull fracture. We report a case of cerebral venous air embolism following head trauma. The patient was a 55-year-old man who fell and hit his head. A head computed tomography (CT) scan showed the air in the superior sagittal sinus; however, no skull fractures were detected. Follow-up CT revealed a fracture line in the right temporal bone. Cerebral venous air embolism following head trauma might have occult skull fractures even if CT could not show the skull fractures.

scholarly journals Superior Sagittal Sinus Thrombosis Complicating Typhoid Fever in a Teenager

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
P. O. Okunola ◽  
G. E. Ofovwe ◽  
M. T. Abiodun ◽  
C. P. Azunna
Keyword(s):  
Typhoid Fever ◽  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Lateral Sinus ◽  
Sagittal Sinus ◽  
Neuropsychiatric Complications ◽  
Sinovenous Thrombosis ◽  
The Right ◽  
Sagittal Sinus Thrombosis ◽  
Superior Sagittal Sinus Thrombosis

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 forSalmonellatyphi 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.

Sagittal suture as an external landmark for the superior sagittal sinus

2001 ◽  
Vol 94 (6) ◽  
pp. 985-987 ◽  
Author(s):  
R. Shane Tubbs ◽  
George Salter ◽  
Scott Elton ◽  
Paul A. Grabb ◽  
W. Jerry Oakes
Keyword(s):  
Superior Sagittal Sinus ◽  
Sagittal Suture ◽  
Middle Portion ◽  
Maximum Displacement ◽  
Content Type ◽  
Sagittal Sinus ◽  
The Right ◽  
External Landmark ◽  
Fine Print

Object. Historically, the sagittal suture has been used as an external landmark to indicate the middle portion of the superior sagittal sinus (SSS). The goal of this study was to verify this relationship. Methods. The authors examined 30 adult cadavers to reveal the location of the SSS with respect to the sagittal suture. Their findings demonstrated that the SSS is deviated to the right of the sagittal suture in the majority of observed specimens, although the maximum displacement to the right side was never more than 11 mm. Conclusions. This information should be useful to the neurosurgeon who must be aware of the SSS and its relationship with superficial skull landmarks.

scholarly journals Parietal Foramen as A Landmark to Locate Intracranial Vascular and Parenchymal Structures

2020 ◽  
Author(s):  
Pedro Brainer-Lima ◽  
Alessandra Brainer-Lima ◽  
Maria Rosana Ferreira ◽  
Paulo Brainer-Lima ◽  
Marcelo Valença
Keyword(s):  
Parietal Lobe ◽  
Superior Sagittal Sinus ◽  
Average Distance ◽  
Air Embolism ◽  
Neurosurgical Procedures ◽  
Parietal Region ◽  
Sagittal Suture ◽  
Emissary Vein ◽  
Sagittal Sinus ◽  
The Right

Abstract The aim of this study was to define the location of the parietal foramina (PF) with reference to skull landmarks and correlate the PF with cerebral and vascular structures to optimize neurosurgical procedures in the intracranial compartment. Two hundred and thirty-eight parietal bones studied by magnetic resonance imaging (MRI) of 119 patients were reviewed. The cephalometric points, inion, bregma, sagittal suture and lambda were used as anatomical references to locate the PF and define its anatomical relationships to parenchymal cerebral structures, especially some eloquent areas. The PF was identified in the MRI in 83 of the 119 individuals (69.7%) and was located at an average distance of 9.5 ± 0.8 cm (mean ± SD) posteriorly and 0.9 ± 0.3cm laterally to the Bregma. In over 90% of cases, the PF was located within a 2 cm radius of the bregma-PF distance’s mean value. Surgeons operating in the parietal region should be aware of the frequency of PF (69.7%), its location (superolateral to lambda) and its stable relationship with underlying anatomical structures. 88% of the 62 left PF’s were situated within 1cm, laterally to the left margin of the superior sagittal sinus (SSS). 60% of the right PF were situated within 1.3 cm laterally from the right margin of the SSS, while 40% were directly above the SSS. We propose that the PF should be used as the reference for the superior sagittal sinus during its course through the parietal lobe, as its constancy overtakes other commonly used landmarks (sagittal suture and midline). In conclusion, clinicians should be aware of the PF to both avoid iatrogenic injury to an emissary vein that courses through it that can lead to air embolism and as a guide to maneuvering through the parietal region.

Anti-MOG Antibody Syndrome and Cerebral Sinovenous Thrombosis: A Cause–Effect Hypothesis

2020 ◽  
Author(s):  
Alessandra Fontana ◽  
Filippo Greco ◽  
Pierluigi Smilari ◽  
Andrea D. Praticò ◽  
Agata Fiumara ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Superior Sagittal Sinus ◽  
Demyelinating Diseases ◽  
Sagittal Sinus ◽  
Cerebral Sinovenous Thrombosis ◽  
Sinovenous Thrombosis ◽  
Clinical Relationship ◽  
Effect Hypothesis ◽  
The Right

AbstractCerebral venous thrombosis is an uncommon event of stroke in childhood. Its origin is multifactorial and often it manifests with nonspecific symptoms that may overlap with underlying predisposing factors. Anti–myelin oligodendrocyte glycoprotein (MOG) antibody syndrome is a group of recently recognized acquired demyelinating diseases that occur more commonly in children, usually, with a favorable outcome. The association between cerebral venous thrombosis and demyelinating syndrome has been reported but their clinical relationship is matter of debate and various hypotheses have been advanced including intravenous (IV) steroid therapy and/or the consequence of a shared inflammatory-thrombotic process. Herein, we report the case of a child with anti-MOG antibody syndromes who developed a thrombosis of the superior sagittal sinus and of the right Trolard's vein.

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