scholarly journals Resolution of intractable retching following mobilization of a dolichoectatic vertebral artery: case report of a unique brainstem–cranial nerve compression syndrome

2017 ◽  
Vol 127 (4) ◽  
pp. 761-767
Author(s):  
Scott Seaman ◽  
Paul Nelson ◽  
Jacob Alexander ◽  
Andrew Swift ◽  
James Fick
Keyword(s):  
Vertebral Artery ◽  
Cranial Nerve ◽  
Anatomical Variation ◽  
Cranial Nerves ◽  
Clinical Consequence ◽  
Vagus Nerves ◽  
Nerve Compression Syndrome ◽  
Root Entry Zone ◽  
Cranial Nerve Dysfunction ◽  
Mri Study

The authors present the case of a 53-year-old man who was referred with disabling retching provoked by left arm abduction. At the time of his initial evaluation, a cervical MRI study was available for review and revealed an anatomical variation of the ipsilateral juxtamedullary vertebrobasilar junction. After brain imaging revealed contact of the medulla by a dolichoectatic vertebral artery at the dorsal root entry zone of the glossopharyngeal and vagus nerves, the patient was successfully treated by microvascular decompression of the brainstem and cranial nerves. This case demonstrates how a dolichoectatic vertebral artery—a common anatomical variation that typically has no clinical consequence—should be considered in cases of cranial nerve dysfunction.

Incidence of cranial nerve palsy after preoperative embolization of glomus jugulare tumors using Onyx

2014 ◽  
Vol 120 (2) ◽  
pp. 377-381 ◽  
Author(s):  
Brandon G. Gaynor ◽  
Mohamed Samy Elhammady ◽  
Daniel Jethanamest ◽  
Simon I. Angeli ◽  
Mohammad A. Aziz-Sultan
Keyword(s):  
Cranial Nerve ◽  
Transarterial Embolization ◽  
Cranial Nerves ◽  
Cranial Neuropathy ◽  
Preoperative Embolization ◽  
Facial Nerve Paralysis ◽  
Lower Cranial Nerve ◽  
Nerve Paralysis ◽  
Glomus Jugulare ◽  
Cranial Nerve Dysfunction

Object The resection of glomus jugulare tumors can be challenging because of their inherent vascularity. Preoperative embolization has been advocated as a means of reducing operative times, blood loss, and surgical complications. However, the incidence of cranial neuropathy associated with the embolization of these tumors has not been established. The authors of this study describe their experience with cranial neuropathy following transarterial embolization of glomus jugulare tumors using ethylene vinyl alcohol (Onyx, eV3 Inc.). Methods The authors retrospectively reviewed all cases of glomus jugulare tumors that had been treated with preoperative embolization using Onyx at their institution in the period from 2006 to 2012. Patient demographics, clinical presentation, grade and amount of Onyx used, degree of angiographic devascularization, and procedural complications were recorded. Results Over a 6-year period, 11 patients with glomus jugulare tumors underwent preoperative embolization with Onyx. All embolization procedures were completed in one session. The overall mean percent of tumor devascularization was 90.7%. No evidence of nontarget embolization was seen on postembolization angiograms. There were 2 cases (18%) of permanent cranial neuropathy attributed to the embolization procedures (facial nerve paralysis and lower cranial nerve dysfunction). Conclusions Embolizing glomus jugulare tumors with Onyx can produce a dramatic reduction in tumor vascularity. However, the intimate anatomical relationship and overlapping blood supply between these tumors and cranial nerves may contribute to a high incidence of cranial neuropathy following Onyx embolization.

Bulbar Compression by an Ectatic Vertebral Artery: A Novel Neurovascular Construct Relieved by Microsurgical Decompression

2005 ◽  
Vol 56 (suppl_1) ◽  
pp. ONS-117-ONS-124 ◽  
Author(s):  
Francesco Tomasello ◽  
Concetta Alafaci ◽  
Francesco M. Salpietro ◽  
Marcello Longo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Vertebral Artery ◽  
Medulla Oblongata ◽  
Microvascular Decompression ◽  
Cranial Nerve ◽  
Resonance Imaging ◽  
Cranial Nerve Dysfunction ◽  
Nerve Dysfunction ◽  
The Right

Abstract OBJECTIVE: Brainstem compression caused by vascular abnormalities has rarely been reported in the literature. We describe five cases of large ectatic vertebral artery causing compression and distortion of the medulla oblongata with pyramidal tract signs and low cranial nerve dysfunction. Microvascular decompression by retracting the vertebral artery and anchoring it to the dura has been the treatment of choice. METHODS: Five patients, four male and one female, presented with progressive myelopathic features and lower cranial nerve dysfunction, especially dysphonia and dysphagia. Four patients were affected by systemic arterial hypertension. Magnetic resonance imaging showed impingement of the right vertebral artery in three patients and the left vertebral artery in two patients, on the right and left lateral medulla, respectively. In two patients, hypoplasia of the contralateral vertebral artery was documented. RESULTS: All patients underwent neurovascular decompression of the medulla oblongata. The ectatic and tortuous vertebral artery was detached from the medulla, shifted away, and repositioned by anchoring to the nearby dura mater using a Gore-Tex vascular slip. Postoperatively, all patients but one had improvement of their previous neurological symptoms. CONCLUSION: Brainstem dysfunction caused by a tortuous ectatic vertebral artery might be less uncommon than expected. It should be considered a new distinct clinical entity, the real incidence of which needs to be carefully evaluated by an appropriate diagnostic protocol, which includes primarily magnetic resonance imaging with specific three-dimensional sequences. Awareness of this condition is necessary to ensure the appropriate treatment. Surgical microvascular decompression seems very effective.

scholarly journals Complete 3rd cranial nerve dysfunction postdeflation/ excision of an encasing pituitary macroadenoma intrasellular cyst: A Case Report

2016 ◽  
Vol 30 (3) ◽  
pp. 382-386
Author(s):  
C. S. Ng ◽  
S. Norlela
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerves ◽  
Fluid Pressure ◽  
Residual Tumour ◽  
Pituitary Macroadenoma ◽  
Cystic Fluid ◽  
First Case ◽  
Cranial Nerve Dysfunction ◽  
Cystic Component ◽  
Cranial Nerve Palsies

Abstract Central nervous system injury in particular cranial nerve palsy has been reported to be as high as 2%. Such prevalence of palsy generally attributed to surgical manipulation at the cavernous sinus, especially incurring the abducens nerve. We report the first case of acute oculomotor nerve sequel to the release of cystic fluid wrapping the nerve following a transsphenoidal excision of pituitary macroadenoma in a 57-year-old woman. She attended with the presentation of acute excruciating headache associated with partial drooping of right eye. The computed tomography and magnetic resonance imaging (MRI) were consistent with pituitary apoplexy of an underlying pituitary macroadenoma. Urgent transsphenoidal hypophysectomy was done. Intra-operatively, cystic fluid was aspirated during pituitary tumour dissection. At the same time, curettage was employed to removal residual tumour after the tumour biopsy. Immediate post-operative assessment noted complete right eye ptosis, with clinical evidence of complete right third and fourth nerve palsies. MRI was repeated a week later in view of such palsy non-resolution. However, no local compression or edema noted. Observation and monitoring were opted versus surgical revision. Propitiously the aforementioned cranial nerve palsies persist for a month and subsequently subsided. In this case, we highlight the potential deleterious impact of aspirating cystic component and curettaging during pituitary surgery. Likely postulated accounts for such occurrence include sudden release of fluid pressure with resultant cystic traction on its enfolding cranial nerves and subsequent neuropraxia. We aim to invite comments that could enlighten us on this gray area.

scholarly journals Far Lateral Transcondylar Transtubercular Approach for Microsurgical Resection of Foramen Magnum Meningioma: Operative Video and Technical Nuances

2020 ◽  
Author(s):  
James K. Liu ◽  
Vincent N. Dodson ◽  
Ali T. Meybodi
Keyword(s):  
Vertebral Artery ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Neurological Deficits ◽  
Endoscopic Endonasal ◽  
Surgical Access ◽  
Far Lateral Approach ◽  
Far Lateral

AbstractSurgical access to the ventral foramen magnum remains a technical challenge. With large lesions in this region compressing the brainstem and distorting the regional neurovascular relationships, formulating a surgical plan and its appropriate execution have crucial importance in achieving favorable outcomes. While the endoscopic endonasal approaches have gained increasing attention to access the clivus and the ventral brainstem, foramen magnum meningiomas are still preferred to be removed via an approach that obviates a trajectory through the nasopharyngeal mucosa. Therefore, the far lateral approach remains one of the most practical approaches for these challenging lesions. This operative video demonstrates the use of the far lateral transcondylar transtubercular approach to remove a large meningioma in the ventral foramen magnum in a 63-year-old male with progressive cervical myelopathy, presenting as spastic quadriparesis without any cranial nerve abnormality. Using a right-sided far lateral transcondylar transtubercular approach, the meningioma was exposed within the cerebellomedullary gutter engulfing the vertebral artery and distorting the course of the adjacent cranial nerves. Using the different corridors identified between the vertebral artery, spinal accessory, vagus, and hypoglossal nerves, multiple angles of attacks to the tumor were established and utilized to resect the lesion. A gross total resection was achieved and the patient was neurologically intact without any neurological deficits. This video demonstrates the importance of understanding the intricacies of neurovascular anatomy of the cervicomedullary region (i.e., the various triangles formed between these structures), and the effective use of these corridors to safely and efficiently remove a challenging ventral foramen magnum meningioma with neurovascular involvement, while preserving cranial nerve function. The surgical technique and nuances are described in a step-by-step fashion in this illustrative operative video.The link to the video can be found at: https://youtu.be/s1dFhuaRSt8.

Hypoglossal Nerve Schwannoma With Severe Brainstem Compression: Microsurgical Excision by Extreme Lateral Approach: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Qazi Zeeshan ◽  
Sneha Chitra Balasubramanian ◽  
Juan P Carrasco Hernandez ◽  
Varadaraya S Shenoy ◽  
Isaac Josh Abecassis ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Nerve Fibers ◽  
Left Vertebral Artery ◽  
Cystic Tumor ◽  
Occipital Condyle ◽  
Limb Weakness ◽  
Posterior Aspect ◽  
Hypoglossal Canal

Abstract A 37-yr-old male presented with a history of left-sided tongue atrophy and fasciculations and weakness of upper limbs for 3 mo. Magnetic resonance imaging (MRI) revealed a large, partially cystic tumor with severe compression of the brainstem and spinal cord, with expansion and erosion of the hypoglossal canal. Computed tomography (CT) angiography showed the left vertebral artery to be anteriorly displaced by the tumor.  A retrosigmoid craniotomy and craniectomy were performed followed by mastoidectomy with unroofing the posterior aspect of the sigmoid sinus. The foramen magnum was completely unroofed. The hypoglossal canal was exposed with a diamond drill and an ultrasonic bone curette, and a tumor was seen within the expanded canal. C1 lamina was removed partially in the lateral aspect, and the occipital condyle was partially removed. After opening the dura mater, the tumor was found to be stretching the eleventh cranial nerve. The tumor was debulked, and dissected from the cranial nerve fibers. The vertebral artery, anterior spinal artery, and other branches displaced by the tumor were carefully preserved. The tumor was removed from the hypoglossal canal with a curette. The patient recovered well, with the resolution of his upper limb weakness. Patient modified Rankin Scale was 1 at 6-mo follow-up. The postoperative MRI showed a small remnant inside the hypoglossal canal, and it was treated by radiosurgery.  This 2-dimensional video demonstrates the technique of complete microsurgical removal of a complex tumor with preservation of cranial nerves and vertebral artery.  Informed consent was obtained from the patient prior to the surgery, which included videotaping of the procedure and its distribution for educational purposes. Also, all relevant patient identifiers have been removed from the video and accompanying radiology slides.

scholarly journals Resection of a Lower Clival Meningioma via Posterolateral Approach: Two-Dimensional Operative Video

2020 ◽  
Author(s):  
Pinar E. Ocak ◽  
Selcuk Yilmazlar
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerves ◽  
Posterolateral Approach ◽  
Left Vertebral Artery ◽  
Posterior Arch ◽  
Upper Cervical Spine ◽  
Two Dimensional ◽  
Lower Cranial Nerve ◽  
Complex Anatomy ◽  
Microsurgical Resection

Abstract Objectives This study aimed to demonstrate resection of a craniovertebral junction (CVJ) meningioma via the posterolateral approach. Design The study is designed with a two-dimensional operative video. Setting This study is conducted at department of neurosurgery in a university hospital. Participants A 50-year-old woman who presented with lower cranial nerve findings due to a left-sided lower clival meningioma (Fig. 1). Main Outcome Measures Microsurgical resection of the meningioma and preservation of the neurovascular structures. Results The patient was placed in park-bench position and a left-sided retrosigmoid suboccipital craniotomy, followed by C1 hemilaminectomy and unroofing the lip of the foramen magnum, was performed. The dural incision extended from the suboccipital region down to the posterior arch of C2 (Fig. 2). The arachnoid overlying the tumor was incised, revealing the course of the cranial nerve (CN) XI on the dorsolateral aspect of the tumor. The left vertebral artery (VA) was encased by the tumor which was originating from the dura below the jugular foramen. The mass was resected in a piecemeal fashion eventually. At the end of the procedure, all relevant cranial nerves and adjacent vascular structures were intact. Postoperative magnetic resonance imaging (MRI) confirmed total resection and the patient was discharged home on postoperative day 3 safely. Conclusions Microsurgical resection of the lesions of the CVJ are challenging as this transition zone between the cranium and upper cervical spine has a complex anatomy. Since adequate exposure of the extradural and intradural segments of the VA can be obtained by the posterolateral approach, this approach can be preferred in cases with tumors anterior to the VA or when the artery is encased by the tumor.The link to the video can be found at: https://youtu.be/d3u5Qrc-zlM.

Persistent triplegia and cranial nerve dysfunction after lysis of epidural adhesions

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Marco LA GRUA ◽  
Irene GRAZZINI ◽  
Gian L. CUNEO ◽  
Gianfranco SINDACO ◽  
Matteo ZANELLA ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Dysfunction ◽  
Nerve Dysfunction

scholarly journals Microvascular Decompression and Nervus Intermedius Sectioning for the Treatment of Geniculate Neuralgia

2018 ◽  
Vol 80 (S 03) ◽  
pp. S316-S317 ◽  
Author(s):  
Tyler J. Kenning ◽  
Christine S. Kim ◽  
Alexander G. Bien
Keyword(s):  
Vertebral Artery ◽  
Microvascular Decompression ◽  
Single Case ◽  
Anterior Inferior Cerebellar Artery ◽  
Root Entry Zone ◽  
Vertebrobasilar System ◽  
Tertiary Center ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Nervus Intermedius

Objectives Demonstrate the surgical treatment of geniculate neuralgia via microvascular decompression and nervus intermedius sectioning. Designs Single case-based operative video. Setting Tertiary center with dedicated skull base team. Participants The patient is a 62-year-old female with a history of deep right-sided otalgia consistent with geniculate neuralgia. She failed appropriate medical treatment. Her magnetic resonance imaging (MRI) showed an ectatic vertebrobasilar system as well as an anterior inferior cerebellar artery (AICA) loop causing compression of the VII/VIII nerve complex in the cerebellopontine angle. Main Outcome Measures Resolution of right-sided otalgia. Results The patient underwent retrosigmoid craniotomy with microvascular decompression of the VII/VIII nerve complex and nervus intermedius sectioning. Intraoperatively, the patient was noted to have an ectatic vertebral artery and AICA that were compressing the root entry zone of the VII/VIII nerve complex. Microvascular decompression was performed of both the vertebral artery and AICA with Teflon. The nervus intermedius was sharply sectioned. The patient's postoperative course was uneventful with no complications. She continues to have resolution of her right sided otalgia at 6 months postoperatively.The link to the video can be found at: https://youtu.be/uRb_QfrINSk.

scholarly journals Intratumoral Bleeding in a Vestibular Schwannoma

2017 ◽  
Vol 37 (01) ◽  
pp. 47-49
Author(s):  
Emanuelle Braga ◽  
Luiza Köhler ◽  
Marcelo de Cesaro ◽  
Tasso Barreto ◽  
Richard Giacomelli ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Cranial Nerve ◽  
Cerebellopontine Angle ◽  
Clinical Presentation ◽  
Cranial Nerves ◽  
Altered Consciousness ◽  
Progressive Hearing Loss ◽  
Asymptomatic Patients ◽  
Intratumoral Bleeding

AbstractVestibular schwannomas (VSs) account for ∼ 70% of all tumors of the cerebellopontine angle (CPA). Their clinical presentation is often insidious, with progressive hearing loss and involvement of other cranial nerves. Spontaneous hemorrhage in those tumors is very unusual, and generally presents with acute clinical features such as nausea, vomiting, headache and altered consciousness, usually with marked dysfunction of the cranial nerve involved, and with new deficits of neighboring cranial nerves. Asymptomatic patients are extremely rare. We present a case report of an incidental VS with asymptomatic bleeding, which evolved to death after surgery.

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