Journal of neurosurgery
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Journal of neurosurgery · Apr 1994
ReviewNonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography.
The question of whether unruptured intracranial vertebral artery dissections should be treated surgically or nonsurgically still remains unresolved. In this study, six consecutive patients with intracranial vertebral artery dissection presenting with brain-stem ischemia without subarachnoid hemorrhage (SAH) were treated non-surgically with control of blood pressure and bed rest, and five received follow-up review with serial angiography. No further progression of dissection or associated SAH occurred in any of the cases, and all patients returned to their previous lifestyles. ⋯ These results indicate that intracranial vertebral artery dissection presenting without SAH can be treated nonsurgically, with careful angiographic follow-up monitoring. Persistent aneurysmal dilatation as a sequela of arterial dissection seemed to form a subgroup of fusiform aneurysms of the posterior circulation. These aneurysms may be prone to late bleeding and may require surgical treatment.
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Journal of neurosurgery · Apr 1994
Case ReportsTreatment of cranial dural arteriovenous fistulae by interruption of leptomeningeal venous drainage.
Cranial dural arteriovenous fistulae (AVF's) of the tentorial incisura or the dura of the middle fossa have a much higher incidence of draining via leptomeningeal veins than do AVF's of the transverse-sigmoid sinuses or the cavernous sinus. Such a drainage pattern is associated with an increased incidence of intracranial hemorrhage and progressive focal neurological deficits. Patients with cranial dural AVF's often undergo surgical excision and/or endovascular embolization for elimination of the AVF. ⋯ Repeat arteriography at 1 to 2 weeks (three patients), 3 months (3 patients), 12 to 15 months (three patients), and 4 years (two patients) revealed no residual AVF and no evidence of abnormal blood flow. Many cranial dural AVF's with leptomeningeal venous drainage (the type with the most aggressive behavior) are drained only by leptomeningeal veins. This subgroup of patients can be identified by selective arteriography and requires only interruption of the draining vein as it enters the subarachnoid space for successful, lasting elimination.
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Journal of neurosurgery · Mar 1994
Continuous measurement of jugular venous oxygen saturation in response to transient elevations of blood pressure in head-injured patients.
Following traumatic brain injury, continuous jugular venous oxygen saturation (SjvO2) measurements have been made and used to assess cerebral oxygenation. Transients of SjvO2 may reflect cerebral blood flow (CBF) changes if measurements are made over a short period of time during which cerebral metabolic rate for oxygen is assumed unchanged. In response to alterations in perfusion pressure, transients of SjvO2 may indicate the extent to which autoregulation has been preserved after injury. ⋯ In 34 of 37 instances of persistent blood pressure elevations lasting for more than 10 minutes (mean 16.0 +/- 8.0 minutes), the SjvO2 elevation persisted (average duration 15.0 +/- 12.4 minutes), suggesting impaired or lost autoregulatory vasoconstriction. The presence or absence of hyperemia was unrelated to the extent of the autoregulation response. Results indicate that SjvO2 rises with increasing perfusion pressure during and after endotracheal suctioning, suggesting a feeble or absent autoregulatory response following traumatic brain injury.
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Small asymptomatic cysts of the pineal gland represent a common incidental finding in adults undergoing computerized tomography or magnetic resonance (MR) imaging or at postmortem examination. In contrast, large symptomatic pineal cysts are rare, being limited to individual case reports or small series. The authors have reviewed 24 cases of large pineal cysts. ⋯ Of the patients referred for study, the cysts were most often initially misdiagnosed as a pineocytoma in eight and a pilocytic astrocytoma in three. Only two patients were correctly diagnosed as having pineal cysts. This stresses the importance of recognizing the histopathological spectrum of pineal cysts, as well as correlation with radiographic findings, if a correct diagnosis is to be attained.
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Journal of neurosurgery · Feb 1994
Case ReportsTranscranial Doppler ultrasound findings in cerebral venous sinus thrombosis. Case report.
Transcranial Doppler ultrasound (TCD) findings are described in a patient with acute thrombosis of the sagittal venous sinus. The TCD finding of prominent venous signals adjacent to the middle cerebral artery gave the first indication of the diagnosis, which was subsequently confirmed by computerized tomography. Awareness of the possible TCD findings in patients with a similar history may lead to a more rapid diagnosis of cerebral venous sinus thrombosis.