1/16. Profound hypothermia and circulatory arrest with skull base approaches for treatment of complex posterior circulation aneurysms.OBJECTIVE: cardiopulmonary bypass with profound hypothermia and circulatory arrest has seen a resurgence as an adjunct technique in neurological surgery. We report our experience with this technique in treating seven complex vertebro-basilar aneurysms. methods: skull base approaches were used in all cases, providing excellent exposure and minimizing brain retraction. There were six basilar artery aneurysms and one giant fusiform vertebro-basilar artery aneurysm. All aneurysms but one had an apparent neck, which could be clipped. The fusiform vertebro-basilar artery aneurysm was trapped, partially resected, and the circulation was reestablished with a saphenous vein graft from the cervical internal carotid artery to the mid-basilar artery. RESULTS: Five patients had an excellent outcome and two had a good outcome at one year or at latest follow up. Two of the patients showed improvement of neurological deficits which were present before the surgical intervention. CONCLUSION: Applying very strict selection criteria in this small series of patients with posterior circulation aneurysms, excellent or good results were achieved using the profound hypothermic circulatory arrest technique.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/16. Combined transcervical transmastoid approach to giant parotid pleomorphic adenoma: a case report.Although rare, giant major salivary gland pleomorphic adenomas are among the most astonishing patient presentations. patients may ignore these slow-growing, benign lesions until significant functional impairment occurs. Complete tumor excision and facial nerve preservation in these cases are challenging requirements and are greatly aided by combined transcervical and transmastoid approaches to these lesions. In the presented case, facial nerve monitoring accurately identified the collateralization between the upper and lower divisions of the facial nerve and allowed the required sacrifice of the lower division without the need for facial nerve grafting or reconstruction. The patient recovered full function of all branches.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
3/16. Giant temporo-occipital sinus pericranii. A case report.A rare case of a giant, temporo-occipital sinus pericranii is presented. A 38-year-old male presented with minor symptoms of headache and heaviness over an enlarging temporo-occipital bone defect. Within the defect a soft, compressible, mass lesion was observed, which varied in size with changes in intracranial pressure. Radiological imaging demonstrated bone erosion around a fluid filled mass, which on angiography communicated via a series of channels with the transverse sinus. A diagnosis of sinus pericranii was made. Due to the risk of future complication the patient elected to undergo surgery, which successfully resected the mass and obliterated the venous communications with the diploic veins and transverse sinus. The classification, aetiology, differential diagnosis, radiological characteristics and management options relating to sinus pericranii are discussed.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/16. Giant cystic pheochromocytoma located in the renal hilus.A malignant tumor in the past medical history of a patient often makes the differential diagnosis of a second tumor more difficult, especially if one of the tumors does not show its characteristic features. The authors report a case of a 55-year-old male who presented with a malignant melanoma on his left shoulder. A retroperitoneal giant cystic mass, 200 mm in diameter, was found incidentally. Adrenal origin was ruled out by imaging techniques. The absence of typical clinical symptoms made a correct preoperative diagnosis unlikely, and severe cardiovascular complications set in during surgery. Considering the characteristics of the cutaneous malignant melanoma, the metastatic origin of the giant retroperitoneal tumor was not likely either. During surgery the left kidney, with a cystic tumor located in the hilus, was removed. The postoperative pathologic diagnosis was pheochromocytoma located in the hilus of the left kidney.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
5/16. Deep hypothermic circulatory arrest for the management of complex anterior and posterior circulation aneurysms.Giant aneurysm surgery continues to be a technically difficult task with high operative morbidity. Recent advances in cardiac surgery have fueled interest in the technique of deep hypothermic circulatory arrest for the treatment of giant and complex intracranial aneurysms. Fourteen patients with giant intracranial aneurysms operated on with the technique of deep hypothermic circulatory arrest are presented. All 14 aneurysms were successfully treated. There were 2 intraoperative strokes: 1 resulted in severe disability and 1 resulted in mild disability. No significant neurological complications were related to the technique of cardiopulmonary bypass with deep hypothermic circulatory arrest. This initial experience indicates that patients with giant and complex intracranial aneurysms might benefit from a surgical approach that included the use of deep hypothermic circulatory arrest.- - - - - - - - - - ranking = 3keywords = giant (Clic here for more details about this article) |
6/16. Primary pulmonary hemangiopericytoma: early local recurrence after perioperative rupture of the giant tumor mass (two cases).We report two recent observations of giant hemangiopericytoma of the lung, one in a 4-year-old child and another in a 65-year-old man. There were no specific clinical signs, but the radiologic appearance was rather characteristic in both cases, as were the histologic findings. pneumonectomy was carried out, complicated in each case by rupture of the fragile, incomplete pseudocapsule and diffuse dissemination of necrotic tumor tissue in the operative field and opposite bronchial tree. Outcome was fatal in both cases within a few months, with extensive, rapidly growing metastases in the subcutaneous scar tissue of the thoracotomy and in the other lung and in one case with diffuse diaphragmatic and intraabdominal metastases. These two observations will offer some guidelines for better understanding of this rare localization of hemangiopericytoma, its natural history, and its optimal treatment, with special reference to the malignant potential and local recurrence rate.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
7/16. Giant prostatic fossa with misleading radiographic features.The long-term complication of a perforation of the prostatic capsule during transurethral resection of the prostate is described. Calcifications in a giant prostatic fossa led to initially misleading radiologic findings.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
8/16. Giant sacrococcygeal teratoma: a method of simple intraoperative control of hemorrhage.A method of emergency hemostasis and continuous intraoperative control of hemorrhage in giant sacrococcygeal teratoma, using an aortic snare, is described. A baby weighing 1,700 g with a 1,300-g sacrococcygeal teratoma was successfully operated using this technique.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
9/16. Secondary surgical management of expulsive choroidal hemorrhage.Eight cases of expulsive hemorrhage with herniation of intraocular contents were managed with secondary procedures after initial operative closure of the eye. Two eyes with giant retinal tears and clear vitreous were treated with photocoagulation alone; each regained 20/200 visual acuity. vitreous hemorrhage, traction retinal detachment, or rhegmatogenous retinal detachment was an indication for surgery in six eyes. vitrectomy, choroidal drainage with simultaneous intraocular infusion, and scleral buckling restored useful vision in two eyes. In cases without vitreous hemorrhage or retinal detachment, conservative management may yield good results, while intraocular surgery may salvage useful vision in more complicated cases.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
10/16. Total excision of a giant angiolipoma of chest wall with A-V malformation and with the use of an autotransfusion system.An 18 year old girl suffering from a giant angiolipoma of back and chest wall with A-V malformation underwent total excision of the tumor in 4 stages. The first two stages included surgical ligation of the arterial blood supply to the tumor. In the third and fourth stages the tumor was resected with the use of an autotransfusion system. The last stage was complicated with massive bleeding and disseminated intravascular clotting. Control of bleeding was achieved by the use of autotransfusion system, right thoracotomy and massive transfusion of blood and its components. After long convalescence period associated with renal and respiratory failure the patient recovered completely without sequellae. This case demonstrates the complexity associated with the treatment of these rare tumors.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
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