1/40. Prenatal sonographic detection of nasopharyngeal teratoma.We present the case of a 34-year-old pregnant woman who had an elevated maternal serum alpha-fetoprotein level and sonographic findings of a semisolid mass protruding from the fetus's oral cavity. The large, heterogeneous mass filled the oropharynx and nasopharynx. Abnormal Doppler waveforms were detected in the umbilical artery of the fetus, who died in utero. Postmortem examination revealed a nasopharyngeal teratoma.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
2/40. Endovascular treatment of radiation-induced petrous internal carotid artery aneurysm presenting with acute haemorrhage. A report of two cases.Haemorrhage from rupture of petrous ICA aneurysm can be life threatening and emergency treatment is required. We report 2 cases of radiation-induced petrous internal carotid artery (ICA) aneurysm presenting with acute haemorrhage (epistaxis and otorrhagia) after radiotherapy (RT) for nasopharyngeal carcinoma (NPC). Both patients had a history of RT treatment for NPC. The first patient, a 54-year-old man, presented with sudden severe epistaxis and haemorrhagic shock. The second patient, a 35-year-old man, presented with episodes of severe otorrhagia. The first patient was immediately resuscitated. Obliteration of the aneurysm was performed by endovascular occlusion of the ICA with Guglielmi detachable coils and fibered platinum coils. For the second patient, the aneurysm was treated by deploying a self-expandable stent across the aneurysm neck. In an emergency situation, ruptured petrous ICA aneurysm can be treated with endovascular occlusion of the ICA with microcoils if there is a good collateral blood flow. Alternatively, the aneurysm can be treated by deployment of a stent, which can induce stasis and eventual thrombosis of the aneurysm.- - - - - - - - - - ranking = 620.65351395587keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
3/40. Resurfacing of the nasopharynx after nasopharyngectomy using a free radial forearm flap.BACKGROUND: Nasopharyngectomy is emerging as an important treatment option for salvaging locally recurrent nasopharyngeal carcinoma (NPC). After nasopharyngectomy, resurfacing the nasopharynx and covering the internal carotid artery is important to minimize the risk of infection, osteoradionecrosis, and carotid rupture. Previous authors have advocated the use of free grafts of skin and mucosa for this purpose but have also described significant rates of partial and total graft failure. methods: We believe that the best and most reliable way to resurface the nasopharynx is with vascularized tissue, and our preference is for the use of a free radial forearm flap. To illustrate our approach, we present two patients who underwent nasopharyngectomy by means of a maxillary swing approach and who had resurfacing of the surgical defect with a free radial forearm flap. RESULTS: Both patients had complete en bloc resection of tumor followed by the insetting of a free radial forearm flap to reline the surgical defect. Both flaps remained completely viable, and both patients achieved successful resurfacing of the entire nasopharynx. The morbidity of surgery was minimal, and there were no perioperative complications. On assessment 1 year later, the free radial forearm flap continues to reline the entire neonasopharynx, and the long-term functional recovery after surgery is excellent. CONCLUSION: Resurfacing the nasopharynx after nasopharyngectomy with a free radial forearm flap aids healing and minimizes the risk of complications. The morbidity of surgery is minimal and the functional recovery is excellent.- - - - - - - - - - ranking = 138.6889476658keywords = carotid, artery (Clic here for more details about this article) |
4/40. Internal carotid artery hemorrhage after irradiation and osteoradionecrosis of the skull base.OBJECTIVE: To evaluate the clinical presentation and management of internal carotid artery rupture after irradiation and osteoradionecrosis of the skull base. STUDY DESIGN AND SETTING: A retrospective review of the patients in an otorhinolaryngology-head and neck secondary and tertiary referral center. METHODOLOGY: From January 1993 to December 1996, patients with hemorrhage from internal carotid artery as a complication of irradiation and osteoradionecrosis of skull base were reviewed and analyzed. RESULTS: Four patients with internal carotid arterial rupture were included in this study. Angiography was performed in all cases. Embolization of the aneurysm was performed on 2 patients and the remaining 2 patients underwent occlusion of their internal carotid arteries. Three of the 4 patients did not survive. The fourth is currently alive and well 18 months after embolization of 1 internal carotid artery. CONCLUSION: skull base osteoradionecrosis with bleeding from internal carotid artery is a potentially fatal complication of irradiation. Angiography was the mainstay of diagnosis with embolization of the aneurysm and embolization or ligation of the internal carotid artery being the management options. Internal carotid artery occlusion is the definitive treatment provided cross circulation is adequate. SIGNIFICANCE: The advantages and disadvantages of the treatment options are discussed and a management protocol is proposed.- - - - - - - - - - ranking = 1378.9959755775keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
5/40. Extreme fenestration of the basilar artery associated with cleft palate, nasopharyngeal mature teratoma, and hypophyseal duplication.The authors present the case of a newborn girl with extreme fenestration of the basilar artery. This anomaly was found incidentally during MR imaging study for cleft palate and nasopharyngeal teratoma. magnetic resonance angiography showed a totally duplicated basilar artery with connections at the proximal and distal ends of the artery, suggesting an extreme fenestration. Duplicated pituitary gland was also found on MR imaging.- - - - - - - - - - ranking = 7keywords = artery (Clic here for more details about this article) |
6/40. Endoscopic transnasal resection of a juvenile angiofibroma using an ultrasonically activated scalpel.We report a case of juvenile nasopharyngeal angiofibroma (JNA). A 19-year-old male came to our clinic complaining of severe nasal obstruction and epistaxis. Imaging investigations using computed tomography and magnetic resonance imaging techniques revealed a soft tissue mass in the nasopharynx with minimal extension to the pterygopalatine fossa. After embolization of the internal maxillary artery, we successfully performed endoscopic transnasal surgery for a JNA using an ultrasonically activated scalpel. Endoscopic follow-up for the 18 months after the surgical procedure revealed no evidence of recurrence or residual tumor.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
7/40. Application of cyberknife for the treatment of juvenile nasopharyngeal angiofibroma: a case report.Juvenile nasopharyngeal angiofibroma (JNA) tumors can be locally destructive when they spread submucosally. The purpose of this study was to present an image-guided, robotic radiotherapy (Cyberknife) to successfully treat a 12-year-old boy with Juvenile nasopharyngeal angiofibroma (JNA). He complained of progressive right nasal obstruction, intermittent epistaxis. Computed tomography (CT), and magnetic resonance imaging (MRI) revealed the presence of a tumor in the right nasal cavity and nasopharynx with significant hypervascularization from the right maxillary artery. Pathological findings confirmed the diagnosis of JNA. Surgical treatment was recommended but refused by religious reasons. We initially treated the patient with external-beam radiation therapy (total treatments, 12; total dose, 2400 cGy), which, after 7 months, failed to reduce the size of the tumor or relieve the patient's symptoms. We subsequently treated the patient with Cyberknife therapy (total treatments, 3; total dose, 4512 cGy) and observed almost complete disappearance of the tumor after 7 months. After 2 years of observation, there has been no tumor recurrence. Cyberknife therapy is compared with other therapeutic options for JNA, and its benefits are discussed in the context of the findings in the literature.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
8/40. Carotid stenting for irradiation-associated carotid stenosis 3 years after previous carotid endarterectomy.Extracranial carotid stenosis is a known complication of external irradiation to the head and neck region. We report on a patient with previous carotid endarterectomy for irradiation-associated carotid stenosis. This patient developed symptomatic carotid stenosis over the ipsilateral common carotid artery proximal to the previous endarterectomy site 3 years later, and was successfully treated with carotid angioplasty and stenting. This case illustrates the importance of Duplex scan surveillance after carotid endarterectomy for patients with irradiation-associated carotid stenosis. The complimentary role of carotid endarterectomy and carotid angioplasty for managing such a patient is highlighted.- - - - - - - - - - ranking = 1294.4867579504keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
9/40. Massive epistaxis related to petrous carotid artery pseudoaneurysm after radiation therapy: emergency treatment with covered stent in two cases.Two patients had acute left carotid rupture from radiation therapy-induced pseudoaneurysms, resulting in hemodynamic collapse. Because the patients were semicomatose and in shock, an immediate salvage procedure was needed. Location of the pseudoaneurysm at the skull base made surgical treatment less possible. Endovascular therapy was the treatment of choice. Preserving patency of the carotid artery was a desirable option. The successful use of a covered stent in the emergency treatment of massive epistaxis due to active bleeding from pseudoaneurysm in the petrous internal carotid artery (ICA) is described.- - - - - - - - - - ranking = 813.62869057994keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
10/40. Oculomotor neuropathy syndrome. A diagnostic challenge in nasopharyngeal carcinoma.Of 22 patients with different kinds of oculomotor neuropathy syndrome (ONS), 18 were initially suspected of suffering from nasopharyngeal carcinoma (NPC). However, in a series of evaluations, their diagnoses eventually proved to be other diseases such as cranial neuritis, aneurysm of intracranial internal carotid artery, chordoma, etc. The remaining four patients initially diagnosed as having aneurysm of skull base or pituitary lesion were actually NPC sufferers. Therefore, one should be very careful in differentiating NPC from many other diseases contributing to the similar manifestation of ONS.- - - - - - - - - - ranking = 124.13070279117keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
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