1/119. hypoglossal nerve injury as a complication of anterior surgery to the upper cervical spine.Injury to the hypoglossal nerve is a recognised complication after soft tissue surgery in the upper part of the anterior aspect of the neck, e.g. branchial cyst or carotid body tumour excision. However, this complication has been rarely reported following surgery of the upper cervical spine. We report the case of a 35-year-old woman with tuberculosis of C2-3. She underwent corpectomy and fusion from C2 to C5 using iliac crest bone graft, through a left anterior oblique incision. She developed hypoglossal nerve palsy in the immediate postoperative period, with dysphagia and dysarthria. It was thought to be due to traction neurapraxia with possible spontaneous recovery. At 18 months' follow-up, she had a solid fusion and tuberculosis was controlled. The hypoglossal palsy persisted, although with minimal functional disability. The only other reported case of hypoglossal lesion after anterior cervical spine surgery in the literature also failed to recover. It is concluded that hypoglossal nerve palsy following anterior cervical spine surgery is unlikely to recover spontaneously and it should be carefully identified.- - - - - - - - - - ranking = 1keywords = carotid (Clic here for more details about this article) |
2/119. Unusual cranial nerve palsy caused by cavernous sinus aneurysms. Clinical and anatomical considerations reviewed.BACKGROUND: Two cases of intracavernous internal carotid artery aneurysm with unusual clinical findings are reported. The pathomechanism and clinical significance are discussed. CASE DESCRIPTION: The first patient was a 49-year-old woman who presented with 6th nerve palsy and Horner's syndrome caused by a posteriorly located intracavernous aneurysm. The symptoms improved gradually in proportion to the size of the aneurysm. The second patient was a 69-year-old woman with isolated oculomotor superior division palsy caused by an anteriorly located large aneurysm. CONCLUSION: In the first case, a local aneurysmal compression at both the 6th nerve and the sympathetic fibers sent from the plexus on the intracavernous internal carotid artery is the most probable explanation. In the second case, the aneurysm might have selectively compressed the superior division of the oculomotor nerve at the anterior cavernous sinus. Clinical recognition of these syndromes results in a better diagnostic orientation. The authors discuss the pertinent anatomy and pathophysiology of the lesions because these findings are rarely seen clinically or in the literature.- - - - - - - - - - ranking = 2.8145107300112keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
3/119. Extensor pollicis longus paralysis following thoracoscopic sympathectomy.Thoracoscopic sympathectomy is an acceptable form of treatment for palmar hyperhidrosis. Many authors have reported favourable results. Complications range from pneumo-haemothorax, Horner's syndrome, compensatory hyperhidrosis and bleeding. Plas et al reported 2.7% of the procedures had complications requiring intervention and 9.7% had non-interventive complications. There have been isolated reports of other rare complications including false aneurysm of intercostal artery, inferior brachial plexus injury and abnormal suntanning. We report an unusual case of isolated extensor pollicis longus paralysis after a thoracoscopic sympathectomy for palmar hyperhidrosis, in a fit young male. Such complications have not been previously reported. We recognise that such isolated nerve injury is uncommon.- - - - - - - - - - ranking = 0.028697447471918keywords = artery (Clic here for more details about this article) |
4/119. A rare local anesthetic misadventure. Case report and anatomic considerations.When the mouth is fully opened, the depth to which the needle is inserted need not be great in order to pass through the submandibular gland capsule, and insertion of the needle behind the second molar tooth would result in passage behind the posterior border of the my-ohyoid muscle. The discussion indicates the relative ease with which fluid may penetrate the parapharyngeal space, particularly if pressure is used in injecting. Fluid diffusing into the region of the carotid triangle may have been responsible for the various symptoms, and anesthesia of the hypoglossal nerve, nerve, thyrohyoid nerve, internal and external laryngeal nerves, and carotid body possibly occurred. anesthesia of the vagus is a remote possibility.- - - - - - - - - - ranking = 2keywords = carotid (Clic here for more details about this article) |
5/119. Guglielmi detachable coil treatment of a partially thrombosed giant basilar artery aneurysm in a child.We report a partially thrombosed giant of the aneurysm basilar artery with prominent mass effect, diagnosed in an 11 year-old child who presented with neurological deficits due to brain stem compression. After the patent portion of the aneurysm was embolised with Guglielmi detachable coils, remarkable clinical improvement occurred. angiography demonstrated complete occlusion of the aneurysm and MRI revealed dramatic shrinkage of the aneurysm at 6-month and 1-year follow-up.- - - - - - - - - - ranking = 0.14348723735959keywords = artery (Clic here for more details about this article) |
6/119. Acute bilateral arm paresis.OBJECTIVE: To study pure motor bilateral arm paresis of acute onset. This syndrome is as yet a barely described clinical feature attributed to ischemia in the territory of the anterior spinal artery (ASA). CASES: We present 2 patients with acute onset of pure motor deficit in both upper extremities. RESULTS: magnetic resonance imaging of the cervical spinal cord revealed infarcts in the territory of the ASA. In 1 case, electrophysiology further suggested discrete gray matter involvement. CONCLUSION: In patients with acute weakness of both arms without further neurological deficits, an incomplete ASA syndrome should be considered with the anterior horns predominantly being affected. magnetic resonance imaging and electrophysiology are valuable tools to further confirm both location and extension of the spinal lesion.- - - - - - - - - - ranking = 0.028697447471918keywords = artery (Clic here for more details about this article) |
7/119. A limited anterior petrosectomy with preoperative embolization of the inferior petrosal sinus for ventral brainstem tumor removal.BACKGROUND: The present study describes the use of a limited subtemporal extradural anterior petrosectomy with preoperative embolization of the inferior petrosal sinus for the management of tumors located behind the clivus and ventral to the brainstem. Details of the procedure and its application in five cases are presented. methods: This procedure consists of using the extradural route to approach the upper side of the petrosal pyramid so that it can be drilled medially, and to resect the apex to come out into the posterior fossa. This route gives a petrosectomy just medial to the horizontal segment of the petrous carotid artery in front of the cochlea. It goes around the labyrinthine mass and the internal auditory canal from above to expose the posterior fossa dura between the two petrosal sinuses. The dural opening exposes the ventral aspect of the pons from the trigeminal nerve to the origin of the abducens nerve, ventral to the facial nerve. Preoperative embolization of the inferior petrosal sinus allows its intraoperative section for a wider exposure along the lower clivus. This approach can easily be combined with an intradural approach to provide additional exposure above the trigeminal nerve. patients who underwent this procedure had prepontine cisternal chordoma or epidermoid cyst of the petroclival region. RESULTS: One patient experienced a cranial nerve deficit as a direct result of the surgical procedure (VIth nerve palsy requiring surgery) but no other patient has had permanent neuromuscular compromise. Complications consisted of a wound infection in one case. Tumor removal was total in three cases and partial in two cases. CONCLUSION: Quite easy to master, the anterior petrosectomy with preoperative embolization of the inferior petrosal sinus is a time-conserving approach giving one of the best routes to reach the ventral brainstem while working in front of the cranial nerves and preserving hearing.- - - - - - - - - - ranking = 1.4072553650056keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
8/119. Severe, traumatic soft-tissue loss in the antecubital fossa and proximal forearm associated with radial and/or median nerve palsy: nerve recovery after coverage with a pedicled latissimus dorsi muscle flap.A total of 6 patients with complex, traumatic wounds of the antecubital fossa and proximal forearm were included in this study. All patients presented with radial and/or median nerve palsies in addition to their soft-tissue defect. Except for 1 patient with a 15-cm defect of the radial nerve, all other traumatized nerves appeared in-continuity at the time of surgery. However, the nerve injury was severe enough to induce wallerian degeneration (i.e., axonotmesis in traumatized nerves in-continuity). Three patients required brachial artery reconstruction with a reverse saphenous vein graft. Wound coverage was accomplished using a pedicled latissimus dorsi muscle flap, which was covered with a split-thickness skin graft. Successful reconstruction was obtained in all patients. Follow-up ranged from 2 to 6 years. The range of motion at the elbow and forearm was considered excellent in 5 patients and good in the remaining patient who had an intra-articular fracture. Motor recovery of traumatized nerves in-continuity was observed in all but 1 patient who had persistent partial anterior interosseous nerve palsy. The grip strength of the injured hand measured 70% to 85% of the contralateral uninjured hand. median nerve sensory recovery was excellent in all patients. The versatility of the pedicled latissimus dorsi muscle flap for coverage of these complex wounds with traumatized neurovascular bundles around the elbow is discussed.- - - - - - - - - - ranking = 0.028697447471918keywords = artery (Clic here for more details about this article) |
9/119. Transsphenoidal computer-navigation-assisted deflation of a balloon after endovascular occlusion of a direct carotid cavernous sinus fistula.SUMMARY: A 49-year-old woman with a direct posttraumatic carotid cavernous fistula (CCF) was treated with detachable balloons via a transcarotid route. After the procedure, her intracranial bruit, conjunctival injection, and orbital congestion were cured, but the preexistent sixth nerve palsy deteriorated. CT showed one balloon positioned in the posterior portion of the right cavernous sinus and was regarded to be responsible for nerve compression. After surgical exposure by use of a transnasal-transsphenoidal approach under 3D navigation control, this balloon was deflated by puncture with a 22-gauge needle. The previously described symptoms resolved after balloon deflation. This report presents a rare complication of endovascular treatment of direct CCF and a new microsurgical approach to a balloon in a case of nerve compression.- - - - - - - - - - ranking = 6keywords = carotid (Clic here for more details about this article) |
10/119. anterior spinal artery syndrome following total hip arthroplasty under epidural anaesthesia.We present a case of anterior spinal artery syndrome in a 57-year-old man having a total hip arthroplasty under epidural anaesthesia. Epidural insertion and surgery were uneventful. Postoperatively bilateral lower limb motor weakness was attributed to the initial dose of local anaesthetic. There was no change in neurological status 24 hours later. magnetic resonance imaging demonstrated spinal cord infarction. The diagnosis of anterior spinal artery syndrome was made based on the patient's neurological condition and MRI findings.- - - - - - - - - - ranking = 0.17218468483151keywords = artery (Clic here for more details about this article) |
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