Cases reported "Vascular Neoplasms"

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1/89. Efficacy of induced hypotension in the surgical treatment of large cavernous sinus cavernomas.

    OBJECT: cavernous sinus cavernomas are rare lesions associated with high rates of intraoperative mortality and morbidity resulting from profuse bleeding. In this paper, the authors report their experience in treating five patients with histologically confirmed cavernous sinus cavernomas and describe the efficacy of induced hypotension in facilitating excision of the lesion. methods: All five patients were women ranging in age from 25 to 54 years, with an average age of 42 years. The mass was small in one and large (>3 cm in diameter) in four. In one patient with a large mass, cardiac arrest occurred after the craniotomy, and remarkable reduction in the size of the cavernoma was evident on postmortem examination. The other three large lesions were successfully removed piecemeal after induction of hypotension (60-80 mm Hg systolic pressure), which remarkably reduced the mass and the bleeding during surgery. In the remaining patient, who had a small lesion, the cavernoma was removed in one piece. CONCLUSIONS: cavernous sinus cavernoma can be thought of as a cluster of sinusoidal cavities, the size of which varies depending on the systemic blood pressure. During surgery, reduction of the mass and control of bleeding from the cavernoma can be achieved by inducing hypotension, which enables the safe excision of this lesion. This technique should be considered by surgeons resecting a cavernous sinus tumor, especially when cavernoma is suspected.
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2/89. Stereotactic radiosurgery for cavernous sinus cavernous hemangioma--case report.

    A 40-year-old female presented with cavernous sinus cavernous hemangioma manifesting as left abducens and trigeminal nerve pareses. magnetic resonance imaging revealed a left cavernous sinus tumor. The tumor was partially removed. Histological examination of the specimen confirmed cavernous hemangioma. radiosurgery was performed using the gamma knife. The tumor markedly decreased in size after radiosurgery and morbidity was avoided. cavernous sinus cavernous hemangiomas may be difficult to treat surgically due to intraoperative bleeding and cranial nerve injury. Stereotactic radiosurgery can be used either as an adjunct treatment to craniotomy, or as the primary treatment for small cavernous sinus cavernous hemangioma.
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3/89. pulmonary artery leiomyosarcoma.

    pulmonary artery leiomyosarcoma is a rare but highly lethal disease, and can be mistaken for pulmonary thromboembolism. We report a case of pulmonary artery leiomyosarcoma managed with surgical resection, chemotherapy, and radiotherapy. A 57-year-old woman was admitted with complaints of aggravated dyspnea. She was initially treated with oxygen therapy and heparinization for a suspected pulmonary embolism. echocardiography revealed a dilated right atrium and ventricle and severe tricuspid regurgitation, with an estimated systolic right ventricular pressure of 95 mm Hg; a shadow of a mass in the main pulmonary artery was also noted. Right ventriculography revealed a filling defect, and to-and-fro motion of the mass in the main pulmonary artery. The left pulmonary artery was almost totally occluded by the mass. The patient's condition improved dramatically after palliative excision of the mass and patch reconstruction of the outflow tract of the right ventricle with a bicuspid xenograft. Pathologic examination of the mass revealed leiomyosarcoma. Chemotherapy and radiotherapy were subsequently administered and follow-up imaging studies 3 months postoperatively revealed no recurrence of the tumor. The patient remains well, more than 1 year after treatment. This report emphasises that pulmonary artery sarcoma should be considered in the differential diagnosis in cases of suspected pulmonary thromboembolism.
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keywords = operative
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4/89. Evolution of pulmonary perfusion defects demonstrated with contrast-enhanced dynamic MR perfusion imaging.

    Pulmonary perfusion defects can be demonstrated with contrast-enhanced dynamic MR perfusion imaging. We present the case of a patient with a pulmonary artery sarcoma who presented with a post-operative pulmonary embolus and was followed in the post-operative period with dynamic contrast-enhanced MR perfusion imaging. This technique allows rapid imaging of the first passage of contrast material through the lung after bolus injection in a peripheral vein. To our knowledge, this case report is the first to describe the use of this MR technique in showing the evolution of peripheral pulmonary perfusion defects associated with pulmonary emboli.
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keywords = operative
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5/89. leiomyosarcoma of the thoracic aorta.

    This case involves a patient with aortic leiomyosarcoma. A patient clinically suspected of type IIIa dissecting aortic aneurysm underwent surgery. The descending thoracic aorta was found to be filled with a soft, yellow tumor and was replaced with a woven Dacron graft. microscopy of the surgical specimen revealed large, atypical spindle cells with numerous mitoses in bundles intersecting at 90 degrees, suggesting leiomyosarcoma. This diagnosis was confirmed immunohistochemical study. The postoperative course was uneventful and the patient was discharged on postoperative day 40; however, the patient developed bronchopneumonia due to malignant pleuritis 3 months postoperatively and died on postoperative day 103.
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ranking = 4
keywords = operative
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6/89. Sylvian fissure lipomas: case reports and review of the literature.

    Two patients with Sylvian fissure lipoma are reported. One of them was operated on because of an increased frequency of epileptic seizures in spite of high dose carbamazepine treatment. A review of the literature regarding the surgical experience with Sylvian lipomas revealed only four cases, and in none of them was the lipoma removed totally. One of ours is the first case in which total removal of the lipoma was achieved. The postoperative course was uneventful and carbamazepine dose was gradually lowered without further epileptic activity. If these exceedingly rare lesions cause symptoms then surgical intervention is indicated. With microsurgical techniques, Sylvian fissure lipomas can be removed totally without complication and symptomatic improvement may result.
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ranking = 1
keywords = operative
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7/89. Planning and simulation of neurosurgery in a virtual reality environment.

    OBJECTIVE: To report our experience with preoperative neurosurgical planning in our stereoscopic virtual reality environment for 21 patients with intra- and extra-axial brain tumors and vascular malformations. methods: A neurosurgical planning system called VIVIAN (Virtual Intracranial Visualization and Navigation) was developed for the Dextroscope, a virtual reality environment in which the operator reaches with both hands behind a mirror into a computer-generated stereoscopic three-dimensional (3-D) object and moves and manipulates the object in real time with natural 3-D hand movements. Patient-specific data sets from multiple imaging techniques (magnetic resonance imaging, magnetic resonance angiography, magnetic resonance venography, and computed tomography) were coregistered, fused, and displayed as a stereoscopic 3-D object. A suite of 3-D tools accessible inside the VIVIAN workspace enabled users to coregister data, perform segmentation, obtain measurements, and simulate intraoperative viewpoints and the removal of bone and soft tissue. RESULTS: VIVIAN was used to plan neurosurgical procedures primarily in difficult-to-access areas, such as the cranial base and the deep brain. The intraoperative and virtual reality 3-D scenarios correlated well. The VIVIAN system substantially contributed to surgical planning by 1) providing a quick and better understanding of intracranial anatomic and abnormal spatial relationships, 2) simulating the craniotomy and the required cranial base bone work, and 3) simulating intraoperative views. CONCLUSION: The VIVIAN system allows users to work with complex imaging data in a fast, comprehensive, and intuitive manner. The 3-D interaction of this virtual reality environment is essential to the efficient assembly of surgically relevant spatial information from the data derived from multiple imaging techniques. The usefulness of the system is highly dependent on the accurate coregistration of the data and the real-time speed of the interaction.
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ranking = 4
keywords = operative
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8/89. Dual phase helical CT of a primary malignant fibrous histiocytoma of the right renal vein.

    A case is reported of primary malignant fibrous histiocytoma of the right renal vein involving the ipsilateral kidney which showed early enhancement on dual phase helical CT. The correct diagnosis of a primary tumour of the renal vein involving the kidney was not made but in retrospect could have been achieved pre-operatively by considering several CT features.
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ranking = 1
keywords = operative
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9/89. Stewart-Treves syndrome: lymphangiosarcoma following mastectomy.

    lymphangiosarcoma (LAS) is an aggressive, malignant vascular tumor following long-lasting chronic lymphedema. patients with LAS demonstrate a history of breast cancer treated by radical mastectomy in the majority of patients. In the 1960s the incidence of LAS in patients with a 5-year survival after radical mastectomy varied from 0.07 to 0.45%. Today, due to changes in the operative techniques of breast cancer, less chronic lymphedema is seen with only a scant number of LAS patients. The etiology of this enigmatic tumor is not yet completely understood. Histologically, LAS arises from vascular endotheliocytes, and all vascular sarcomas originating in the setting of a chronic lymphedema are categorized as LAS. There is no standard treatment of LAS. The treatment options include radical ablative surgery, radiation therapy, and chemotherapy. The prognosis of LAS is poor; long-term survival is the exception. Only early recognition and radical surgery offer a chance of cure.
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keywords = operative
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10/89. Intravenous leiomyomatosis with cardiac extension: tumor thrombectomy through an abdominal approach.

    Intravenous leiomyomatosis is an uncommon vascular tumor that may be seen with potentially life-threatening symptoms resulting from intracardiac extension. This tumor is frequently misdiagnosed and treated without appropriate preoperative imaging and planning, which at times leads to inadequate treatment and incomplete resections. The appropriate therapy is complete excision of the tumor. We describe a patient who was treated with a new approach involving a single-stage operation without the need for median sternotomy, cardiopulmonary bypass graft, or hypothermic arrest by resection of the tumor from the point of attachment in the abdominal portion of the inferior vena cava.
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