Oropharyngeal injury after transesophageal echocardiography.
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Aged↗
Biomedical subjects
D C Bigelow
Publications and source records attributed to D C Bigelow.
Angiographic assessment of the transverse sinus and vein of labbé to avoid complications in skull base surgery.
Advances in the field of skull base surgery have dramatically reduced the mortality and morbidity of operations on the skull base. Nevertheless, cerebral ischemic events from compromised blood supply to areas of the brain still occur. Although arterial compromise is responsible for a majority of these events, the venous side of the circulation can also play a role in producing cerebral infarctions. A key area of cerebral venous drainage is at the junction of the transverse sinus, sigmoid sinus, and vein of Labbé. Absence of the transverse sinus with the outflow of the vein of Labbé limited to the sigmoid sinus puts these patients at an increased risk for venous infarcts when this area is manipulated during skull base surgery. We have studied 100 consecutive carotid angiograms performed on 50 individuals for carotid artery disease or to rule out aneurysms. We have found that 16.7% of individuals have one atretic transverse sinus. We discuss our results and the implications that they have in skull base surgery. It is our hope that a better understanding of the cerebral venous drainage patterns will help skull base surgeons avoid complications in the future.
Journal Article↗
Hearing preservation following a transtemporal resection of an acoustic schwannoma: a case report.
The transtemporal or translabyrinthine approach is generally regarded as the most reliable method of ensuring total tumor removal and preservation of facial nerve function in the resection of a cerebellopontine angle tumor. This is particularly true in removing a tumor that has a significant extension into the patient's internal auditory canal. An anticipated deficit associated with the approach is a total hearing loss in the patient's hearing on the operated side. We have encountered a patient, however, who was serially documented as having serviceable hearing after a transtemporal removal of an acoustic schwannoma. Plausible reasons for the functional preservation of some of this patient's hearing are included in the discussion.
Cerebellopontine Angle↗
Management of high parapharyngeal space tumors.
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Head and Neck Neoplasms↗
Cost of departure from optimality in arterial branching.
Measurements of branching angles in the arterial tree have in the past indicated a great deal of scatter away from what is expected to be optimum on theoretical grounds. In this study the cost penalty of nonoptimum branching angles is calculated for the first time to determine how far from optimum these angles are. The results lead to the remarkable conclusion that while the scatter of the measured branching angles is fairly large, they represent deviations from optimum angles which correspond to only 2% or so penalty in cost.
Arteries↗
Sound- and pressure-induced vertigo associated with dehiscence of the roof of the superior semicircular canal.
In many types of peripheral vertigo, imaging is not part of the initial evaluation. We present a patient with sound- and pressure-induced vertigo associated with bony dehiscence of the roof of the superior semicircular canal. The diagnosis of this new entity can only be made by high-resolution coronal CT imaging of the temporal bones. In patients with this symptom complex, CT should be performed early in the diagnostic workup.
Adult↗
Use of preoperative MR to predict dural, perineural, and venous sinus invasion of skull base tumors.
PURPOSE: To assess the accuracy of MR imaging in predicting dural, venous sinus, and perineural invasion by skull base tumors. METHODS: The preoperative MR images of 22 patients who had resection of skull base neoplasms were evaluated for the following characteristics: dural enhancement, pial enhancement, local perineural invasion by adjacent tumor, and venous sinus invasion by tumor. The greatest width of dural enhancement was measured, and the character of dural enhancement was noted. The pathologic and surgical reports were reviewed retrospectively with specific attention to dural, venous, and local perineural invasion. RESULTS: Of the 22 patients studied, dural invasion by tumor was confirmed in eight patients, vascular invasion in six patients, and perineural invasion in four patients. The sensitivity of dural enhancement in predicting invasion was 88%, the specificity 50%, and the accuracy 64%. When enhancement and focal nodularity were present, the sensitivity remained at 88%; however, specificity was 100% and accuracy 95%. If the dural enhancement was more than 5 mm thick, sensitivity, specificity, and accuracy were 75%, 100%, and 91%, respectively. Predicting tumor invasion of the dura by the presence of pial enhancement was 50% sensitive and 100% specific. Venous sinus/jugular vein invasion was predicted with 100% sensitivity, 94% specificity, and 95% accuracy. Local perineural invasion was predicted with 100% sensitivity, 50% specificity, and 59% accuracy. CONCLUSIONS: The presence of pial enhancement, focal dural nodules, or dural thickening of more than 5 mm is highly accurate in predicting the presence of neoplastic dural invasion. Linear enhancement of dura does not imply dural infiltration by tumor. Venous invasion by tumor can be predicted accurately with preoperative MR imaging.
Adult↗