PubMed · 5806991
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L B Jongkees. 1969. Cervical vertigo.. https://doi.org/10.1288/00005537-196908000-00011
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We have performed a prospective study of the use of magnetic resonance (MR) imaging in 14 patients undergoing neuro-endoscopic third ventriculostomy. MR imaging was undertaken prior to the endoscopy and serial studies were carried out after the procedure. MR imaging provides important information concerning the morphology of the third ventricle and allows the identification of an appropriate puncture site in the floor of the third ventricle. In particular, the relationship of the third ventricular floor to the basilar artery is well demonstrated. Following an endoscopic septostomy, MR imaging allows visualisation of any change in ventricular size. A cerebro-spinal fluid (CSF) flow void in the anterior inferior third ventricle, sometimes extending into the suprasellar cisterns was frequently demonstrated and this was found to be a more constant feature than reduction in ventricular size. MR imaging provides an indispensable tool for both planning and follow-up of endoscopic third ventriculostomy.
The authors describe a technique for mobilization of the internal carotid artery (ICA) for basilar artery (BA) aneurysm surgery. Using the epidural approach, the anterior clinoid process, orbital roof, and optic canal are drilled away. The ICA is made mobile to the C3 segment by cutting the dural ring and dissecting the ICA from the carotid groove. The ophthalmic artery is then dissected from the optic canal. This mobilization of the ICA secures wide operative fields on both its medial and lateral sides and permits complete clipping of BA aneurysms.
Vertebrobasilar ectasia is a rare cause of typical trigeminal neualgia. In a recently published large series only thirty-one (2%) of 1404 consecutive patients with vascularly determined neuralgia were found to have vertebrobasilar compression. We present three patients with trigeminal neuralgia caused by vertebrobasilar ectasia, who were evaluated with high resolution magnetic resonance imaging (MRI). MRI studies provided accurate information on the anatomical location and course of the ectatic vessel in the cerebellopontine angle and the caused mass effect on the brainstem. With gadolinium-enhancement vascular compression of the trigeminal nerve was demonstrated clearly. Surgery confirmed compression of the fifth nerve by an ectatic and tortuous vertebrobasilar artery in two cases. Following microvascular decompression neither patient experienced further pain. The third patient was treated with a ventriculoperitoneal shunt, as he developed occlusive hydrocephalus caused by the vertebrobasilar dolicho-ectasia. MRI is useful in the evaluation of trigeminal neuralgia as it excludes other aetiologies such as tumour or arteriovenous malformation, but also demonstrates cranial nerve compression by ectatic vertebral arteries.