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At least 181 records · Page 10Linked to original sources

PubMed2001

Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both.

BACKGROUND: Patent foramen ovale and atrial septal aneurysm have been identified as potential risk factors for stroke, but information about their effect on the risk of recurrent stroke is limited. We studied the risks of recurrent cerebrovascular events associated with these cardiac abnormalities. METHODS: A total of 581 patients (age, 18 to 55 years) who had had an ischemic stroke of unknown origin within the preceding three months were consecutively enrolled at 30 neurology departments. All patients received aspirin (300 mg per day) for secondary prevention. RESULTS: After four years, the risk of recurrent stroke was 2.3 percent (95 percent confidence interval, 0.3 to 4.3 percent) among the patients with patent foramen ovale alone, 15.2 percent (95 percent confidence interval, 1.8 to 28.6 percent) among the patients with both patent foramen ovale and atrial septal aneurysm, and 4.2 percent (95 percent confidence interval, 1.8 to 6.6 percent) among the patients with neither of these cardiac abnormalities. There were no recurrences among the patients with an atrial septal aneurysm alone. The presence of both cardiac abnormalities was a significant predictor of an increased risk of recurrent stroke (hazard ratio for the comparison with the absence of these abnormalities, 4.17; 95 percent confidence interval, 1.47 to 11.84), whereas isolated patent foramen ovale, whether small or large, was not. CONCLUSIONS: Patients with both patent foramen ovale and atrial septal aneurysm who have had a stroke constitute a subgroup at substantial risk for recurrent stroke, and preventive strategies other than aspirin should be considered.

Adolescent↗

PubMed1997

Foramen magnum decompression for cervicomedullary encroachment in craniometaphyseal dysplasia: case report.

OBJECTIVE AND IMPORTANCE: Foramen magnum encroachment has been cited as a potential cause for the premature demise of patients afflicted with craniometaphyseal dysplasia (CMD). To our knowledge, the association of Chiari malformation and syringomyelia with CMD has not been previously reported. We describe our evaluation and surgical treatment of a patient presenting with CMD, foramen magnum stenosis, Chiari I malformation, and syringomyelia. CLINICAL PRESENTATION: A 15-year-old female patient with CMD presented with severe headaches and progressive myelopathy. Evaluation by computed tomography and magnetic resonance imaging revealed mild ventriculomegaly, cervicomedullary compression secondary to Chiari I malformation and foramen magnum stenosis, and C3-T10 syringomyelia. INTERVENTION: Foramen magnum decompression was performed via suboccipital craniectomy, C1-C2 laminectomy, and dural augmentation. Dysplastic bone was revealed to be extremely thick and mineralized. Removal required lengthy and extensive drilling. The postoperative course was complicated by prolonged intubation secondary to airway obstruction and a perforated duodenal ulcer. Airway obstruction was attributed to severe nasopharyngeal bony dysplasia and soft tissue edema. The use of steroids in the treatment of airway edema and delayed enteral feeding was thought to contribute to ulcer development. Nevertheless, neurological symptoms improved dramatically. CONCLUSION: Foramen magnum decompression can be used to treat life-threatening cervicomedullary compression in patients with CMD. However, caution should be used because surgical intervention may be associated with a higher incidence of complications because of lengthy procedures and the spectrum of craniofacial impairments in patients with CMD.

Adolescent↗

PubMed2005

Lateral approach to anterolateral tumors at the foramen magnum: factors determining surgical procedure.

OBJECTIVE: We discuss and evaluate surgical strategies and results in 42 patients with a variety of tumors involving the anterior and anterolateral foramen magnum and present factors affecting the degree of resection and patient outcomes. We describe our surgical techniques for resection of these tumors via the lateral approach, including consideration for occipital condylar resection and vertebral artery management. METHODS: A retrospective analysis was performed of 42 surgically treated patients with tumors involving the anterior and anterolateral foramen magnum. Patients received treatment between 1991 and 2002; patients' files, operative notes, and pre- and postoperative imaging studies were used for the analysis. RESULTS: The female-to-male ratio was 28:14. Mean patient age was 47 years. Pathological entities comprised 18 meningiomas, 12 chordomas, 3 glomus tumors, 3 schwannomas, and 6 miscellaneous tumors. We mobilized the vertebral artery at the dural entry point in all patients with meningiomas. The vertebral artery was mobilized at the C1 transverse foramen for the majority of extradural tumors. Partial condyle resection was performed in eight meningiomas and five extradural tumors. Complete condyle resection was required in 12 cases, including 9 chordomas, 2 carcinomas, and 1 bone-invading pituitary adenoma. Thirteen patients required occipitocervical fusion after tumor resection. CONCLUSION: In anterior or anterolaterally located foramen magnum tumors, we think the extreme lateral or far lateral approach affords significant advantages. Vertebral artery mobilization and occipital condyle resection may be needed depending on the extent and location of the foramen magnum tumor and its specific pathological characteristics. Tumor invading the occipital condyle or significant condylar resection may cause occipitocervical instability and require fusion.

Adolescent↗

PubMed2002

Syringomyelia associated with foramen magnum arachnoiditis.

OBJECT: Syringomyelia is often linked to pathological lesions of the foramen magnum. The most common cause is hindbrain herniation, usually referred to as Chiari I or II malformation. Foramen magnum arachnoiditis without either Chiari I or II malformation is a rare cause of syringomyelia. The authors undertook a retrospective analysis of 21 patients with foramen magnum arachnoiditis (FMA) and syringomyelia treated between 1978 and 2000 to determine clinical course and optimum management. METHODS: In the review of records, 21 patients with FMA and syringomyelia were documented. A stable clinical course was demonstrated in three patients in whom surgery was not performed, and one patient refused surgical intervention. Seventeen patients underwent 23 operations to treat progressive neurological disease. Of these 23 operations, 18 involved opening of the foramen magnum, arachnoid dissection, and placement of a large dural graft. One patient underwent insertion of a ventriculoperitoneal shunt for treatment of accompanying hydrocephalus, one patient received a cystoperitoneal shunt for an accompanying arachnoid cyst; two syringoperitoneal and one syringosubarachnoid shunts were also inserted. Hospital and outpatient files, neuroimaging studies, and intraoperative photographic and video material were analyzed. Additional follow-up information was obtained by telephone interview and questionnaires. Standard and cardiac-gated magnetic resonance imaging studies are the diagnostic procedures of choice in these patients. Sensory disturbances, dysesthesias, and pain were the only symptoms likely to improve after foramen magnum surgery. Motor weakness and gait disturbances, which were severe in a considerable number of patients, and swallowing disorders tended to remain unchanged. As a consequence of the rather severe arachnoid lesions in most patients, clinical recurrences were observed in 57% over a 5-year period. CONCLUSIONS: Surgery for FMA and syringomyelia has to provide clear cerebrospinal fluid pathways between the cerebellopontine cisterns, spinal canal, and fourth ventricle. If this can be achieved successfully, the syrinx decreases in size and the clinical course of the patient may even improve. In patients with severe and widespread areas of arachnoiditis, however, multiple operations may be required at least to stabilize the clinical course.

Adult↗

PubMed2005

A study on anterior clinoid process and optic strut with emphasis on variations of caroticoclinoid foramen.

This study presents the incidence of carotico-clinoid foramen, dimensions of the anterior clinoid process and optic strut in dry skulls to provide a guide to neurosurgeons in surgical approach especially to anterior part of cavernous sinus. Thirty-five dry skulls were used. Basal width, length, thickness of anterior clinoid process and thickness of optic strut was measured. Morphology of carotico-clinoid foramen was also studied. The average length, basal width and thickness of the anterior clinoid process on right side were 10.74 +/- 2.37 mm, 10.83 +/- 1.20 mm, 5.13 +/- 1.03 mm and left side were 9.91 +/- 1.50 mm, 11.0 +/- 1.12, 5.33 +/- 0.96 mm. Average thickness of optic strut was 3.79 +/- 0.88 mm on right side and 3.61 +/- 0.78 mm on left side. Out of 70 sides in thirty five skulls examined, carotico-clinoid foramen was observed in 14 (20.0%) cases. Out of which complete foramen was in 3 (right side, 4.3%), partial in 8 (6 right, 2 left, 11.4%) and contact in 3 (left side, 4.3%) respectively. Comparison with other races and differences between right and left sides were also discussed. The present study was done to obtain dimensions of anterior clinoid, optic strut, their anatomical variants and incidence of caroticoclinoid foramen in location population. This study will help the surgeons to plan their approach to this area and thus will make the surgical procedure safer

Anthropometry↗

PubMed1985

A study of the position of the mandibular foramen in the adult human mandible.

Eighty dry, adult human mandibles of East Indian ethnic origin and bilateral eruption of third molar teeth were examined to measure the location of the mandibular foramen. The position of the foramen was found to be variable. However, the foramen was predominantly located at the anteroposterior midpoint of the ramus halfway between the mandibular notch and the lower surface of the mandible and two thirds of the way down a line joining the coronoid process to the angle of the mandible. In the majority of the mandibles studied the foramen was located below the occlusal surfaces of the molar teeth. It is concluded that the marked variability in the position of the mandibular foramen may be responsible for an occasional failure to block the inferior alveolar nerve.

Humans↗

PubMed1980

The foramen ovale and sphenoidal angle in man.

The structure of the greater wing of the sphenoid in the region of the foramen ovale and sphenoidal angle is described in both the adult human and in two partly ossified human embryos. It is shown that the foramen ovale of man is enclosed by membrane bone, derived from a medial process associated with the scaphoid fossa, and a lateral tongue, the most dorsal part of which is present in many adults as a process on the lateral margin of the foramen. These structures are parts of an extensive membrane bone which forms the larger part of the greater wing of the sphenoid. It is shown that the foramen of Vesalius represents the site of fusion between this membrane bone and the more medial, cartilaginous, ala temporalis. Various inconstant patterns of grooves and foramina in the vicinity of the foramen ovale can be interpreted as arising from the interplay of the various parts of the membrane bone and the emissary venous plexus from the middle meningeal veins to the pterygoid plexus. The embryonic anlagen of the pterygo-sphenoidal and pterygo-spinous ligaments are described, and the association of these structures with the parts of the membrane bone are discussed.

Humans↗

PubMed2004

Jugular foramen papillary meningioma: a case report.

Jugular foramen meningioma is very rare. Papillary meningioma, the histological aspects and clinical behavior of which are highly malignant, is also very rare. Only 55 cases of jugular foramen meningioma have been reported in the literature. To our knowledge, this is the first report of a jugular foramen papillary meningioma. A 25-year-old woman presented with hoarseness and right hearing disturbance. Neurological examination showed deficits of the right hypoglossal and vagus nerves with palsy. Magnetic resonance imaging (MRI) revealed a mass on the right jugular foramen extending intracranially and extracranially, with weak contrast enhancement. The intracranial tumor was removed via the right lateral suboccipital approach. Histopathological examination confirmed the diagnosis of papillary meningioma. We report here the first case of jugular foramen papillary meningioma. No completely effective treatment for papillary meningiomas exists at present, with the exception of surgery.

Adult↗

PubMed2001

[Preoperative scanning laser ophthalmoscopy: findings in idiopathic macular foramen].

BACKGROUND: The aim of our study was a detailed morphological and functional assessment of macular foramen stages II-IV by scanning laser ophthalmoscopy (SLO) and fundus perimetry including a correlation with clinical findings. METHODS AND MATERIALS: Included in this prospective study were 78 patients where SLO imaging and fundus perimetry were performed with the SLO-105 (Rodenstock) prior to pars plana vitrectomy for macular foramen on one eye. Both the size and shape the of macular foramen were assessed. Deep (0 dB) and relative (12 dB) scotomata were tested using the Goldmann II stimulus in the 20 degrees field of the SLO. Imaging was performed with the infrared laser and confocal aperture C2. RESULTS: The size of macular foramen ranged from 140 microns to 800 microns (median: 420 microns) and 20 (26%) had irregular, polycyclic borders. In 21 patients (27%) a bright sector could be seen just outside the hole. Deep scotomata were notably smaller than the visible macular hole in 4 patients (6%) and 18 deep scotomata (25%) extended beyond the hole. There was a weak inverse correlation between the size of deep, relative scotomata and the diameter of the macular holes with the visual acuity (r = -0.46; r = -0.39 or r = -0.53), but no correlation with the duration of symptoms could be demonstrated. CONCLUSION: Polycyclic borders were seen as a new feature of some idiopathic macular foramen. This may be due to asymmetric traction or adhesions on the macular area. Also, deep scotomata either smaller or larger than the visible macular hole were found.

Aged↗

PubMed2000

Membranous occlusion of the foramen of Monro following ventriculoperitoneal shunt insertion: a role for endoscopic foraminoplasty.

We report two cases of lateral ventricle dilatation due to membranous occlusion of the foramen of Monro following ventriculoperitoneal shunt insertion. Both cases were treated successfully by endoscopic foraminoplasty of the obstructed foramen of Monro and III ventriculostomy. One child had meningomyelocele and hydrocephalus. She had CSF infection after repair of the back lesion. Isolated left lateral ventricle occurred after insertion of a right ventriculoperitoneal shunt for hydrocephalus when the girl was 2 months old. A right ventriculoperitoneal shunt was then inserted. Chronic shunt infection with abdominal pseudocyst was found 8 years later. The shunts were exteriorized. Membranous obstruction of the foramen of Monro was found endoscopically. Fenestration of the membranous obstruction along with a III ventriculostomy was performed. After the endoscopic procedure, the exteriorized ventriculoperitoneal shunt was removed 2 weeks later. The patient was still symptom free without shunting 14 months after the operation. The other child had hydrocephalus after a premature birth and hemorrhage. Repeated ventriculoperitoneal shunt infections contributed to membranous obstruction of bilateral foramen of Monro. After the shunt infection was treated this patient's shunting procedure was simplified by endoscopic foraminoplasty of the left and right foramen of Monro along with a III ventriculostomy. He was symptom free with a new ventriculoperitoneal shunt 9 months after the operation.

Cerebral Ventricles↗

PubMed1999

[Surgical treatment of atrial septal aneurysms with patent foramen ovale in patients with cerebral ischemia as an alternative to life-long anticoagulant therapy: surgical strategy and results in 5 patients].

There is a significantly higher incidence of cerebral ischemia among patients with an atrial septal aneurysm and/or a patent foramen ovale. According to the information provided by modern diagnostic procedures--and in particular by transesophageal echocardiography--two pathogenic mechanisms should be considered as possible causes of the cerebral ischemia. Thrombi may develop locally in the left atrium or atrial septal aneurysm and lead to embolization or, alternatively, thrombi from the inflow region of the inferior vena cava may become trapped in the atrial septal aneurysm and pass through the patent foramen ovale to bring about embolization in the arterial bloodstream. Current treatment consists of life-long anticoagulation with coumarin derivatives in order to prevent further neurological complications. With this treatment, however, the risk of producing hemorrhages cannot be regarded as trivial, especially in old people. Surgical intervention with the insertion of a button device has so far only been attempted in a few isolated cases, and it is in any case no use if there is only an atrial septal aneurysm without a patent foramen ovale. As an alternative to administering anticoagulants for the rest of the patient's life, we operated on five cases of atrial septal aneurysm with patent foramen ovale followed by the appearance of cerebral ischemia. As with the surgical treatment of atrial septal defects in general, the risk of the operation (or of subsequent complications) is very slight indeed. No such problems arose in any of our patients, no blood transfusions were necessary, and after short postoperative treatment they could all be discharged. For younger patients with little risk from the treatment itself, we regard surgical intervention in cases of atrial septal aneurysm with a patent foramen ovale and cerebral ischemia as an important therapeutic alternative.

Adult↗

PubMed2005

Differentiating imaging findings in primary and secondary tumors of the jugular foramen.

The preoperative diagnosis of a jugular foramen tumor may be challenging, since a large variety of unusual lesions may be located in this region. These tumors may be classified as primary lesions (which are located in the jugular foramen or extend from the jugular foramen into the surrounding structures) and as secondary lesions (that extend from the surrounding structures into the jugular foramen). Primary tumors include glomus jugulare tumors, schwannomas, meningiomas and peripheral primitive neuroectodermal tumors, while secondary tumors comprise chordomas, chondrosarcomas, chondroblastomas, giant-cell tumors, cholesterol granulomas, giant cholesterol cyst, endolymphatic sac tumors, reactive myofibroblastic tumors, temporal bone carcinomas and metastases. Accurate preoperative radiological suspicion is of great value for preoperative patient counseling and has a direct impact on the surgical planning in these cases. The present study describes and discusses the main differentiating imaging features of lesions involving the jugular foramen, whose accurate preoperative radiological evaluation is essential for proper surgical planning.

Brain Neoplasms↗

PubMed1994

Comparison of transcranial contrast Doppler sonography and transesophageal contrast echocardiography for the detection of patent foramen ovale in young stroke patients.

The prevalence of a patent foramen ovale was assessed by simultaneously performing transesophageal contrast echocardiography and transcranial contrast Doppler sonography (TCD) in 137 subjects (mean age 36 years) with stroke of unclarified etiology (n = 41), clarified etiology (n = 33), and in normal subjects (n = 63; mean age 32 years). Patent foramen ovale was found significantly more often in patients with unclarified than clarified strokes or in normal subjects (66% vs 33%, or 43%). Massive paradoxical embolism through a patent foramen ovale, identified by TCD, occurred significantly (p < 0.01) more often in patients with unclarified (64%) than clarified (27%) strokes or in normal subjects (3%). However, minimal shunts were typical in normal subjects (79%). Patent foramen ovale was detected indirectly by TCD when calculated on the basis of transesophageal contrast echocardiographic findings (sensitivity 89%, specificity 92%). Thus, TCD reliably detects paradoxical cerebral embolism through a patent foramen ovale, and provides important additional information for evaluating its clinical relevance by semi-quantification of embolic contrast material.

Adult↗

PubMed1991

Patent foramen ovale: a cause of hypoxemia in patients on left ventricular support.

We describe 2 patients who experienced right-to-left shunting during support with a left ventricular assist device as a result of patent foramen ovale. In the first patient, the patent foramen ovale was not found until autopsy. In the second patient, fluctuations in continuous mixed venous oxygen saturations caused us to suspect a patent foramen ovale, which was confirmed with transesophageal contrast echocardiography. We promptly repaired the defect and this patient survived. When patients on assist devices experience unexplained arterial hypoxemia, a patent foramen ovale should be considered. If a patent foramen ovale is found, surgical correction should be done early.

Adult↗

PubMed1977

The mandibular foramen: its anteroposterior position.

This study has been conducted on forty-five Asiatic skulls and sixty-two mixed skulls of black and white Americans to determine the anteroposterior relationship of the mandibular foramen. The mean size of the anterior dimension was greater than the mean size of the posterior dimension of the ramus in all instances. The mandibular foramen was found to be located in the third quadrant anteroposteriorly. The lingula was located just anterior to the mandibular foramen. There was no right- or left-side dominance in the ramus size and position of the mandibular foramen. No appreciable difference was noted in the location of mandibular foramen in the two groups studied.

Asia↗

PubMed1989

Patency of foramen ovale--does it influence haemodynamics in newborn infants?

Colour-coded Doppler ultrasound examination was carried out in 37 healthy newborns at 24 h of age to determine the patency of the foramen ovale. In addition, Doppler-derived cardiac output was measured 5 times during the first 2 days of life in the same infants. Our aim was to examine the influence of foramen ovale on Doppler-derived cardiac output and its association with left-to-right shunting through the ductus arteriosus. In 22 infants the foramen ovale was patent at 24 h of age and in 15 it was closed. Haemodynamic variables measured using non-imaging Doppler-ultrasonic methods did not differ between these two groups. The closure of left-to-right shunt at the ductus was similar in both groups. In a follow-up examination at the age of 1 year, one child had an open foramen ovale without haemodynamic consequences. This study provides evidence that patency of foramen ovale does not influence hemodynamics in early infancy.

Blood Pressure↗

PubMedDate not supplied

Transverse colon herniation through the foramen of Winslow presenting with unusual CT findings.

Bowel herniation through the foramen of Winslow is among the rarest of internal hernias, accounting for less than 0.8%. In its origin, a pivotal role is played by some anatomic variations, or anomalies such as the increased mobility of the right transverse colon, and maybe the exceedingly large bore of the foramen itself. The first case of hernia through the foramen of Winslow was reported by Blandin in 1834. Since then, no more that 200 new cases have been described. Diagnosis usually is established during surgery while treating a bowel obstruction. Only in an exceedingly small group of patients is diagnosis achieved preoperatively on the basis of radiological findings. We describe a preoperatively diagnosed case of transverse colon herniation through the foramen of Winslow, showing a portal vein narrowing and periportal lymphedema at computed tomography (CT). To the best of our knowledge, only a few cases of preoperative CT diagnosis of Winslow foramen hernia have been described in the past. None had the above-mentioned CT findings.

Colon, Transverse↗

PubMed2003

Timing of transesophageal echocardiography in diagnosing patent foramen ovale in patients supported with left ventricular assist device.

Left ventricular assist devices unload the left ventricle and decrease left atrial pressure. This hemodynamic change may cause a right to left atrial shunt and hypoxemia in patients with patent foramen ovale. We prospectively studied the best time for performing diagnostic transesophageal echocardiography in left ventricular assist device patients. Intraoperative transesophageal echocardiography was performed in 14 patients before cardiopulmonary bypass was initiated and after left ventricular assist device was implanted. No patent foramen ovale was detected when transesophageal echocardiography was done before bypass, but a patent foramen ovale was found in 3 patients when transesophageal echocardiography was performed after left ventricular assist device was activated. Patent foramen ovale was confirmed by inspection in all three patients and surgically closed during the same procedure. There were no patent foramen ovale closure-related complications.

Cardiac Surgical Procedures↗