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At least 253 records · Page 14Linked to original sources

PubMed1993

Transcranial Doppler with contrast injection for the detection of patent foramen ovale in stroke patients.

Right-to-left shunt through a patent foramen ovale was searched for in 80 patients with acute ischemic stroke by simultaneously performing transthoracic two-dimensional echocardiography and transcranial Doppler during agitated saline injection. A patent foramen ovale was detected by echocardiography in 14 patients (17.5%). Transcranial Doppler correctly identified all 14 patients, and 7 more patients in whom echocardiographic findings were indeterminate. Prevalence of patent foramen ovale by transcranial Doppler was therefore 26.3% (21 of 80 patients). Concordance between the two tests was 91.3% (73 of 80 patients). The delivery of contrast material to cerebral vessels is therefore demonstrable by transcranial Doppler in all patients diagnosed by contrast echocardiography, suggesting that paradoxical embolization through a patent foramen ovale may be more frequent than previously thought. Transcranial Doppler with contrast injection is a valid alternative in case of poor echocardiographic image quality.

Cerebral Arteries↗

PubMed1994

Anatomic basis of the infratemporal approach of the jugular foramen.

A description of the lateral infratemporal approach of the jugular foramen (JF) was performed according to bone data, anatomico-radiologic relationships and microsurgical and endoscopic dissection: the jugular foramen is an anteromedial fissure of the petro-occipital fissure. The location of the exocranial facial nerve and the skeletonization of the third portion of the facial canal represents the main obstacle. A retro-facial dissection, then a medio-facial sub-labyrinthine dissection, while displacing the sigmoid sinus, should avoid a systematic diversion of the nerve, which is the cause of severe paralysis. The broad approach of the "pars nervosa" of the jugular foramen demands the control of the vertical part of the carotid canal. The lateral infratemporal approach of the jugular foramen is necessary for the treatment of specific lesions of the area (chemodectoma, neurinoma), which is invaded contiguously (carcinoma).

Adult↗

PubMed1988

Prolapsed valve of the foramen ovale in newborns and infants with coarctation of the aorta.

Out of 60 newborns and infants with symptomatic coarctation of the aorta, 34 had a significant left-to-right shunt at atrial level. In 20 of these 34 children, the atrial shunt had disappeared after surgical correction of the coarctation. All patients with this "reversible" shunt, thought to be secondary to an incompetent valve of the foramen ovale, were younger than 35 days at first cardiac catheterization. Left atrial pressure and left atrial volume of these patients did not differ significantly from those in a control group without atrial shunt. The conditions necessary for the development of a valve-incompetent foramen ovale include not only an increased left ventricular work load, but also a thin and pliable valve of the foramen ovale. It is only in infants younger than one month of age that the valve is thin and pliable enough to prolapse through the foramen ovale and form a channel between the two atria, which results in a left-to-right atrial shunt.

Aortic Coarctation↗

PubMed2003

[Microsurgical resection of jugular foramen tumors with hearing preservation and without facial nerve palsy].

BACKGROUND: The juxtacondylar microsurgical approach is an adequate alternative to the classical infratemporal approach for the resection of tumors of the jugular foramen. PATIENTS AND METHODS: Retrospectively, we report on our experience with eight patients suffering from tumors of the jugular foramen with different etiologies, who were treated successfully via the juxtacondylar approach with interdisciplinary cooperation. RESULTS: The advantage of the juxtacondylar approach is that there is no need to expose and transpose the facial nerve. Additionally, reduction or translocation of the posterior wall of the auditory canal and removal of the ossicular chain are not necessary. CONCLUSIONS: Tumors of the jugular foramen can be safely removed without damaging the facial nerve or auditory capacity, with a comparatively much better overview over the vascular and neural structures of the jugular foramen. This more neurosurgically orientated skull base approach is not very well known in the ENT surgical literature.

Adult↗

PubMed2000

Herniation through both Winslow's foramen and a lesser omental defect: report of a case.

The herniation of small bowel through Winslow's foramen is a rare type of internal hernia which can cause ileus; however, a hernia traversing the lesser sac is even more unusual. To the best of our knowledge, only 25 cases of herniation through Winslow's foramen and 10 cases of lesser sac hernia have been reported in the Japanese literature. We describe herein the case of a 33-year-old man who presented to our hospital complaining of abdominal pain in whom a plain abdominal radiograph revealed small bowel gas with air-fluid levels, suggesting ileus. Following admission, an ileus tube was inserted, but the intestinal shadow did not improve and surgery was performed based on suspicion of an internal hernia. Approximately 100 cm of ileum was found to have herniated through a defect in the lesser omentum after passing through Winslow's foramen. Since the herniated bowel was viable, manual reduction without resection was performed. The patient had a satisfactory postoperative course, and was discharged on postoperative day 11. There are many unknown aspects surrounding the etiology of Winslow's foramen hernia and lesser sac hernia, and although internal hernia is a rare cause of ileus, its possibility should be kept in mind.

Adult↗

PubMed2006

A model for foramen ovale puncture training: Technical note.

BACKGROUND: Trigeminal neuralgia is a common cause of facial pain, characterized by shock-like pain affecting one or more branches of the trigeminal nerve. When conservative treatment fails and microdecompression is not indicated, percutaneous procedures are helpful. This percutaneous approach is done by a puncture up to the Gasserian ganglion, through the foramen ovale. Although simple and safe, this puncture demands some expertise from neurosurgeons. For that, a partnership between neurosurgeons and bio-engineers has developed a model for foramen ovale puncture, allowing practice for residents and young neurosurgeons. METHOD: A model for foramen ovale puncture has been created by interposition of synthetic materials over a skull, simulating the human face. FINDINGS: This model has shown great similarity with that found in conventional surgeries, even upon repeated testing by experienced functional neurosurgeons and young residents. CONCLUSION: This model for foramen ovale puncture training has demonstrated valuable help for initial practicing of this common neurosurgical procedure, particularly in centers where there are not many cadavers available for training.

Catheter Ablation↗

PubMed2005

Meningiomas of the jugular foramen.

Primary meningiomas of the jugular foramen are extremely rare. There is controversy regarding the management of these tumors. The objective of this article is to analyze the treatment and results in a series of ten cases. From a series of 107 patients that had been operated on for jugular foramen tumors between 1987 and 2005, ten had meningiomas. The clinical, histological and imaging findings, as well as the outcome of these cases, were reviewed. A high incidence of malignant or aggressive tumors (six cases) was found. Gross total resection (Simpson I and II) was achieved in five patients. Four patients with meningotheliomatous meningiomas are alive, with a mean follow-up time of 71.8 months (6.5 years). Two patients (one with anaplastic type and one with papillary type) died in the immediate postoperative period. Four patients (two with papillary type, one with microcystic type and one with anaplastic type) died because of disease progression, with a mean survival time of 35 months. Radical removal of benign jugular foramen meningiomas is possible. The incidence of postoperative deficit of cranial nerves is higher than in other benign tumors of the jugular foramen. A high incidence of aggressive (malignant) tumors was observed in this series.

Adult↗

PubMed1993

Left-to-right shunt through patent foramen ovale in adult patients with left-sided cardiac lesions: a transesophageal echocardiographic study.

To define the prevalence rate of left-to-right interatrial shunt through patent foramen ovale in adults with symptomatic left-sided cardiac lesions, 56 patients were examined with transthoracic and transesophageal echocardiography and cardiac catheterization. By transesophageal echocardiography, 15 patients (group A) were found to have left-to-right interatrial shunt through patent foramen ovale, constituting a prevalence rate of 27%. In group A, transthoracic echocardiography detected the interatrial shunt in two patients, and catheterization detected it in only one. The remaining 41 patients (group B) had no shunt demonstrated by either echocardiographic or catheterization examinations. In another 44 patients (group C) with no significant left-sided cardiac lesions, no interatrial shunt could be found by transesophageal echocardiography even though some of them had a patent foramen ovale. All patients with such shunt had left atrial size > 34 mm (45.1 +/- 6.0 mm), left atrial pressure > 13 mm Hg (23.4 +/- 7.6 mm Hg), and pressure gradient between left and right atria > 10 mm Hg (19.3 +/- 5.2 mm Hg). These findings support the concept that in the presence of a patent foramen ovale any left-sided cardiac lesion increasing left atrial size and pressure may induce left-to-right interatrial shunt through this channel and that the prevalence rate is much higher than generally acknowledged.

Adult↗

PubMed1977

The incidence and relationship of the lateral ramus prominence to the mandibular foramen.

A study was undertaken to determine the incidence of the lateral ramus prominence and its relationship to the mandibular foramen. The lateral ramus prominence, as determined by inspection and palpation, was identified on both the right and left rami of all specimens. Bilateral measurements were made on fifty randomly selected adult dentulous mandibles. Significant correlation coefficients were obtained for all measurements between right and left rami. Therefore, either the left or right side measurement for each parameter was selected at random, and the data were subjected to statistical analysis. The lateral ramus prominence varied from 4.7 mm. anterior to 4.7 mm. posterior to the foramen, and from 0.9 mm. to 16.2 mm. superior to the foramen. It was located anterior to the foramen 66 per cent of the time.

Adult↗

PubMed1994

The transcondylar approach to the jugular foramen: a comparative anatomic study.

The standard neurosurgical approach to the jugular foramen involves suboccipital craniectomy with access along the petrous bone. However, even after wide removal of the foramen magnum, only limited access into the infratemporal fossa can be obtained. The neurootologic exposures provide excellent infratemporal access but limited exposure to the posterior fossa, resulting in hearing loss and facial paresis or paralysis. Using cadaver specimens, we exposed the jugular foramen region by the transcondylar approach. A retromastoid incision is extended into the neck. The transverse foramen of the atlas is opened and the vertebral artery transposed medially, thereby providing exposure into the infratemporal fossa. A suboccipital craniectomy extending anterior to the sigmoid sinus is performed, and the posterolateral occipital condyle is resected. After resection of the sigmoid sinus, cranial nerves 9 through 12 are easily identified extracranially in the infratemporal fossa and can be followed proximally through their foramina to the brain stem. We compared the transcondylar approach to three standard approaches, morphometrically and anatomically, and found that the transcondylar approach not only compares favorably but also offers advantages in that it preserves auditory and facial nerve function and is useful for one-stage tumor resection.

Cadaver↗

PubMed2004

Foramen of Morgagni hernia: changes in diagnosis and treatment.

BACKGROUND: Foramen of Morgagni hernias are uncommon diaphragmatic hernias for which there are limited reported data. The purpose of this study is to report a recent case series of foramen of Morgagni hernias in the context of new diagnostic and treatment modalities. METHODS: A retrospective chart review was performed over a 15-year period, from 1987 to 2001. Twelve patients who had a foramen of Morgagni hernia repaired at our hospital were identified, and data from these patients were collected. RESULTS: The average age at treatment was 45 years, with 50% of patients being asymptomatic. Radiographic evaluation included computed tomography scans in two thirds of the patients with a 100% sensitivity for diagnosis. All hernias were right-sided, and the most common contents of the hernias were omentum and colon. The transabdominal route was the preferred surgical approach. Thoracoscopy was used in 2 patients to further characterize a mediastinal mass. Two patients underwent laparoscopic repair. Postoperative complications were infrequent, and there were no recurrences during a 6-month to 10-year follow-up. CONCLUSIONS: The emergence of highly accurate diagnostic computed tomography scans combined with less invasive surgical techniques utilizing laparoscopy and thoracoscopy has aided in the treatment of foramen of Morgagni hernias over the last 15 years.

Adult↗

PubMed2005

Jugular foramen syndrome caused by choleastatoma.

Unilateral paresis of 9th-11th cranial nerves together is defined as jugular foramen (Vernet's) syndrome. A cholesteatoma case that penetrated into intracranial area after eroding temporal bone and led to jugular foramen syndrome is presented here, since such a case has not been reported in the literature hitherto. A 46-year-old male patient was evaluated for hoarseness. It was learnt from his anamnesis that he had been operated for otitis media nearly 20 years ago. Uvula deviated towards right. Loss of gag reflex was remarkable on the left. Paresis was found on the left vocal cord. There was weakness in rotation of the head to the right. Computerized tomography (CT) scan revealed that the temporal bone lost its integrity and that there was an extra-axial hypodense mass neighboring pontocerebellum. Post-contrast magnetic resonance imaging showed that the mass, which showed thin, regular circular contrasting and which was hypointense in T1-weighted MR and hyperintense in T2-weighted MR, extended to the left jugular foramen. The mass was totally removed with left sub-occipital approach in the treatment. After the treatment, hoarseness, weakness in the rotation movement of the head and loss of gag reflex recovered totally, while deviation in the uvula was permanent. Cholesteatomas can extend to posterior fossa and cause jugular foramen syndrome. Early surgery is important to completely reverse the lost nerve functions in treatment.

Cholesteatoma, Middle Ear↗

PubMed2006

Intraventricular cavernous hemangioma at the foramen of Monro: Case report and literature review.

Cavernous hemangiomas rarely occur in the cerebral ventricles. Those occurring at the foramen of Monro are even less frequent. So far, only eight cases of cavernous hemangioma at the foramen of Monro have been reported in the literature. Here, we present a similar case and correlated the radiographic with the histopathologic findings of the patient. A 51-year-old woman was admitted with obstructive hydrocephalus-related symptoms. The computed tomography (CT) and magnetic resonance imaging (MRI) revealed a partly calcified lesion with slight contrast enhancement located in the area of the right foramen of Monro. The lesion was completely removed by surgical resection with a transfrontal transventricular approach. The resected mass was histologically diagnosed as cavernous hemangioma. The patient's symptoms resolved immediately after operation. Cavernous hemangioma at the foramen of Monro in the present case had common MRI features as previously reported. Although MRI can provide initial diagnosis for such unusually localized tumor, it should be confirmed histopathologically.

Cerebral Ventricle Neoplasms↗

PubMed2006

Review of complications due to foramen ovale puncture.

We aim to evaluate the mechanisms responsible for complications during trigeminal rhizotomy via foramen ovale puncture. Ten dry skulls and 10 skull-base specimens were investigated in the present study. In cadaveric skull-base specimens, the anatomical relationships between the foramen ovale, mandibular nerve and Gasserian ganglion and the surrounding neurovascular structures were investigated intradurally. The distance between the foramen ovale and Gasserian ganglion was measured as 6 mm. The abducent nerve, adjacent to the anterior tail of the petrolingual ligament, was observed passing along the lateral wall of the cavernous sinus. Advancement of the catheter more than 10 mm from the foramen ovale is likely to damage the internal carotid artery and the abducent nerve at the medial side of the petrolingual ligament. Thermocoagulation of the lateral wall of the cavernous sinus may damage the cranial nerves by heat, giving rise to pareses.

Anatomy, Regional↗

PubMed1996

Diagnosis of patent foramen ovale by contrast versus color Doppler by transesophageal echocardiography: relation to atrial size.

To ascertain the factors related to the transesophageal echocardiographic diagnosis of patent foramen ovale, the primary echocardiographic data were reviewed from 74 patients with that diagnosis. Similar detection rates were observed with contrast echocardiography (82%) and color flow mapping (78%), but contrast was more sensitive in patients with normal-sized atria (94%) and isolated right atrial enlargement (100%) than in those with enlarged left atria, all but three of whom had biatrial enlargement (52%) (p < 0.001 by chi-square test). Doppler flow mapping was less sensitive for normal-sized atria (66%) than for isolated enlarged right atria (81%) and left (bi-) atrial enlargement (96%) (p = 0.024). Patent foramen ovale was directly visualized by two-dimensional echocardiography in 80%, with close agreement to the size of the color flow jet (r = 0.90, delta = 0.1 +/- 0.4 mm); foramen ovale size was related to right atrial area (r = 0.31, p = 0.015). Thus both saline contrast and color flow imaging are necessary to exclude the diagnosis of patent foramen ovale.

Case-Control Studies↗

PubMed1996

Surgical prophylaxis of recurrent stroke in patients with patent foramen ovale: a pilot study.

Prevention of recurrent stroke in adults with patent foramen ovale represents a therapeutic challenge. Antiplatelet or anticoagulant treatment is widely introduced, but its exact indication is not known. In this pilot study, eight men and three women with previous ischemic cerebral events underwent direct surgical closure of the patent foramen ovale. Mean age was 39.4 (from 30 to 58) years. No coexisting cause of stroke was found after extensive investigations, including blood and coagulation tests, echocardiography, 24-hour three-lead electrocardiographic monitoring, extracranial and transcranial Doppler ultrasonography, and cerebral angiography. Criteria for operation also included at least two of the following: atrial septal aneurysm, multiple cerebral infarcts, a history of multiple cerebral events, and Valsalva strain before stroke. Before operation, one patient had two shunts (1 patent foramen ovale, 1 intrapulmonary shunt). No intraoperative or postoperative complications occurred, but a few hours after operation transient arrhythmias developed in two patients without atrial fibrillation, hemodynamic instability, or embolism. During a median follow-up of 12.2 months, no patient had recurrent stroke. All patients prospectively underwent brain magnetic resonance imaging and contrast echocardiography with simultaneous transcranial Doppler ultrasonography. A residual right-to-left interatrial shunt, smaller than the preoperative one, was observed in only one patient, whereas no lesion was seen on magnetic resonance imaging. Our study suggests that surgical closure of patent foramen ovale in patients with presumed paradoxic embolism is safe, with no recurrent stroke in the first year of follow-up. Further studies are needed to evaluate the long-term prognosis of patients with versus without operation and to define the role of operation as an alternative to prolonged antithrombotic treatment.

Adult↗

PubMed1992

The mental foramen: 3. Size and position on panoramic radiographs.

Panoramic radiographs were made of 75 dry, adult human mandibles. The size and position of the mental foramen in relation to the second premolar was determined. The mental foramen on panographic radiographs was slightly larger than reported on periapical radiographs. The average position of the foramen was mesial and below the radiographic apex of the tooth. Panoramic radiography may account for a distal shift of the foramen and a 23% increase in size of the mandibles examined.

Bicuspid↗

PubMed1993

Evaluation of the effectiveness and comfort of incisive nerve anesthesia given inside or outside the mental foramen.

Thirty volunteer subjects were given bilateral injections of one-half carpule of 2% Xylocaine with 1:100,000 epinephrine to anesthetize the incisive nerve. Injections were given either inside or outside the mental foramen. Success (80/80 reading) and duration of anesthesia were verified with the Analytic Technology pulp tester. Pain and preference for either injection type were evaluated via questionnaire. The mental foramen could be located in 1 min 56.6% of the time. There was a significantly greater chance of success for injections given inside the foramen for the second bicuspid (p = 0.0422) and the canine (p = 0.015). There was no statistically significant difference in success for either type injection for the first bicuspid (p = 0.184). There was no significant difference in duration of anesthesia whether given inside or outside the foramen and no difference in pain of injection with either type. Patients had no clear-cut preference for either injection type.

Adolescent↗