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At least 433 records · Page 24Linked to original sources

PubMed2005

Jugular foramen schwannomas: diagnosis, management, and outcomes.

OBJECTIVES/HYPOTHESIS: To describe the presentation, radiographic findings, and surgical management of seven patients who have been diagnosed and treated with jugular foramen schwannomas at the University of Utah. STUDY DESIGN: Retrospective chart review. METHODS: The charts of seven patients diagnosed with jugular foramen schwannomas were reviewed for presentation symptoms, radiographic findings, and physical examination findings. For the six who underwent surgical excision, the surgical procedure used, cranial nerve function results, audiometric results, perioperative complications, and other follow-up data are presented. RESULTS: Seven patients were identified from ages 24 to 69 years. Six of the seven underwent surgical excision. Primary presentation symptoms included dizziness, hearing loss, dysphagia, diplopia, tongue paresis, and hoarseness. The choice of surgical approach was based on the size and location of the tumor. All patients had complete excision of their tumors. The nerve of origin included the glossopharyngeal, vagus, and spinal accessory nerves. Preoperative cranial nerve dysfunction continued postoperatively for lower cranial nerves but resolved in patients who were noted to have preoperative dysfunction of cranial nerve V and VI. The rate of new lower cranial nerve injury was 15% and was only seen in the cranial nerves that were determined to be the nerve of origin. In two cases, a temporary feeding tube was required. No recurrences have been noted to date. CONCLUSIONS: Jugular foramen schwannomas can be successfully diagnosed preoperatively with computed tomography and magnetic resonance imaging. These tumors can be successfully managed with surgery and low morbidity.

Adult↗

PubMed2006

Patent foramen ovale: assessment, clinical significance and therapeutic options.

Foramen ovale plays an important function in the fetus but is of no physiologic significance after birth and closes in most individuals. In about one fourth of the population, however, foramen ovale remains open for life and has been associated with cerebrovascular accidents, especially in younger patients, presumably through paradoxical embolism. Patent foramen ovale (PFO) has also been associated with hypoxia, migraine headaches and neurologic findings of decompression illness in scuba divers. Availability of transesophageal echocardiography and its frequent use in the management of patients with stroke has lead to frequent detection of PFO. In addition, the recent development of devices and techniques for percutaneous closure of PFO has resulted in widespread enthusiasm for such interventions, even when a clear etiologic role for PFO may not be established. In the United States, the Federal Drug Administration (FDA) has approved two such devices through compassionate investigational device exemption without adequate data from large randomized clinical studies. Other such devices are undergoing evaluation in clinical trials. Expert opinions have been helpful for clinical decision making in management of patients with PFO associated with stroke, hypoxia, decompression sickness and migraine headaches.

Heart Septal Defects, Atrial↗

PubMed1991

The ability of the radiograph to determine the location of the apical foramen.

An in-vitro radiographic study of human teeth was performed in order to evaluate the ability of radiographs to determine the location of the apical foramen. The tip of an endodontic file was positioned at the apical foramen of each canal in 117 extracted human teeth (213 canals) and in 56 teeth (92 canals) still within the alveolus of dried jaw specimens. Parallel radiographs were taken in a bucco-lingual plane of all teeth. The tip of the instrument appeared to be at the root surface (apical foramen) in 82 per cent of canals. There was no significant difference in results between the teeth radiographed in the alveolus of dried jaw specimens and extracted teeth when the radiographs were evaluated under a stereomicroscope.

Dental Pulp Cavity↗

PubMed2005

Ex vivo evaluation of the capacity of the Tri Auto ZX to locate the apical foramen during root canal retreatment.

AIM: To evaluate ex vivo the capacity of the Tri Auto ZX to locate the apical foramen during root canal retreatment. METHODOLOGY: The root canals of 62 maxillary and mandibular canines were prepared to a length 1 mm short of the apical foramen, to an apical size 35 using 1% sodium hypochlorite as an irrigant. Once prepared, the length of each tooth was measured directly using a size 15 K-Flexofile introduced in the canal until the tip was visible at the apical foramen. After the file was removed, its length was recorded to a precision of 0.01 mm using a calliper. These direct lengths (DL) became the 'gold standard' for comparison with the electronic lengths (EL) derived from the Tri Auto ZX. After direct measurement, the tooth was measured electronically (EL1) and the canals were filled using lateral condensation of gutta-percha cones and sealer. Seven days later the root filling was removed using solvent, Gates-Glidden burs, and K-files, and new electronic lengths determined (EL2). The electronic lengths (EL1 and EL2) were compared with the DL, and the differences were analysed statistically using the proportions test and Student's t-test. RESULTS: At a tolerance limit of +/-0.5 mm, EL1 coincided with the DL in 76% of cases. Lengths obtained in the presence of remnant of filling material (EL2) coincided in 81% of cases. The proportions test used to compare these percentages showed no statistically significant difference between EL1 and EL2 (P > 0.05). The Student's t-test revealed a statistically significant difference (P < 0.05) between the means of the differences between DL/EL1 (-0.36 mm) and DL/EL2 (-0.04 mm). CONCLUSION: The Tri Auto ZX was accurate to +/-0.5 mm in more than 80% of teeth following removal of root fillings.

Cuspid↗

PubMed2006

Jugular foramen chordoid meningioma.

Chordoid meningioma (CM) is a rare histological variant of meningioma and is classified as an atypical meningioma on pattern alone. Herein is described the first case of CM occurring in the jugular foramen. The patient was a 45-year-old woman with a 2 year history of progressive right hearing loss. Magnetic resonance imaging (MRI) demonstrated a large, dumbbell-shaped, homogenously gadolinium-enhanced mass in the right jugular foramen, extending medially to the cerebellopontine angle and caudally into the upper carotid space. Angiographic findings supported a diagnosis of schwannoma. Intraoperatively, the tumor appeared to involve the right glossopharyngeal nerve completely and the vagus nerve incompletely, and was incompletely resected. Microscopically, the tumor consisted predominantly of cords and nests of medium-sized cells with bland cytological features, surrounded by a pale basophilic mucin. Immunohistochemically, the tumor cells demonstrated reactivity for epithelial membrane antigen (membranous) and vimentin, with negative staining for S-100 protein, cytokeratin, CD34, glial fibrillary acidic protein (GFAP), synaptophysin, and chromogranin A. Based on the chordoid histology, an organoid lobular arrangement of the tumor cells, and the location of the tumor (jugular foramen), the differential diagnosis included not only a chordoma but also a paraganglioma (glomus jugulare tumor). Histological identification of typical meningotheliomatous areas, plus selective immunohistochemical panel, is important to establish the correct diagnosis.

Biomarkers, Tumor↗

PubMedDate not supplied

Analysis of foramen ovale electrode-recorded seizures and correlation with outcome following amygdalohippocampectomy.

We report a detailed electroclinical analysis of 320 seizures recorded by foramen ovale electrodes in 77 potential candidates for selective temporal lobe surgery because of antiepileptic drug-resistant seizures. The exact localization of the origin of seizure discharges, the electroencephalographic (EEG) seizure onset patterns, transhemispheric propagation, propagation time, duration of discharge, laterality of discharge termination, postictal focal slowing, correspondence between foramen ovale recordings and the scalp EEG, and the influence of antiepileptic drug modifications were studied and correlated with the clinical seizure semiology and with postoperative outcome following selective amygdalohippocampectomy. In general, the foramen ovale electrode technique provided good neurophysiological information in candidates for selective amygdalohippocampectomy. The following ictal signs predicted a good surgical outcome: (a) unilateral and anterior mediobasal temporal lobe seizure onset, (b) short seizure duration, (c) no or infrequent contralateral seizure discharge propagation, and (d) if propagation to the contralateral mediobasal temporal lobe occurred, the postoperative outcome was better the later the contralateral mediobasal temporal lobe was affected. Postoperative outcome was also better the less frequently contralateral interictal spikes occurred. No direct predictive value could be attributed to the presence of an initial arrest reaction.

Adult↗

PubMed1998

Neuronal complexity loss in interictal EEG recorded with foramen ovale electrodes predicts side of primary epileptogenic area in temporal lobe epilepsy: a replication study.

PURPOSE: To investigate whether a correct lateralization of the primary epileptogenic area by means of neuronal complexity loss analysis can be obtained from interictal EEG recordings using semi-invasive foramen ovale electrodes. In a previous study with recordings from intrahippocampal depth and subdural strip electrodes it was shown that the dynamics of the primary epileptogenic area can be characterized by an increased loss of neuronal complexity in patients with unilateral temporal lobe epilepsy (TLE). METHODS: Neuronal complexity loss analysis was applied. This analysis method is derived from the theory of nonlinear dynamics and provides a topological diagnosis even in cases where no actual seizure activity can be recorded. We examined interictal EEG recorded intracranially from multipolar foramen ovale electrodes in 19 patients with unilateral TLE undergoing presurgical evaluation. RESULTS: The primary epileptogenic area was correctly lateralized in 16 of the 19 investigated patients. The misclassification of the side of seizure onset in three patients might be attributed to the larger distance between the foramen ovale electrodes and the mesial temporal structures as compared to intrahippocampal depth electrodes. CONCLUSIONS: Our results confirm the previous findings and provide further evidence for the usefulness of nonlinear time-series analysis for the characterization of the spatiotemporal dynamics of the primary epileptogenic area in mesial temporal lobe epilepsy.

Adult↗

PubMed2001

Neurological aspects of patent foramen ovale: in search of the optimal treatment.

Although paradoxical embolism through a patent foramen ovale (PFO) has become an established cause of cerebral ischemia in younger patients without other obvious causes of stroke, the therapeutic options have not been investigated satisfactorily. There are still uncertainties about the natural history of PFO patients after suffering a stroke, and diagnostic criteria proving a causal and not incidental relation to the embolic event are not established. The stroke recurrence has been evaluated in several studies in a heterogeneous population and seems as low as 1.9% per year. Secondary prophylactic treatment has become a matter of discussion since efforts were made to close the PFO either surgically or by percutaneous transcatheter methods. Foramen closure seems to be effective in eliminating the mechanism of paradoxical embolism but its benefit-risk ratio has yet to be established. Following the goals of evidence-based medicine, none of the therapeutic options can be recommended. Fortunately, the issue has gone to trial and there are two studies underway to compare foramen closure to medical therapy.

Brain Ischemia↗

PubMed1994

In vitro evaluation of an audiometric device in locating the apical foramen of teeth.

A new audiometric device to determine the location of the apical foramen of teeth undergoing endodontic treatment according to "the relative value method" was tested in in vitro experiments. In 96.5% of the 350 human teeth used in the experiment, the location of the apical foramen was determined within acceptable limits (0-0.5 mm). In 60 teeth, where the measurements were based on an intermittent audio signal, a point about 1 mm short of the apical foramen was located. The results were considered promising and a clinical evaluation of the device will be carried out.

Auscultation↗

PubMed1999

Transcatheter closure of patent foramen ovale using the Amplatzer septal occluder to prevent recurrence of neurological decompression illness in divers.

OBJECTIVE: Large flap valve patent foramens may cause paradoxical thromboembolism and neurological decompression illness in divers. The ability of a self expanding Nitinol wire mesh device (Amplatzer septal occluder) to produce complete closure of the patent foramen ovale was assessed. PATIENTS: Seven adults, aged 18-60 years, who had experienced neurological decompression illness related to diving. Six appeared to have a normal atrial septum on transthoracic echocardiography, while one was found to have an aneurysm of the interatrial septum. METHODS: Right atrial angiography was performed to delineate the morphology of the right to left shunt. The defects were sized bidirectionally with a precalibrated balloon filled with dilute contrast. The largest balloon diameter that could be repeatedly passed across the septum was used to select the occlusion device diameter. Devices were introduced through 7 F long sheaths. All patients underwent transthoracic contrast echocardiography one month after the implant. RESULTS: Device placement was successful in all patients. Device sizes ranged from 9-14 mm. The patient with an aneurysm of the interatrial septum had three defects, which were closed with two devices. Right atrial angiography showed complete immediate closure in all patients. Median (range) fluoroscopy time was 13.7 (6-35) minutes. Follow up contrast echocardiography showed no right to left shunting in six of seven patients and the passage of a few bubbles in one patient. All patients have been allowed to return to diving. CONCLUSION: The Amplatzer septal occluder can close the large flap valve patent foramen ovale in divers who have experienced neurological decompression illness. Interatrial septal aneurysms with multiple defects may require more than one device.

Adult↗

PubMed2002

Sublabral foramen and buford complex: inferior extent of the unattached or absent labrum in 50 patients.

PURPOSE: To determine the inferiormost extent of the anterosuperior labral variants on conventional transverse MR images. MATERIALS AND METHODS: We reviewed transverse MR images in 50 consecutive patients with a sublabral foramen or Buford complex at arthroscopy. Images were randomly mixed with those of 58 patients with either a normal labrum (n = 20) or an anterior labral tear (n = 38) at arthroscopy. MR imaging was fat suppressed fast spin echo intermediate or T2 weighted (repetition time msec/effective echo time msec, 1,800-3,000/30-102). Two radiologists evaluated by means of consensus the anterior labrum while blinded to patient history and arthroscopic results. Transverse images obtained through the glenoid fossa were totalled to determine the midpoint. Sensitivity, specificity, and accuracy of MR for depicting a sublabral foramen or Buford complex were calculated along with 95% CIs, by using surgical findings as the reference standard. RESULTS: The sensitivity of MR for diagnosing a sublabral foramen or Buford complex was 0.94 (47 of 50 patients, 95% CI: 0.87, 1.00), specificity was 0.80 (16 of 20 patients, 95% CI: 0.62, 0.97), and accuracy was 0.90 (63 of 70 patients, 95% CI: 0.82, 0.97). The anterior labrum was abnormal on the first transverse section inferior to the midpoint in nine (18%) patients. The labrum was also abnormal on the second section below the midpoint in three (6%) patients. Because of the anterior tilt of the scapula, the midpoint was near the anterior glenoid notch at about the position between 2- and 3-o'clock. CONCLUSION: The labrum may be unattached or absent on the first two transverse images obtained below the midpoint.

Adolescent↗

PubMed1986

Drainage of pelvic abscesses through the greater sciatic foramen.

A computed tomographic (CT) guided transgluteal approach through the greater sciatic foramen was used to drain pelvic abscesses and fluid collections in 21 patients. Ideal catheter placement should traverse the lower portion of the greater sciatic foramen at the level of the sacrospinous ligament. This avoids the vascular and neural elements that are located slightly cephalad at the level of the piriformis muscle. Percutaneous drainage through this approach was successful in avoiding surgery in 17 patients (81%). Pain was the most common complication and was generally associated with a more cephalad approach, transgressing the piriformis and the sacral plexus. CT-guided percutaneous drainage of pelvic abscesses through the greater sciatic foramen should be used when the more standard transperitoneal approach is not possible.

Abscess↗

PubMedDate not supplied

Prenatal diagnosis of isolated foramen ovale obstruction. A report of two cases.

Premature obstruction of the foramen ovale is a rare but serious clinical entity. Obstruction can be associated with right ventricular failure, fetal hydrops, tricuspid regurgitation, left heart obstructive defects and supraventricular tachycardia. In most cases, the diagnosis is made at the postmortem examination. The etiology is unknown. We discuss 2 prenatal cases with the sole diagnosis of ventricular asymmetry. The right ventricle was dilated and hypertrophic, and the foramen ovale ballooned into the left atrium without color Doppler detection of right-to-left flow. After delivery, the infants had no hydrops or symptoms of cardiac or respiratory distress. Echocardiography demonstrated a structurally normal heart with increased right ventricle dimensions until the 7th day of life. Delivery should be induced if possible in cases of foramen ovale obstruction with signs of cardiac decompensation.

Echocardiography↗

PubMed1995

Absence of foramen transversarium in the human atlas vertebra: a case report.

Anatomical texts allude to many variations in the foramen transversarium of the seventh cervical vertebra, including its absence, but absent foramen transversarium of the atlas vertebra has not been mentioned. This is the case report of an atlas vertebra, the transverse process of which did not exhibit this foramen on the left side. However, the groove for the vertebral artery was present bilaterally on the posterior arch. The possible factors responsible for this interesting variant are discussed.

Adult↗

PubMed1995

Trapped venous embolus in a patent foramen ovale causing recurrent paradoxical embolism.

The combination of deep venous thrombosis, patent foramen ovale and arterial emboli suggests the diagnosis of paradoxical embolism. In these cases, only very rarely, a causal relationship between the venous thrombus and the patent foramen can be established. An instructive case of trapped venous embolism within the foramen ovale is described proving a causal relationship between arterial embolism and its venous origin.

Adult↗

PubMed1994

A comparison of transesophageal echocardiography and transcranial Doppler sonography with contrast medium for detection of patent foramen ovale.

BACKGROUND: Patent foramen ovale as a possible stroke risk factor can be diagnosed with transcranial Doppler sonography (TCD) by detecting intravenous contrast medium crossing from the right to the left atrium. The present study evaluates the reliability of this method. SUMMARY OF REPORT: We performed TCD and transesophageal echocardiography simultaneously in 50 patients using galactose microbubbles. We observed bubble signals passing the middle cerebral artery in 7 patients less than 20 seconds after injection; we found positive TCD tests in 14 patients using the Valsalva maneuver. With transesophageal echocardiography patent foramen ovale could be detected in 15 patients (sensitivity, 0.93; specificity, 1; P < .01). CONCLUSIONS: TCD with echo contrast is a reliable screening tool for patent foramen ovale. A standardized procedure including the Valsalva maneuver is essential to prevent false-negative results.

Adult↗

PubMed1985

Physiologic closure of a symptomatic patent foramen ovale with oxygen therapy.

Surgery is required for correction of a physiologically significant patent foramen ovale. We report a patient with poliomyelitis and respiratory failure in whom a patent foramen ovale became symptomatic because of hypoxemia-induced pulmonary hypertension. Oxygen therapy and mechanical ventilation reversed the pulmonary hypertension, resulting in physiologic termination of the patent foramen ovale without surgery.

Aged↗

PubMed2001

Cryptogenic ischemic stroke and paradoxical embolism: should a patent foramen ovale be closed? Case report and literature review.

Paradoxical embolism is a well-recognized cause of stroke. While the diagnosis in the majority of the cases with a patent foramen ovale is presumptive, numerous treatment strategies have been described. However, there is no single approach that has been overwhelmingly recommended for these patients. A patient is described who presented with ischemic stroke. Transesophageal echocardiography revealed a thrombus that straddled a patent foramen ovale. Anticoagulation with intravenous heparin resulted in resolution of thrombus and neurologic deficit. The literature regarding diagnosis and treatment of paradoxical embolism in the presence of patent foramen ovale is reviewed.

Aged↗