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At least 667 records · Page 37Linked to original sources

[The foramen of Monro--blockage caused by a giant aneurysm of the basilar artery. A case report and review of the literature].

A case of a giant aneurysma of the basilar artery bifurcation with occlusive hydrocephalus due to bilateral foramen of Monro occlusion is reported. The patient presented with progressive neurological deterioration which led to computerized tomography examination and implantation of a ventricular shunt as an emergency procedure. After the patient had recovered to a certain extent, four-vessel angiography was performed that demonstrated a giant basilar tip aneurysm. As the posterior communicating, the posterior cerebral as well as the superior cerebellar arteries originated from the aneurysm sac direct surgical attack as well as endovascular treatment was considered to be impossible. A permanent biventricular-abdominal shunt system was implanted and the patient was discharged. Three weeks later the patient was readmitted comatose after he had suffered a massive subarachnoid hemorrhage from which he finally died. The clinical and radiological signs, the differential-diagnostic considerations as well as the few cases of foramen of Monro occlusion by a giant basilar artery tip aneurysm, presented in the literature so far, are discussed.

Basilar Artery↗

Jugular foramen schwannomas: diagnosis and suggestions for surgical management.

Schwannomas arising in the parapharyngeal space are rare lesions; however, those originating in the jugular foramen are even less common. Two cases, each with marked intra- and extracranial extensions, are discussed. Clinical presentation and preoperative evaluation emphasizing computerized tomographic and magnetic resonance imaging will be presented. An aggressive two-stage surgical approach consisting of a retrosigmoid craniectomy combined with infratemporal removal is advocated for those lesions arising within the jugular foramen.

Journal Article↗

Functional deficits of cranial nerves in patients with jugular foramen lesions.

Lower cranial neuropathies are a leading presenting symptom in patients with tumors involving the jugular foramen. The purpose of this study is to assess acute and chronic functional deficits along with neurologic findings in 31 patients who underwent resection of a tumor involving the jugular foramen. Preoperative nerve dysfunction made intraoperative preservation unlikely, while postoperative lower cranial nerve dysfunction was found to be transient in many patients. Compensation of permanent dysfunction was usually excellent.

Journal Article↗

[Patent foramen ovale and platypnea after pneumonectomy].

Six months after a pneumonectomy for myeloma, which had preoperatively been indistinguishable from bronchial carcinoma, a 50-year-old man presented with shortage of breath, cyanosis and episodes of syncope on standing or walking, symptoms which improved on lying down (platypnea). On one occasion these symptoms necessitated controlled artificial ventilation, but even at an inspiratory oxygen saturation of 100%, blood gases only partially improved (pCO2 27 mm Hg, pO2 67 mm Hg, O2 saturation 93%). Right heart catheterization in recumbency revealed a right to left shunt at atrial level of 37% of systemic flow. Contrast medium injection into the inferior vena cava near the heart demonstrated cardiac displacement and rotation. Part of the inferior vena cava flow passed into the left atrium via a patent foramen ovale: it is likely that this shunt increased in the upright position. After surgical closure of the patent foramen ovale and partial relocation of the heart (with a vicryl net) the patient has now remained free of symptoms for 5 years.

Dyspnea↗

Acute myocardial infarction caused by paradoxical coronary embolization in a patient with a patent foramen ovale.

We describe the case of a young woman without cardiac risk factors who had an acute inferoapical myocardial infarction. Coronary angiographic appearance was consistent with thrombus in the distal left anterior descending coronary artery. A patent foramen ovale with moderate right-to-left shunting after the Valsalva maneuver was detected by contrast transesophageal echocardiography. No other cardioembolic source was identified. Paradoxical embolization through a patent foramen ovale is a rare phenomenon, which appeared to have resulted in myocardial infarction in this patient.

Adult↗

Differential diagnosis between patent foramen ovale and pulmonary arteriovenous fistula in two patients with previous cryptogenic stroke caused by presumed paradoxical embolism.

Development of improved devices for interventional closure of atrial septal defect and patent foramen ovale increased the number of adult patients who are being referred for transcatheter closure. We report two cases that were scheduled for patent foramen ovale closure because of a right-to-left atrial shunt detected at contrast transesophageal echocardiography in another institution and that were found to have pulmonary arteriovenous fistulas. Embolization of pulmonary arteriovenous fistulas was carried out successfully by transcatheter technique.

Aged↗

A new class of electrodes of 'intermediate invasiveness': preliminary experience with epidural pegs and foramen ovale electrodes in the mapping of seizure foci.

Non-invasive electroencephalographic (EEG) recording with scalp and sphenoidal leads is often insensitive to precise localization of ictal onset, and can be distorted by skull defects and underlying lesions or deformities of the brain. We present preliminary experience with epidural pegs and foramen ovale electrodes used in 30 cases of intractable partial epilepsy where non-invasive EEG did not define a zone of epileptogenesis with sufficient precision to recommend resection, or to dictate precise placement of depth electrodes or subdural girds. Custom designed mushroom shaped peg electrodes were implanted via 4.5 mm twist-drill skull holes for epidural recording from cortical areas of suspected epileptogenesis. Foramen ovale electrodes (flexible 3-contact leads) were introduced via percutaneous puncture of Meckel's cave cistern for recording from mesiotemporal regions. Chronic recording was performed for 4 to 26 days (mean 9.2 days). There were no serious complications and signal quality was excellent in every electrode. Based on interictal and ictal records, resective surgery was performed in 8 cases, more focused further invasive recording was recommended in 15 cases (with subsequent resective surgery), and surgical options were excluded in 7 cases. It is concluded that these electrodes of 'intermediate invasiveness' represent a safe and effective tool in the armamentarium for mapping complicated or elusive epileptic foci. They can be used in lieu of, in addition to, or prior to more invasive measures. Their greatest advantage lies in their relative safety and ability to survey extensive zones of suspected epileptogenesis so as to guide and focus further mapping and surgical intervention.

Adolescent↗

Cost-efficient localization of seizures of mesiotemporal onset with foramen-ovale electrodes.

Foramen ovale (FO) electrodes can identify mesiotemporal lobe (MTL) seizure onsets but are infrequently used in the USA. Ten patients with presumed MTL ictal onset, unlocalized noninvasively, had FO electrodes inserted during long term monitoring for epilepsy. Placement was facilitated by intraoperative use of oblique submental and modified Caldwell view fluoroscopy. Eighty percent of patients had ictal localization by FO electrodes. This led to anterior temporal lobectomy in six with 83% being seizure free after follow-up of 20-32 months. The mean total costs of placing these electrodes was approximately half that of subdural strips and a quarter that of depth electrodes. Foramen ovale electrodes represent a cost-effective and efficient method of seizure localization when noninvasive workup suggests but is not definitive for MTL origin.

Cost-Benefit Analysis↗

Onset of right-to-left shunting through a foramen ovale in a 70-year-old woman: successful surgical treatment.

A 70-year-old woman presented with disabling breathlessness. She was found to have severe arterial hypoxaemia due to isolated right-to-left shunting through a patent foramen ovale. In the absence of pulmonary hypertension or evidence of right ventricular dysfunction this is attributed to reduced right atrial compliance. The phasic nature of the shunt, which occurred only during atrial filling, supports this view. Surgical closure of the foramen abolished the hypoxaemia and her symptoms.

Aged↗

The impact of newly diagnosed patent foramen ovale in patients undergoing off-pump coronary artery bypass grafting: case series of eleven patients.

UNLABELLED: The increased use of transesophageal echocardiography (TEE) by anesthesiologists may lead to an increase in the intraoperative detection of previously undiagnosed patent foramen ovale (PFO). The impact of heart manipulation on interatrial shunting through a PFO during off-pump coronary artery bypass graft (CABG) has not been studied. We retrospectively studied 11 patients with PFOs who underwent off-pump CABG. TEE contrast studies and blood gas analyses were performed at baseline, during heart elevation for distal coronary arteries anastomoses, and at the end of the surgery. At baseline, 5 of 11 patients had left-to-right shunting and 2 of 11 had right-to-left shunting. Heart elevation did not result in oxygen desaturation in any patient; however, it caused the disappearance of a right-to-left shunt (n = 1), persistence of this shunt (n = 1), and the development of a new right-to-left shunt (n = 2). Return of the heart to its original position resulted in a return of TEE findings to the baseline state in all patients. This series suggests that off-pump CABG can be performed safely in the majority of patients with PFOs; however, additional investigation is needed to assure that adverse effects do not occur in a subset of patients undergoing off-pump CABG in the presence of a PFO. IMPLICATIONS: This case series suggests that coronary artery bypass graft surgery can be safely performed in most patients with patent foramen ovale without the use of a cardiopulmonary bypass.

Adult↗

Cysticercosis presenting as a mass lesion at foramen of Monro.

Cysticercosis is a parasitic infestation that commonly affects the central nervous system. This is a report of computed tomography findings in a patient with a noncalcified cyst causing asymmetric lateral ventricular obstruction at the foramen of Monro. The lesion was isodense and uniformly enhancing, an unusual finding possibly related to presentation early in the course of the disease. This disease should be considered in the differential diagnosis of the lesions at the foramen of Monro in patients with appropriate residence or travel history.

Adult↗

The accessory costotransverse foramen: a radioanatomical study.

One hundred fifty-six anatomical specimens of cervical vertebrae and 55 C1 and 53 C2 vertebrae were examined for the presence of an accessory costotransverse foramen. We also reviewed 60 cervical spine computed tomographic (CT) scans. The variations of the costotransverse and accessory foramen are discussed. The frequency of the latter is 19% in the anatomical specimens and 45% in CT scans. The local anatomy and the excellent visualization on axial transverse CT are stressed.

Cervical Vertebrae↗

Cervical chordoma presenting with intervertebral foramen enlargement mimicking neurofibroma: CT findings.

A cervical chordoma, confirmed at surgery, presented on plain spine films as a focal enlargement of the intervertebral foramen and mimicked the characteristic appearance of cervical neurofibroma. Computed tomography (CT) of the cervical spine was obtained immediately following metrizamide myelography; it demonstrated a soft-tissue mass in the enlarged intervertebral foramen that extended posteriorly to compress the spinal cord and anteriorly to compress the hypopharynx. The mass was sharply demarcated, inhomogeneous, and low in attenuation; CT density measured between those of cerebrospinal fluid and muscle. Although this CT appearance is not specific for cervical chordoma, it is unusual for neurofibroma. Cervical chordoma should be considered in the differential diagnosis of focal enlargement of cervical intervertebral foramina.

Adult↗

Measurement of the distance between the minor foramen and the anatomic apex by digital and conventional radiography.

The purpose of this study was to determine the distance between the minor foramen and the anatomic apex from digital and conventional radiographs. Thirty permanent single-canal teeth with mature root apex were used. After access preparation, a K-file was inserted into the canal until the tip of the file was just seen at the minor foramen under a x40 stereomicroscope. The file was fixed in the canal by filling the access with composite resin. The teeth with files in the canals were radiographed using a Schick CDR digital system and conventional radiography with E-speed film. For digital radiographs, the distance between the file tip and the center of radiographic apex was directly measured from the computer screen by using Schick CDR measurement software. For conventional radiographs, the distance was measured under a stereomicroscope at a magnification of x10 with a calibrated millimeter ruler. The mean distance was 0.494 mm measured from conventional radiographs and 0.594 mm from digital radiographs. These results agree with the current conception that endodontic working length should terminate 1 mm from the radiographic apex. There was a significant difference between the measurements on digital radiographs and those on conventional radiographs (p < 0.05, paired t test). However, the 0.1-mm difference has no clinical significance, because clinically, the working length is generally measured to the nearest 0.5 mm.

Dental Pulp Cavity↗

Morphology of the physiological foramen: I. Maxillary and mandibular molars.

Information concerning the anatomy of the physiological foramen is limited. The aim of this study was to investigate the distance between the physiological and anatomical apex, accessory foramina frequency, and the shape and diameter of the physiological foramen in maxillary and mandibular molars. The apical anatomy of 523 maxillary and 574 mandibular molars from an Egyptian population was investigated by means of a computer-aided stereomicroscope (40 x magnification). The following results were obtained:

Dental Pulp Cavity↗

Certain anatomical relations and the precise morphometry of the infraorbital foramen--canal and groove: an anatomical and cephalometric study.

OBJECTIVES: To determine and to standardize the certain anatomical relations, and the precise size, course, and location of the infraorbital foramen, canal, and groove for facilitating surgical and invasive procedures. STUDY DESIGN: This anatomical study consisted of two main steps, namely, the examination of skulls and the cephalometric analysis of the skulls. Measurements of the skulls and of the radiograms were performed. METHODS: Thirty-five adult bony heads (70 sides) were studied regarding the localization and dimensions of the infraorbital groove (IOG), infraorbital canal (IOC), and infraorbital foramen (IOF) as well as their relationships with different anatomical landmarks. The cephalometric analysis of the skulls was measured for evaluating the relationships of certain anatomical points and the distances of the skulls in the cephalometric analysis. For this purpose, 13 different distances and two angles were measured on anteroposterior and lateral craniographies. Differences between data of skull and cephalogram measurements were analyzed by the Student t test. The Pearson correlation test was used in the statistical analysis of the 15 values in the cephalogram. RESULTS: Examination of the 70 sides of the 35 bony heads revealed that the shape of the IOF was oval in 34.3%, round in 38.6%, and semilunar in 27.1% of all skulls. The IOF was single in 94.3% and double in 5.7% of the cases. The average distance from the IOF to the infraorbital margin and to the lateral process of the canine tooth in vertical direction and to the lateral nasal border in horizontal direction were 7.19 +/- 1.39 mm, 33.94 +/- 3.15, and 17.23 +/- 2.64 mm, respectively. In cephalometric analysis, when S-N (the distance between the center of the sella turcica and the nasion) and N-ANS (the distance between the nasion and the anterior nasal spine) distances were used as independent parameters for the linear analysis, the correlation of the three values for both independent parameters were statistically significant. CONCLUSION: While the IOF has no statistically significant changes with regard to the size of the skull, expressive changes take place in the course and the length of the IOG and IOC. Meticulous preoperative evaluation of the IOF and the route of the infraorbital nerve are necessary in patients who are candidates for maxillofacial surgery and regional block anesthesia. If these measurements are taken into account, there will be little surgical risk, and this will be helpful in identifying the extent of the operative field.

Adult↗

The jugular foramen: microsurgical anatomy and operative approaches.

The jugular foramen, based on these studies of microsurgical anatomy, is divided into three compartments: two venous and a neural or intrajugular compartment. The venous compartments consist of a larger posterolateral venous channel, the sigmoid part, which receives the flow of the sigmoid sinus, and a smaller anteromedial venous channel, the petrosal part, which receives the drainage of the inferior petrosal sinus. The petrosal part forms a characteristic venous confluens by also receiving tributaries from the hypoglossal canal, petroclival fissure, and vertebral venous plexus. The petrosal part empties into the sigmoid part through an opening in the medial wall of the jugular bulb between the glossopharyngeal nerve anteriorly and the vagus and accessory nerves posteriorly. The intrajugular or neural part, through which the glossopharyngeal, vagus, and accessory nerves course, is located between the sigmoid and petrosal parts at the site of the intrajugular processes of the temporal and occipital bones, which are joined by a fibrous or osseous bridge. The glossopharyngeal, vagus, and accessory nerves penetrate the dura on the medial margin of the intrajugular process of the temporal bone to reach the medial wall of the internal jugular vein. The operative approaches, which access the foramen and adjacent areas and are demonstrated in a stepwise manner, are the postauricular transtemporal, retrosigmoid, extreme lateral transcondylar, and preauricular subtemporal-infratemporal approaches.

Accessory Nerve↗