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The foramen of Monro has a remarkable constant anatomical situation. A method using only one basic line (bregma-dorsum sellae) for the stereotactic introduction of a canula in front or within the foramen of Monro for a stereotactic ventriculography is reported. The simplicity and safety of the technique as well as its advantages are emphasized.
The jugular foramen syndrome (JFS) specifically refers to paralysis to the IX-XIth cranial nerves. In a more general meaning, however, any combination of palsies affecting the last four cranial nerves has been referred to as a JFS. The anatomy of the jugular foramen and the structures which traverse it are reviewed. Two cases histories of a JFS are described; the first with chronic otitis media, and the second with a glomus tumor. A variety of neoplasms, vascular insults, infections, and trauma have been reported to cause JFS. Treatment is directed toward the underlying cause. A variety of radiological techniques which are useful in the investigation of JFS are outlined.
The obturator foramen bypass has been described as an alternative procedure to solve complicated vascular problems in the groin. This extra-anatomic bypass has been used successfully in cases of infection, mycotic aneurysms, traumatic lesions, irradiation ulcers, and excessive scar tissue in the femoral triangle. With this technique, the vascular continuity can be restored immediately. Although data on the long-term results of this operative procedure are not yet available, out report and a review of the literature suggest that the obturator foramen bypass is a very useful technique for saving a patient's leg and in some cases his life.
A dissection study of 20 cadaver specimens gives a firm knowledge of the anatomy of the pterygopalatine foramen in the middle and upper meatus of the nose. Measurements of the proportions between the end of the middle concha, the hiatus semilunaris and the foramen are described. A new, curved needle for puncturing of the maxillary sinus through the fontanella is shown.
In an obese 50 year-old heavy cigarette smoker with finger clubbing, persistent hypoxemia following an episode of right heart failure proved to be caused in part by a 12% right-to-left shunt through a patent foramen ovale. In this case report, we review the mechanisms of hypoxemia in patients with such a combination of diseases and suggest that the functional opening of a patent foramen ovale is likely to occur in some 25% of patients with right heart failure.
An incarcerated internal hernia through the foramen of Winslow is an extremely rare cause of intestinal obstruction and about 105 such cases have been reported. An additional patient, in whom a part of jejunum was incarcerated through the foramen into the lesser sac and who was successfully treated surgically, is reported. The etiology, diagnosis, treatment and prognosis of this rare condition are discussed.
Refractory hypoxemia as a complication of right ventricular infarction is rare. A 74-year-old man developed persistent hypoxemia due to right-to-left interatrial shunting through a patent foramen ovale during the acute phase of right ventricular infarction. Short-term percutaneous transvenous closure of the patent foramen ovale with a large balloon occlusion catheter was life-saving.
The structure of the foramen ovale from 16 species representing 4 carnivore families, the Felidae, Canidae, Ursidae and Hyaenidae, was studied using the scanning electron microscope. The Felidae were represented by 9 domestic cat fetuses (Felis catus), 2 snow leopard neonates (Uncia uncia), an ocelot neonate (Leopardus pardalis), 2 lion neonates (Panthera leo), a panther neonate (Panthera pardus) and 3 tigers (Neofelis tigris), comprising 2 fetuses and a neonate. The Canidae were represented by a golden jackal neonate (Canis aureus), a newborn wolf (Canis lupus), 8 domestic dog fetuses (Canis familiaris), 3 red fox neonates (Vulpes vulpes) and a dhole neonate (Cuon alpinus). The Ursidae were represented by a brown bear neonate (Ursus arctos), a day-old grizzly bear cub (Ursus arctos horribilis), a polar bear neonate (Ursus maritimus), and 2 additional bear fetuses (species unknown). The Hyaenidae were represented by a striped hyaena neonate (Hyaena hyaena). In each species, the foramen ovale, when viewed from the terminal part of the caudal vena cava, had the appearance of a short tunnel. A thin fold of tissue, the developed remains of the embryonic septum primum, extended from the distal end of the caudal vena cava for a variable distance into the lumen of the left atrium and contributed towards the 'tunnel' appearance in all specimens. It constituted a large proportion of the tube, and its distal end was straight-edged. There was fibrous material underlying the endothelium of the flap, the apparent morphology of which suggested that it comprised cardiac muscle.(ABSTRACT TRUNCATED AT 250 WORDS)
Intracardiac right-to-left shunting through a patent foramen ovale is a known cause of arterial hypoxemia. We present a case report of a patient supported with a left ventricular assist device who had significant right-to-left shunting as visualized with transesophageal echocardiography. When the device was turned off, no further shunting occurred and arterial hypoxemia resolved. Our report is the first visual representation of the anatomy of a patent foramen ovale in a patient supported with a left ventricular assist device.
A patient with bronchogenic cancer underwent right pneumonectomy. Surgical and infectious criteria were normal during the postoperative period when immediate postoperative severe hypoxeamia occurred. Pure oxygen only incompletely corrected the situation. Transoesophageal echocardiography with injection of microbulles for contrast imaging demonstrated a right-left shunt due to an open foramen ovale. Reopening the foramen ovale is rare but well documented complication of pneumonectomy. The pathogenics is still debated since hyperpressure in the right atria usually is not present. Echocardiography with contrast test is the best means of making the diagnosis.
Herniation through the foramen of Winslow (HFW) is exceedingly rare, the ileum, coecum or ascending colon is involved mostly. One new case is presented here to illustrate the clinical findings, which are often discreet, and the characteristical radiographic features, which can lead to definitive preoperative diagnosis. Treatment is by surgical reduction of the hernia, resection of non-viable bowel or fixation of coecum and ascending colon. Closure of the foramen is generally considered unnecessary. Without delay in diagnosis and treatment, the former high letality rate of the condition is now nearly zero.
Enlargement of the foramen of Monro is an essential maneuver to obtain an appropriate surgical view when large, solid lesions in and around the third ventricle are to be removed via the anterior transcallosal approach (ATA). For this purpose, three methods, i.e., the subchoroidal, transchororidal, and transfornicial approaches have so far been reported. However, since the locations and the pathological natures of space occupying lesions in this region are widely variable, the indication as well as the feasibility of each approach has remained rather unclear. The present paper deals with our surgical experience with six patients (2 gliomas, 1 angioma, 1 AVM, 1 plexus papilloma, 1 basilar top aneurysm) operated on using the ATA in which variable methods of enlarging the foramen of Monro were employed. Aiming at complete removal or clipping of the lesion, the seemingly best among the above three approaches was determined preoperatively, considering the size, location, and pathological nature of the lesion. The shape of the choroid plexus of the roof of the IIIrd ventricle as revealed by MRI was also taken into account. The subchoroidal, transchoroidal, and the transfornicial approaches were employed in 3, 2, and 1 cases, respectively. Except for one glioma which ended up being removed extensively, all the tumors and AVM were totally removed and the aneurysm successfully clipped. From the above experience, the merits and demerits of each approach for different types of lesions are discussed in view of their suitability for achieving total removal.(ABSTRACT TRUNCATED AT 250 WORDS)
Twenty-eight cases of tumours of the paraganglioma of the foramen jugulare arising from the jugular foramen were treated from 1982 to 1990. The follow-up and the iatrogenic effect of embolization, surgery and radiotherapy were studied. Routine pre-operative embolisation has changed the therapeutic approach to these tumours although a certain number of mainly neurological complications still occur (32% of the cases with 18% of major accidents) especially when the internal carotid component must be excluded. Current oto-neurosurgical techniques allow wider and more complete exeresis of the tumour but often lead to neurological deficits involving the facial nerve (45%), the mixed nerves (32%) and/or the XII (18%). These deficits occur due to unavoidable sacrifice or peroperative manipulation. Radiotherapy is an essential therapeutic possibility with only minor complications and can be proposed in cases of inoperable or relapsing tumours or after an incomplete surgical exeresis. Our critical analysis led us to propose the present indications for surgery. Surgery is indicated in patients with two or more of the following criteria: age less than 55, unilateral tumour, a tumour considered to be inoperable, preoperative otoneurological manifestations, invasion of the posterior fossa. In the other cases, radiotherapy remains the indicated therapy. It is effective and should be used more often for inoperable tumours of the para-jugular lymph nodes, for relapses or after incomplete surgical exeresis.
A 37 year old woman was admitted to the hospital with acute severe asthma, shortly followed by respiratory failure and circulatory arrest. Despite intensive cardio-pulmonary resuscitation, during which extreme arterial hypoxaemia persisted, the patient died. Postmortem examination revealed a patent foramen ovale, with a diameter of 1 cm. A severe right-to-left shunt, initiated by acute pulmonary hypertension, was considered to be the cause of death. Because of the relatively high prevalence of patent foramen ovale in the normal population, we suggest this patency may enhance the risk of fatal outcome of acute severe asthma.
A 62-year-old man was admitted to our hospital for disturbed consciousness and left-side motor sensory deficit. His blood pressure was 142/100 mmHg and an electrocardiogram was normal. CT of the brain revealed a low density area in the distribution of the right middle cerebral artery (MCA). Cerebral angiography demonstrated occlusion of the right internal carotid artery and an embolus. We diagnosed cerebral embolism, but we could not detect source of embolism. His condition deteriorated rapidly, and he died four days later. At necropsy, an elongated piece of thrombus 10 cm in length was lodged in a patent foramen ovale lying in each atrium. No other thrombus was seen in the heart, the myocardium and coronary arteries were normal. Both main pulmonary arteries contained thrombus. The lungs showed edema and congestion. There was no thrombus of both common iliac veins. The right internal carotid artery was occluded at its bifurcation by embolus, distal to which the cavernous segment was 7 cm filled with clot. We reported a rare paradoxical cerebral embolism through a patent foramen ovale diagnosed by necropsy. If no left-sided circulatory source can be demonstrated, the possibility of a paradoxical embolism should be considered.
A 7-year-old Thoroughbred mare underwent exploratory celiotomy for diagnosis and treatment of colic. An irreducible herniation of the large colon through the epiploic foramen was found. To reduce the hernia, the pelvic flexure was transected and the ends of the large colon were closed. The intercolonic mesentery was divided, and unaffected left ventral colon was moved into the epiploic foramen, providing sufficient space so that affected left dorsal colon could be reduced. The affected left ventral colon was then reduced and the diseased portion of both colons was resected. The colons were resected. The colons were rejoined with an end-to-end anastomosis.
The use of transesophageal echocardiography for intraoperative management of critically ill patients allows for routine evaluation of foramen ovale patency. The high prevalence of preoperatively unrecognized flow-patency of this structure has led investigators to emphasize the potential for paradoxical embolization in any patient undergoing anesthesia. This perspective led us to research earliest documentation of paradoxical embolization through a patent foramen ovale as a historical issue with present day relevance. This report examines the 1877 text of Julius Cohnheim in which he described a fatal case of paradoxical embolization to the middle meningeal artery. The 1880 manuscript of Moritz Litten documenting paradoxical embolization to the lower extremity is also presented. Both translations, to our knowledge, represent the first such representations of both the original 1877 edition of Cohnheim's work and Litten's journal article.
A 4-month Arabian filly presented for abdominal pain of 30 hours duration was found to have tachycardia, tachypnea, congested mucous membranes and gross abdominal distension. Further examination disclosed gastric reflux and small intestinal distension. Dehydration, prerenal azotemia, electrolyte abnormalities and metabolic alkalemia were observed. There was a progressive nonresponse to analgesic medication and deterioration in the foal's physiologic condition consistent with a small intestinal strangulating obstruction. Surgical exploration was declined. Necropsy examination revealed incarceration of the mid-jejunum in the epiploic foramen with proximal jejunal distension. This case is remarkable as the first report of entrapment of the jejunum in the epiploic foramen of a young foal.