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The angiographic findings in five cases of tumors at the foramen of Monro are presented. Characteristic changes in the course and configuration of the medial posterior choroidal artery are described.
Two cases of congenital atresia of the foramen of Monro are described, one 8 days old and the other 2 months old. Both are associated with a parieto-occipital paraventricular diverticulum and spontaneous ventriculostomy with the passing of the cerebrospinal fluid to the posterior fossa and the formation of a cyst in the supracerebella region which compressed and displaced the structures of the posterior fossa.
Case reports of seven patients in whom unusual abnormalities caused widening of the cervical intervertebral foramen are presented. Plain roentgenographic and tomographic changes may be quite distinctive, especially in a patient with an absent pedicle or a tortuous vertebral artery. However, angiography has proved to be a useful adjunct to determine the etiology in many of these lesions.
A case is reported of a patient with nocturnal myoclonus and weakness of the left arm in whom a round defect was seen in the arch of C2 on the left side. Vertebral angiogram revealed that this was caused by an anomalous course of the vertebral artery and not by an aneurysm. A similar location of this foramen was found in nine of 100 cases reviewed.
Unilateral hydrocephalus due to foramen of Monro-obstruction was diagnosed in a newborn who presented with macrocephaly at birth. The mother had mumps in the second trimester of pregnancy and immunological studies indicated possible intrauterine infection of the baby with mumps virus. His condition deteriorated rapidly, and he developed myoclonic seizures. The possible relationship of intrauterine mumps infection to neonatal neurological complications is discussed.
Two cases of the hypoplastic left heart syndrome with premature closure of the foramen ovale and levoatriocardinal veins are described and the literature is reviewed. One of the patients is the only case with both mitral and aortic valve atresia. The other is associated with the asplenia syndrome, double-outlet right ventricle without ventricular septal defect, and an anomalous connection of the left atrium to the right auricle.
We report two cases of hydrocephalus in adults. The radiological investigations and direct inspection during surgery in one of the cases indicate that the hydrocephalus is caused in both cases by a benign stricture in the region of the foramen of Monro and that this constriction is congenital. This origin of hydrocephalus has not been reported previously in adults.
A newborn infant with primary restrictive foramen ovale, tubular hypoplasia of the aortic arch, and some other developmental defects is described. This combination resulted in fetal hydrops, as was shown by ultrasonography. The child died 24 h after birth due to low output syndrome and extensive bronchopneumonia. The pathogenesis of this clinical entity is discussed.
Intervertebral foramen narrowing on plain radiographs of the cervical spine was graded from 0 (normal) to 3 according to its severity; myelographic nerve root sleeve deformity was graded from 1 to 3 in 99 consecutive patients with cervical radiculopathy. We thus examined 1118 foramina and root sleeves. Plain radiographs of 684 foramina were normal, changes of one grade were seen in 243, of two grades in 145 and of three grades in 46. Grading of myelographic root sleeves' was normal in 789, changes of one grade in 157, of two grades in 129, and of three grades in 43. The correlations between the foraminal and root sleeve changes were: full correlation in 63.9%, a difference of one grade in 27.4%, a difference of two grades in 7.4% and a difference of three grades in 1.3%. The positive predictive value of the plain radiographs for myelographic root sleeve deformities was 55.5% and the negative value 87.1%.
Unilateral hydrocephalus due to occlusion of one foramen of Monro was found incidentally at necropsy in a 52-year-old man. There was no evidence of a postinflammatory or neoplastic origin of the occlusion. Backward tilting of the diencephalon, asymmetric insertion of the septum pellucidum, lateral tilting of the fornices, and deformation of the hippocampal formation indicated an early developmental origin of the lesion.
A survey is given of the clinical picture, diagnosis and management of foramen jugulare paragangliomas (JFP), based on reports of 175 cases from the literature and personal experience of 26 cases. Special emphasis is given to the operative techniques. Improvements of diagnostic possibilities as well as operative techniques, including the pre-operative occlusion of tumour-feeding arteries by endovascular methods have markedly reduced the operative mortality to a rate between 0 and 5 percent. The rate of incomplete removal of C and D tumours dropped to about 15%. But very large and extensive tumours remain a real challenge. Teamwork between neuroradiologists, ENT-surgeons and neurosurgeons is mandatory.
The computed tomographic (CT) appearance of a case of cecal herniation through the foramen of Winslow is described. This is an extremely uncommon type of internal hernia, and, to the best of our knowledge, its CT appearance has not been reported. Its recognition is important to both establish a preoperative diagnosis and to distinguish it from a lesser sac collection or abscess.
Computed tomography was performed on a patient presenting with cryptic small bowel obstruction. A correct preoperative diagnosis of obturator foramen hernia was arrived at based on the recognition of a loop of ileum protruding between the pectineus and external obturator muscles.
We report on a case of hypoplastic left heart syndrome (HLHS), associated with premature closure of the foramen ovale and an unusual type of totally anomalous pulmonary venous return. The existence of an anomalous connection of the right upper pulmonary vein to the superior vena cava-right atrial (SVC-RA) junction and the existence of the anomalous intrapulmonary venous channel between right upper and lower pulmonary vein allowed all the pulmonary blood to drain into the SVC-RA junction, whereas she had only partially anomalous pulmonary venous connection. The several intrapulmonary venous channels helped to delay the progression of pulmonary venous obstruction. Chromosomal analysis revealed that the patient had XO Turner syndrome. We conclude that all infants with HLHS should be carefully evaluated for the existence of anomalous pulmonary venous return. Two-dimensional Doppler echocardiography is one of the most useful techniques for evaluating such anomalies.
UNLABELLED: To assess presence, predominant direction and natural history of interatrial shunt flow in the normal newborn period an uncontrolled pilot study was performed. Twenty term ( > 36 completed weeks gestational age) newborns were studied using cross sectional, M-mode and colour Doppler echocardiography; cardiac, pulmonary or renal disease were excluded before entry to the study. In 11 of 20 normal term newborns a predominant left to right interatrial shunt was detected on the 1st day after birth. This shunting, taking place in ventricular systole, disappeared in 10 cases during the first 6 postnatal days and in 1 case after 6 weeks. No relation was found between the presence of an atrial left to right shunt and gestational age or patency of the ductus arteriosus. CONCLUSION: We conclude that interatrial left to right shunting is common in half of the normal newborns (95% confidence interval 31.5%-76.9%), during the first 6 days of extra-uterine life. Our findings may be explained by a transient period of physiological expansion of extracellular volume in the newborn, resulting in slight atrial stretch, and this in combination with a relatively short foramen ovale flap.
PURPOSE: Sacral spinal nerve stimulation is a new therapeutic approach for patients with severe fecal incontinence owing to functional deficits of the external anal sphincter. It aims to use the morphologically intact anatomy to recruit residual function. This study evaluates the long-term results of the first patients treated with this novel approach applying two techniques of sacral spinal nerve stimulator implantation. METHODS: Six patients underwent either of two techniques for electrode placement: one "closed" (electrodes placed through the sacral foramen) and one "open" (cuff electrodes placed after sacral laminectomy). Follow-up evaluation of their continence status ranged from 5 to 66 months. RESULTS: Incontinence improved in all patients. The percentage of incontinent bowel movements decreased during chronic stimulation from a mean of 40.2 percent to 2.8 percent, and the Wexner score decreased from a mean of 17 to 2. The function of the striated anal sphincter improved during chronic stimulation: maximum squeeze pressure increased from a mean of 48.5 mmHg to 92.7 mmHg, and median squeeze pressure increased from a mean of 37.3 mmHg to 72.5 mmHg. No complications were encountered perioperatively or postoperatively. Two devices had to be removed because of intractable pain, in one patient at the site of the electrode after five months and in the other at the site of the impulse generator after 45 months. CONCLUSION: Long-term sacral spinal nerve stimulation persistently improves continence and increases striated anal sphincter function in patients with fecal incontinence owing to functional deficits, but in whom the striated anal sphincter is morphologically intact. Two different operative approaches can be applied effectively.
By means of transthoracic contrast echocardiography, the prevalence of a patent foramen ovale (PFO) was studied, in a continuous series of 48 patients aged less than 50 years with a recent episode of acute cerebral ischemia. A PFO was found in 11 subjects (23%). In the subgroup of younger patients (aged less than 30 years), the prevalence was much higher than in those aged 30 or more (58% against 11%, p = 0.0022). In the 19 patients with clear evidence of extracardiac causal factors of cerebral ischemia, there was no PFO; of the remaining 29 subjects, a PFO was present in 11 (38%) (p = 0.0015). In conclusion, the possible presence of a PFO must be carefully investigated in subjects with cerebral ischemia aged less than 30, as well as in subjects aged between 30 and 50 in whom there is no acceptable explanation for their cerebral ischemic episode.
The authors present a case of dumbbell-shaped schwannoma arising from the vagus nerve. A 40-year-old woman was admitted with a 3-month history of hearing loss on the left ear without vertigo. Neuro-otological examinations revealed retrocochlear deafness with abnormal left vestibular function. Magnetic resonance imaging revealed a dumbbell-shaped tumor of the jugular foramen. The tumor was removed through a cervical-transmastoid approach using Cavitoron ultrasonic surgical aspiration. Two months after the operation, the patient's hearing loss had improved, although she still had some aspiration of saliva and hoarseness.