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At least 1,099 records · Page 61Linked to original sources
PubMed1998

The jugular foramen: a comparative radioanatomic study.

BACKGROUND: Advances in microsurgical techniques made possible the removal of advanced jugular foramen (JF) lesions, which once had been accepted as unoperable. However, successful surgery requires detailed knowledge of the JF anatomy. METHODS: Sixteen jugular foramina in eight formalin-preserved adult cadavers were scanned with axial and coronal high resolution computed tomography (HRCT) prior to dissection. After craniectomy and removal of brain tissue, the relationships of the neurovascular structures in the JF were determined by drilling the temporal bones from superior to inferior on planes parallel to the skull base. RESULTS: No bony partition of the JF was observed. A dural band consistently divided the JF into two parts. Anterior to it was the glossopharyngeal nerve (IX) while the vagus (X) and accessory (XI) nerves were located posteriorly. There was a notch in which the IX nerve entered the JF. It was also identified on the CT scans and defined as the glossopharyngeal recess. The IX nerve made a genu within the JF in all specimens. Then, it ran inferiorly through a bony canal in three specimens (18.75%), and through an incomplete bony canal in two (12.5%), which were also defined on the CT images. The inferior petrosal sinus ran through a sulcus anteromedial to the glossopharyngeal recess. The posterior meningeal artery was found to be located between the X and XI nerves within the JF. CONCLUSIONS: This study revealed a complex and highly variable pattern of the relationships of the neurovascular structures in the JF, and their HRCT images correlated well with the anatomic microdissections.

Aged↗
PubMed1995

Avoiding the mental foramen during periapical surgery.

Many endodontists avoid surgical procedures in proximity to the mental foramen. Although a healthy respect for regional anatomy is important, this should not be at the expense of failing to offer the most appropriate endodontic care. When correct preoperative diagnostic and surgical techniques are used, serious negative sequelae are rarely encountered. Three simple steps used during presurgical diagnosis, flap design, and surgery are presented to increase the practitioner's confidence and safety while performing mandibular periapical surgery.

Chin↗
PubMedDate not supplied

Giant cell tumors of the jugular foramen.

PURPOSE: To review the diagnosis and treatment of giant cell tumors of the jugular foramen. MATERIALS AND METHODS: A typical case is reported. Symptoms, signs, and diagnostic studies are reviewed. Photomicrographs and angiographic studies showing the differences between these and glomus jugulare tumors are provided. A coherent approach to their management is presented. RESULTS: These hypervascular, traditionally radioresistant tumors may cause pulsatile tinnitus, conductive hearing loss, and lower cranial nerve paresis. Angiographic studies showed a hypervascular lesion supplied by numerous small branches of the external carotid artery, making embolization difficult. Complete resection was achieved by an infratemporal fossa approach with preoperative embolization. CONCLUSION: Giant cell tumors of the temporal bone may mimic glomus jugulare tumors with respect to anatomic location, cranial nerve deficits, and vascularity.

Adult↗
PubMed2006

[Meningioma of the jugular foramen with a large cervical extension].

Meningioma rarely gives an extra cranial extension. The authors report a case of meningioma of the jugular foramen reaching the left side of the neck. Epidemiological and clinical aspects of meningiomas of the neck are presented. The pathogenesis of this ectopic meningioma is discussed. We stress the contribution of imaging to evoke the diagnosis, determine the exact extent of the tumor, guide biopsies and allow post-therapeutic surveillance. Histological diagnosis of meningiomas of the neck is difficult since it can mimic more commonly encountered neck tumours. Difficulties of surgical techniques used to manage the tumor are also reported.

Female↗
PubMed1998

[Patent foramen ovale as a cause of recurrent cerebral embolism. Closure with minimally invasive surgery].

We report a clinical case of a 63-year-old patient, referred with a history of repeated strokes, whose only cause was a patent foramen ovale with shunt right to left diagnosed by transesophageal echocardiography. He underwent minimally invasive surgery, through right parasternal minithoracotomy, practising defect closure. We comment on the value of echocardiography for diagnosing this pathology and the utility of this surgical technique for repairing these defects.

Cardiac Surgical Procedures↗
PubMed1999

Non-invasive diagnostic assessment of extensive vertebral artery tortuosity with enlargement of the intervertebral foramen.

Two cases with an incidental finding of a widened intervertebral foramen due to extensive tortuosity of the vertebral artery are presented. Computed tomography angiography and magnetic resonance imaging/magnetic resonance angiography (MRA) both proved to be useful as non-invasive techniques to provide the diagnosis. In-plane saturation is a disadvantage seen with the two-dimensional time-of-flight MRA technique.

Adult↗
PubMed2000

Transmitral Doppler: a new transthoracic contrast method for patent foramen ovale detection and quantification.

OBJECTIVES: This study compared a new transthoracic echocardiographic (TTE) method for detection of right to left bubble passage, transmitral Doppler (TMD), against two-dimensional (2D) TTE contrast study and the gold standard, of transesophageal echocardiography (TEE), and assessed its utility in quantitative assessment of patent foramen ovales (PFO). BACKGROUND: Current TTE methods are relatively insensitive in PFO detection and do not allow quantitative assessment of right to left shunt. METHODS: In 44 patients (59 years, range 34 to 76 years) saline contrast and color Doppler studies were performed in three conditions--TTE TMD, TTE 2D and TEE. Bubble transit on the TMD was measured semiquantitatively by a visual bubble score and objectively by integrating the acoustic power within the mitral velocity envelope. RESULTS: By TEE it was determined that 17 patients (39%) had PFOs; 16 had right to left contrast passage, and only 1 had left to right flow by color Doppler. Against TEE contrast study, the sensitivity of TMD and 2D contrast studies were 100% and 75%, respectively, with specificity of 96% and 100%. Greater than 10 bubbles on a single beat of the resting contrast TMD identified patients with a maximum resting TEE PFO opening diameter >2 mm with 78% sensitivity and 100% specificity. There was a strong correlation (r2 = 0.72, p<0.01) between the TMD acoustic power and PFO opening diameter. CONCLUSIONS: Transmitral Doppler is a sensitive and specific method for TTE PFO detection that allows quantification of right to left bubble passage and may obviate the need for TEE in many patients after stroke.

Adult↗
PubMed2002

Transcatheter closure of patent foramen ovale in patients with cerebral ischemia.

OBJECTIVES: The present study was conducted to determine the safety of the transcatheter closure of a patent foramen ovale (PFO) in patients with cryptogenic cerebral ischemia and the midterm follow-up of recurrent thromboembolic events after interventional PFO closure. BACKGROUND: Current therapeutic options for stroke prevention in patients with PFO and a history of thromboembolic events include chronic antithrombotics and more invasive treatments such as surgical closure or minor invasive transcatheter permanent closure of the PFO. Promising preliminary and pilot data with the Amplatzer Septal Occluder or the PFO-Star Occluder have been reported. Systematic and long-term data are still missing. METHODS: A total of 276 consecutive patients with a PFO and a history of at least one thromboembolic event were recruited in four medical centers and underwent percutaneous PFO closure with the PFO-Star device. Follow-up data were analyzed over an average of 15.1 months, equivalent to 345 patient-years. RESULTS: The implantation was successful in all 276 patients. Peri-interventional reversible complications included transient ST-segment elevations (1.8%) and transient ischemic attack (TIA) (0.8%). Two devices have been removed surgically. During follow-up the annual recurrence rate of thromboembolic events was 1.7% for TIA, 0% for stroke and 0% for peripheral emboli. CONCLUSIONS: Interventional PFO closure with the PFO-Star device appears to be a reliable and promising technique resulting in a low recurrence rate of thromboembolic events, especially stroke in patients with a history of cryptogenic ischemia presumably due to paradoxical embolization. To our knowledge, this is the largest coherent and prospective study for interventional PFO closure.

Adult↗
PubMed1986

Progressive obstruction of the foramen ovale in patients with left atrioventricular valve atresia.

Thirteen patients with left atrioventricular (AV) valve atresia and a normal aortic root were studied to evaluate the status of the interatrial communication with advancing age. Six patients had cardiac catheterization within the first 2 weeks of age; of these, five had repeat studies before 7 months of age. The seven other patients initially underwent catheterization after 2 weeks of age. In the group with catheterization before 2 weeks of age, the mean left atrial pressure was 7.8 +/- 5.5 mm Hg and the left atrial-right atrial mean pressure gradient was 1.7 +/- 2.4 mm Hg. In the combined group of patients with catheterization after 2 weeks of age, the mean left atrial pressure was 25.9 +/- 5.6 mm Hg and the mean left atrial-right atrial pressure gradient was 21.1 +/- 5.1 mm Hg. Seven of the 13 patients have survived and have now reached a median age of 6.5 years. Balloon atrial septostomy was adequate for long-term survival in one patient; all of the others have required surgical atrial septectomy. Progressive obstruction of the foramen ovale is part of the natural history of left AV valve atresia, and obstruction develops despite the absence of a left atrial-right atrial gradient during newborn study. Balloon atrial septostomy is recommended during the neonatal period in all patients with left AV valve atresia, even in the absence of an interatrial gradient. Because early surgical atrial septectomy is usually necessary for long-term survival, these patients should have serial noninvasive evaluation of the patency of the interatrial communication.

Cardiac Catheterization↗
PubMed2000

Pulmonary embolism complicated by patent foramen ovale and paradoxical embolization.

We present the case of a 74-year-old male with chest pain, dyspnea, and syncope secondary to an acute pulmonary embolism complicated by a patent foramen ovale with straddling thrombus and paradoxical embolization. We review the literature with specific focus on the pathogenesis and acute treatment of this life-threatening occurrence.

Aged↗
PubMed2001

[Transesophageal echocardiography and air embolism during posterior fossa neurosurgery. Intraoperative detection in the foramen ovale].

Sitting position during neurosurgery is discussed because the risk of venous air embolism and paradoxical air embolism is increased. Preoperative transoesophageal echocardiography is proposed to screen patients with patent foramen ovale to avoid them for the sitting position. This work reported 2 patients in conflict with this screening. It is discussed the physiological principles governing the paradoxical air embolism and the actual recommended monitoring for this position.

Astrocytoma↗
PubMed1994

[Arterial embolism caused by an intra-aortic thrombus or a patent foramen ovale? Diagnosis by transesophageal echocardiography].

This case report demonstrates the value of transoesophageal echocardiography (TOE) in comparison with transthoracic echocardiography as it allows a better view of the thoracic aorta, the auricles, the interauricular septum and the cardiac valves, especially in the intubated and ventilated patients. A 84-year-old woman was admitted to the ICU for hypoxia after carotid-subclavian bypass surgery for acute ischaemia of the left upper limb. The TOE showed a dilated right heart and a patent foramen ovale, compatible with pulmonary embolism as well as two thrombi in the aortic arch. The patient died on the 8th postoperative day from refractory hypoxia. the autopsy confirmed the pulmonary embolism and the intraaortic thrombi. It is concluded that TOE, readily feasible is indicated in case of hypoxia, shock and systemic embolism without cause immediately recognizable, especially in ventilated patients.

Aged↗
PubMedDate not supplied

Identification of a malpositioned atrial pacemaker lead across a patent foramen ovale by transesophageal echocardiography.

Transesophageal echocardiography was used for defining the unusual left atrial location of a malpositioned atrial pacemaker lead. This malpositioning occurred in a 75-year-old woman who had a small atrial septal aneurysm and a patent foramen ovale. Neither the precise location of the pacemaker lead tip nor the course of the lead was apparent by radiographic or transthoracic echocardiographic techniques. This report extends the potential utility of transesophageal echocardiography for the identification of malpositioned atrial pacemaker leads.

Aged↗
PubMedDate not supplied

Thromboembolus traversing a patent foramen ovale: resolution with anticoagulation.

This case report documents echocardiographically a thromboembolus actively traversing a patent foramen ovale in a 72-year-old man with a dilated cardiomyopathy and systemic lupus erythematosis complicated by chronic low-grade disseminated intravascular coagulation and multiple lower extremity deep venous thromboses. With intravenous heparin therapy, there was apparent resolution of this thromboembolus without clinical evidence of systemic embolization.

Aged↗
PubMedDate not supplied

Right-to-left shunt through a patent foramen ovale caused by severe tricuspid regurgitation detected with color Doppler echocardiography.

We describe a 65-year-old patient with moderate combined mitral disease and severe tricuspid regurgitation, in whom the tricuspid regurgitant jet was oriented toward the interatrial septum. Color flow and pulsed Doppler demonstrated a late-systolic to mid-diastolic, right-to-left shunting of the tricuspid regurgitant jet through the foramen ovale. This finding was subsequently confirmed with transesophageal echocardiography.

Aged↗
PubMedDate not supplied

Patent foramen ovale: a nonfunctional embryological remnant or a potential cause of significant pathology?

A patent foramen ovale (PFO) is an embryological remnant found in 27% of adults. It is a potential right-to-left intracardiac shunt. Shunting may be the result of reversal in the interatrial pressure gradient or abnormal streaming of blood in the right atrium. The pathologic consequences of right-to-left shunting include hypoxemia and paradoxical embolism. PFO may exacerbate preexisting hypoxemia or be its primary cause. Paradoxical embolism through a PFO is well documented. Its role in cryptogenic stroke remains controversial. A PFO may be detected by both invasive and noninvasive techniques. Contrast transesophageal echocardiography with provocative maneuvers is the diagnostic method of choice allowing visualization of the shunt. Patients with cryptogenic stroke should be screened for a PFO. If detected, noninvasive studies for deep vein thrombosis are recommended. Treatment must be tailored to the presentation. Surgical or transcatheter closure is recommended for hypoxemia. Prevention of venous embolism (air or thrombus) with or without closure of the PFO is recommended for paradoxical embolism.

Heart Septal Defects, Atrial↗
PubMed1997

Multiplane transesophageal echocardiography to detect effectiveness of selective pulmonary recombinant tissue-type plasminogen activator thrombolysis in pulmonary embolism and patent foramen ovale.

A functionally patent foramen ovale can create a relevant right-to-left shunt during massive pulmonary embolism. This associated feature, although maintaining adequate cardiac output, may explain both the paradoxic embolism and the uneffectiveness of peripherally administered drugs. This case demonstrates the potential of transesophageal echocardiography in monitoring the hemodynamic findings of such patients and, consequently, the effectiveness of thrombolytic treatment.

Echocardiography, Transesophageal↗