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Carotid artery surgery

Luen Shaun Chew, Julian Xinguang Han, Yew Poh Ng, Hua Bak Ng
Carotid-jugular fistula is a rare presentation of arteriovenous fistula. A case of a 60-year-old Chinese man who presented with iatrogenic carotid-jugular fistula with multiple fistulous points was reported. His presenting complaint was a gradually enlarging right pulsatile neck mass complicated by worsening symptoms of congestive cardiac failure. He had recent mitral valve annuloplasty, and a right internal jugular central venous pressure monitor insertion was performed then. Angiography revealed right carotid-jugular fistula with feeders from the external carotid, internal carotid and right vertebral arteries, all draining into the right internal jugular vein...
March 16, 2019: BMJ Case Reports
Tyler Lazaro, Visish M Srinivasan, Phillip Cooper, Michael Phillips, Robert Garcia, Stephen R Chen, Jeremiah Johnson, Dalis E Collins, Peter Kan
BACKGROUND: Endovascular technological advances have revolutionized the field of neurovascular surgery and have become the mainstay of treatment for many cerebrovascular pathologies. Digital subtraction angiography (DSA) is the 'gold standard' for visualization of the vasculature and deployment of endovascular devices. Nonetheless, with recent technological advances in optics, angioscopy has emerged as a potentially important adjunct to DSA. Angioscopy can offer direct visualization of the intracranial vasculature, and direct observation and inspection of device deployment...
March 16, 2019: Journal of Neurointerventional Surgery
Kosmas I Paraskevas, Gert J de Borst, Frank J Veith
OBJECTIVE: Randomized controlled trials (RCTs) constitute level I evidence and are used as the backbone of guidelines and recommendations for treatment. Although RCTs are theoretically the studies of choice for the assessment of the effectiveness of health care interventions, these trials (and their interpretation) may sometimes result in erroneous conclusions, erroneous therapeutic decisions, and incorrect recommendations. We aimed to check the applicability of the results of RCTs to everyday practice...
March 13, 2019: Journal of Vascular Surgery
T Reiff, H H Eckstein, U Mansmann, O Jansen, G Fraedrich, H Mudra, D Böckler, M Böhm, H Brückmann, E S Debus, J Fiehler, W Lang, K Mathias, E B Ringelstein, J Schmidli, R Stingele, R Zahn, T Zeller, A Hetzel, U Bodechtel, A Binder, J Glahn, W Hacke, P A Ringleb
BACKGROUND: Treatment of individuals with asymptomatic carotid artery stenosis is still handled controversially. Recommendations for treatment of asymptomatic carotid stenosis with carotid endarterectomy (CEA) are based on trials having recruited patients more than 15 years ago. Registry data indicate that advances in best medical treatment (BMT) may lead to a markedly decreasing risk of stroke in asymptomatic carotid stenosis. The aim of the SPACE-2 trial (ISRCTN78592017) was to compare the stroke preventive effects of BMT alone with that of BMT in combination with CEA or carotid artery stenting (CAS), respectively, in patients with asymptomatic carotid artery stenosis of ≥70% European Carotid Surgery Trial (ECST) criteria...
March 15, 2019: International Journal of Stroke: Official Journal of the International Stroke Society
Hussam Abou-Al-Shaar, Yair M Gozal, Philipp Taussky, William T Couldwell
Petrous internal carotid artery (ICA) aneurysms are rare, complicated lesions to treat. The management paradigms include observation, endovascular exclusion, or surgical trapping with or without revascularization. The case described in this video involved a 67-yr-old woman with a known history of chronic lymphocytic leukemia, who presented after a mechanical ground-level fall. Clinically, she had a nasal deformity and resolving epistaxis consistent with mild facial trauma. Computed tomography (CT) revealed a comminuted nasal bone fracture and an incidental 3-cm right petrous ICA aneurysm...
March 14, 2019: Operative Neurosurgery (Hagerstown, Md.)
Alhusain Nagm, Tetsuyoshi Horiuchi, Kazuhiro Hongo
This surgical video emphasizes the nuances that needed to overcome daunting challenges of clipping of paraclinoid carotidophthalmic and superior hypophyseal artery (SHA) aneurysms. To avoid hazardous manipulations, scarifying the ipsilateral SHA under visual evoked potential (VEP) guidance can be done without risk of postoperative visual decline. This technique is associated with better visual outcome.1 A 66-yr-old woman presented with gradually enlarging right paraclinoid carotidophthalmic and SHA aneurysms...
March 13, 2019: Operative Neurosurgery (Hagerstown, Md.)
Bo Lin, Hong-Yu Yang, Hui-Jun Yang, Shi-Yue Shen
BACKGROUND: Paraganglioma/pheochromocytoma and medullary thyroid carcinoma can coexist and are often found in multiple endocrine neoplasia (MEN). However, very few cases highlight papillary thyroid carcinoma. We present herein a rare case of head and neck paraganglioma associated with papillary thyroid carcinoma. CASE SUMMARY: A 51-year-old man presented to our department with right-sided neck swelling and hypertension. Physical examination showed neck masses with obvious pulsation...
March 6, 2019: World Journal of Clinical Cases
Mingxin Wang, Guoqiang Li, Shouguang Sui, Shaoyan Cao, Xinyu Gai, Jingtong Zhu, Chao Li Chao Li
The paper discuss the surgical techniques and clinical curative effects of CEA (Carotid Endarterectomy, CEA) under a microscope via anterior cervical triangle posterior vena jugularisinterna approach combining with suspended carotid artery on the treatment of high level and complex carotid artery stenosis. Retrospective analysis was conducted on the clinical data of 21 cases of patients. The far end of carotid artery stenosis section is located above the lower edge of the second cervical vertebra centrum. The carotid artery stenosis section of three cases is located at the middle lower edge of the first cervical vertebrae...
January 2019: Pakistan Journal of Pharmaceutical Sciences
Elaine J Zhou, Adam R Sweeney, Stephen R Chen, Michael T Yen
Intraorbital arteriovenous fistula is a rare vascular disease characterized by an acquired arteriovenous communication without direct cavernous sinus involvement. Intraorbital arteriovenous fistula may develop slowly and present similarly to other insidious orbitopathies, such as carotid-cavernous fistula. The authors present a case of a superficial temporal artery to superior ophthalmic vein fistula arising in the absence of trauma or prior surgery. This is the first report of a spontaneous intraorbital arteriovenous fistula arising between these vessels and further describes the rare occurrence of intraorbital arteriovenous fistula...
March 5, 2019: Ophthalmic Plastic and Reconstructive Surgery
Chuanwei Wang, Yulin Zhang, Jiangang Wang, Shilei Ni
BACKGROUND: This report discusses the risks and complications of using the extended endoscopic endonasal transsphenoidal approach (EEETA) in a special craniopharyngioma case to caution neurosurgeons. CASE DESCRIPTION: A 38-year-old woman with craniopharyngioma underwent the EEETA surgery. Her anterior cerebral artery (ACA) was punctured intra-operatively and clipped by using an aneurysm clip through the nose in an emergency procedure. CONCLUSIONS: The coexistence of the severe calcified craniopharyngiomas especially with sharp calcified spurs, a narrow distance between the anterior communicating artery (AComA) and the planum sphenoidale, and a narrow distance between the bilateral internal carotid artery (ICA) is a significant waring signal during EEETA for craniopharyngiomas...
March 4, 2019: World Neurosurgery
Pauline Mury, Mathilde Mura, Nellie Della-Schiava, Stéphanie Chanon, Aurélie Vieille-Marchiset, Virginie Nicaise, Erica N Chirico, Diane Collet-Benzaquen, Patrick Lermusiaux, Philippe Connes, Antoine Millon, Vincent Pialoux
OBJECTIVE: Carotid atherosclerotic plaques are a source of emboli for stroke. 'Unstable' carotid atherosclerotic plaques may have intraplaque haemorrhages, neovessels, prevalent macrophages, excessive calcium deposits, a large lipid core and a thin fibrous cap. Regular physical activity (PA) may lower the risk of plaques becoming unstable. We evaluated the association of both PA and sedentary behaviour (SB) with carotid plaque histopathology. METHODS: 90 asymptomatic patients who were undergoing carotid endarterectomy for carotid artery narrowing identified on ultrasound reported their PA and SB by questionnaires...
March 6, 2019: British Journal of Sports Medicine
Hidetoshi Matsukawa, Hiroyasu Kamiyama, Takanori Miyazaki, Yu Kinoshita, Nakao Ota, Kosumo Noda, Takaharu Shonai, Osamu Takahashi, Sadahisa Tokuda, Rokuya Tanikawa
OBJECTIVEPerforator territory infarction (PTI) is still a major problem needing to be solved to achieve good outcomes in aneurysm surgery. However, details and risk factors of PTI diagnosed on postoperative MRI remain unknown. The authors aimed to investigate the details of PTI on postoperative diffusion-weighted imaging (DWI) in patients with surgically treated unruptured intracranial saccular aneurysms (UISAs).METHODSThe data of 848 patients with 1047 UISAs were retrospectively evaluated. PTI was diagnosed on DWI, which was performed the day after aneurysm surgery...
March 1, 2019: Journal of Neurosurgery
Yue Hei, Rong Chen, Xingang Mao, Jiancai Wang, Qianfa Long, Weiping Liu
Neuregulin1 (NRG1) is an effective neuroprotectant. Previously we demonstrated that the expression of hippocampal NRG1/ErbB4 gradually decreased and correlates with neuronal apoptosis during chronic cerebral hypoperfusion (CCH). Here we aimed to further investigate the protective role of NRG1 in CCH. AG1478, an ErbB4 inhibitor, was used to explore the involvement of ErbB4 receptors in NRG1's action. Permanent bilateral common carotid artery occlusion (2VO) or sham operation was performed in Sprague-Dawley rats...
February 28, 2019: Behavioural Brain Research
Hiroto Ito, Syunsuke Yokoi, Kinya Yokoyama, Takumi Asai, Kenji Uda, Yoshio Araki, Syuntaro Takasu, Rei Kobayashi, Hisashi Okada, Satoshi Okuda
BACKGROUND: Moyamoya vasculopathy (MMV) associated with Graves' disease (GD) is a rare condition resulting in ischemic stroke accompanied by thyrotoxicity. Radiological findings of vasculitis have been reported in the walls of distal internal carotid arteries (ICAs) in these patients; however, no reports have described in detail the processes of progression of the lesions in the proximal ICA. Moreover, treatments to prevent recurrence of ischemic stroke and progression of MMV have not yet been sufficiently elucidated...
March 2, 2019: BMC Neurology
Noritaka Komune, Satoshi Matsuo, Takashi Nakagawa
OBJECT: A profound understanding of the relationship between deep cervical fasciae and the skull base is essential for skull base surgery. To our knowledge, there has been little research on the relationship between the deep cervical fasciae and inferior surface of the skull base; thus, this study aims to examine the fascial network of the skull base. METHODS: Cadaveric study. RESULTS: The interpterygoid fascia is attached to the skull base along the sphenopetrosal fissure and tympanosquamous suture...
February 27, 2019: World Neurosurgery
Ville Nurminen, Leena Kivipelto, Riku Kivisaari, Mika Niemelä, Martin Lehecka
OBJECTIVE: Bypass surgery is a special technique used to treat complex ICA aneurysms. The aim of this retrospective study is to provide a comprehensive description of treatment and outcome of complex ICA aneurysms at different ICA segments (cavernous, supraclinoid, ICA bifurcation) treated with bypass procedures. METHODS: We identified 39 consecutive patients with 41 complex ICA aneurysms that were treated with 44 bypass procedures between 1998 and 2016. We divided the aneurysms into three anatomic subgroups to review our treatment strategy...
February 27, 2019: World Neurosurgery
D'Angelo Luca, Paglia Francesco, Caporlingua Alessandro, Sampirisi Luigi, Guidetti Giulio, Santoro Antonio
INTRODUCTION: Carotid Cavernous Fistulas (CCFs) are a rare type of arteriovenous shunt that develop within the cavernous sinus (CS). Direct CCFs entails a direct communication between the cavernous internal carotid artery (cICA) and the CS and are typically high flow lesion. Most CCFs drains into the ophthalmic veins (typical venous drainage pattern), leading to the pathognomic ocular clinical triad associated with a CCF. When an obstruction of the typical venous outflow is present, the arterial pressure generated by the fistula, is transmitted into the cerebral venous system via the sphenoparietal sinus which might lead to intra-cerebral hemorrhage...
February 25, 2019: World Neurosurgery
Ewa Biegaj, Joanna Rutkowska-Zimirska, Małgorzata Radzymińska-Maliszewska, Anna Zaremba, Jarosław Pniewski
We present a case of patient with a rare vessel pathology - arteriovenous fistula (AVF) of superficial temporal artery and vein. The 56-year old man was admitted to the Department of Neurology because of a headache in the right temporal region with concomitant buzzing sound in his right ear. The pain was present mainly in the evenings and was stronger when touching the temporal region. He denied having any head injury in the last few years. There were no signs of central nervous system involvement in the neurological examination...
February 28, 2019: Folia Morphologica (Warsz)
Serdar Akansel, Murat Sarğın, Sevinç Bayer Erdoğan, Murat Baştopçu, Hüseyin Kuplay, Onur Sokullu Md, Serap Aykut Aka Md
BACKGROUND: The coexistence of coronary artery disease (CAD) in patients undergoing coronary artery bypass surgery (CABG) is a risk factor for stroke and death. The aim of this study is to evaluate the potential of the SYNTAX score (SXscore) for predicting carotid stenosis in patients undergoing CABG. METHODS: We retrospectively reviewed 291 patients (225 males, mean age 60.5 ± 8.5 years) who underwent CABG in a single center in 2014 and were screened for carotid artery preoperatively...
February 27, 2019: Journal of Cardiac Surgery
Jessica Ruzicki, Eric K Chin, David Almeida
Branch retinal artery occlusion (BRAO) is typically associated with irreversible vision and peripheral visual field loss. We report a case of a 62-year-old woman with a BRAO related to several cardiovascular risk factors. Our patient encountered gradual but significant vision recovery months following carotid artery endarterectomy for carotid stenosis.
2019: Case Reports in Ophthalmological Medicine
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