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Neurosurgery: Posterior fossa surgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Brainstem cavernoma are another rare entity in elderly population and are most frequently found in pons (11). Patients often present with sudden bleeding/rebleeding episodes causing severe neurological deficits including ataxia, dysarthria, hemiplegia, quadriplegia and disturbances in consciousness. Apart from age related neurosurgical concerns in elderly, surgical excision of these cavernomas is in general difficult in view of their location and bleeding risk. However, compared to their young counterparts, elderly patients undergo rapid neurological deterioration in the event of rebleeding, leading to worsened outcomes. Thus, radical resection of the cavernoma in patients with severe symptoms, especially in those with multiple rebleeding events, may be recommended even in elderly patients, to remove the mass effect on brainstem and prevent further bleeding episodes (11). Surgery is best advised during the subacute phase of bleed, that is, when the hematoma is liquefied, to allow maximum removal of the hematoma with a minimal brainstem damage, thus facilitating neurological recovery (11,12).
Cranial Neurosurgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
disorder. About 20-30% of patients fail to achieve adequate seizure control with drugs, and many of these focal epilepsies may benefit from surgery. Where a primary lesion such as a tumour, AVM or cavernoma is present, lesionectomy alone may be appropriate. In other cases the clinical picture, including seizure type, focal features and investigation results, can be used to identify the seizure focus. Dual pathology refers to the presence of an extrahippocampal lesion plus hippocampal atrophy, important because removal of both the lesion and the atrophic hippocampus will be necessary to achieve seizure control.
Test Paper 4
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
Developmental venous anomalies (DVAs), also called venous angiomas, are variations of the normal veins that are necessary for the drainage of white and grey matter. They are associated with other vascular malformations like cavernoma. On contrast-enhanced CT, the venous collector of the DVA is readily detectable as a linear or curvilinear focus of enhancement, typically coursing from the deep white matter to a cortical or a deep vein or to the dural sinus. On MRI, DVAs typically have a transhemispheric flow void, on both T1-weighted and T2-weighted images. The collector vein is detected as a linear or small, round, signal-void structure on all sequences and is shown most clearly on T2-weighted imaging. On contrast-enhanced MRI, the cluster of veins in DVAs has a spoked wheel appearance; the veins are small at the periphery and gradually enlarge as they approach a central draining vein. This appearance has been referred to as caput medusae (or the ‘head of Medusa’).
Emerging indications for stereotactic laser interstitial thermal therapy in pediatric neurosurgery
Published in International Journal of Hyperthermia, 2020
Madison Remick, Michael M. McDowell, Kanupriya Gupta, James Felker, Taylor J. Abel
Cerebral cavernous malformations (CCMs) are benign clusters of abnormal vasculature most often found in the brain and spinal cord [45]. Patients with cavernoma-related epilepsy (CRE) are often treated with resective surgery, however LITT has increasingly been proposed as an alternative treatment [45–48]. Retrospective cohort studies suggest that early surgical treatment of CRE with LITT is associated with higher long-term seizure freedom rates and higher rates of discontinuing anti-seizure medication as opposed to resection. Potential to offer a less invasive approach through LITT may be associated with patients and families electing to have surgical treatment for CRE earlier.
Endoscopic endonasal resection of a medullary cavernoma: a novel case
Published in British Journal of Neurosurgery, 2019
Puya Alikhani, Sananthan Sivakanthan, Ramsey Ashour, Mark Tabor, Harry van Loveren, Siviero Agazzi
Cavernomas (a.k.a. cavernous malformatioms, cavernous angiomas, cavernous hemangiomas) are clusters of abnormally organized vascular channels surrounded by intervening brain parenchyma. They account for approximately 8–15% of all intracranial and spinal vascular abnormalities with an estimated incidence of one in 100–200 people.1,2 Asymptomatic cavernomas can be observed, whereas surgical resection is the primary treatment for symptomatic lesions. While the decision to perform surgery depends on a variety of patient- and lesion-specific factors, the location of the cavernoma is one of the main determinants of surgical risk.
Emergency surgery for brainstem cavernoma haemorrhage with severe neurological presentation. Is it indicated and worthwhile?
Published in British Journal of Neurosurgery, 2020
Cristiano M. Antunes, Renata S. F. Marques, Maria J. S. Machado, Leandro T. M. Marques, Miguel A. R. Filipe, João S. Fernandes, Carlos M. G. Alegria
In our opinion and experience, the removal of a BSCM in an acute phase is equally achievable and not necessarily harder than when performed in a subacute phase. After reaching BSCM pial or ependymal surface, the hematoma is drained and the cavernoma gently dissected and manipulated with piecemeal removal until complete exclusion is achieved. Care must be taken to preserve possible venous development anomalies and no hemosiderin margins are removed as with supratentorial cavernoma.