Cavernous angioma is encountered most frequently in正 ntraorbital tumors , It is important to know the detailed anatomy of the orblt in order to approach such a mass lesion , so we studied the microsurgical anatomy of the orbit using cadaver heads. In 3 clinical cases reported here , the mass was all located within the muscle cone , ln which the optic nerve was dispiaced medially and superiorly in 2 cases and was displaced laterally and superiorly in l case . The tumor was approached through fronto − orbital craniotonly with additional orbitotomy and was removed en bloc using a coagulation technique by a lateral route in 2 cases and by a medial route in l case . Postoperatively proptosis , diplopia and anisocoria were observed ;however, these cleared up except for mild anisocoria within a few months .
Summary:We report the case of 41-year-old woman with a de novo aneurysm originating at the antero-lateral wall of the contralateral internal carotid artery (ICA) 31 days after the cerebral infarction due to the dissection of the ipsilateral cervical ICA. She developed right hemiparesis and aphasia. Head CT showed fresh cerebral infarction in the left ICA territory, and head MRA showed a stenosis in the left cervical ICA. Carotid ultrasonography indicated an intramural hematoma at the origin of the left ICA, and staccato flow was observed on the Doppler examination, suggesting the dissection of the ICA.Although neuroprotective and anticoagulant therapies were carried out, she developed a sudden severe headache and generalized convulsion on Day 31 since cerebral infarction. Head CT revealed subarachnoid hemorrhage, and a following 3D-CT angiogram showed a saccular de novo aneurysm at the anterolateral and non-branching wall of the supraclinoid ICA on the right. We performed right fronto-temporal craniotomy and neck clipping of the aneurysm. Since no aneurysms had been observed at the affected site on the initial MRA, which was conducted at the onset of cerebral infarction, it was surmised that a de novo aneurysm developed over a short period of time as a result of the hemodynamic stress after the occlusion of the left ICA.This case study may be of importance for clarifying the pathogenesis of aneurysms.
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