Microsurgical approach of arteriovenous malformations in the central lobule

Chaddad-Neto, Feres; Joaquim, Andrei Fernandes; Santos, Marcos Juliano dos; Linhares, Paulo Wagner; Oliveira, Evandro de

doi:10.1590/s0004-282x2008000600018

Cited by 14 publications

(8 citation statements)

References 9 publications

(12 reference statements)

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“…It can be felt superficially and is an important site for burr holes. [ 4 , 11 ] It is the area overlaying the region of the inferior frontal sulcus and precentral sulcus. [ 4 ] To the best our knowledge, there are no reported cases of PBSI describing FB insertion through the stephanion, and our case represents the first one with outstanding recovery.…”

Section: Discussionmentioning

confidence: 99%

Stephanion to cranial base penetrating stab wound with outstanding recovery: A case report

Abdulsada

Ismail

Elsayed

et al. 2023

Surgical Neurology International

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Background: Mortality due to head trauma is common in developed countries in all age groups. Nonmissile penetrating skull base injuries (PSBIs) due to foreign bodies are quite rare, accounting for about 0.4%. PSBI carries that a poor prognosis brainstem involvement usually is often fatal. We are reporting the first case of PSBI with a foreign body insertion site through the stephanion with a remarkable outcome. Case Description: The 38-year-old male patient was referred with a penetrating stab wound to the head through the stephanion caused by a knife after a conflict in the street. He had no focal neurological deficit or cerebrospinal fluid leak, and Glasgow coma scale (GCS) was 15/15 on admission. A preoperative computed tomography scan showed the path of the stab beginning at the stephanion, which is the point where the coronal suture crosses the superior temporal line, heading toward the cranial base. Postoperatively, GCS was 15/15 without any deficit apart from the left wrist drop, possibly due to a left arm stab. Conclusion: Careful investigations and diagnoses must be made to ensure convenient knowledge of the case due to the variety of injury mechanisms, foreign body characteristics, and individual patients’ characteristics. Reported cases of PSBIs in adults have not reported a stephanion skull base injury. Although brain stem involvement is usually fatal, our patient had a remarkable outcome.

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Section: Discussionmentioning

confidence: 99%

Stephanion to cranial base penetrating stab wound with outstanding recovery: A case report

Abdulsada

Ismail

Elsayed

et al. 2023

Surgical Neurology International

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show abstract

“…Classical cerebral AVMs have various treatment options, including surgical resection, radiosurgery, and embolization. [ 5 6 ] However, CPAs have intervening normal brain parenchyma between vascular channels, which makes above mentioned treatment procedure difficult because such patient have risk of developing permanent neurological deficit. Therefore, treatment options for CPA are limited.…”

Section: Discussionmentioning

confidence: 99%

Infratentorial hemorrhagic cerebral proliferative angiopathy: A rare presentation of a rare disease

et al. 2015

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Cerebral proliferative angiopathy (CPA) is a unique and rare vascular malformation with distinct clinico-radiological features. CPA is associated with low risk of hemorrhage as compared to classical cerebral arteriovenous malformations (AVMs). Infratentorial location of diffuse nidus is also an uncommon presentation. Infratentorial hemorrhagic presentation of CPA is a rare co-occurrence. Herein, we report a case of an elderly old male, who presented with acute onset severe headache, recurrent vomiting, vertigo and swaying toward left side while walking. Cerebellar signs in the form of scanning speech, nystagmus, impaired finger-to-nose incoordination test, dysdiadochokinesia, and limb ataxia on the left side were present. Magnetic resonance imaging (MRI) brain revealed diffuse vascular network with intermingled normal brain parenchyma and hemorrhage in the left cerebellum. Digital subtraction angiography (DSA) revealed diffuse, ill-defined, nidus in left posterior fossa involving the left posterior inferior cerebellar, anterior inferior cerebellar and posterior cerebral arterial territories. There were no definite arterial feeders. DSA showed scattered “puddling” appearance of contrast material in the widespread nidus and drained into the multiple ill-defined posterior fossa veins. The MRI brain and DSA findings were consistent with the diagnosis of the CPA. Treatment in our case was limited to supportive medical therapy because selective embolization was not feasible due to nonidentifiable arterial feeders. He was asymptomatic at 1-year follow-up. This case highlights a rare entity called CPAs, which have different clinical presentations, angiographic features, treatment options and patient outcome as compared to classical cerebral AVMs.

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“…Treatment of AVMs, based on the Spetzler-Martin´s classification, may be done by surgical resection, embolization and radiosurgery [7][8][9][10] . In CPA however, the normal brain tissue between vascular spaces carry the risk of permanent neurological deficit.…”

Section: Discussionmentioning

confidence: 99%