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Marianna S, Ilaria F, Teresa P, Armando P, Giuseppe F, Marisole T, Valerio R, Priscilla N, Palumbo P, Giulio I, Vito D, Carlo R. Hybrid endovascular and surgical staged approach for mycotic carotid pseudoaneurysms: a case report and literature review. Front Surg 2024; 11:1394441. [PMID: 39045087 PMCID: PMC11263163 DOI: 10.3389/fsurg.2024.1394441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/17/2024] [Indexed: 07/25/2024] Open
Abstract
Background Mycotic carotid pseudoaneurysms represent a challenge for surgeons. They are rare and associated with high mortality and morbidity. Methods We reported a case of a 61-year-old man with a mycotic pseudoaneurysm of carotid bifurcation. The case was managed by a staged procedure, starting with initial endovascular control using a stent graft, followed by open arterial reconstruction using a saphenous vein graft. Results The patient was discharged home with a patent carotid artery and no sign of infection or bleeding. A computed tomography scan performed at 1 month, 6 months, and 1 year later confirmed good patency of the graft without imaging of cerebral ischemia. Conclusions Mycotic pseudoaneurysms of the extracranial carotid artery are rare and should always be treated surgically. This disease, despite its rarity, requires early detection and treatment to avoid fatal outcomes. A hybrid staged approach is suggested, compared to one-staged surgery, to avoid rupture and improve clinical outcomes. This approach involves using a stent graft combined with antibiotic therapy as bridge treatment until definitive surgery can be performed to enable arterial reconstruction with an autologous graft.
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Affiliation(s)
| | | | - Prisco Teresa
- Vascular Surgery Unit, Cardarelli Hospital, Naples, Italy
| | | | | | - Toni Marisole
- Department of Surgical Sciences, University of Rome “La Sapeinza”, Rome, Italy
| | - Rinaldi Valerio
- Department of Surgical Sciences, University of Rome “La Sapeinza”, Rome, Italy
| | - Nardi Priscilla
- Department of Surgical Sciences, University of Rome “La Sapeinza”, Rome, Italy
| | - Piergaspare Palumbo
- Department of Surgical Sciences, University of Rome “La Sapeinza”, Rome, Italy
| | - Illuminati Giulio
- Department of Surgical Sciences, University of Rome “La Sapeinza”, Rome, Italy
| | - D’Andrea Vito
- Department of Surgical Sciences, University of Rome “La Sapeinza”, Rome, Italy
| | - Ruotolo Carlo
- Vascular Surgery Unit, Cardarelli Hospital, Naples, Italy
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Ogolo DE, Ajare E, Ndubuisi C, Okwuoma O, Nnama S, Ohaegbulam S. Volumetric assessment of Posterior cranial fossa in a West African population. World Neurosurg X 2024; 22:100334. [PMID: 38455251 PMCID: PMC10918262 DOI: 10.1016/j.wnsx.2024.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Posterior fossa pathologies can have potentially devastating outcomes. The volumetric capacity of this fossa, known to have ethnoregional variations, can thus be critical in determining outcomes and intervention measures and approaches to pathologies involving this region. This study aimed to evaluate the normal posterior fossa volumes within the West-African subpopulation. METHODS This was a descriptive study of all patients presenting for a cranial imaging study at the study location within a two-year period using a 1.5T MRI of this cranial region. Obtained data included the transverse and anteroposterior diameters, and the height of this fossa and the obtained data was analyzed. P values < 0.05 was statistically significant. RESULTS A total of 315 patients were recruited (165 males and 150 females). The average posterior fossa transverse diameter, anteroposterior diameter and height were 108.19 mm, 71.58 mm and 35.53 mm respectively for males, and 105.7 mm, 66.48 mm, and 34.24 mm for females respectively. The average posterior fossa volume for males (292.36 cm3) was significantly higher than for females (252.90 cm3) (p= 0.0038). The highest average posterior fossa volume was between 16-30 years for males and above 75 years for females. CONCLUSION Posterior cranial fossa volumes for the West African population is significantly higher than those obtained for other regions. In addition to being beneficial in some posterior fossa space occupying lesions, this larger volume can explain the relative rarity and sexual preferences of some posterior fossa congenital abnormalities like Chiari-1 malformation amongst the West African population.
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Affiliation(s)
- Donald E. Ogolo
- Memfys Hospital Enugu, Nigeria
- Macquarie University Hospital, Sydney, Australia
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Hanger M, Baker DM. Infective Native Extracranial Carotid Artery Aneurysms: A Systematic Review. Ann Vasc Surg 2023; 91:275-286. [PMID: 36549478 DOI: 10.1016/j.avsg.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 11/16/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Infective native extracranial carotid artery aneurysms are rare, and their management is variable due to a lack of evidence assessing outcomes. METHODS We performed a systematic literature review following PRISMA guidelines to identify all reported cases of infective native extracranial carotid artery aneurysms between January 1970 and March 2021. RESULTS This study identified 193 infective native aneurysms of the extracranial carotid artery from 154 sources. Patients were predominantly male (71.4%), and age ranged from 6 months to 89 years old. The most common presenting features were a neck mass and fever, but also included hemorrhage, respiratory distress, and neurological symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.3%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (20.9%). Most appeared to become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In 4 cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In 5 cases, there was antibiotic treatment alone. In the open surgery-treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%. CONCLUSIONS Our review identified 193 cases of infective native extracranial carotid artery aneurysms. Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer early complications than open surgical management.
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Affiliation(s)
- Melissa Hanger
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Daryll M Baker
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK.
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Braut T, Maršić M, Ravlić I, Maržić D, Marijić B, Malvić G, Vrebac I, Velepič M. Posttraumatic Vernet syndrome without fracture: A case report and short literature review. Medicine (Baltimore) 2021; 100:e27618. [PMID: 34713846 PMCID: PMC8556020 DOI: 10.1097/md.0000000000027618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/13/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The aim of this case is to emphasize the need to include nerve traction in the differential diagnosis of nerve deficits associated with Vernet syndrome. This mechanism of injury has been described only once, but must not be overlooked and should be considered and included as a possible cause in diagnostic algorithms. PATIENT CONCERNS A patient presenting with dysphagia, extreme hoarseness, and limited shoulder movement after head injury was admitted to the emergency department. DIAGNOSES Multidisciplinary evaluation was performed, and nerve traction-induced Vernet syndrome was established as a running diagnosis. INTERVENTIONS Intensive swallowing and speech exercises, assisted by a specialist, were performed. OUTCOMES Swallowing and speech exercises significantly and objectively improved the patient's swallowing and voice, with mild hoarseness of voice remaining as the main symptom. Spectral acoustic analysis went from a voice pitch of 163.77 Hz to normal (187.77 Hz), jitter improved from 17.87% to 0.86% and shimmer values decreased from 39.86% to 19.60%. Breathiness during phonation measuring 2.91% was reduced to 1.08% and appropriate average intensity of voice (63.95 dB) was achieved. Initial dysphagia and fluid retention in the right piriform sinus, along with tracheal aspiration, were not observed in control fiberoptic endoscopic evaluation of swallowing. LESSONS According to our knowledge and literature data, this is the second reported case of posttraumatic Vernet syndrome without radiologically confirmed jugular foramen fracture, induced by nerve traction. Such patients need a prompt multidisciplinary approach in diagnosis and timely posttraumatic rehabilitation therapy for favorable clinical evolution and retrieval of nerve function.
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Affiliation(s)
- Tamara Braut
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia
| | - Matej Maršić
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia
| | - Iva Ravlić
- University of Rijeka, Faculty of Medicine, Rijeka, Croatia
| | - Diana Maržić
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia
| | - Blažen Marijić
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia
| | - Goran Malvić
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia
| | - Ilinko Vrebac
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia
| | - Marko Velepič
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia
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Lower cranial nerve syndromes: a review. Neurosurg Rev 2020; 44:1345-1355. [PMID: 32638140 DOI: 10.1007/s10143-020-01344-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/09/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
The purpose of this paper is to provide a comprehensive review encompassing the syndromes associated with the lower cranial nerves (LCNs). We will discuss the anatomy of some of these syndromes and the historical contributors after whom they were named. The LCNs can be affected individually or in combination, since the cranial nerves at this level share their courses through the jugular foramen and hypoglossal canal and the extracranial spaces. Numerous alterations affecting them have been described in the literature, but much remains to be discovered on this topic. This paper will highlight some of the subtle differences among these syndromes. Symptoms and signs that have localization value for LCN lesions include impaired speech, deglutition, sensory functions, alterations in taste, autonomic dysfunction, neuralgic pain, dysphagia, head or neck pain, cardiac or gastrointestinal compromise, and weakness of the tongue, trapezius, or sternocleidomastoid muscles. To assess the manifestations of LCN lesions correctly, precise knowledge of the anatomy and physiology of the area is required. Treatments currently used for these conditions will also be addressed here. Effective treatments are available in several such cases, but a precondition for complete recovery is a correct and swift diagnosis.
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Mohorko J, Glavan M, Čizmarevič B, Lanišnik B. Mycotic Aneurysm of the Extracranial Internal Carotid Artery Following Otitis Media. Indian J Otolaryngol Head Neck Surg 2019; 71:1453-1457. [PMID: 31750195 PMCID: PMC6841752 DOI: 10.1007/s12070-018-1545-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/28/2018] [Indexed: 11/29/2022] Open
Abstract
Mycotic aneurysm of the internal carotid artery following otomastoiditis can manifest as a nasopharyngeal mass. This is a very rarely described condition. The case of a patient diagnosed with a retropharyngeal mycotic aneurysm of the left internal carotid artery following otitis media, treated with exclusion of the mycotic aneurysm from the circulation and transnasal drainage. Infection of the mastoid can spread to the parapharyngeal space of the nasopharynx and damage the carotid artery wall, resulting in an infected aneurysm. There are no guidelines on how to surgically approach those aneurysms. An endoscopic transnasal approach can be beneficial.
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Affiliation(s)
- Janez Mohorko
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - Matic Glavan
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - Bogdan Čizmarevič
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Boštjan Lanišnik
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
- Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Coburn JA, Golden E, Brucker J, Kennedy TA. Nontraumatic Vascular Emergencies of the Neck. Semin Ultrasound CT MR 2019; 40:157-171. [PMID: 31030739 DOI: 10.1053/j.sult.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Nontraumatic vascular emergencies of the head and neck are uncommon, but can occur in patients with central venous catheters, head and neck infections, and in patients with head and neck cancer. Recognizing the imaging findings of vascular complications in these patient populations is critically important to ensure expeditious treatment to avoid significant morbidity and mortality.
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Affiliation(s)
- John A Coburn
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Edwarda Golden
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Justin Brucker
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tabassum A Kennedy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Dansey K, Stratton L, Park BD. Staphylococcus hominis carotid artery infection with septic embolization. J Vasc Surg Cases 2015; 1:81-83. [PMID: 31724579 PMCID: PMC6849890 DOI: 10.1016/j.jvsc.2015.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/01/2015] [Indexed: 11/28/2022] Open
Abstract
We present the case report of a Staphylococcus hominis carotid artery plaque infection, without mycotic aneurysm formation, that provided the nidus for septic embolization. The patient presented with transient neurologic symptoms, with no clinical signs or symptoms of sepsis. Multiple preoperative imaging modalities revealed critical carotid stenosis but no indication of an infection. Secondary carotid infection was discovered incidentally intraoperatively, and carotid reconstruction was completed with autogenous tissue. The patient transiently manifested sepsis only after the carotid reconstruction and recovered with the institution of parenteral antibiotics.
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Affiliation(s)
- Kirsten Dansey
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of South Florida, Tampa, Fla
| | - Lee Stratton
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of South Florida, Tampa, Fla
| | - Brian D Park
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of South Florida, Tampa, Fla
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Baker A, Rizk H, Carroll W, Lambert P. Cervical internal carotid Artery pseudoaneurysm complicating malignant otitis externa: First case report. Laryngoscope 2014; 125:733-5. [DOI: 10.1002/lary.24877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/16/2014] [Accepted: 07/21/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Andrew Baker
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Habib Rizk
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - William Carroll
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Paul Lambert
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
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Le AQ, Walcott BP, Redjal N, Coumans JV. Cervical osteophyte resulting in compression of the jugular foramen: Case report. J Neurosurg Spine 2014; 21:565-7. [PMID: 25014503 DOI: 10.3171/2014.6.spine13908] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Jugular foramen syndrome is a condition characterized by unilateral paresis of cranial nerves IX, X, and XI in the setting of extrinsic compression. Here, the authors describe the case of a giant cervical osteophyte resulting in compression of the jugular foramen. A 74-year-old man who presented with progressive dysphagia and dysarthria was found to have right-sided tongue deviation, left palatal droop, and hypophonia. His dysphagia had progressed to the point that he had lost 25 kg over a 4-month period, necessitating a gastrostomy to maintain adequate nutrition. He underwent extensive workup for his dysphagia with several normal radiographic studies. Ultimately, CT scanning and postcontrast MRI revealed a posterior osteophyte arising from the C1-2 joint space and projecting into the right jugular foramen. This resulted in a jugular foramen syndrome in addition to delayed filling of the patient's right internal jugular vein distal to the osteophyte. Although rare, a posterior cervical osteophyte should be considered in cases of jugular foramen syndrome.
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Affiliation(s)
- Andrew Q Le
- Department of Neurosurgery, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
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Mycotic Aneurysm of the Internal Carotid Artery. Ann Vasc Surg 2013; 27:826-30. [DOI: 10.1016/j.avsg.2012.10.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 09/24/2012] [Accepted: 10/29/2012] [Indexed: 11/20/2022]
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