Dynamic Exophthalmos Secondary to an Orbital Varix

We present a case of dynamic exophthalmos secondary to an orbital varix. Objectives of this paper are to describe this rare entity and review its etiology, diagnosis and treatment options. A 21-year-old woman presented complaining of exophthalmos in the right eye on bending forward. Neuroimaging studies revealed an irregularly shaped mass located in the posterior intra-extraconal region adjacent to the orbital roof. Surgical and interventional endovascular therapies were considered, but due to the complex nature of the lesion the patient was followed-up conservatively. Orbital varix may cause dynamic exophthalmos and most patients may be managed conservatively. Patients harboring non-treatable orbital varix should be advised to avoid any strenuous exercises and postures which may increase intraorbital pressure.

Surgical Treatment of Cervical Arteriovenous Fistula in a Patient with Neurofibromatosis Type 1

Vasculopathies are frequently associated with neurofibromatosis type-1, and they are generally occlusive or stenotic type lesions. Vertebral arteriovenous fistula (AVF) is quite rare in neurofibromatosis type 1 patients. They can be treated with surgical excision or endovascular occlusion. We describe a surgically treated cervical AVF in a neurofibromatosis type 1 (NF-1) patient and discuss the selection of the patient for the surgery. Although endovascular occlusion is the first line treatment option for cervical AVFs, some selected cases can be successfully treated by surgery. Surgery should be considered as a treatment option in spite of its risks, especially for cervical AVF which is associated with fibromuscular system diseases like NF-1.

The anterior spinal artery origin: a microanatomical study

BACKGROUND

Detailed knowledge of the pattern of origin of the anterior spinal artery is critical as surgical and endovascular procedures involving the area of the ventral medulla and the vertebrobasilar junction are commonplace. We conducted a detailed microanatomical study to elucidate the site and pattern of origin of this critically important artery.

METHOD

Nine adult cadaveric heads (18 sides) were examined after injection of colored silicon. In every specimen, the site of origin of the rami of the anterior spinal artery, their course, branching pattern and anastomoses, external diameters, and the distance from neighbor critical vessels were recorded. The dissections were performed with the aid of both the surgical microscope and a 0 degree endoscope.

FINDINGS

The pattern and site of origin of the anterior spinal artery show great variability. Also the distance of the origin of the two rami (right and left) forming the anterior spinal artery from the vertex of the vertebrobasilar junction and from the origin of the posterior inferior cerebellar artery is highly variable.

CONCLUSIONS

Knowledge of the different pattern of origin and course of the proximal portion of the anterior spinal artery is critically important when planning and executing endovascular and surgical procedures involving the distal vertebral artery, the vertebrobasilar junction and the ventral medulla. On the basis of our and other authors' findings, we propose an overall classification of the pattern of origin and distribution of the proximal anterior spinal artery, which has clinical repercussions.

Isolated unilateral sixth nerve palsy as a presenting symptom of cerebral aneurysms. Report of two cases

We describe two patients with intracranial aneurysms who presented with isolated sixth nerve palsy. A 68-year-old woman with gradual onset of horizontal lateral diplopia was found to have a giant aneurysm at the junction of the petrous and cavernous portion of the internal carotid artery. A 58-year-old man presented with gradual onset of occipital pain followed by a sixth nerve palsy. He was found to have a distal anterior inferior cerebellar artery aneurysm which spontaneously thrombosed on subsequent neuroimaging studies. Although uncommon, isolated sixth nerve palsy can be the only neurological sign of an intracranial aneurysm.

Spinal intradural extramedullary cavernous angioma: case report and review of the literature

STUDY DESIGN

Case report and review of the literature.

OBJECTIVE

To report an unusual case of a spinal intradural extramedullary cavernous angioma (CA), located at the cauda equina, and to compare it with the previously published 22 surgically treated cases in the literature.

SETTING

Ankara, Turkey.

METHOD

A 67-year-old man presented with a 4-month history of back pain and sciatica and a 4-week history of progressive lower extremity paresthesia, difficulty walking, and loss of bladder and bowel sphincter control. Neurological examination revealed bilateral hypoesthesia below the T12 dermatome with spastic paraparesis. Magnetic resonance imaging (MRI) of the cauda equina revealed a heterogeneous enhancing intradural extramedullary mass obliterating the spinal canal and expanding the spinal cord. T12 laminectomy and total tumor removal were performed without additional neurological deficit. Pathological examination confirmed the diagnosis of a CA.

RESULT

The patient's neurological status improved during postoperative recovery. He was ambulatory without assistance and regained full sphincter control on the eighth postoperative week.

CONCLUSION

CAs of the spinal cord are extremely rare lesions. Typically, they present with low back pain and sciatica, neurological deficits, or as a subarachnoid hemorrhage. These lesions have characteristic features on MRI and should be considered in the differential diagnosis of intradural spinal lesions. Following a thorough literature review of reported cases, the authors propose that for patients presenting with severe preoperative neurological signs, immediate microsurgical tumor excision or decompression increases the chance of neurological improvement.

Spontaneous regression of cervical disc herniations

The spontaneous regression of cervical disc herniations is a rare occurrence. Six herniated cervical discs that had regressed spontaneously are presented. All radiological disc regressions correlated well with clinical improvements. We want to underscore the potential for regression that should be considered in the evaluation and management of any patient with a herniated cervical disc.

Cranial infantile myofibromatosis: report of three cases

BACKGROUND

Infantile myofibromatosis is a proliferative disorder of infancy and early childhood characterized by the development of single or multiple nodular lesions arising from cutaneous or subcutaneous tissue, muscle, bone or visceral organs. In approximately one-third of cases, this myofibroblastic proliferation involves the head and neck region.

CASE REPORT

In this paper we report on three cases of cranial infantile myofibromatosis in infants. The clinical presentation and the deceptive histopathological features can make diagnosis difficult.

CONCLUSION

The significance of recognizing this entity is stressed, since its indolent clinical behavior might prevent diagnosis.