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Mayorga-Corvacho J, Vergara-Garcia D, Benavides C, Riveros WM. Ruptured brain arteriovenous malformation in a pregnant woman: a case report. Br J Neurosurg 2022:1-4. [PMID: 35510560 DOI: 10.1080/02688697.2022.2064426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 11/24/2021] [Accepted: 04/06/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Brain arteriovenous malformations (bAVMs) are vascular lesions that commonly present with intracranial haemorrhage. Pregnancy has been associated with an increased risk of bAVM rupture. However, their natural history in pregnant women is uncertain. CASE DESCRIPTION A 27-year-old female at 28 weeks of gestation presented with a compromised neurological status secondary to a ruptured left frontal Spetzler-Martin scale (SM) III + bAVM. An emergent caesarean section was performed due to the high risk of foetal distress. Endovascular treatment successfully controlled the bleeding site, and stereotactic radiosurgery was offered as a subsequent treatment option. CONCLUSION bAVMs should be considered in pregnant women with intracranial haemorrhage. The management of these lesions during pregnancy is controversial. Surgical risk and foetal development should be considered when selecting a management strategy.
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Affiliation(s)
- Juliana Mayorga-Corvacho
- Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - David Vergara-Garcia
- Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - Camilo Benavides
- Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - William Mauricio Riveros
- Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
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Abaunza-Camacho JF, Vergara-Garcia D, Madrinan-Navia H, Riveros WM, Caballero A. Onyx Embolization of an Indirect Carotid–Cavernous Fistula with Cortical Venous Reflux: Technical note. J Neurol Surg A Cent Eur Neurosurg 2022. [PMID: 35073584 DOI: 10.1055/s-0041-1741547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background Indirect carotid–cavernous fistulas (iCCFs) are shunts between meningeal branches of the internal carotid and/or the external carotid arteries and the cavernous sinus. They account for 83% of all carotid–cavernous fistulas (CCFs). Symptomatic iCCFs and those with increased risk of hemorrhage should be treated. Transvenous endovascular treatment is the preferred treatment modality. However, in complex cases, a combination of transarterial and transvenous approaches (multimodal treatment) is required.
Methods A middle-aged woman presented with signs of increased intraocular pressure, blurry vision, diplopia, left proptosis, chemosis, conjunctival injection, ptosis, and cranial nerve VI palsy. Imaging confirmed the presence of a Barrow type D and Thomas type 4 iCCF with cortical venous reflux (CVR).
Results The patient underwent transarterial and transvenous onyx embolization of the shunt, achieving a complete obliteration of the fistula. No complications occurred and the patient had a satisfactory postprocedural evolution.
Conclusion Multimodal onyx embolization is an effective option for the treatment of a complex symptomatic iCCF. If CVR is identified, these lesions should be promptly treated to prevent hemorrhage secondary to rupture.
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Affiliation(s)
- Juan Felipe Abaunza-Camacho
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
| | - David Vergara-Garcia
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
| | - Humberto Madrinan-Navia
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
| | - William Mauricio Riveros
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
| | - Alberto Caballero
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Bogotá, Colombia
- Rosario University School of Medicine, Bogotá, Colombia
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Ramírez-Ferrer E, Perez F, Caballero A, Riveros WM, Osorio-Bohorquez LA. Focal, Extranodal Primary Polymorphous Hemangioendothelioma Treated With Endovascular Embolization and Resection Surgery. Cureus 2021; 13:e19756. [PMID: 34950543 PMCID: PMC8687796 DOI: 10.7759/cureus.19756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/22/2022] Open
Abstract
A male 28-year-old patient complained of a dorsal mass that has been increasing in size in the last six months. The mass was painful, soft, no mobile, and no neurological symptoms or signs were documented. A vascular-type tumor was suspected and endovascular followed by open surgical resection was indicated. Histopathological revealed a rare case of an adult with a primary extranodal polymorphous hemangioendothelioma. Total resection was confirmed by tumor-free resection margin. The postoperative course was uneventful. Polymorph hemangioendothelioma is a rare vascular tumor. Preoperative endovascular embolization is recommended given the high vascular features of the lesion and, therefore, the high rate of bleeding during surgery, to achieve complete resection.
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Affiliation(s)
- Esteban Ramírez-Ferrer
- Neurological Surgery, Center for Research and Training in Neurosurgery (CIEN), Bogotá, COL.,Neurological Surgery, Hospital Universitario de La Samaritana, Bogotá, COL.,Neurological Surgery, Rosario University School of Medicine, Bogotá, COL.,Neurological Surgery, Hospital Universitario Mayor de Méderi, Bogotá, COL
| | - Francisco Perez
- Neurological Surgery, Center for Research and Training In Neurosurgery (CIEN), Bogotá, COL.,Neurological Surgery, Hospital Universitario de La Samaritana, Bogotá, COL.,Neurological Surgery, Rosario University School of Medicine, Bogotá, COL.,Neurological Surgery, Hospital Universitario Mayor de Méderi, Bogotá, COL
| | - Alberto Caballero
- Neurological Endovascular Surgery, Hospital Universitario de La Samaritana, Bogotá, COL.,Neurological Endovascular Surgery, Center for Research and Training in Neurosurgery (CIEN), Bogotá, COL
| | - William Mauricio Riveros
- Neurological Surgery, Rosario University School of Medicine, Bogotá, COL.,Neurological Surgery, Center for Research and Training In Neurosurgery (CIEN), Bogotá, COL.,Neurological Surgery, Hospital Universitario Mayor de Méderi, Bogotá, COL.,Neurological Surgery, Hospital Universitario de La Samaritana, Bogotá, COL
| | - Luis Alejandro Osorio-Bohorquez
- Neurological Surgery, Hospital Universitario Mayor de Méderi, Bogotá, COL.,Neurological Surgery, Center for Research and Training In Neurosurgery (CIEN), Bogotá, COL.,Neurological Surgery, Hospital Universitario de La Samaritana, Bogotá, COL
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Vergara-Garcia D, Abaunza-Camacho JF, Agudelo-Arrieta M, Riveros WM, Caballero A. Transient third cranial nerve palsy after pipeline shield treatment of a ruptured anterior cerebral artery dissecting aneurysm: Case report. Surg Neurol Int 2021; 12:489. [PMID: 34754539 PMCID: PMC8571181 DOI: 10.25259/sni_764_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/13/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Intracranial dissecting aneurysms (IDAs) are rare vascular lesions usually arising from the posterior circulation. The anterior cerebral artery (ACA) is an unusual location for this pathology. Even rarer is the occurrence of a transient de novo third cranial nerve (CN) palsy after flow-diverting device (FDD) treatment of an ACA dissecting aneurysm. Case Description: A middle-aged man with a prior history of hypertension was admitted to our emergency department with severe headache and loss of consciousness after sexual intercourse. Imaging revealed a subarachnoid hemorrhage with stenosis of the left A1 segment of the ACA. Cerebral digital subtraction angiography confirmed a dissecting aneurysm of the left A1 segment. The aneurysm was treated with an FDD (Pipeline Shield). Transient isolated incomplete third CN palsy was documented 12 h after treatment. No evidence of ischemic or hemorrhagic strokes was found. The condition improved after a few days of empiric steroid treatment. Conclusion: An FDD is a suitable alternative for the treatment of a ruptured IDA of the anterior circulation. Some infrequent complications associated with the device, such as de novo cranial neuropathies, are yet to be studied.
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Affiliation(s)
- David Vergara-Garcia
- Department of Neurosurgery, Center for Research and Training in Neurosurgery, Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - Juan Felipe Abaunza-Camacho
- Department of Neurosurgery, Center for Research and Training in Neurosurgery, Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - Mariana Agudelo-Arrieta
- Department of Neurosurgery, Center for Research and Training in Neurosurgery, Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - William Mauricio Riveros
- Department of Neurosurgery, Center for Research and Training in Neurosurgery, Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - Alberto Caballero
- Department of Neurosurgery, Center for Research and Training in Neurosurgery, Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
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Mayorga-Corvacho J, Vergara-Garcia D, Riveros WM, Torres J. Tuberculoma in the Fourth Ventricle: An Unusual Location. Turk Neurosurg 2021; 31:658-660. [PMID: 34169986 DOI: 10.5137/1019-5149.jtn.32344-20.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To present a young immunocompetent patient with a fourth ventricle tuberculoma without pulmonary tuberculosis. A previously healthy young male patient presented with a history of headache, nausea, and blurred vision. Neuroimaging revealed a mass present in the fourth ventricle. The lesion was successfully resected. Histological and microbiological findings suggested the presence of a tuberculoma. Tuberculomas can be found in the posterior fossa in adults. This infectious pathology should not be forsaken when considering the differential diagnosis for infratentorial masses.
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Affiliation(s)
- Juliana Mayorga-Corvacho
- Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
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Perez-Pinto F, Abaunza-Camacho JF, Vergara-Garcia D, Benavides C, Riveros WM, Laverde L. Management of recurrent schwannoma of the cauda equina: A case report. Surg Neurol Int 2021; 12:312. [PMID: 34345453 PMCID: PMC8326104 DOI: 10.25259/sni_357_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Schwannomas of the cauda equina are rare intradural primary spinal tumors. Many of these patients initially present with cauda equina syndromes, and only 2.2% demonstrate clinical recurrence. Gross total excision is the procedure of choice. Case Description: A 62-year-old female had undergone resection of a cauda equina schwannoma 5 years previously. She newly presented with cauda equina symptoms attributed to a recurrent schwannoma. Following gross total secondary tumor resection, the patient’s preoperative deficits fully resolved, and the tumor never recurred. Conclusion: Secondary gross total excision of schwannomas of the cauda equina is critical to avoid further tumor recurrence.
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Affiliation(s)
- Francisco Perez-Pinto
- Department of Neurosurgery, Center for Research and Training in Neurosurgery, Samaritana University Hospital, Rosario University School of Medicine, Bogotu, Colombia
| | - Juan Felipe Abaunza-Camacho
- Department of Neurosurgery, Center for Research and Training in Neurosurgery, Samaritana University Hospital, Rosario University School of Medicine, Bogotu, Colombia
| | - David Vergara-Garcia
- Department of Neurosurgery, Center for Research and Training in Neurosurgery, Samaritana University Hospital, Rosario University School of Medicine, Bogotu, Colombia
| | - Camilo Benavides
- Department of Neurosurgery, Center for Research and Training in Neurosurgery, Samaritana University Hospital, Rosario University School of Medicine, Bogotu, Colombia
| | - William Mauricio Riveros
- Department of Neurosurgery, Center for Research and Training in Neurosurgery, Samaritana University Hospital, Rosario University School of Medicine, Bogotu, Colombia
| | - Leonardo Laverde
- Department of Neurosurgery, Center for Research and Training in Neurosurgery, Samaritana University Hospital, Rosario University School of Medicine, Bogotu, Colombia
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Abaunza-Camacho JF, Vergara-Garcia D, Perez F, Benavides C, Caballero A, Torres J, Riveros WM. Emergent Hybrid Treatment of a Ruptured Scalp Arteriovenous Fistula with Eyelid involvement: Technical Note. J Neurol Surg A Cent Eur Neurosurg 2021; 82:490-493. [PMID: 33845513 DOI: 10.1055/s-0041-1723848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Scalp arteriovenous fistulas (AVFs) are a rare vascular disease usually presenting as a progressively increasing pulsating mass in the scalp. These lesions can be associated with mild to severe complications, including congestive heart failure. If ruptures, this pathology constitutes a life-threatening medical emergency because of its potential to cause severe bleeding and acute anemia. METHODS We describe the case of a young woman with a ruptured Yokouchi type C scalp AVF with eyelid involvement. RESULTS The patient presented with hypovolemic shock and acute anemia due to severe bleeding from the lesion. Emergent treatment through a combined endovascular and open surgical approach was required to stop bleeding and stabilize the patient. CONCLUSIONS Emergent and effective treatment is required to stop bleeding when a scalp AVF ruptures. A combination of endovascular embolization and microsurgical excision of the shunt is a treatment option.
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Affiliation(s)
- Juan Felipe Abaunza-Camacho
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Rosario University School of Medicine, Samaritan University Hospital, Bogotá, Colombia
| | - David Vergara-Garcia
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Rosario University School of Medicine, Samaritan University Hospital, Bogotá, Colombia
| | - Francisco Perez
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Rosario University School of Medicine, Samaritan University Hospital, Bogotá, Colombia
| | - Camilo Benavides
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Rosario University School of Medicine, Samaritan University Hospital, Bogotá, Colombia
| | - Alberto Caballero
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Rosario University School of Medicine, Samaritan University Hospital, Bogotá, Colombia
| | - Jorge Torres
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Rosario University School of Medicine, Samaritan University Hospital, Bogotá, Colombia
| | - William Mauricio Riveros
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Rosario University School of Medicine, Samaritan University Hospital, Bogotá, Colombia
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Agudelo-Arrieta M, Vergara-Garcia D, Madrinan-Navia H, Palmera-Pineda H, Vergara-Dagobeth E, Riveros WM, Caballero A. Concurrent carotid-cavernous fistula and cervical internal carotid artery pseudoaneurysm due to a gunshot injury: A case report. Neurochirurgie 2021; 68:133-136. [PMID: 33771618 DOI: 10.1016/j.neuchi.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/17/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- M Agudelo-Arrieta
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - D Vergara-Garcia
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia.
| | - H Madrinan-Navia
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - H Palmera-Pineda
- Department of Neurosurgery, Central Military Hospital, Nueva Granada Military University, Bogotá, Colombia
| | - E Vergara-Dagobeth
- Department of Surgery, Sucre University School of Medicine, Sincelejo, Colombia
| | - W M Riveros
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - A Caballero
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia; Department of Neurosurgery, Central Military Hospital, Nueva Granada Military University, Bogotá, Colombia
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Abaunza-Camacho JF, Vergara-Garcia D, Perez F, Benavides C, Portilla F, Riveros WM, Caballero A. Direct transcranial coil and Onyx embolization of a dural arteriovenous fistula: Technical note and brief literature review. J Clin Neurosci 2020; 80:232-237. [PMID: 33099352 DOI: 10.1016/j.jocn.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/27/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
Intracranial high-grade dural arteriovenous fistulas (DAVFs) have higher bleeding rates compared to other intracranial vascular malformations. Endovascular treatment is usually recommended for high-grade lesions, aiming at a complete fistula obliteration. However, some patients have vascular abnormalities that limit endovascular access to the precise location of the shunt. Alternative techniques may be considered in this scenario. A middle-aged man presented with intracranial hypertension secondary to a high-grade DAVF. Because of vascular abnormalities precluding transvenous access to the intracranial venous circulation, the patient required treatment by a direct transcranial coil and Onyx embolization of the shunt. Direct transcranial cannulation of a dural sinus is an alternative and effective route for transvenous embolization of DAVFs, especially if abnormal venous anatomy precluding venous access to the required cranial venous system is identified.
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Affiliation(s)
- Juan Felipe Abaunza-Camacho
- Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - David Vergara-Garcia
- Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia.
| | - Francisco Perez
- Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - Camilo Benavides
- Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - Fernando Portilla
- Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - William Mauricio Riveros
- Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - Alberto Caballero
- Neurosurgery Department, Center for Research and Training in Neurosurgery (CIEN), Samaritana University Hospital, Rosario University School of Medicine, Bogotá, Colombia
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