[Vascular compression syndromes of the cranial nerves]

The blood vessels which are running nearby the cranial nerves and the brainstem can be elongated; curves and loops of the vessels may develop mostly due to the degenerative alterations of ageing and these vessels can compress the surrounding neural elements. The authors report a review of vascular compression syndromes based on the literature and their own experience. The typical clinical symptoms of the syndromes subserving the proper diagnosis, the pathomechanism, the significance of imaging especially the magnetic resonance angiography, the experience with the surgical technique of microvascular decompression which is the only causal treatment of the syndromes are discussed. In cases of non-responsible medical treatment the microvascular decompression should be the eligible treatment in certain syndromes (trigeminal and glossopharyngeal neuralgia, hemifacial spasm) for it is a highly effective and low risk method.

Ets-1 expression is associated with cranial neural crest migration and vasculogenesis in the chick embryo

The transcription factor Ets-1 is expressed in many different migratory cell types, suggesting that it may play an important role in regulating motility. To determine whether its expression in the neural crest is consistent with such a function, we have performed a detailed analysis of its expression during early chick embryogenesis. Our results show that this transcription factor is up-regulated in the cranial neural folds and dorsal neural tube approximately 4-6 h prior to commencement of neural crest migration. c-Ets-1 continues to be expressed by migrating cranial neural crest cells and subsequently by some neural crest-derived tissues. In addition to neural crest, we find expression of c-Ets-1 in endothelial cells of blood vessels, in somitic and intermediate mesoderm, in limb buds and in the heart.

Internal carotid aneurysms presenting with mass effect symptoms of cranial nerve dysfunction: efficacy and imitations of endosaccular embolization with GDC

OBJECTIVE

The authors report a retrospective analysis of their experience in the endosaccular embolization of internal carotid aneurysms which caused mass effect symptoms of cranial nerves (CN) and review the efficacy and limitations of this technique.

METHODS

Between April 1997 and August 2002, 12 internal carotid aneurysms that caused mass effect symptoms of CN were treated by endosaccular GDC embolization with parent artery preservation. The locations were the cavernous internal carotid artery (CV) in six patients, carotid-ophthalmic artery (CO) in two patients, and posterior communicating artery (PCo) in four patients. The angiographical size of the aneurysms ranged from 6 to 20 mm, with a mean of 13.3 mm. Duration of symptoms ranged from 0.5 to 120 months, with a mean of 13.7 months. All aneurysms were treated by endosaccular guglielmi detachable coil (GDC) embolization with preservation of the internal carotid artery.

RESULTS

Five patients (42%) had complete resolution of symptoms, four (33%) had significant improvement of symptoms, and three (25%) were unchanged. Immediate posttreatment angiographic studies revealed neck remnant (NR) in nine patients and dome filling (DF) in three patients. In one patient (case 10), the resolved symptoms became worse 29 months later. Follow-up angiograms were obtained in 10 patients, and recanalization was observed in four of them (40%). Transient thrombotic complication occurred in only one patient. The group with resolution or improvement of symptoms demonstrated a shorter duration of symptoms before GDC treatment (< or = 12 months).

CONCLUSION

Even subtotal endosaccular embolization of aneurysms may reduce mass effect symptoms of cranial nerves. However, careful follow-up is needed because subtotal occlusion carries a future risk of growth.

Transvenous embolization of a direct carotid cavernous fistula through the pterygoid plexus

Closure of a direct carotid cavernous fistula with detachable coils by transpterygoid venous approach to the cavernous sinus is an alternative technique that may be applied in cases in which other techniques offer increased risk or in which other techniques have failed. In this case report, we present the details of the management of a direct carotid cavernous fistula by this method.

Topographic microsurgical anatomy of the paraclinoid carotid artery

In this publication, the authors describe the microanatomic topography of the entire paraclinoid area with respect to the paraclinoid segment of the internal carotid artery and its surrounding anatomical structures. Special attention was given to the borders of the paraclinoid area, cavernous sinus, arterial vessels, and cranial nerves passing through the region. The paraclinoid region was defined as a pyramid-formed space formed by the dural covering of the anterior clinoid process. The superior border is formed by the continuity of the anterior petroclinoid fold, anteriorly on the superior surface of the anterior clinoid process and medially in the direction of the diaphragma sellae. This dural sheet encircles the internal carotid artery and forms the so-called distal dural ring of the internal carotid artery. The medial border of the paraclinoid region is formed by the body of the sphenoid bone and the adjacent periosteal sheet. The inferior border is formed by a fibrous plate between the middle and anterior clinoid processes. This so-called proximal dural ring separates the venous compartments of the cavernous area from the paraclinoid area. The lateral border is formed by the lateral surface of the anterior clinoid process with its dural covering. The arterial supply of this region is provided by branches of the intracavernous carotid segment and the ophthalmic artery. The important nerves in close vicinity to the paraclinoidal area are the optic and the oculomotor nerves. Understanding and knowledge of the topographic anatomy of the paraclinoid area is essential for microsurgical exposure of this region.

Neuroendoscopy in microvascular decompression for trigeminal neuralgia and hemifacial spasm: technical note

Miocrovascular decompression is an effective treatment for trigeminal neuralgia (TN) and hemifacial spasm (HFS). A complete cure cannot be obtained, and additional adjuncts for extended use of endoscopy are needed. The use of an endoscope combined with the operating microscope can enhance the surgeon's ability to view deep structures during operation. We study the application of combined microsurgical and endoscopic techniques in 21 cases of HFS and 12 cases of TN. With these techniques the surgeon can explore the ventral aspect of the brainstem and cranial nerves without further retraction, can see the groove caused by compression of the offending artery, and can confirm the proper position of the prosthesis after attachment to the dura by fibrin glue. In HFS the most common offending vessels in 75% of cases were the posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA) and in 25% of cases the vertebral artery (VA). In trigeminal neuralgia the offending vessel in 60% of cases was the superior cerebellar artery (SCA), and in 40% of cases the AICA. The overall success rate was 97% with minimal morbidity 3% (facial palsy) and no mortality. The aim of this work is to study advantages and disadvantages of using endoscopy during microvascular decompression for TN and HFS.

Innervation pattern of substance P- and calcitonin gene-related peptide-immunoreactive nerves of the cerebral arteries in the quail

The pattern of cerebrovascular substance P (SP)- and calcitonin gene-related peptide (CGRP)-immunoreactive (IR) innervation was investigated in the quail. SP- and CGRP-IR nerves were relatively a few in the rostral part of the anterior circulation, and very scanty or lacking in its caudal part and the whole of the posterior circulation. A significant finding was that the anterior circulation in the majority of individuals is furnished with a varying proportion of SP-IR nerves with or without CGRP immunoreactivity. There was a good correlation in the expression of CGRP immunoreactivity between SP-IR cells in the ophthalmic division of the trigeminal ganglion and SP-IR nerves supplying the major cerebral arteries. In the quail, SP- and CGRP-IR fiber bundles are usually present in the internal ethmoidal artery (IEA). From these and other findings, it is most probable that cerebral perivascular SP- and CGRP-IR nerves are mainly derived from the same categories of neurons in the primary sensory ganglion via the IEA. The close association of varicose SP-IR axons to the nerve cells in the pial arteries suggests that these intrinsic neurons may play some vasocontrolling roles through the modulatory effect of their pericellular SP-IR axons.

Anatomy and blood supply of the lower four cranial and cervical nerves: relevance to surgical neck dissection

This study is a continuation of previous work searching for possible anatomic reasons to explain variable and usually unpredictable postoperative pain and dysfunction after the same nerve losses with similar neck dissection operations. The study consisted of dissections of 19 deceased unpreserved elderly subjects arterially injected with dyed latex. Of the 19 subjects, 14 had brain stem and cervical spinal cord dissections, and all had neck dissections. The findings suggested two possible anatomic reasons for the pain and dysfunction: (i) The intracranial anatomy of the lower four cranial nerves, the glossopharyngeal (IX), the vagus (X), the spinal accessory (XI), and the hypoglossal (XII), was just as variable as the previously reported peripheral spinal accessory nerve plexus; and (ii) Both the intracranial and neck dissections indicated that the blood supply to the lower four cranial and cervical nerves, particularly to the brachial plexus, could be impaired by atherosclerosis and/or neuroforaminal impingement or operative loss. This loss of blood supply theoretically could result in ischemia as another possible cause of postoperative pain and dysfunction. It is concluded that because of the potential importance of each nerve and vessel, often unknown at operation, it is very important to spare as many of them as possible to avoid subsequent painful impairment.

Aspirin use and the prevention of acute ischemic cranial nerve palsy

PURPOSE

To assess the relationship of aspirin use and ischemic cranial nerve palsies among patients with diabetes mellitus and hypertension.

METHODS

This retrospective case-control study involved 100 patients with ischemic cranial nerve palsies in association with diabetes, hypertension, or both (palsy cases) and 163 age-matched and sex-matched patients with diabetes, hypertension, or both but without ischemic cranial nerve palsies (nonpalsy control subjects). Comparisons were made with respect to duration of diabetes, dose and duration of aspirin use, dose and duration of tobacco use, and presence of cardiac or cerebrovascular disease.

RESULTS

There were 20 oculomotor, 33 trochlear, 37 abducens, and 10 facial nerve palsy cases. The median duration of diabetes was 6 years for cases and 7 years for control subjects. There were 34 cases (34%) who had used aspirin for a mean duration of 5.5 years before the onset of the cranial nerve palsy and 49 control subjects (30.1%) who had used aspirin for a mean duration of 4.3 years. There were no significant differences between cases and control subjects for duration of diabetes (P =.94); aspirin use (P =.51), duration (P =.50), and dosage (P =.89); tobacco use (P =.73) and consumption (P =.45); and proportion of cardiac disease (P =.17). Cerebrovascular disease was significantly less common among palsy cases than nonpalsy control subjects (P<.001). There was no significant difference in the odds of a patient having cranial nerve palsy in the aspirin group compared with the nonaspirin group (odds ratio, 1.12; 95% confidence interval, 0.70-2.04).

CONCLUSION

Aspirin use was not associated with a reduced rate of ischemic third, fourth, sixth, and seventh nerve palsies among patients with diabetes mellitus and hypertension. Aspirin appears to be ineffective in preventing ischemic third, fourth, sixth, and seventh cranial nerve palsies. Patients with ischemic cranial nerve palsy have a significantly lower rate of strokes and transient ischemic attacks than patients who have diabetes or hypertension but who do not have a history of cranial nerve palsy.

On the mechanism of transient postoperative deficit of cranial nerves

BACKGROUND

Transient cranial nerve deficit is a common postoperative complication after surgery at the cranial base. In this type of surgery, the cranial nerves are often not macroscopically damaged or transected, but more or less manipulated during surgery. In this article, the cellular mechanisms of postoperative cranial nerve deficit are reviewed.

METHODS

Experimental and clinical papers concerning cranial and peripheral nerve damage during surgery were critically reviewed.

RESULTS

There are definite differences in the anatomical and histological structure between peripheral and intracranial nerves, which make the latter much more prone to intraoperative damage. Several pathological mechanisms are responsible for postoperative deficit, such as segmental demyelination of the nerve, comprised microcirculation within the nerve, postoperative edema, and "synaptic stripping" around the cell bodies of the affected neurons, which can be regarded as a regenerative response of the nervous system.

CONCLUSIONS

Several cellular mechanisms are responsible for postoperative cranial nerve deficit after skull base surgery. Understanding these mechanisms is important for all surgeons involved in the treatment of skull base lesions.

Branches of the intracavernous internal carotid artery and the blood supply of the intracavernous cranial nerves

With the increasing frequency of surgical operations to the cavernous sinus greater knowledge of the microanatomy of the cavernous sinus has become necessary. The most frequently seen complications during cavernous sinus surgery involve impairment of cranial nerves. This can occur due to direct damage or ischemia. For these reasons, it is important to know the arterial supplies to the cranial nerves in the cavernous sinus and the anatomy of these branches as well. 15 formaline fixed adult cadavers were used in this study. Before the dissections, the internal carotid artery and vertebral artery were filled with coloured latex on both sides. In this report, the intracavernous branches of internal carotid artery (I.I.C.A.) were identified based on the principles of Nomina Anatomica (1989) and compared with others. In our study we found that the segment of the abducens nerve which lies in Dorello's channel was supplied by the meningeal branch; from the point at which it pierces the cerebellar tentorium, the trochlear nerve is supplied by the tentorial cerebellar artery; the posterior cerebellar artery supplies the proximal segment of the oculomotor nerve that proceeds to the oculomotor triangle. Except for these, all the cranial nerves that were located on the lateral wall of the sinus cavernosus are supplied by the tentorial marginal branch and the branches of the lateral trunk.

The meningohypophyseal trunk and its blood supply to different intracranial structures. An anatomical study

50 meningohypophyseal trunks of the intracavernous internal carotid artery were studied in 25 human cadavers. Special attention was given to the main variations of branching patterns of this trunk. The dorsal meningeal arteries were found in all cases and three typical variations were observed in their origins and courses: a prominent medial branch (52%), a bifurcating type (38%) or a single lateral branch was present (10%). The tentorial artery of Bernasconi-Cassinari arised as a single branch in 64% of the cases, while in 36% two or more branches took a direct origin from the main trunk. The inferior hypophyseal artery was prominent in 82% of the cases. The inferolateral trunk had a common origin with the meningohypophyseal trunk in 8% of our dissections. A large number of anastomoses between these vessels was observed. As a number of tumorous and vascular pathologies, which can be treated with microsurgical techniques, take their origin from the cavernous sinus, the knowledge of the smaller vessels arising from the intracavernous internal carotid artery as well as their main variations is important.

Vascular permeability to sodium fluorescein in the rabbit cranial nerve root: possible correlation with normal cranial nerve enhancement on gadolinium-enhanced magnetic resonance imaging

Vascular permeability in cranial nerve roots was examined after intravenous injection of sodium fluorescein in the adult rabbit. Fluorescence was observed in the distal nerves through the following portions: intracavernous portion of the oculomotor nerve, distal internal auditory canal segment of the facial nerve, and ganglionic portions of the trigeminal, glossopharyngeal and vagus nerves. In the acoustic nerve, the vestibular ganglion showed fluorescence. No fluorescence was observed in the olfactory or optic nerves. During in vivo gadolinium-enhanced magnetic resonance imaging (Gd-MRI) of two separate animals, trigeminal nerve enhancement was observed in the region showing fluorescence. Histologically, intense fluorescence was observed in ganglia and external nerve sheaths of the cranial nerves showing macroscopic fluorescence. A slight fluorescence was also seen in endoneurial connective tissue but not observed within the nerve fibers. The results of this study suggest that the physiological enhancement of human cranial nerves seen on Gd-MRI may correlate with vascular permeability.

Microsurgical anatomy of the cavernous sinus

The cavernous sinuses of 50 adult cadavers were examined to investigate the relationships of the blood vessels and cranial nerves, important structures during surgery in this sinus. The first and second divisions of the fifth cranial nerve were embedded in the deep dural layer of the cavernous sinus and were supplied by the two main branches of the intracavernous carotid artery. The meningohypophyseal artery supplied the sixth cranial nerve in Dorello's canal and the third and fourth cranial nerves where they entered the dura. The inferolateral trunk supplied the third, fourth, fifth, and sixth cranial nerves. The size of the meningohypophyseal artery was usually inversely proportional to the size of the inferolateral trunk. The capsular artery did not supply the cranial nerves. The cavernous sinus can be approached through various routes: a) superior, through the anteromedial or medial triangle; b) lateral, through the paramedial, Parkinson's, anterolateral, and lateral triangles; c) inferior, through the posterolateral and posteromedial triangles; and d) from the inferomedial walls. The choice of surgical approach depends mainly on the location of the lesion to be treated.

The blood supply of the intracavernous cranial nerves: an anatomic study

Cranial nerve deficits are the most common complications of cavernous sinus surgery. Often the deficit occurs despite anatomic preservation of the nerve, and ischemic injury is thought to be the cause. A better understanding of the blood supply of these nerves may help to prevent such complications. The authors performed a cadaveric microsurgical study of the intracavernous cranial nerves and their blood supply in 20 cavernous sinuses. The oculomotor nerve received branches from the inferolateral trunk or its equivalent in all specimens (100%). The proximal trochlear nerve received branches from the inferolateral trunk in 80% of the specimens and from the tentorial artery of the meningohypophyseal trunk in 20%. The distal half was supplied by the branches from the inferolateral trunk only. In the region of Dorello's canal, the proximal third of the abducens nerve received branches from the dorsal clival artery of the meningohypophyseal trunk. The middle and distal thirds received branches from the inferolateral trunk. The ophthalmic and proximal maxillary segments of the trigeminal nerve received branches from the inferolateral trunk. The distal maxillary segment was supplied by the artery of the foramen rotundum. In the majority of cases, the medial third of the Gasserian ganglion received branches from both the inferolateral trunk and the tentorial artery. The middle third of the ganglion received branches from either the inferolateral trunk or the middle meningeal artery. Our findings indicate the important role the intracavernous branches of the internal carotid artery play in the blood supply of the intracavernous cranial nerves, and stress the need to preserve these branches to prevent or minimize postoperative deficits.

["Palatolaryngeal hemiplegia" in transient brain stem ischemia--a contribution to neurogenic dysphagia]

A 65-year old man suffering from dysphagia with aspiration was examined. ENT examination showed a Horner syndrome and cranial nerve palsy with paralysis of the soft palate and one vocal cord (palatolaryngeal hemiplegia, Avellis' syndrome). Pharyngeal manometry and videofluoroscopy depicted an asynergic swallowing with cricopharyngeal achalasia. CT scans of mediastinum, head, neck, and skull base showed no signs of abnormality. MR imaging of the brain stem demonstrated an enrichment of contrast medium in the dorsal region of the upper medulla oblongata in the level of the centre of the glossopharyngeal and vagus nerve. This case demonstrates an uncommon cause of dysphagia which was related to transitory brain stem ischaemia. After a period of three weeks the patients' complaints vanished as well as the clinical features. In a follow-up of MR-imaging three months later no focal enhancement of contrast medium was seen confirming the diagnosis of a brain stem ischaemic lesion.

The Collet-Sicard syndrome as a complication of cardiovascular surgery

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The clinical importance of the inferolateral trunk of the internal carotid artery

The inferolateral trunk (ILT) of the internal carotid artery (ICA) is a branch that arises inferiorly from the C4 segment of the cavernous ICA. It provides blood supply to the 3rd, 4th, and 6th cranial nerves, as well as to the gasserian ganglion. The ILT anastomoses to branches of the internal maxillary artery, providing collateral circulation between the external carotid artery and the ICA systems. Retinal and cerebral emboli can arise from the external carotid artery system and travel via the ILT to the ICA. Cranial nerve palsies may result after occlusion of the ILT. We present the cases of four patients who had iatrogenic neurological dysfunction subsequent to intravascular procedures that involved the ILT. These cases provide further clinical confirmation of the importance of this blood vessel. A 5th case involving iatrogenic occlusion of the ILT and no neurological deficit is also presented, demonstrating that the ILT is not the sole blood supply of the cranial nerves in the cavernous sinus.

The cranial nerve vascular compression syndrome: II. A review of pathophysiology

The various hypotheses regarding the pathophysiologies of trigeminal neuralgia and hemifacial spasm are reviewed, and the results of recent physiological studies on the pathogenesis of hemifacial spasm are discussed. Evidence is presented that strongly supports the hypothesis that the symptoms and signs of hemifacial spasm are caused by hyperactivity in the facial motonucleus. Some of the contradictions regarding the prevalence of vascular conflicts in the cerebellopontine angle and the symptoms of vascular compression are discussed, and a hypothesis is presented that assumes that a suitable substrate must be present, in addition to vascular compression of the respective cranial nerve root, for the symptoms and signs of a cranial nerve vascular compression disorder to develop. Finally, it is discussed how this hypothesis can explain some of the differences between the disorders that can be cured by microvascular decompression of respective cranial nerves.

Neurovascular relationships of the root entry zone of lower cranial nerves: a microsurgical anatomic study in fresh cadavers

The study describes the microsurgical neurovascular relationships of the root entry zone of lower cranial nerves in 23 cadavers. The vessel type, frequency of contact and site of contact on the root entry zone were analysed. Three types of vascular patterns (Types I-III) were found. Facial nerve: frequency of contact 31.8%; arterial contact 92.9%, Type I (lying across) 78.9%; anterior inferior cerebellar artery in 84.6%. Glossopharyngeal nerve: frequency of contact 23.9%; arteries 54.5%, veins 45.5%; posterior inferior cerebellar artery in 83.3% and Type II (loop) 50.1%. Vagus nerve: frequency of contact 26.1%, arteries 58.3%. Types II and III (passing through) formed 42.9% each. Hypoglossal nerve: frequency of contact 78.2%; vertebral artery 88.9%. No 'grooving' on any nerve was seen. Hence, 'contact' by a vessel at the root entry zone may not be significant in the etiology of lower cranial rhizopathies.

Neurons with access to the general circulation in the central nervous system of the rat: a retrograde tracing study with fluoro-gold

Central nervous system neurons which have access to the general circulation were identified by injecting the retrograde tracer Fluoro-Gold peripherally. Fluoro-Gold does not penetrate the blood-brain barrier but is taken up by nerve terminals which project to areas supplied by fenestrated capillaries or to the periphery. Fluoro-Gold-accumulating neurons were present in the following regions or cell groups of the central nervous system: diagonal band of Broca; medial preoptic area; organum vasculosum of the lamina terminalis; subfornical organ; anterior periventricular area; paraventricular nucleus; arcuate nucleus; accessory magnocellular nuclei of the hypothalamus; motor neurons of cranial nerves III-VII, and IX-XII in the brainstem and spinal cord; autonomic ganglionic cells of cranial nerve III (Westphal-Edinger nucleus) in the mesencephalon and the intermediolateral column of the spinal cord; sensory ganglia of the cranial nerve V (mesencephalic trigeminal nucleus); and the C1-C2 and A2 adrenergic cell groups in the medulla. In addition, Fluoro-Gold-accumulating neurons were seen in the sensory ganglia of cranial and spinal nerves. Retrograde labeling with Fluoro-Gold can be combined with immunocytochemistry to identify the chemical messengers within Fluoro-Gold-labeled perikarya. Although a large number of neurons are labeled in the central nervous system with Fluoro-Gold when it is administered peripherally, this technique in combination with immunocytochemistry can be a powerful tool to identify selected neuronal systems in the central nervous system.

Cavernous-carotid thrombosis and ocular motor paresis

A 64-year-old man presented with the acute onset of unilateral blindness and ipsilateral ocular motor paresis. Occlusion of the central retinal artery associated with thrombosis of the internal carotid artery in the cavernous sinus was demonstrated by angiography and magnetic resonance imaging. Cases of carotid thrombosis associated with ipsilateral ocular motor paresis are rare. The pathophysiology of intracavernous carotid thrombosis is discussed in connection with blood supply of the cranial nerves in the cavernous sinus.

Persistent primitive trigeminal artery: a possible cause of trigeminal and abducens nerve palsy

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Relapsing spinal cord and cranial nerve syndromes in Takayasu's arteritis

Isolated spinal cord and cranial nerve syndromes are extremely rare manifestations of Takayasu's arteritis and relapsing syndrome has not been described. A report of 31 year old lady is presented who had four distinct neurological syndromes over a period of six years with involvement of spinal cord and cranial nerves. Significance of this presentation is discussed.

Cranial nerve ischaemic arterial syndromes. A review

Topographical vascular disorders involving combinations of cranial nerves are reviewed in this study. These are indicated by the correspondence between groupings of clinical manifestations and anatomical vascular distributions. Confirmatory evidence is provided by mishaps, following diagnostic or therapeutic angiography. Three systems play a role in the vascularization of cranial nerves: the inferolateral trunk (ILT), most often arising from the internal carotid artery, the middle meningeal system (MMS), and the ascending pharyngeal system (APS); the latter two are both derived from the external carotid artery. Conclusions concerning the ILT are least definite because of variations in vascular territory and the lack of confirmation from embolic events in a vascular region that is rarely the site of embolization. The specific ILT territory includes cranial nerve III and also nerves IV, VI and V1. Knowledge of the vascularization of nerve III may furnish explanations as to its different modes of involvement in diabetes mellitus. For the MMS, the cranial nerves concerned are V2, V3 and VII. Two vascular territories for the intrapetrous portion of nerve VII are defined: the first (stylomastoid artery) is limited to nerve VII; the second (MMS) supplies VII and V. Two examples of involvement of VII and V following selective MMS embolization are presented. A study of Bell's palsy associated with nerve V impairment is summarized. The APS supplies nerves IX, X, XI and XII; XI has a dual vascularization which explains why it can either be spared (as was the case in an angiographic accident) or involved (as in a case of herpes zoster). A vascular mechanism should be considered when cranial nerve lesions occur in the syndromes described here.

Lidocaine injection into external carotid branches: provocative test to preserve cranial nerve function in therapeutic embolization

Endovascular obliteration of hypervascular lesions of the head and neck has become clinically accepted, but it may cause stroke and peripheral cranial nerve palsy. By using a flow-controlled technique to deliver the materials and by knowing the vascular anatomy of the cranial nerves, these problems are less likely to occur. Occasionally, though, vascular anatomy is distorted by the lesion or is anomalous in its distribution. A provocative test of lidocaine injected into the appropriate artery seems to offer a functional test of whether the capillary bed will tolerate small-particle or liquid plastic occlusion. Twenty-six patients had various branches of their external carotid arteries challenged with lidocaine. Three developed transient palsies, and their treatments were modified. None of the 26 patients developed a complication of embolization.

[Organogenesis of cranial ganglia in the chick embryo: a comparison of the development of blood vessels and neurocytodifferentiation]

Neurohistogenetic and vasculogenetic processes have been analytically compared in several cranial ganglia, ciliary (III nerve), semilunar (V nerve), vestibulocochlear (VIII nerve), petrosal (IX nerve) and nodose (X nerve), of chicken embryos from the 3rd to the 12th incubation day. The results indicate that during the organogenesis of these ganglia the formation of the first intrinsic vessels and the successive development of vascular networks follow the beginning and, respectively, the main steps of the neuroblast morphological maturation. The differences noticed by the Authors as concerns the chronological sequence showed by the vasculogenetic events in the various ganglia have been ascribed to the different proceeding of the neurohistogenesis since blood vessels first appear and build networks where the ganglionic development and differentiation are more precocious.

Monitoring auditory functions during cranial nerve microvascular decompression operations by direct recording from the eighth nerve

A method is described for recording sound-evoked responses directly from the eighth nerve during operations in the cerebellopontine angle, particularly during microvascular decompression operations for cranial nerve dysfunction. This method provides important information to the surgeon during the operation that cannot be provided by recording brain-stem auditory evoked potentials (BAEP) using surface electrodes. By recording sound-evoked responses intracranially and recording BAEP with scalp electrodes, the risk of hearing loss in these operations is decreased.

Further evidence for a muscarinic component to the neural vasodilator innervation of cerebral and cranial extracerebral arteries of the cat

Transmural electrical stimulation of segments of lingual and cerebral (basilar, middle and posterior cerebral) and also other cranial arteries of the cat results after a long latency in a dilator response. The response may be resolved into two components--an initial transient atropine-sensitive component and a slower more ponderous one that is atropine-resistant. The variability in pattern of dilation responses from segments of different vessels or even those from the same segment of different cats is considerable. Some responses are entirely atropine-sensitive and others atropine-resistant; however the vast majority show a dilation that can be considered to be made up of both components. The latencies of the atropine-sensitive and atropine-resistant components are not different. The effect of atropine on the lingual but not the cerebral arteries is frequency dependent, being proportionately greater at low than at high frequencies. In both vessels, the effect of atropine is independent of train length at 1 Hz. Physostigmine potentiates significantly the dilation of the lingual artery but not that of the cerebral arteries. The potentiation is reversed by atropine. The endogenous acetylcholine level was measured in a series of vessels. It can be correlated with the activity of choline acetyltransferase and the presence of neurogenic dilation. It is proposed that there are two transmitters released in parallel from nerve(s) in the walls of cerebral, lingual, and possibly, other cranial arteries to cause vasodilation. It seems that one of these is acetylcholine.

[Unilateral involvement of IX, X, Xi and XII in cervical zoster. Cranial nerve contribution to vascular pathology]

The authors report a case of a cervical zoster (C2 - C4) with unilateral involvement of the IXth, Xth, XIth and XIIth cranial nerves. Angiography failed to opacify the ascending pharyngeal artery on the same side, presumably because of a thrombosis secondary to the zoster infection. As the ascending pharyngeal artery is known to supply the last four cranial nerves, this study should be seen as a further example of the varied cranial nerve involvement which may arise on a vascular basis.

[Cogan's syndrome with angitis of cranial nerves, aortitis, endocarditis, and glomerulonephritis (author's transl)]

A 34-year-old woman died of left-heart failure due to combinated aortic-valve disease three years after manifestation of Cogan's syndrome characterized by sudden inner-ear deafness, loss of equilibrium, interstitial keratitis, and progressive loss of vision during pregnancy. At necropsy there was evidence of recurrent endocarditis of the aortic valves with stenosis and regurgitation, severe angitis of the thoracic aorta with marked secondary sclerosing changes as the cause of the heart failure. Angitis within the optical fasciculus and stato-acoustic nerve was the cause of the vestibular and optical defects. Primary changes in the visual and auditory cortices, the retina and inner ear were excluded as causes. There was also acute membrano-proliferative glomerulonephritis, which may have been coincidental.