No abstract available.
Caves ; Facial Paralysis ; Fistula

OBJECTIVES: Vascular leiomyoma is an uncommon benign tumor of smooth muscle origin that arises from the muscularis layer of blood vessel walls. We report our experiences with the clinical manifestations, pathologic characteristics, and management of vascular leiomyoma in the head and neck. METHODS: The clinical records of 12 patients with vascular leiomyoma of the head and neck in the 11-year period were reviewed retrospectively. RESULTS: The 12 patients included nine men and three women. The locations of the tumors were variable, including nasal cavity, auricle, hard palate, upper lip, upper eyelid, and supraclavicular space. All but three patients reported an asymptomatic spherical mass; the other three patients complained of intermittent epistaxis or unilateral nasal obstruction resulting from the tumor originating in the nasal cavity. All tumors were painless. Computed tomography consistently revealed a well-defined, intensely enhanced small mass on the mucosa. No case was dignosed corretly as vascular leiomyoma before surgical excision. All patients underwent localized surgical excision of the tumor without recurrence. Five of 12 tumors (42%) were of solid type, four (33%) were of venous type, and three (25%) were of cavernous in histological classification. The histologic type was not related to gender, site of occurrence, and presence of pain. CONCLUSION: Vascular leiomyoma presents as a small, painless mass in various locations of the head and neck region. Localized surgical excision is the only way to make the diagnosis and yields excellent results.
Angiomyoma ; Blood Vessels ; Caves ; Epistaxis ; Eyelids ; Female ; Glycosaminoglycans ; Head ; Humans ; Lip ; Male ; Mucous Membrane ; Muscle, Smooth ; Nasal Cavity ; Nasal Obstruction ; Neck ; Palate, Hard ; Recurrence

PURPOSE: We report a case of a patient with ptosis, lid swelling, limitation of ocular movement, and visual disturbance after a trauma. The patient was diagnosed with unilateral orbital cellulitis, ophthalmic vein thrombosis and bilateral septic cavernous thrombosis and treated. CASE SUMMARY: After head and facial area trauma that occurred 1 month earlier, a 56-year-old man suffered from ongoing visual loss, limitation of ocular movement in all directions, proptosis in the left eye and abduction limitation of the right eye. A week before admission, mild fever and chills were also present. At admission, visual acuity of the left eye was no light perception and pupil reflex was lost. Brain MRA and MRI indicated dilation and thrombosis of the left superior ophthalmic vein, left orbital cellulitis and inflammation in bilateral cavernous sinuses. The patient was immediately treated with systemic antibiotics and steroid injection. Coagulase negative staphylococci were detected in blood culture. CONCLUSIONS: Infection caused by facial trauma spread through the facial area's venous plexus and caused orbital cellulitis. As a result, septic cavernous sinus thrombosis and ophthalmic vein thrombophlebitis occurred. Serious complications can occur after facial trauma, thus rapid differential diagnosis and appropriate treatment are important in determining prognosis.
Anti-Bacterial Agents ; Brain ; Cavernous Sinus ; Cavernous Sinus Thrombosis ; Caves ; Chills ; Coagulase ; Diagnosis, Differential ; Exophthalmos ; Eye ; Fever ; Head ; Humans ; Inflammation ; Light ; Orbital Cellulitis ; Prognosis ; Pupil ; Reflex ; Thrombophlebitis ; Thrombosis ; Veins ; Visual Acuity

Cerebral cavernous malformation with giant cysts is rare and literature descriptions of its clinical features are few. In this case study, the authors describe the clinical symptoms, radiological findings, and pathological diagnosis of cerebral cavernous malformations with giant cysts, reviewing the relevant literature to clearly differentiate this from other disease entities. The authors present a case of a 19-year-old male with a giant cystic cavernous malformation, who was referred to the division of neurosurgery due to right sided motor weakness (grade II/II). Imaging revealed a large homogenous cystic mass, 7.2x4.6x6 cm in size, in the left fronto-parietal lobe and basal ganglia. The mass had an intra-cystic lesion, abutting the basal portion of the mass. The initial diagnosis considered this mass a glioma or infection. A left frontal craniotomy was performed, followed by a transcortical approach to resect the mass. Total removal was accomplished without post-operative complications. An open biopsy and a histopathological exam diagnosed the mass as a giant cystic cavernous malformation. Imaging appearances of giant cavernous malformations may vary. The clinical features, radiological features, and management of giant cavernous malformations are described based on pertinent literature review.
Basal Ganglia ; Biopsy ; Caves ; Craniotomy ; Glioma ; Hemangioma, Cavernous, Central Nervous System ; Humans ; Male ; Neurosurgery ; Young Adult

Intraosseous arteriovenous malformation (AVM) in the craniofacial region is rare. When it occurs, it is predominantly located in the mandible and maxilla. We encountered a 43-year-old woman with Klippel-Trenaunay syndrome affecting the right lower extremity who presented with a left orbital chemosis and proptosis mimicking the cavernous sinus dural arteriovenous fistula. Computed tomography angiography revealed an intraosseous AVM of the sphenoid bone. The patient's symptoms were completely relieved after embolization with Onyx. We report an extremely rare case of intraosseous AVM involving the sphenoid bone, associated with Klippel-Trenaunay syndrome.
Adult ; Angiography ; Arteriovenous Malformations ; Cavernous Sinus ; Caves ; Central Nervous System Vascular Malformations ; Exophthalmos ; Female ; Hemangioma ; Humans ; Klippel-Trenaunay-Weber Syndrome ; Lower Extremity ; Mandible ; Maxilla ; Orbit ; Sphenoid Bone

Direct carotid cavernous fistula (CCF), which is an abnormal communication between the intracavernous carotid artery and the cavernous sinus, is a very rare condition that is generally associated with head trauma, intracavernous aneurysms, and certain connective-tissue diseases. The case of a patient with an infarction in the anterior choroidal artery territory is described herein. Cerebral angiography was performed during consecutive workups to investigate the discrepancy between the magnetic resonance angiography data. An unexpected direct CCF of the ipsilateral side of the infarction was found. It is possible that the CCF had influenced the development of the infarction in the anterior choroidal artery territory.
Aneurysm ; Arteries ; Carotid Arteries ; Cavernous Sinus ; Caves ; Cerebral Angiography ; Cerebral Infarction ; Choroid ; Craniocerebral Trauma ; Fistula ; Humans ; Infarction ; Magnetic Resonance Angiography

Direct carotid cavernous fistula (CCF), which is an abnormal communication between the intracavernous carotid artery and the cavernous sinus, is a very rare condition that is generally associated with head trauma, intracavernous aneurysms, and certain connective-tissue diseases. The case of a patient with an infarction in the anterior choroidal artery territory is described herein. Cerebral angiography was performed during consecutive workups to investigate the discrepancy between the magnetic resonance angiography data. An unexpected direct CCF of the ipsilateral side of the infarction was found. It is possible that the CCF had influenced the development of the infarction in the anterior choroidal artery territory.
Aneurysm ; Arteries ; Carotid Arteries ; Cavernous Sinus ; Caves ; Cerebral Angiography ; Cerebral Infarction ; Choroid ; Craniocerebral Trauma ; Fistula ; Humans ; Infarction ; Magnetic Resonance Angiography

Angioleiomyoma is a rare benign tumor arising from vascular smooth muscle which commonly develops on the lower extremities of middle-aged women. It is rare to occur on the fingers. Angioleiomyoma is classified into three histological subtypes; solid, venous and cavernous. The solid type is most common but the cavernous type is very rare. We report a case of a 53-year-old female with a digital cavernous angioleiomyoma. The patient had a 2-year history of an asymptomatic and slowly enlarging 1.3x1.0 cm-sized subcutaneous nodule on the distal phalanx of her second left finger. Histopathologic examination showed a well-demarcated nodular tumor in the dermis, which composed of numerous, dilated vessels and bundles of smooth muscle fibers.
Angiomyoma ; Caves ; Dermis ; Female ; Fingers ; Humans ; Lower Extremity ; Muscle, Smooth ; Muscle, Smooth, Vascular

PURPOSE: The aim of this study was to evaluate the feasibility and safety of the transfacial venous embolization of cavernous or paracavernous dural arteriovenous fistula (DAVF) in which approach via inferior petrosal sinus (IPS) was not feasible. MATERIALS AND METHODS: We identified the cases of transfacial venous embolization of cavernous sinus (CS) or adjacent dural sinuses from the neurointerventional database of three hospitals. The causes and clinical and angiographic outcomes of transfacial venous embolization were retrospectively evaluated. RESULTS: Twelve patients with CS (n = 11) or lesser wing of sphenoid sinus (LWSS, n = 1) DAVF were attempted to treat by transvenous embolization via ipsilateral (n = 10) or contralateral (n = 2) facial vein. Trans-IPS access to the target lesion was impossible due to chronic occlusion (n = 11) or acute angulation adjacent the target lesion (n = 1). In all twelve cases, it was possible to navigate through facial vein, angular vein, superior ophthalmic vein, and then CS. It was also possible to further navigation to contralateral CS through intercavernous sinus in two cases, and laterally into LWSS in one case. Post-treatment control angiography revealed complete occlusion of the DAVF in eleven cases and partial occlusion in one patient, resulting in complete resolution of presenting symptom in eight and gradually clinical improvement in four patients. There was no treatment-related complication during or after the procedure. CONCLUSION: In the cavernous or paracavernous DAVF in which trans-IPS approach is not feasible, the facial vein seems to be safe and effective alternative route for transvenous embolization.
Angiography ; Arteriovenous Fistula ; Cavernous Sinus ; Caves ; Central Nervous System Vascular Malformations ; Humans ; Retrospective Studies ; Sphenoid Sinus ; Veins

PURPOSE: The use of drug-eluting stent (DES) to treat intracranial stenosis has shown short-term success. However, there are no reports regarding the long-term results of DES. We present the long-term clinical outcome after DES stenting for symptomatic severe intracranial stenosis. MATERIALS AND METHODS: Our study included a consecutive series of 11 patients who underwent intracranial stenting using DES between March and July, 2006, during the time when bare metal stents were not available at our medical institution. The mean patient age was 59 years. Lesion location was the middle cerebral artery in five patients, the intradural vertebral artery in three, the basilar artery in one, the vertebrobasilar junction in one, and the cavernous internal cerebral artery in one patient. We evaluated the technical success, defined as reduction of residual stenosis < or =30% in the target lesion) as well as the clinical and imaging outcomes as long as 75 months following the procedure. In addition to a cerebral angiogram (n = 2), follow-up study was obtained by CT angiography (n = 6) or intracranial Doppler imaging (n = 2) during a mean time of 55 months after the procedure (range, 24 to 73 months). Three patients refused imaging follow-up and accepted only clinical follow-up. The mean clinical follow-up period was 67 months (range, 47-75 months). RESULTS: Stenting in all patients was technically successful and without periprocedural complications. There was thrombus formation during the procedure in one patient who experienced no further complications. There were no new neurological events during the mean follow-up period of 5.6 years. No patients were found to have restenosis > or =50% at during the mean follow-up period of 55 months. One patient died of a sudden heart attack 59 months following the procedure which was regarded as unrelated to the cerebral lesion. CONCLUSION: Our study demonstrates that DES shows long-term stability and safety, and results in good clinical outcomes with a low rate of restenosis.
Angiography ; Atherosclerosis ; Basilar Artery ; Caves ; Cerebral Arteries ; Constriction, Pathologic ; Drug-Eluting Stents ; Follow-Up Studies ; Heart ; Humans ; Middle Cerebral Artery ; Stents ; Thrombosis ; Vertebral Artery