Right frontotemporal craniotomy for ECA-to-MCA direct and indirect bypass and occipital artery indirect bypass to the posterior circulation: case report

2020 ◽  
pp. 1-5
Author(s):  
Mitchell W. Couldwell ◽  
Samuel Cheshier ◽  
Philipp Taussky ◽  
Vance Mortimer ◽  
William T. Couldwell
Keyword(s):  
Case Report ◽  
Pediatric Patients ◽  
Posterior Circulation ◽  
Occipital Artery ◽  
Transient Ischemic Attacks ◽  
Collateral Vessel ◽  
Suboccipital Craniotomy ◽  
Uncommon Disease ◽  
Indirect Revascularization ◽  
The Brain

Moyamoya is an uncommon disease that presents with stenoocclusion of the major vasculature at the base of the brain and associated collateral vessel formation. Many pediatric patients with moyamoya present with transient ischemic attacks or complete occlusions. The authors report the case of a 9-year-old girl who presented with posterior fossa hemorrhage and was treated with an emergency suboccipital craniotomy for evacuation. After emergency surgery, an angiogram was performed, and the patient was diagnosed with moyamoya disease. Six months later, the patient was treated for moyamoya using direct and indirect revascularization; after surgery there was excellent vascularization in both regions of the bypass and no further progression of moyamoya changes. This case illustrates a rare example of intracerebral hemorrhage associated with moyamoya changes in the posterior vascularization in a pediatric patient and subsequent use of direct and indirect revascularization to reduce the risk of future hemorrhage and moyamoya progression.

scholarly journals Posterior cerebral artery stenosis and posterior circulation revascularization surgery in pediatric patients with moyamoya disease

2018 ◽  
Vol 21 (6) ◽  
pp. 632-638 ◽  
Author(s):  
Tomomi Kimiwada ◽  
Toshiaki Hayashi ◽  
Reizo Shirane ◽  
Teiji Tominaga
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Pediatric Patients ◽  
Posterior Cerebral Artery ◽  
Posterior Circulation ◽  
Initial Diagnosis ◽  
Occipital Artery ◽  
Anterior Circulation ◽  
Before And After ◽  
Revascularization Surgery

OBJECTIVESome pediatric patients with moyamoya disease (MMD) present with posterior cerebral artery (PCA) stenosis before and after anterior circulation revascularization surgery and require posterior circulation revascularization surgery. This study evaluated the factors associated with PCA stenosis and assessed the efficacy of posterior circulation revascularization surgery, including occipital artery (OA)–PCA bypass, in pediatric patients with MMD.METHODSThe presence of PCA stenosis before and after anterior circulation revascularization surgery and its clinical characteristics were investigated in 62 pediatric patients (< 16 years of age) with MMD.RESULTSTwenty-three pediatric patients (37%) with MMD presented with PCA stenosis at the time of the initial diagnosis. A strong correlation between the presence of infarction and PCA stenosis before anterior revascularization was observed (p < 0.001). In addition, progressive PCA stenosis was observed in 12 patients (19.4%) after anterior revascularization. The presence of infarction and a younger age at the time of initial diagnosis were risk factors for progressive PCA stenosis after anterior revascularization (p < 0.001 and p = 0.002, respectively). Posterior circulation revascularization surgery, including OA-PCA bypass, was performed in 9 of the 12 patients with progressive PCA stenosis, all of whom showed symptomatic and/or radiological improvement.CONCLUSIONSPCA stenosis is an important clinical factor related to poor prognosis in pediatric MMD. One should be aware of the possibility of progressive PCA stenosis during the postoperative follow-up period and consider performing posterior circulation revascularization surgery.

scholarly journals Seizure outcome in moyamoya after indirect revascularization in pediatric patients: Retrospective study and literature review

2021 ◽  
Vol 12 ◽  
pp. 73
Author(s):  
Abdullah Alramadan ◽  
Anwar Ul Haq ◽  
Sarah Basindwah ◽  
Essam Alshail
Keyword(s):  
Pediatric Patients ◽  
Treatment Options ◽  
Seizure Outcome ◽  
Common Symptom ◽  
Cerebrovascular Disorder ◽  
Surgical Revascularization ◽  
Uncommon Disease ◽  
Bilateral Surgery ◽  
Indirect Revascularization ◽  
Primary Presentation

Background: Moyamoya disease (MMD) is a unique cerebrovascular disorder characterized by progressive stenosis of anterior cerebral circulation. Moyamoya is not an uncommon disease in Saudi Arabia. Although a less common symptom of the disease, the incidence of seizure in MMD ranges from 6 to 30%. Indirect revascularization through Encephaloduroarteriosynangiosis technique is one of the surgical treatment options for MMD. In our cohort, we aim to evaluate seizure outcome in pediatric patients with moyamoya. Methods: Eleven patients with seizure as primary presentation for MMD over a period of 10 years were included in the study. All patients underwent EDAS surgery. All patients underwent pre- and postoperative assessment of multiple factors contributing to seizure outcome. Patients were evaluated for surgery control clinically and radiologically. Results: About 73% of MMD patients with seizures improved after EDAS surgery (P < 0.0005). Six patients out of 11 became seizure free. Patients with bilateral involvement of disease undergoing bilateral surgery had better seizure control than those undergoing unilateral surgery (P < 0.07). Conclusion: Patients with controlled seizure before surgery are more likely to be seizure free after intervention. Seizure outcome is favorable after indirect surgical revascularization in pediatric moyamoya patients.

scholarly journals CADASIL: case report

2012 ◽  
Vol 6 (3) ◽  
pp. 188-191
Author(s):  
Julio Cesar Vasconcelos da Silva ◽  
Emerson L. Gasparetto ◽  
Eliasz Engelhardt
Keyword(s):  
Cognitive Impairment ◽  
Case Report ◽  
Genetic Testing ◽  
Autosomal Dominant ◽  
Transient Ischemic Attacks ◽  
Imaging Studies ◽  
Notch 3 ◽  
Sensory Motor ◽  
Cerebral Arteriopathy ◽  
The Brain

ABSTRACT Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a hereditary cerebral arteriopathy caused by mutations in the Notch-3 gene. The diagnosis is reached by skin biopsy revealing presence of granular osmiophílic material (GOM), and/or by genetic testing for Notch-3. We report a case of a 52-year-old man with recurrent transient ischemic attacks (TIA), migraine, in addition to progressive sensory, motor and cognitive impairment. He was submitted to a neuropsychological assessment with the CERAD (Consortium to Establish a Registry for Alzheimer's Disease) battery along with other tests, as well as neuroimaging and genetic analysis for Notch-3, confirming the diagnosis. Executive function, memory, language and important apraxic changes were found. Imaging studies suggested greater involvement in the frontal lobes and deep areas of the brain.

Tandem Bypass: Occipital Artery to Posterior Inferior Cerebellar Artery Side-to-Side Anastomosis and Occipital Artery to Anterior Inferior Cerebellar Artery End-to-Side Anastomosis—a Case Report

Neurosurgery ◽  
1988 ◽  
Vol 22 (5) ◽  
pp. 919-922 ◽  
Author(s):  
James I. Ausman ◽  
Jeffrey E. Pearce ◽  
Dante F. Vacca ◽  
Fernando G. Diaz ◽  
Carl E. Shrontz ◽  
...  
Keyword(s):  
Case Report ◽  
Posterior Fossa ◽  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Anterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Cerebellar Artery

Abstract A unique example of posterior fossa revascularization is presented. A tandem bypass was performed by anastomosing the midoccipital artery to the posterior inferior cerebellar artery in a side-to-side fashion followed by an anastomosis of the distal occipital artery to the anterior inferior cerebellar artery in an end-to-side fashion. The operation was designed to revascularize two separate vascular territories that were isolated in a patient thought to have an extremely compromised posterior circulation. The patient is doing well and is asymptomatic 3 years postoperatively.

CHILDHOOD SARCOIDOSIS: A CASE REPORT

2020 ◽  
pp. 106-109
Author(s):  
Anh Le Thy Phuong
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Key Words ◽  
Clinical Features ◽  
Early Onset ◽  
Pediatric Patients ◽  
Systemic Involvement ◽  
Uncommon Disease ◽  
Systemic Manifestations ◽  
Granulomatous Disorder

Childhood sarcoidosis is an uncommon disease and recognition of this disease in children is often delayed because of the lack of awareness and unfamiliarity with its clinical features. With the aim of providing clues for diagnosis and treatment of disease, we reported a a 23-month-old boy hospitalized for multiple pinkish papules  and painless cystic swellings in ankles and wrists, diagnosed with sarcoidosis, treated with corticosteroid and well recovered. This case reminds us to include childhood sarcoidosis in the differential diagnosis in pediatric patients who present with multiple papular eruptions along with systemic manifestations. It is characterized by arthritis, uveitis, and cutaneous involvement. The prognosis of early-onset childhood sarcoidosis varies in different studies due to the rarity of the disease. The treatment of choice in systemic involvement of childhood sarcoidosis is corticosteroids. Key words: sarcoidosis in children, childhood sarcoidosis, granulomatous disorder, arthritis, uveitis.

scholarly journals Transpalatine Route for the Correction of Transsphenoidal Encephalocele in a Child: A Case Report and Literature Review

2017 ◽  
Vol 36 (04) ◽  
pp. 234-237
Author(s):  
Aldo Silva ◽  
Fabrício Lopes
Keyword(s):  
Case Report ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Female Child ◽  
Bony Defect ◽  
Upper Airways ◽  
Rare Congenital Anomaly ◽  
Excellent Outcome ◽  
Hypothalamic Pituitary Axis ◽  
The Brain

Introduction Transsphenoidal encephalocele is a rare neural tube defect characterized by the herniation of meninges and eventually of parts of the brain through a bony defect in the sphenoid bone. The clinical presentation is variable, and surgical treatment is controversial. Case Report This report describes the case of an 8-month-old female child diagnosed with transsphenoidal encephalocele. The child presented with obstruction of the upper airways and was fed via a nasogastric tube but did not present changes in the hypothalamic-pituitary-axis. The patient underwent surgery with the transsphenoidal–transpalatine route, with an excellent outcome and without fistulas or infections. Conclusions Although transsphenoidal encephalocele is a rare congenital anomaly, the transsphenoidal–transpalatine route for the correction of this type of encephalocele is a safe option and produces a favorable outcome in pediatric patients.

Utility of depth electrode placement in the neurosurgical management of bottom-of-sulcus lesions: technical note

2019 ◽  
Vol 24 (3) ◽  
pp. 284-292
Author(s):  
Eisha A. Christian ◽  
Elysa Widjaja ◽  
Ayako Ochi ◽  
Hiroshi Otsubo ◽  
Stephanie Holowka ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Focal Cortical Dysplasia ◽  
Target Identification ◽  
Cortical Dysplasia ◽  
Technical Note ◽  
Electrode Placement ◽  
Electrode Implantation ◽  
Depth Electrodes ◽  
Intracranial Electrode ◽  
The Brain

OBJECTIVESmall lesions at the depth of the sulcus, such as with bottom-of-sulcus focal cortical dysplasia, are not visible from the surface of the brain and can therefore be technically challenging to resect. In this technical note, the authors describe their method of using depth electrodes as landmarks for the subsequent resection of these exacting lesions.METHODSA retrospective review was performed on pediatric patients who had undergone invasive electroencephalography with depth electrodes that were subsequently used as guides for resection in the period between July 2015 and June 2017.RESULTSTen patients (3–15 years old) met the criteria for this study. At the same time as invasive subdural grid and/or strip insertion, between 2 and 4 depth electrodes were placed using a hand-held frameless neuronavigation technique. Of the total 28 depth electrodes inserted, all were found within the targeted locations on postoperative imaging. There was 1 patient in whom an asymptomatic subarachnoid hemorrhage was demonstrated on postprocedural imaging. Depth electrodes aided in target identification in all 10 cases.CONCLUSIONSDepth electrodes placed at the time of invasive intracranial electrode implantation can be used to help localize, target, and resect primary zones of epileptogenesis caused by bottom-of-sulcus lesions.

Candida spp. In linear gingival erythema lesions in HIV- infeceted children: reports of six cases

2013 ◽  
Author(s):  
Maristela Barbosa Portela,
Keyword(s):  
Case Report ◽  
Hiv Infection ◽  
Pediatric Patients ◽  
Predictive Marker ◽  
Etiologic Agent ◽  
Candida Spp ◽  
Oral Manifestation ◽  
Oral Candidosis ◽  
Positive Growth ◽  
Microbiological Analyses

Linear gingival erythema (LGE), formally referred as HIV-gingivitis, is the most common form of HIV-associated periodontal disease in HIV-infection. These lesions were recently evaluated as a possible form of erythematous oral candidosis, mainly caused by Candida albicans. Other species are also being associated such as C. tropicalis, C. stellatoidea, C. krusei, C. parapsilosis, C. glabrata and C. dubliniensis, that was identified in some HIV-infected subjects. This case report demonstrates the presence of typical LGE lesions in six HIV-infected children, also investigates the etiologic agent by microbiological exams and correlates this oral manifestation with patients’ systemic conditions. Microbiological analyses showed positive growth for Candida spp in all patients, all of whom had severe imunessupression. After antifungal medication, the regression of lesions could be note. The presence of LGE in pediatric patients with AIDS may indicate its feature as a predictive marker in progression of HIV-infection in children.

APICAL PLEURAL ASPERGILLOSIS WITH PANCOAST'S SYNDROME AND POSTERIOR CIRCULATION STROKE: A CASE REPORT

2021 ◽  
pp. 101154
Author(s):  
Y Muralidhar Reddy ◽  
Subhendu Parida ◽  
Premchand Gupta ◽  
Shyam K Jaiswal ◽  
Ganjisreenivasa Gnaneswar ◽  
...  
Keyword(s):  
Case Report ◽  
Posterior Circulation ◽  
Posterior Circulation Stroke
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