Limits...
Successful treatment of suprasellar tumors associated with poor brain blood perfusion by severe intracranial arterial stenosis: two case reports.

Ogawa Y, Tominaga T - BMC Res Notes (2013)

Bottom Line: Two patients were treated for skull base tumor in the presence of severe stenosis of the internal carotid artery, unilateral in one patient and bilateral in the other patient.Both patients were asymptomatic but had reduced vascular reserve capacity.Although more experiences based on sub-classified etiology for internal carotid artery stenosis are required, various types of operations including intracranial-extracranial vascular surgery might be justified based on this principle.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Kohnan Hospital, 4-20-1, Nagamachiminami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan. yogawa@kohnan-sendai.or.jp.

ABSTRACT

Background: Treatment strategy to prevent perioperative cerebral infarction in patients with asymptomatic severe stenosis of the internal carotid artery is not fully established.

Case presentation: Two patients were treated for skull base tumor in the presence of severe stenosis of the internal carotid artery, unilateral in one patient and bilateral in the other patient. Both patients were asymptomatic but had reduced vascular reserve capacity. The extended transsphenoidal approach was planned avoiding the low perfusion pressure region, with only conventional methods of maintaining blood pressure and PaCO2 rather than performing prophylactic vascular reconstruction surgery, and successful tumor removals were achieved without causing further neurological or radiological deficits.

Conclusion: If the surgical route is planned to avoid the distribution of stenotic vessels and low perfusion pressure, prophylactic vascular reconstruction surgery would be unnecessary. Although more experiences based on sub-classified etiology for internal carotid artery stenosis are required, various types of operations including intracranial-extracranial vascular surgery might be justified based on this principle.

Show MeSH

Related in: MedlinePlus

Iodine-123 N-isopropyl-p-iodoamphetamine single photon emission computed tomography scans revealing severe reduction of cerebral blood flow especially in the right hemisphere, and the steal phenomenon bilaterally after injection of acetazolamide.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4222111&req=5

Figure 2: Iodine-123 N-isopropyl-p-iodoamphetamine single photon emission computed tomography scans revealing severe reduction of cerebral blood flow especially in the right hemisphere, and the steal phenomenon bilaterally after injection of acetazolamide.

Mentions: Magnetic resonance (MR) imaging showed a well-demarcated skull base tumor extending from the planum sphenoidale to the diaphragm sellae. Abnormal mesh-like enhancement was seen in the right half of the tumor around the right ICA terminal, and also at the distal portion of the anterior cerebral artery (ACA) in the convexity [Figure 1a, b]. MR angiography showed severe stenoses in the bilateral ICA terminals and moyamoya vessels around the horizontal segment of the ACA and the middle cerebral artery (MCA) [Figure 1c]. Iodine-123 N-isopropyl-p-iodoamphetamine single-photon emission computed tomography (SPECT) using the autoradiographic method indicated reduced cerebral blood flow (right ACA distribution/right MCA distribution 38.4/31.4 ml/100 g/min, left ACA distribution/left MCA distribution 39.7/43.1 ml/100 g/min), and acetazolamide administration disclosed the steal phenomenon (right ACA distribution/right MCA distribution 33.9/28.9 ml/100 g/min, left ACA distribution/left MCA distribution 39.1/42.5 ml/100 g/min) [Figure 2].


Successful treatment of suprasellar tumors associated with poor brain blood perfusion by severe intracranial arterial stenosis: two case reports.

Ogawa Y, Tominaga T - BMC Res Notes (2013)

Iodine-123 N-isopropyl-p-iodoamphetamine single photon emission computed tomography scans revealing severe reduction of cerebral blood flow especially in the right hemisphere, and the steal phenomenon bilaterally after injection of acetazolamide.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222111&req=5

Figure 2: Iodine-123 N-isopropyl-p-iodoamphetamine single photon emission computed tomography scans revealing severe reduction of cerebral blood flow especially in the right hemisphere, and the steal phenomenon bilaterally after injection of acetazolamide.
Mentions: Magnetic resonance (MR) imaging showed a well-demarcated skull base tumor extending from the planum sphenoidale to the diaphragm sellae. Abnormal mesh-like enhancement was seen in the right half of the tumor around the right ICA terminal, and also at the distal portion of the anterior cerebral artery (ACA) in the convexity [Figure 1a, b]. MR angiography showed severe stenoses in the bilateral ICA terminals and moyamoya vessels around the horizontal segment of the ACA and the middle cerebral artery (MCA) [Figure 1c]. Iodine-123 N-isopropyl-p-iodoamphetamine single-photon emission computed tomography (SPECT) using the autoradiographic method indicated reduced cerebral blood flow (right ACA distribution/right MCA distribution 38.4/31.4 ml/100 g/min, left ACA distribution/left MCA distribution 39.7/43.1 ml/100 g/min), and acetazolamide administration disclosed the steal phenomenon (right ACA distribution/right MCA distribution 33.9/28.9 ml/100 g/min, left ACA distribution/left MCA distribution 39.1/42.5 ml/100 g/min) [Figure 2].

Bottom Line: Two patients were treated for skull base tumor in the presence of severe stenosis of the internal carotid artery, unilateral in one patient and bilateral in the other patient.Both patients were asymptomatic but had reduced vascular reserve capacity.Although more experiences based on sub-classified etiology for internal carotid artery stenosis are required, various types of operations including intracranial-extracranial vascular surgery might be justified based on this principle.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Kohnan Hospital, 4-20-1, Nagamachiminami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan. yogawa@kohnan-sendai.or.jp.

ABSTRACT

Background: Treatment strategy to prevent perioperative cerebral infarction in patients with asymptomatic severe stenosis of the internal carotid artery is not fully established.

Case presentation: Two patients were treated for skull base tumor in the presence of severe stenosis of the internal carotid artery, unilateral in one patient and bilateral in the other patient. Both patients were asymptomatic but had reduced vascular reserve capacity. The extended transsphenoidal approach was planned avoiding the low perfusion pressure region, with only conventional methods of maintaining blood pressure and PaCO2 rather than performing prophylactic vascular reconstruction surgery, and successful tumor removals were achieved without causing further neurological or radiological deficits.

Conclusion: If the surgical route is planned to avoid the distribution of stenotic vessels and low perfusion pressure, prophylactic vascular reconstruction surgery would be unnecessary. Although more experiences based on sub-classified etiology for internal carotid artery stenosis are required, various types of operations including intracranial-extracranial vascular surgery might be justified based on this principle.

Show MeSH
Related in: MedlinePlus