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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.

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Case 2. Coronal (a) and sagittal (b) head MR images with contrast medium showing a dumbbell-shaped, partially solid and partially cystic tumor extending from the suprasellar cistern to the third ventricle. MR angiogram showing showed severe stenosis of the right ICA in the cavernous portion, and both A1 and M1 were only faintly visualized (c).
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Figure 4: Case 2. Coronal (a) and sagittal (b) head MR images with contrast medium showing a dumbbell-shaped, partially solid and partially cystic tumor extending from the suprasellar cistern to the third ventricle. MR angiogram showing showed severe stenosis of the right ICA in the cavernous portion, and both A1 and M1 were only faintly visualized (c).

Mentions: On admission, MR imaging showed a partially ossified solid tumor in the suprasellar cistern, which had compressed the optic chiasm upwards, and a large cyst with thin wall in the third ventricle [Figure 4a, b]. MR angiography showed the right ICA was severely narrowed in the cavernous portion, and both A1 and M1 were only faintly visualized [Figure 4c]. Iodine-123 N-isopropyl-p-iodoamphetamine SPECT indicated slight reduction of cerebral blood flow (right ACA distribution/right MCA distribution 27.9/24.8 ml/100 g/min, left ACA distribution/left MCA distribution 27.9/28.4 ml/100 g/min), but acetazolamide administration indicated compromised cerebrovascular reactivity (right ACA distribution/right MCA distribution 36.1/28.3 ml/100 g/min, left ACA distribution/left MCA distribution 43.4/54.6 ml/100 g/min) [Figure 5].


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)

Case 2. Coronal (a) and sagittal (b) head MR images with contrast medium showing a dumbbell-shaped, partially solid and partially cystic tumor extending from the suprasellar cistern to the third ventricle. MR angiogram showing showed severe stenosis of the right ICA in the cavernous portion, and both A1 and M1 were only faintly visualized (c).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Case 2. Coronal (a) and sagittal (b) head MR images with contrast medium showing a dumbbell-shaped, partially solid and partially cystic tumor extending from the suprasellar cistern to the third ventricle. MR angiogram showing showed severe stenosis of the right ICA in the cavernous portion, and both A1 and M1 were only faintly visualized (c).
Mentions: On admission, MR imaging showed a partially ossified solid tumor in the suprasellar cistern, which had compressed the optic chiasm upwards, and a large cyst with thin wall in the third ventricle [Figure 4a, b]. MR angiography showed the right ICA was severely narrowed in the cavernous portion, and both A1 and M1 were only faintly visualized [Figure 4c]. Iodine-123 N-isopropyl-p-iodoamphetamine SPECT indicated slight reduction of cerebral blood flow (right ACA distribution/right MCA distribution 27.9/24.8 ml/100 g/min, left ACA distribution/left MCA distribution 27.9/28.4 ml/100 g/min), but acetazolamide administration indicated compromised cerebrovascular reactivity (right ACA distribution/right MCA distribution 36.1/28.3 ml/100 g/min, left ACA distribution/left MCA distribution 43.4/54.6 ml/100 g/min) [Figure 5].

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