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Chiari I malformation with neurogenic hypertension after suboccipital decompression. Childs Nerv Syst 2021; 37:659-663. [PMID: 32435888 DOI: 10.1007/s00381-020-04670-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
Patients with Chiari I malformations have a spectrum of symptoms related to craniocervical structural compression. Neurogenic hypertension has been reported in some patients with this disorder, with resolution of hypertension after suboccipital decompressions in some cases. The pathophysiology of neurogenic hypertension in these patients is thought to be related to ventrolateral medullary compression. The important role of the ventrolateral medulla in blood pressure control has been studied extensively. In this report, we present the case of a pediatric patient diagnosed with a Chiari I malformation who developed hypertension after a suboccipital decompression. We believe that this case demonstrates the important role of the ventrolateral medulla in neurogenic hypertension.
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Splavski B, Zbytek B, Arnautovic KI. Surgical management and outcome of adult posterior cranial fossa and spinal hemangioblastoma: a 6-case series and literature review. Neurol Res 2020; 42:1010-1017. [PMID: 32697158 DOI: 10.1080/01616412.2020.1796382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Hemangioblastomas of the posterior cranial fossa and spinal cord in adults are excessively vascularized, well-differentiated, and scarce tumors with no metastatic potential. This paper discusses its surgical management and outcome, pointing out their morphological, radiological, and histopathological aspects. This report based on a personal series of six patients and on a literature review. METHODS A single-institution personal 6-case series of adult patients diagnosed and operated on by a senior neurosurgeon (KIA) due to posterior cranial fossa or spinal cord hemangioblastoma was analyzed. For easier understanding of hemangioblastoma, we have classified them into four different types. RESULTS The tumors, which were all surgically treated, were located in the posterior cranial fossa in five patients (4 cerebellar, 1 brain stem) and intramedullary in the thoracic spinal cord in one patient. All patients successfully recovered neurologically after a complete tumor resection, having no post-operative neurological deficit or other complications. CONCLUSION Surgical management of cerebellar and spinal cord hemangioblastoma in adults is highly dependent on its morphological features, as well as on microsurgical technique applied. Since huge differences exist between the cystic/nodular tumor type (Type 1) and the solid type and its two additional variants (Types 2-4), morphology is the most important consideration when deciding surgical approach. Despite significant morphological differences among different subtypes of hemangioblastomas, their histology appears to be relatively similar. Nonetheless, a meticulous and refined surgical technique has to be utilized to achieve a successful outcome.
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Affiliation(s)
- Bruno Splavski
- Department of Neurosurgery, Sestre Milosrdnice University Hospital Center , Zagreb, Croatia.,School of Dental Medicine and Health, J.J. Strossmayer University of Osijek , Osijek, Croatia.,J.J. Strossmayer University of Osijek School of Medicine , Osijek, Croatia
| | | | - Kenan I Arnautovic
- Department of Neurosurgery, University of Tennessee Health Science Center , Memphis, TN, USA.,Semmes Murphey Clinic , Memphis, TN, USA
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Akaishi T, Kiyomoto H, Abe M, Okuda H, Ishizawa K, Endo T, Miyata M, Nakayama K, Ito S, Tominaga T, Ishii T. A 29-year-old Woman with Recurrent Pregnancy-induced Hypertension Based on Vascular Compression of the Medulla Oblongata. Intern Med 2019; 58:2257-2261. [PMID: 30996172 PMCID: PMC6709317 DOI: 10.2169/internalmedicine.2382-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a report of a 29-year-old woman with non-dipper type refractory hypertension due to the vascular compression of the medulla oblongata. The patient was diagnosed with hypertension at 17 years of age and underwent emergency Caesarean section at 26 weeks of gestation during 2 pregnancies due to severe high blood pressure. We suspected medullary compression by the curved posterior inferior cerebellar artery as the cause of her intractable hypertension, and she underwent Jannetta's decompression surgery. After the surgery, her blood pressure swiftly decreased to almost within the normal range, and her blood pressure pattern normalized to dipper type.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Japan
| | - Hideyasu Kiyomoto
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Japan
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Japan
| | - Michiaki Abe
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Japan
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Japan
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Japan
| | - Hiroshi Okuda
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Japan
| | - Kota Ishizawa
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Japan
| | | | | | - Sadayoshi Ito
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Japan
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Japan
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Japan
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Cutsforth-Gregory JK, Benarroch EE. Nucleus of the solitary tract, medullary reflexes, and clinical implications. Neurology 2017; 88:1187-1196. [PMID: 28202704 DOI: 10.1212/wnl.0000000000003751] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Martín-Gallego A, González-García L, Carrasco-Brenes A, Segura-Fernández-Nogueras M, Delgado-Babiano A, Ros-Sanjuán A, Romero-Moreno L, Domínguez-Páez M, Dawid-Milner MS, Arráez-Sánchez MA. Brainstem and Autonomic Nervous System Dysfunction: A Neurosurgical Point of View. ACTA NEUROCHIRURGICA. SUPPLEMENT 2017; 124:221-229. [PMID: 28120078 DOI: 10.1007/978-3-319-39546-3_34] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Central autonomic control nuclei and pathways are mainly integrated within the brainstem, especially in the medulla oblongata. Lesions within these structures can lead to central dysautonomia.Central autonomic control structures can be damaged by tumors, during surgery, or by other neurosurgical pathologies. These may elicit clinical or subclinical autonomic complications that can constitute a serious clinical problem.The authors present a broad review of the central autonomic nervous system, its possible dysfunctions, and the relation between neurosurgery and this "not-well-known system". Preliminary results of an autonomic study of brainstem lesions that is currently being carried out by the authors are also shown.
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Affiliation(s)
- A Martín-Gallego
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain.
| | - L González-García
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
| | - A Carrasco-Brenes
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
| | - M Segura-Fernández-Nogueras
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
| | - A Delgado-Babiano
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
| | - A Ros-Sanjuán
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
| | - L Romero-Moreno
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
| | - M Domínguez-Páez
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
| | - M S Dawid-Milner
- Department of Autonomic Nervous System, CIMES, University of Málaga Foundation (FGUMA), Malaga, Spain
| | - M A Arráez-Sánchez
- Department of Neurosurgery, Regional University Hospital of Málaga, Avenida Carlos Haya s/n, 29010, Málaga, Spain
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Martín-Gallego A, Andrade-Andrade I, Dawid-Milner M, Domínguez-Páez M, Romero-Moreno L, González-García L, Carrasco-Brenes A, Segura-Fernández-Nogueras M, Ros-López B, Arráez-Sánchez M. Autonomic dysfunction elicited by a medulla oblongata injury after fourth ventricle tumor surgery in a pediatric patient. Auton Neurosci 2016; 194:52-7. [DOI: 10.1016/j.autneu.2015.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/28/2015] [Accepted: 12/03/2015] [Indexed: 02/07/2023]
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Ideguchi M, Kajiwara K, Yoshikawa K, Sadahiro H, Nomura S, Fujii M, Suzuki M. Characteristics of intraoperative abnormal hemodynamics during resection of an intra-fourth ventricular tumor located on the dorsal medulla oblongata. Neurol Med Chir (Tokyo) 2013; 53:655-62. [PMID: 24077276 PMCID: PMC4508747 DOI: 10.2176/nmc.oa2012-0401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abnormal hemodynamics during extirpation of a para-medulla oblongata (MO) tumor is common and may be associated with direct vagal stimulation of the medullary circuit. However, resection of tumors on the dorsal MO may also induce hemodynamic instability without direct vagal stimulus. The objective of this study was to examine the characteristics of hemodynamic instability unrelated to vagal stimulus during dissection of an intra-fourth ventricular tumor with attachment to the dorsal MO. A retrospective analysis was performed in 13 patients. Abnormal hemodynamics were defined as a > 20% change from the means of the intraoperative mean arterial pressure (MAP) and heart rate (HR). Relationships of intraoperative hemodynamics were evaluated with various parameters, including the volume of the MO. Six patients (46.2%) had intraoperative hypertension during separation of the tumor bulk from the dorsal MO. The maximum MAP and HR in these patients were significantly greater than those in patients with normal hemodynamics (116.0 ± 18.0 mmHg versus 85.6 ± 6.5 mmHg; 124.3 ± 22.8 bpm versus 90.5 ± 14.7 bpm). All six cases with abnormal hemodynamics showed hemodynamic fluctuation during separation of the tumor bulk from the dorsal MO. The preoperative volume of the MO in these patients was 1.11 cc less than that in patients with normal hemodynamics, but the volume after tumor resection was similar in the two groups (5.23 cc and 5.12 cc). This suggests that the MO was compressed by the conglutinate tumor bulk, with resultant fluctuation of hemodynamics. Recognition of and preparation for this phenomenon are important for surgery on a tumor located on the dorsal MO.
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Affiliation(s)
- Makoto Ideguchi
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine
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Inoue H, Nakagawa Y, Ikemura M, Usugi E, Kiyofuji Y, Nata M. Acute brainstem compression by intratumoral hemorrhages in an intracranial hypoglossal schwannoma. Leg Med (Tokyo) 2013; 15:249-52. [PMID: 23541888 DOI: 10.1016/j.legalmed.2013.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 01/25/2013] [Accepted: 02/06/2013] [Indexed: 11/27/2022]
Abstract
A 77-year-old female in the hospital was found tachycardic and hypothermic by a nurse, and the patient's respiration subsequently ceased. Forensic autopsy revealed an intracranial cystic tumor that would have compressed the brainstem. On microscopic examination, the tumor was diagnosed as an Antoni A schwannoma growth, and recent multiple intratumoral hemorrhages in the intracranial schwannoma were observed, suggesting the sudden enlargement of the intracranial schwannoma due to intratumoral hemorrhaging. Accordingly, we diagnosed the cause of death as brainstem compression induced by the intratumoral hemorrhaging in the intracranial schwannoma. Meanwhile, a rhinopharyngeal tumor was also detected by the autopsy, which was compatible with an antemortem diagnosis of a dumbbell-shaped hypoglossal schwannoma.
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Affiliation(s)
- Hiromasa Inoue
- Department of Forensic Medicine and Sciences, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie 514-8507, Japan.
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Sezer S, Baykan A, Yilmaz E, Unal E, Onan SH, Yikilmaz A, Uzum K, Ozdemir MA, Narin N. Atrial fibrillation as an uncommon presentation in a large pleomorphic xanthoastrocytoma. Childs Nerv Syst 2012; 28:475-9. [PMID: 22086138 DOI: 10.1007/s00381-011-1631-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 11/02/2011] [Indexed: 10/15/2022]
Affiliation(s)
- Sadettin Sezer
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Chen CC, Fan YP, Shin HS, Su CK. Basal sympathetic activity generated in neonatal mouse brainstem-spinal cord preparation requires T-type calcium channel subunit α1H. Exp Physiol 2011; 96:486-94. [DOI: 10.1113/expphysiol.2010.056085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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