Dilated venous plexus of the hypoglossal canal mimicking disease (original) (raw)
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The blood supply of the hypoglossal nerve: The microsurgical anatomy of its cisternal segment
Surgical Neurology, 1997
While the characteristics of the vasculature of the second (intracanalicular) segment of the hypoglossal nerve are well known, the vascularization of the first (cisternal) segment of this nerve has not been examined so far. Many pathologic processes and malformations can be located in the premedullary cistern, which may affect the vasculature of the cisternal segment. Consequently, we decided to examine the blood supply of the cisternal segment. The anatomic features of the cisternal segment and its vasculature were examined in 15 hypoglossal nerves after injection of india ink and gelatin into the vertebrobasilar arterial system. The cisternal segment was noted to consist of 3-15 long roots, which usually formed two trunks of the hypoglossal nerve. The roots of each nerve received blood from the anterolateral and the lateral medullary arteries, which ranged from 3 to 5 in number and between 100 microns and 500 microns in caliber. These arteries may arise from the perforating branches or the pontomedullary branch of the basilar artery; the vertebral artery or its perforators; the anterior spinal artery or its vascular roots; the posterior spinal artery; and the posterior inferior cerebellar artery. The main hypoglossal arteries, which ranged in diameter from 20 microns to 80 microns, always coursed along the dorsal surface of the roots of the hypoglossal nerve. The cisternal segment of the hypoglossal nerve was always vascularized by several vessels, which mainly originated from the vertebral artery and its branches. This observation was discussed from the neurosurgical point of view.
A Vascular Malformation Presenting as a Peripheral Nerve Sheath Tumor
Journal of brachial plexus and peripheral nerve injury, 2016
We present the case of a venous malformation (VM) masquerading as a schwannoma. VMs are thin-walled vascular dilations of various sizes that typically present as soft, compressible, blue masses that are associated with pain or dysesthesia. VMs are commonly found in the head and neck as well as the distal extremities. Notably, slow-flow VMs are hypointense on T1-weighted imaging, hyperintense on T2-weighted imaging, and enhance markedly with contrast. However, VMs tend to be poorly circumscribed and fraught with venous lakes and phleboliths. Conservative therapy and sclerotherapy are the primary treatment options. In this case report, we present a VM presenting near the neurovascular bundle of the upper extremity axilla. Our case is unique in that the patient presented with symptoms and imaging qualities characteristic for a peripheral nerve schwannoma.
European Journal of Radiology, 2010
The hypoglossal nerve is a pure motor nerve. It provides motor control to the intrinsic and extrinsic tongue muscles thus being essential for normal tongue movement and coordination. In order to design a useful imaging approach and a working differential diagnosis in cases of hypoglossal nerve damage one has to have a good knowledge of the normal anatomy of the nerve trunk and its main branches. A successful imaging evaluation to hypoglossal diseases always requires high resolution studies due to the small size of the structures being studied. MRI is the preferred modality to directly visualize the nerve, while CT is superior in displaying the bony anatomy of the neurovascular foramina of the skull base. Also, while CT is only able to detect nerve pathology by indirect signs, such as bony expansion of the hypoglossal canal, MRI is able to visualize directly the causative pathological process as in the case of small tumors, or infectious/inflammatory processes affecting the nerve. The easiest way to approach the study of the hypoglossal nerve is to divide it in its main segments: intra-axial, cisternal, skull base and extracranial segment, tailoring the imaging technique to each anatomical area while bearing in mind the main disease entities affecting each segment.
Anatomic variations in the course of the hypoglossal nerve: A case report
Journal of the Anatomical Society of India, 2018
To achieve a successful surgical anatomy a detailed knowledge of regional anatomy and anatomical variations is an important fundamental. The extra cranial hypoglossal nerve has a well described course as it traverses the neck, and is frequently identified during neck dissection. This serves a guide to the surgeon of such atypical variations in anatomy to avoid injury to important structures during dissection. We are presenting a case report which demonstrates the extra cranial variation of Hypoglossal nerve.
Surgical anatomy of the cervical segment of the hypoglossal nerve
Clinical Anatomy, 2005
The surgical anatomy of the extracranial segment of the hypoglossal nerve (HN) has been sparsely investigated in the literature. This article studies the course and anatomical and topographic relationships of the HN in 23 formalin fixed cadavers bilaterally dissected under a surgical microscope. The descriptive anatomy is presented with relevant clinical and surgical implications. Clin. Anat. 19:37-43, 2006. V V C 2005 Wiley-Liss, Inc.
AJNR. American journal of neuroradiology, 2003
MR imaging is the method of choice for evaluating the trigeminal nerve. Detection of abnormalities such as perineural tumor spread requires detailed knowledge of the normal MR appearance of the trigeminal nerve and surrounding structures. The purpose of this study was to clarify the normal MR appearance and variations of the trigeminal ganglion, maxillary nerve (V2), and mandibular nerve (V3) with their corresponding perineural vascular plexus. S: MR images obtained in 32 patients without symptoms referable to the trigeminal nerve were retrospectively reviewed. The trigeminal ganglion in Meckel's cave, V2 within the foramen rotundum, and V3 at the level of foramen ovale were assessed for visualization and enhancement. The configuration of the perineural vascular plexus was recorded. Correlation to cadaver specimens was made. The trigeminal ganglion and V3 were observed to enhance in 3-4% of patients unilaterally. V2 and V3 were well visualized 93% of the time. The perineural vas...
Pathology of the peripheral nervous system
Critical Reviews in Neurosurgery, 1998
This review deals with papers on important topics in peripheral nerve surgery. Some new diagnostic tools and microsurgical procedures are brought to the attention of neurosurgeons. The first four papers are related to new surgical strategies in treating brachial plexus injury (BPI), particularly root avulsion. Concepts based on experimental studies are applied to clinical practice. Re-establishment of the continuity of interrupted spinal roots or reimplantation of the avulsed spinal roots into the spinal cord are attempted. The authors demonstrate how computed tomography (CT) myelography can be used to plan surgical treatment correctly. The use of reinnervated free-muscle transfer after complete brachial plexus C5-T1 root avulsion is described and critically evaluated. The results obtained after repair of interrupted spinal roots or reimplantation of avulsed spinal roots into the spinal cord are not as clear as described by the authors. Further experimental studies and surgical outcomes are necessary before accepting the efficacy of such surgical procedures in BPI. Reinnervated free-muscle transfer appears to be a promising method for treating such severe lesions. The fifth paper is a case report in which the trapezius branch of the spinal accessory nerve was neurotized with the dorsal branch of the third cervical nerve. This procedure was performed after an injury to the spinal accessory nerve in the neck. The proximal stump of the spinal accessory nerve was available only intracranially. Using this procedure, the risk related to an intracranial approach to the spinal accessory nerve is avoided. A review of one case of primitive neuroectodermal malignant tumor of the median nerve is used to discuss some controversies related to the treatment of malignant tumors involving peripheral nerves.
Cavernous angioma of the VIIIth cranial nerve
Neurosurgical Review, 1998
We report a case of a 24-year-old woman affected by a cavernous angioma of the right VIIIth cranial nerve associated with a venous angioma. The malformation was diagnosed by MRI, performed in relation to an acute onset of right anacusia. The case report is indicative that, even if unusual, an acute onset of an cerebellopontine angle syndrome can be subsequent to a bleeding cavernous angioma. This occurrence must be kept in mind in the differential diagnosis of the cerebellopontine angle tumors.
Surgical Anatomy of the Cervical Part of the Hypoglossal Nerve
Craniomaxillofacial Trauma & Reconstruction, 2017
Iatrogenic injuries to cranial nerves, half of which affect the hypoglossal nerve, occur in up to 20% of surgical procedures involving the neck. The risk of injury could be minimized by in-depth knowledge of its positional and relational anatomy. Forty-one hypoglossal nerves were dissected from cadaveric specimens and positions described in relation to the internal carotid artery (ICA), external carotid artery (ECA), carotid bifurcation, mandible, hyoid bone, mastoid process, and the digastric tendon. The distance of the nerve from where it crossed the ICA and ECA to the carotid bifurcation was 29.93 (± 5.99) mm and 15.19 (± 6.68) mm, respectively. The point where it crossed the ICA was 12.24 (± 3.71) mm superior to the greater horn of hyoid, 17.16 (± 4.40) mm inferior to the angle of the mandible, and 39.08 (± 5.69) mm from tip of the mastoid. The hypoglossal nerve loop was inferior to the digastric tendon in 73% of the cases. The hypoglossal nerves formed high loops in this study ...