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2 results

  • Third Nerve Palsy Due to Intracranial Aneurysms and Recovery after Endovascular Coiling

  • Michelle Kameda-Smith, Akshat Pai, Youngkyung Jung, Dure Khan, Ashley A. Adile, Katrina Hui, Amanda Martyniuk, Ramiro Larrazabal, Almunder Algird, Paula Klurfan, Thorsteinn Gunnarsson, Forough Farrokhyar, Brian van Adel
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 49 / Issue 4 / July 2022
    Published online by Cambridge University Press:
    24 June 2021, pp. 560-568
    • Article
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  • Introduction:

    The modality of treatment of third nerve palsy (TNP) associated with intracranial aneurysms remains controversial. While treatment varies with the location of the aneurysm, microsurgical clipping of PComm aneurysms has generally been the traditional choice, with endovascular coiling emerging as a reasonable alternative.

    Methods:

    Patients with TNP due to an intracranial aneurysm who subsequently underwent treatment at a mid-sized Canadian neurosurgical center over a 15-year period (2003–2018) were examined.

    Results:

    A total of 616 intracranial aneurysms in 538 patients were treated; the majority underwent endovascular coiling with only 24 patients treated with surgical clipping. Only 37 patients (6.9%) presented with either a partial or complete TNP and underwent endovascular embolization; of these, 17 presented with a SAH secondary to intracranial aneurysm rupture. Aneurysms associated with TNP included PComm (64.9%), terminal ICA (29.7%), proximal MCA (2.7%), and basilar tip (2.7%) aneurysms. In general, smaller aneurysms and earlier treatment were provided for patients for ruptured aneurysms with a shorter mean interval to TNP recovery. In the endovascularly treated cohort initially presenting with TNP, seven presented with a complete TNP and the remaining were partial TNPs. TNP resolved completely in 20 patients (55.1%) and partially in 10 patients (27.0%). Neither time to coiling nor SAH at presentation were significantly associated with the recovery status of TNP.

    Conclusion:

    Endovascular coil embolization is a viable treatment modality for patients presenting with an associated cranial nerve palsy.

  • Case 29 - Postoperativehematoma and airway compromise after carotid endarterectomy

  • from Section I - Neuroanesthesia
  • Edited by George A. Mashour, Ehab Farag
  • Book:
    Case Studies in Neuroanesthesia and Neurocritical Care
    Published online:
    03 May 2011
    Print publication:
    03 February 2011, pp 94-95

  • Summary

    Indocyanine green (ICG) is a tricarbocyanine organic dye that has diverse clinical uses including cardiac dye-dilution studies, liver function and blood flow determination, and ophthalmic angiography. This chapter presents a case study of a 67-year-old American Society of Anesthesiologists Class III female scheduled to undergo elective left pterional craniotomy for clipping of intracranial aneurysms. Adverse reactions to ICG dye vary both in system involvement and severity. Treatment in case reports has included intravenous crystalloid and colloids, airway management if necessary, corticosteroids, epinephrine, diphenhydramine, beta-agonist nebulizers, and theophylline. It was initially proposed that patients with iodine sensitivity were susceptible because of the solubilizing iodine component of the pharmaceutical product, but this has been refuted by a large case series. Both anaphylactoid and nonallergic reactions have been proposed as possible mechanisms for ICG dye reactions. Awareness of adverse reactions associated with ICG dye is imperative given its increasing use in neurosurgery.