Vascular Anatomy of the Cavernous Sinus and Involved Cranial Nerves

Analysis of the embryology of the vessels provides the basis for understanding the variations of collaterals between the external and internal carotid artery systems in the orbit and the cavernous sinus area. 1. The internal maxillary artery (IMA) anastomoses to the inferior and lateral branches (ILT- inferior lateral trunk of the cavernous carotid artery. These collaterals are found anteriorly, through the artery of the foramen rotundum, inferiorly, via the middle meningeal artery (MMA), and anterolaterally, through the accessory middle meningeal artery (AMA). 2. The ascending pharyngeal artery, which originates from the external carotid artery (less commonly from the occipital artery or ICA), gives a superior pharyngeal artery which provides a branch artery that anastamoses to the CS segment of the siphon on the ICA. Both ascending pharyngeal arteries provide a branch from the hypoglossal artery which passes medially to anastamose with the medial clival arterial arcade that connects the right and let C5 segments of both cavernous carotid arteries (Lasuaunias and Berenstien. Surgical Neuro-anglogrphy I, pp,129-143). 3. Another potential collateral between the two ICA's is the capsular artery which courses along the floor of the sella turcica (MacConnel EM. The arterial blood supply of the human hypophysis cerebral. Anatomy Rec 115:175- 203,1953)

The Non-Benign Aspects of Migraine

The non-benign aspects of migraine

New Treatments in Neuro-Ophthalmology: The Role for Evidence

Patterns of ganglion cell complex (GCC) loss detected by optical coherence tomography provide an objective measure of optic nerve injury. These patterns aid in early diagnosis and localization of chiasmal lesions. Twenty-three patients with chiasmal compression seen between 2010 and 2015 were imaged with the Cirrus high-definition optical coherence tomography macular cube 512 × 128, retinal nerve fiber layer (RNFL) scan protocols and automated (30-2 Humphrey) visual fields (VFs). Age-matched controls were included for comparison. Generalized estimating equations were performed comparing RNFL and GCC thicknesses between patients and their controls. Effect size (d) was calculated to assess the magnitude of difference between patients and controls. The average GCC and RNFL thicknesses also were correlated with VF mean deviation (MD). Pre operative average GCC thickness was correlated to post operative VF MD. Patterns of GCC thinning corresponded to VF defects. The average GCC thickness was 67 ± 9 μm in patients and 86 ± 5 μm in controls (P < 0.001). The effect size was the greatest for GCC thickness (d = 2.72). The mean deviation was better correlated with GCC thickness (r =0.25) than RNFL thicknesses (r =0.15). Postoperatively, VF MD improved in 7 of 8 patients with persistent nasal GCC thinning. Six patients had no VF defect and showed statistically significant loss of GCC compared with controls (P = 0.001). Distinct patterns of GCC loss were identified in patients with chiasmal compression. Binasal GCC loss was typical and could be seen with minimal or no detectable VF loss. Thinning of the GCC may be detected before loss of the RNFL in some patients. After decompression, the majority of patients showed improvement in VF despite persistent GCC loss. Patients with less GCC loss before decompression had better postoperative VFs. Therefore, GCC analysis may be an objective method to diagnose and follow patients with chiasmal lesions

Vascular Anatomy of the Cavernous Sinus and Involved Cranial Nerves

Analysis of the embryology of the vessels provides the basis for understanding the variations of collaterals between the external and internal carotid artery systems in the orbit and the cavernous sinus area

Escape From Bromocryptine

Three cases of prolactin secreting macroadenomas causing visual loss, treated post-surgically with Bromocryptine for persistent tumor and elevated prolactin, had normalization of prolactin but experienced worsening of visual function. All three had improved visual performance following re-operation and or radiotherapy as well as Bromocryptine

Temporal Field Loss in 'Unaffected' Eye With Acute Optic Neuritis: A Lesion at Wilbrand's Knee

Recent work suggests that Wilbrand's 'knee' is an artifact of longstanding unilateral optic nerve damage and the associated junctional scotoma is due to compression of the chiasm at multiple sites rather than a focal lesion where the posterior optic nerve enters the chiasm

Papilledema in Two Cases with Dural AVM's

Two cases are presented with visual dysfunction related to chronic papilledema associated with 'dural AVM's of the posterior fossa. Both patients had a headache and a subjective bruit. Sleep apnea was the only other neurological problem in one case. The second case had a history of subdural hematoma and had been diagnosed as Meniere's disease. We will present the radiographic findings and our approach to managing these patients. The outcome in each case was markedly different