Cerebral diagnostic and therapeutic angiography for neonatal arteriovenous fistulas.

SUMMARY: Cerebral diagnostic and therapeutic angiography for neonatal arteriovenous fistulas is reported. Three neonatal boys with vein of Galen aneurysmal malformation (1 patient) and dural arteriovenous fistulas (2 patients) presented severe congestive heart failure soon after birth, and were treated by transarterial and/or transvenous embolization using various access routes. In the neonatal period, umbilical approach and direct cervical approach provide unique access routes in addition to the usual transfemoral route. Characteristics of neonatal angiography are discussed.

Transfemoral, transvenous embolisation of dural arteriovenous fistula involving the isolated transverse-sigmoid sinus from the contralateral side.

BACKGROUND: A dural arteriovenous fistula (AVF) involving the transverse-sigmoid (T-S) sinus which is occluded at its proximal and distal ends i.e., an isolated sinus, runs the risk of haemorrhaging or causing serious neurological deficits as a result of its retrograde leptomeningeal venous drainage. While lesions of this type have not been considered to be treatable by percutaneous, transvenous embolisation, this paper challenges this view. CASE PRESENTATION: Two middle-aged men with dural AVFs involving the isolated left T-S sinus presented with motor aphasia due to focal brain edema or haemorrhage. Under local anaesthesia, transfemoral, transvenous embolisation was performed with a microcatheter that was passed through the occluded proximal transverse sinus from the right (contralateral) side. The isolated sinus was then occluded with platinum coils. This embolisation resulted in angiographic and clinical cure of dural AVFs in both patients. INTERPRETATION: Transfemoral, transvenous embolisation is a therapeutic alternative for the treatment of dural AVFs involving the isolated T-S sinus. Embolisation obviates the need for craniotomy and general anaesthesia, which are required for the established modes of treatment, i.e., direct surgery or direct percutaneous sinus packing.

Simultaneous dissection of intra- and extracranial vertebral artery. Report of two cases and review of literature.

Two patients who developed subarachnoid haemorrhage are presented. The first patient was a 41-year-old woman whose angiograms showed right extracranial vertebral artery (VA) dissection starting at the C2 level extending to the intracranial VA near the VA union. Proximal occlusion of the right VA by the endovascular approach was performed. The second patient was a 57-year-old man whose angiograms showed the left intracranial VA dissection distal to the posterior inferior cerebellar artery and an extracranial aneurysmal dilatation of the left VA at the C1 level and extracranial VA dissection in the V3 portion of the right VA. Left intracranial VA dissection was surgically trapped, and the remaining lesions were conservatively treated. Simultaneous dissection of the intracranial and extracranial portions of the VA is rare. Such lesions usually cause brain ischaemia, but may cause intracranial subarachnoid haemorrhage.

Anterior choroidal artery variant and acute embolic stroke. Case report.

SUMMARY: The anterior choroidal artery has the cortical branches to the temporal, parietal, and occipital lobes in the early embryological stage, which later become the posterior cerebral artery distal to the posterior communicating artery (P2-4). Acute embolic stroke occurred in a 57-year-old man with an anterior choroidal artery having such a persistent embryonic branch to the temporal lobe. Recognition of this embryological form of the anterior choroidal artery is clinically important in acute cerebral ischaemia because the cerebral region between the territories supplied by the middle cerebral artery and the anterior choroidal artery is shown on carotid angiography as an avascular area, which could be misunderstood as a region of the acute ischaemia.

Evaluation of pleomorphic xanthoastrocytoma by use of positron emission tomography with.

We present a case of pleomorphic xanthoastrocytoma (PXA) in a patient with temporal lobe seizures. Imaging sequences included MR, and results of positron emission tomography (PET) with [18F]-fluorodeoxyglucose (FDG) and [11C]-methionine (Met) tracers revealed a hypermetabolic region equivalent or nearly equivalent to normal cerebral cortex, suggesting that the tumor might have malignant potential. Histopathologic findings indicated low-grade glioma. The mechanism for glucose hypermetabolic activity of PXA is not clear; however, the positive findings obtained from FDG-PET may not always indicate the degree of malignancy associated with PXA.

Surgical management of syringomyelia associated with spinal adhesive arachnoiditis.

The authors describe a new surgical technique to minimise the postoperative recurrence of adhesion after microlysis of adhesion to treat syringomyelia associated with spinal adhesive arachnoiditis. A 47 year old male presented with numbness of the lower extremities and urinary disturbance and was demonstrated to have a case of syringomyelia from C1 to T2 which was thought to be secondary to adhesive spinal arachnoiditis related to a history of tuberculous meningitis. Following meticulous microlysis of the adhesions, maximal expansion of a blocked subarachnoid space was performed by expansive duraplasty with a Gore-Tex surgical membrane, expansive laminoplasty and multiple tenting sutures of the Gore-Tex graft. Postoperatively, the syringomyelia had be en completely obliterated and improvement of the symptoms had been also achieved. The technique described may contribute to improvement of the surgical outcome following arachnoid dissection by maintaining continuity of the reconstructed subarachnoid space.

Intracranial hypotension due to cerebrospinal fluid leakage detected by radioisotope cisternography.

Seven patients, six females and one male aged 26 to 39 years old, presented with headache in the upright posture, which was completely relieved in the recumbent posture. Radioisotope cisternography with technetium-99m-human serum albumin detected cerebrospinal fluid (CSF) leakage at the cervicothoracic level in six patients, and at the high cervical level in one patient. The diagnosis was intracranial hypotension due to spontaneous CSF leakage. Complete bed rest for more than 2 weeks resulted in complete resolution of the headache in all patients, and follow-up cisternography showed no leakage. Radioisotope cisternography is useful for the diagnosis of spontaneous CSF leakage, and complete bed rest for more than 2 weeks may be the best method of treatment.

Simultaneous bilateral thalamic hemorrhage: case report.

A 60-year-old man presented with an extremely rare case of simultaneous hypertensive bilateral thalamic hemorrhage manifesting as left hemiparesis with headache followed by deterioration in consciousness and tetraparesis. CT scan confirmed the bilateral thalamic hemorrhages 17 hours after onset. Magnetic resonance imaging showed the bilateral thalamic lesions had similar signal intensities, consistent with the simultaneous onset, and had no evidence of hemorrhagic reason. Conservative treatment achieved some neurological improvement, but he died of pneumonia six months after onset. The prognosis of a patient with bilateral hemorrhages is worse than would be indicated by the size of the hemorrhages.

Meningioma associated with acute subdural hematoma--case report.

A 48-year-old woman presented with sudden left hemiplegia with headache, which deteriorated two days later. CT scan showed repeated intratumoral and subdural hemorrhages. Magnetic resonance imaging showed a parasagittal tumor infiltrating into the superior sagittal sinus, with intratumoral hemorrhage and acute subdural hematoma in the interhemispheric fissure. The intratumoral hematoma had several different intensities, which indicated repeated hemorrhages. The subdural hematoma and the tumor were removed via frontoparietal craniotomy. The histological diagnosis was fibrous-type meningioma with a high Ki-67 labeling index (6.7). As there were tumor cells within the subdural hematoma, it seemed to have resulted from tumoral hemorrhage. A high index of cell proliferation may indicate some mechanism responsible for hemorrhage in malignant tumor.

[Binocularity after treatment for constant exotropia].

We studied the binocularity of cured chronic exotropic patients and discussed the critical period of gross stereopsis and its vulnerability. An infant, developing chronic exotropia associated with myasthenia gravis at the age of 17 months, returned to exophoria 10 months later and showed a stereo-acuity of 800 sec. This clinical finding suggests that the critical period for gross stereopsis is before the age of 18 months and the function is recoverable even when it is suppressed for several months after that period. Of the 18 patients with chronic exotropia who had undergone surgery after school age. 16 patients (83.3%) recovered stereoacuity of 3,000 sec or better, which suggests that gross stereopsis once established will never vanish. Patients with chronic exotropia with poor central vision also recovered gross stereopsis and stable eye position after strabismus surgery, indicating that gross stereopsis with peripheral fusion is significant for the stabilization of the eye position.