Ruptured Tentorium Originating Masson Tumor.

Intravascular papillary endothelial hyperplasia (IPEH) also known as Masson's tumor, is a benign, slow growing, vascular lesion which is seen very rarely and only a few cases have been reported intracranially in the literature. It has been reported at many sites, but the posterior fossa involvement is very rare. The preoperative diagnosis is very difficult, as there is no enough cases to achieve a clear understanding about the details of its radiological findings. Differential diagnosis have to be made especially from angiosarcoma and meningioma. It is curable by total surgical removal. In this article we presented the characteristic clinical, radiological, perioperative and pathological findings in a case of IPEH in an unusual location, origin and behavior. To best of our knowledge, we presented the first case of IPEH originating from tentorium.

Assessing Aneurysm Obliteration and Neck Remnants in 225 Clipped Aneurysms Using Indocyanine Green Video Angiography, Micro-Doppler Ultrasonography and Postoperative Digital Subtraction Angiography.

AIM: To present our experience of 225 clipped aneurysms in 196 patients to compare indocyanine green video angiography (ICGVA), micro-Doppler ultrasonography (MDUSG), and postoperative digital subtraction angiography (DSA) in terms of determining aneurysm obliteration, neck remnants, and parent artery patency. MATERIAL AND METHODS: This retrospective study included 196 patients (108 female and 88 male patients) treated between 2013 and 2016. In all cases, aneurysm neck remnants and vessel patency were assessed using ICG-VA and 16-Hz MDUSG. DSA was performed in every case postoperatively within the first 5 days. RESULTS: The mean patient age was 55.8 years (range, 31-80 years), and the mean follow-up duration was 25 months (range, 2-48 months). Of the 225 clipped aneurysms, 86 were located in the anterior cerebral artery and its branches, 103 in the bifurcation of the middle cerebral artery (MCA) and the branches of the MCA, 34 in the internal cerebral artery and its branches, 1 in the posterior inferior cerebellar artery, and 1 at the basilar apex. We observed 2 neck remnants (0.8%), 2 parent/perforating artery occlusions (0.8%), and 2 residual aneurysm fillings (0.8%). There were no striking differences among the assessed methods. CONCLUSION: ICG-VA, MDUSG, and dome puncturing are all useful techniques in aneurysm surgery for assessing complete obliteration of the aneurysm. In our experience, all the 3 tools are complementary to each other, and none of them is superior to the others. We recommend the use of all 3 tools to obtain a favorable outcome.

Calvarial Reconstruction of Small-Size Skull Defects Performing "8 Cranioplasty" in Children: Surgical Experience, Clinical Results and Treatment Algorithm.

AIM: To report our clinical experience, surgical treatment algorithm and technique in the reconstruction of uncomplicated and small-size calvarial defects by performing autologous split-bone grafting technique on anatomical findings and patients" outcome. MATERIAL AND METHODS: We covered the defective calvarial zone without bone (area, 3.8 to 7.5 centimetersquare; median area 4.2 centimetersquare) following the resection of pathological skull region with an inner table of horizontally split adjacent skull site in thirty-six patients (aged between 28 and 125 months; median age, 68.75 months, minimum follow-up 14 months). The donor site, the characteristics of skin incision such as length, shape, location and bone splitting technique were determined based on our treatment algorithm for "8 cranioplasty". Pre- and postoperative clinical outcomes and courses as well as radiological results are documented. RESULTS: Mean follow-up period for all children was 25 months. There was no mortality and 5.55% morbidity (n=2: 1 sterile wound dehiscence and 1 sterile wound discharge). No infected flap was seen and none of the patients required a second surgery. No graft failure, tumor recurrence or residue occurred. CONCLUSION: Almost all of our patients reported good surgical and clinical outcomes with this presented management and surgical algorithm. Autologous split bone grafting technique in small-size skull defects, with its proposed name "8 cranioplasty" is a safe and effective reconstructive procedure due to its short-term surgery, small-size surgical zone, low complication rate, good cosmetic results and cost effectiveness. In addition, our algorithm specified for this procedure is purposive and also saves the surgeon time in the surgical planning stage.