Visual failure and recovery after thrombosis of a giant carotid ophthalmic aneurysm following vascular bypass and carotid artery ligation.

Thrombosis via Hunterian ligation, with or without high-flow bypass, is the definitive treatment for unclippable giant aneurysms; however, secondary deterioration may occur. We present a 67-year-old woman with an unclippable giant (33mm) carotid ophthalmic aneurysm. High-flow external carotid artery to middle cerebral artery bypass and proximal cervical internal carotid artery Hunterian ligation achieved complete thrombosis. Subsequent expansion of the thrombosed aneurysm created mass effect with hydrocephalus, leading to marked cognitive and visual decline. Aneurysmal decompression led to improved vision and near-normal neurological function.

Association between increased central venous pressure and hydrocephalus in children undergoing cardiac catheterization. A prospective study.

OBJECTS: The relationship between increased central venous pressure (CVP) and development of hydrocephalus has been extensively discussed in the neuropediatric literature. However, the possibility of a direct connection has not been systematically examined. The purpose of this prospective study was to examine whether there was a correlation between elevated CVP and hydrocephalus in children undergoing cardiac catheterization. METHODS: We used cardiac catheterization to measure the right atrial and superior vena caval pressure in 37 children (mean age 30 months) with congenital heart malformations. The children had CVP higher than normal (mean 10.2+/-3.1 mmHg, range 4-18). To evaluate the size of the lateral and fourth ventricles, we performed CT scans of the brain on each child. Abnormal scans were found in 15/37 children, showing brain atrophy (12/37), ventriculomegaly (3/37), and focal infarction (1/37). Cerebral atrophy was more likely to occur in young children (P<0.001). The average head circumference among these children was less than 2SD below the mean for healthy children of comparable ages. Using a correlation coefficient regression model, no relationship was found between CVP and ventricular diameters or head circumference. CONCLUSIONS: These results argue against the hypothesis that mild to moderately elevated venous pressure is involved in the mechanism and development of pediatric hydrocephalus.

Tumor prostaglandin levels correlate with edema around supratentorial meningiomas.

The pathophysiological mechanisms to explain peritumoral edema have not been clarified. Multiple aspects of brain edema secondary to supratentorial meningiomas were prospectively investigated in a group of 29 patients who underwent surgery consecutively. Sixty-nine tumor samples were analyzed for prostanoid levels. Levels of 6-keto-PGF1 alpha, the stable metabolite of prostacycline, were found to correlate well with the extent of edema (r = 0.51, P < 0.01). The ratio, 6-keto-PGF1 alpha x PGE2/TXB2, was found to have the best correlation with edema index (extension/tumor volume) (r = 0.69, P < 0.005). A case of a hemangiopericytic meningioma with the largest edema extent within the study group also exhibited the highest level of 6-keto-PGF1 alpha (2420 pg/mg protein). Steroid treatment (dosage, duration of therapy, and their product) did not correlate with prostaglandin levels. These findings may explain the inconsistent clinical effects of steroids on meningioma-induced edema. Possible explanations for this phenomenon are discussed. Otherwise, histology, pathological features of tumor aggressiveness, or mechanical parameters, such as its volume, location, and insertion site, did not correlate well with edema parameters or with prostaglandin levels. Similarly, tumor water content, imaging parameters in computed tomography and magnetic resonance, and operative findings (including dissection plane, vascularity, and tumor firmness) did not correlate well with edema parameters. Although a direct cause-effect relationship between prostaglandins and peritumoral edema is not conclusively established, the circumstantial evidence of the ability of prostaglandins to induce vasogenic brain edema and the robust association with peritumoral edema is persuasive.(ABSTRACT TRUNCATED AT 250 WORDS)

Successful chemotherapy of recurrent intracranial germinoma with spinal metastases.

A recurrent CNS germinoma with subependymal and spinal metastases was treated by combination of cis-platinum, bleomycin, and vinblastine, resulting in disappearance of intracranial and spinal tumor. Second intracranial relapse responded again to the same combination chemotherapy. Response of spinal metastases to this combination chemotherapy has not been reported previously.