Aneurysms of the distal anterior cerebral artery: a clinical series.

BACKGROUND AND PURPOSE: Distal anterior cerebral artery (DACA) aneurysms, also called pericallosal or A2 aneurysms, are rare and comprise about 1.5 to 9% of all intracranial aneurysms. In this study, a series of 10 patients with DACA aneurysms who were surgically treated in our clinic is presented and discussed, focusing on their clinical features and sur-gical outcomes. MATERIAL AND METHODS: A total of 344 patients with cerebral aneurysms were operated on in our clinic and 10 patients (2.9%) with DACA aneurysms were studied retrospectively. All patients underwent a computed tomography (CT) scan followed by four-vessel digital subtraction angiography (DSA). RESULTS: Initial CT revealed intracerebral haematoma (ICH) in 7 patients (70%) and in 2 of them the haematoma was over 3 cm in diameter. The pericallosal-callosomarginal bifurcation was the most common location in 9 patients (90%). Four cases (40%) showed multiple aneurysms. The mean waiting time for the operation was 4.8 days. Surgical clipping was performed in all the cases. Multiple aneurysms required two different craniotomies in the same session. The patients with ICH over 3 cm in diameter, in addition to poor preoperative grade, are likely to have a poor outcome, and so clinical grade is the definite factor affecting the surgical outcome of patients. CONCLUSIONS: DACA aneurysms are usually small and bleeding occurs irrespective of their size because of the lack of resistant arachnoid membranes at the level of the pericallosal cisterns. All DACA aneurysms, even if very small in size or discovered incidentally, should be aggressively treated because of the high tendency to rupture.

Intracerebral hematoma following lumboperitoneal shunt insertion: a rare case report.

Lumboperitoneal shunting is widely used for the surgical management of pseudotumor cerebri and other pathologies such as communicating hydrocephalus. Although it is a safe method, it could be associated with complications including subarachnoid hemorrhage, subdural and rarely intracerebral hematoma. A 44-year-old female applied to our clinic with complaints of severe headache, retroorbital pain and blurred vision. Lumbar puncture demonstrated cerebrospinal fluid opening pressure of cmH2O. A non-programmable lumboperitoneal shunt with two distal slit valves was inserted due to pseudotumor cerebri. She deteriorated shortly after surgery. Immediate cranial computed tomography scan revealed a right parietal intracerebral hematoma. Development of intracerebral hematoma following lumboperitoneal shunt is a rare complication. We discuss this rare event accompanied by the literature.

Chronic subdural hematoma in capoeira sport.

Chronic subdural hematomas in young people is extremely rare and has some provoking factors such as V-P shunts, arachnoid cyst, anticoagulant drug usage, vigorous sports and coagulopathies. A static or dynamic mechanical load is almost always delivered to skull associated with either mild or severe head trauma. A 25-year old-man who was previously healthy has complained of intermittent headache for six months. He had been interested in capoiera (Brazilian exciting sport) for two years and has had no any evidence of head injury. After admission, he was operated immediately because of chronic subdural hematoma. We report a patient who is the first chronic subdural hematoma in the literature due to playing capoeira.

Angiographically occult vascular malformation of the third ventricle.

Angiographically occult vascular malformations (AOVM) are cerebrovascular malformations that are not demonstrable on cerebral angiography. The majority of AOVMs located in the third ventricle are cavernous malformations. To the best of our knowledge an angiographically occult arteriovenous malformation (AOAVM) of the third ventricle has not been previously reported. We report an unusual vascular malformation of the third ventricle presenting with hydrocephalus due to mass effect, verified histopathologically as an AOAVM.

Early changes in the cervical foraminal area after anterior interbody fusion with polyetheretherketone (PEEK) cage containing synthetic bone particulate: a prospective study of 20 cases.

OBJECTIVES: Although the use of intervertebral fusion after anterior cervical microdiscectomy remains controversial, a new surgical device is proposed for use in intervertebral fusion instead of bone graft. The authors evaluate the effects of implantation of polyetheretherketone (PEEK) cage containing synthetic bone particulate on the height and cross-sectional area of the foramen, the intervertebral disk height and the degree of lordosis. METHODS: Twenty consecutive patients with radiculopathy owing to cervical disk herniation were scheduled. They underwent multislice computed tomographic scanning pre-operatively and 1 day post-operatively. RESULTS: Pre-operatively, the mean height of the right foramina was 8.807 +/- 1.120 mm, the left foramina was 9.500 +/- 1.529 mm. Post-operatively, the mean foraminal height of the right side was 11.080 +/- 1.121 mm and 10.020 +/- 1.453 mm on the left. This difference reached statistical significance on the right foraminal height (p=0.000) but not on the left side (p=0.078). The mean area of the right foramina was 46.82 +/- 14.54 mm(2) and 52.71 +/- 15.62 mm(2) on the left side pre-operatively. Post-operatively, the values were 60.87 +/- 15.91 mm(2) and 55.83 +/- 13.88 mm(2) respectively. In terms of pre-operative value, the 1 day post-operative measurement reached again statistical significance (p=0.002) on the right side. The mean value of disk height was 3.653 +/- 0.596 mm pre-operatively and 6.387 +/- 0.533 mm at 1 day post-operatively. This difference is statistically significant (p=0.000). DISCUSSION: Implantation of a PEEK cage containing synthetic bone particulate in the treatment of cervical disk disease offers good immediate stabilization by easier implantation technique and avoids donor site morbidity. It provides an increase in height and cross-sectional area of the neural foramina. These preliminary results suggest that interbody fusion cages appear to be safe and effective.

Peritumoral brain edema in intracranial meningiomas.

OBJECTIVE: The goal of this study was to determine the relationship between patient age and gender and meningioma location, histological subtype, size, lobulation and peritumoral brain edema (PTBE). PATIENTS AND METHODS: In a series of 55 patients with intracranial meningiomas, factors possibly related to the development of PTBE were analyzed. We used an EI (edema index) as the indicator of PTBE. EI was calculated by dividing the area of PTBE by that of the tumor. Thus if EI = 1, there is no PTBE. Univariate analysis was used to evaluate the relationship between EI and related factors. The MEI (mean edema index) difference between age groups was calculated using the Duncan Test. RESULTS: We found that none of the factors analyzed influenced PTBE except patient age 61-70 years, which correlated with PTBE (p = 0.022). The difference between MEI in the 41-50 years and 61-70 years age groups was significant, with that in the 61-70 years age group being significantly higher. CONCLUSION: We conclude that these findings in the 61-70 years age group may constitute an increased risk of perioperative mortality and morbidity.