Traumatic Dural Venous Sinus Injury / 대한신경손상학회지

OBJECTIVE: The importance of traumatic dural venous sinus injury lies in the probability of massive blood loss at the time of trauma or emergency operation resulting in a high mortality rate during the perioperative period. We considered the appropriate methods of treatment that are most essential in the overall management of traumatic dural venous sinus injuries. METHODS: We conducted a retrospective review of all cases involving patients with dural venous sinus injury who presented to our hospital between January 1999 and December 2014. RESULTS: Between January 1999 and December 2014, 20 patients with a dural venous sinus injury out of the 1,200 patients with severe head injuries who had been operated upon in our clinic were reviewed retrospectively. There were 17 male and 3 female patients. In 11 out of the 13 patients with a linear skull fracture crossing the dural venous sinus, massive blood loss from the injured sinus wall could be controlled by simple digital pressure using Gelfoam. All 5 patients with a linear skull fracture parallel to the sinus over the venous sinus developed massive sinus bleeding that could not be controlled by simple digital pressure. CONCLUSION: When there is a linear skull fracture parallel to the sinus over the dural venous sinus or a depressed skull fracture penetrating the sinus, the surgeon should be prepared for the possibility of potentially fatal venous sinus injury, even in the absence of a hematoma.

Rapid Clinical Course of Cerebral Metastatic Angiosarcoma from the Heart

We report here one case of rapid and aggressive course of cerebral metastatic angiosarcoma from the heart. A 36-year-old man presented with 10-days history of headache. Magnetic resonance imaging demonstrated subacute hemorrhage with a small region of enhancement in right parietal region and the pathological diagnosis was angiosarcoma. Transthoracic echocardiography demonstrated 3.2x3 cm sized mass on right atrial wall. Newly developed lesion was reoperated, three and four weeks later respectively, and whole brain radiotherapy of total 30 Gy was done. With the interval of two months, gamma knife surgery was done for new lesions two times, which were well controlled. Newly developed lesions rapidly happened even in the adjuvant treatment. He died 9 months after the diagnosis because of the aggravation of primary cancer. The cerebral metastatic angiosarcoma from the heart showed the rapid aggressive behavior and the closed follow-up could be needed for the adjuvant treatment.

Tailored Surgical Approaches for Benign Craniovertebral Junction Tumors

OBJECTIVE: We report our surgical experience in the treatment of 16 consecutive patients with benign craniovertebral junction (CVJ) tumor, observed from 2003 to 2008 at our department. METHODS: We had treated 6 foramen magnum meningiomas, 6 cervicomedullary hemangioblastomas, 1 accessory nerve schwannoma, 1 hypoglossal nerve schwannoma, 1 C2 root schwannoma, and 1 cavernous hemangioma. Clinical results were evaluated by Karnofsky Performance Scale (KPS) and all patients underwent preoperative neuroradiological evaluation with computed tomography (CT) and magnetic resonance image (MRI). Angiography was performed in 15 patients and preoperative embolization was done in 2 patients. RESULTS: Five far-lateral, 1 supracondylar and 10 midline suboccipital approaches were performed. Gross total removal was achieved in 15 cases (94%) and subtotal removal in 1 patient (6%). None of the patients required occipitocervical fusion. Radiological follow-up showed no recurrence in cases totally removed. Postoperative decrease of KPS scores was recorded in only 1 patient. The treatment of cervicomedullary solid hemangioblastoma presented particular issues : by preoperative embolization, we removed tumor totally without an excessive bleeding or brainstem injury. In one of foramen magnum meningioma, we carried out subtotal removal due to hard tumor consistency and encasement of neurovascular structures. CONCLUSION: : The choice of surgical approaches and the extent of bone resection should be defined according to the location and size of individual tumors. Moreover, we emphasize that preoperative neuroradiological evaluations on presumptive tumor type could be helpful to the surgeon in tailoring the technique and providing the required exposure for different lesions, without unnecessary surgical steps.

Fatal Subarachnoid Hemorrhage After Early Carotid Stenting For Progressive Stroke: Case Report / 대한뇌혈관외과학회지

Subarachnoid hemorrhage (SAH) after surgical or interventional treatment for carotid stenosis is rare, with only a few cases reported in the literature. Our department treated a 78-year-old female with symptoms of deteriorated mental functioning and focal neurological signs. Despite medical treatment, serial magnetic resonance imaging (MRI) studies revealed a progressive extension of multiple infarctions in her left cerebral hemisphere. Cerebral angiography revealed greater than 95% stenosis in the proximal left internal carotid artery (ICA), accompanied by multiple stenoses of the contralateral ICA. For this progressive stroke, we performed early carotid stenting in the left ICA stenosis. Two hours after the procedure, the patient suddenly collapsed, and a computed tomography (CT) scan showed a diffuse SAH with acute hydrocephalus. Despite medical and surgical treatment, the patient died six days after the procedure. The case presented here and a review of the reports on the previous instances suggest that long-standing, severe carotid stenosis with contralateral multiple severe stenoses, persistent hypertension, and the extensive use of heparin and antithrombotic agents may predispose patients to SAH.