Large fusiform posterior cerebral artery aneurysm (P2 segment): successful trapping and excision via subtemporal approach.

A 62-year-old man presented with a 2-month history of right occipito-parietal headache and worsening ipsilateral ptosis. CT scan and cerebral angiography revealed a large fusiform aneurysm of the P2 segment of the right posterior cerebral artery (PCA). The aneurysm was successfully trapped and subsequently excised via sub temporal approach leaving no additional neurological deficits to our patient.

Choroid plexus carcinoma in an infant.

Choroid plexus carcinoma is a rare intracranial neoplasm, affecting mainly very young children. The commonest site is within the lateral ventricles and the prognosis is very poor. We report a seven month old baby boy who presented with raised intracranial pressure and seizures. Brain CT scan showed large intraventricular mass with calcification and hydrocephalus. Total macroscopic resection of the tumour was performed and diagnosis of choroid plexus carcinoma was made. However, the patient died 11 days after the tumour excision. The histopathology of this rare childhood neoplasm is discussed.

Vestibular nerve section in a child with intractable Menière's disease.

Clinical presentation of Menière's disease in children is not as typical as in adults. The triad of vertigo, tinnitus and deafness are not usually elicited, diagnosis often being made after years of follow up and batteries of investigation. A case of Menière's disease in a 3-year-old boy is presented. The diagnosis was only obvious at the age of 8 when the triad of vertigo, deafness and tinnitus were present. His disease progressed despite a trial of intratympanic gentamicin injections and endolymphatic sac decompression. Vestibular nerve section was subsequently performed for his intractable disease. Following the procedure he was asymptomatic and able to attend school.

Changing role for preoperative embolisation in the management of arteriovenous malformations of the brain.

BACKGROUND: The aim of this study was to analyse the results of the use of preoperative embolisation in the management of arteriovenous malformations of the brain at one institution between 1989 and 1999. METHODS: Two hundred and fifty consecutive cases of angiographically confirmed arteriovenous malformations underwent surgery by one surgeon. Cases of dural or spinal arteriovenous malformations have been excluded. Forty-five cases underwent preoperative embolisation. Embolisation was mostly by particulate embolic material delivered 4 to 6 days before the intended surgery. The incidence of embolisation declined from 21 cases of the first 50 arteriovenous malformation cases surgically treated to five in the last 50 cases. For arteriovenous malformations of less than 3 cm, only the first two temporal quintiles had embolised cases; six in the first and three in the second. Outcome was measured by the Modified Rankin Scale. RESULTS: By 12 months (or last follow up, if less than this time has elapsed) following surgery, 1.6% of patients had died, 2.4% had a Modified Rankin scale score of 4 or 5, 6.4% had a Modified Rankin scale score of 3, 8.4% had a Modified Rankin scale score of 2, 14.4% had a Modified Rankin scale score of 1, and 66.8% were without neurological deficit. There was no difference in outcomes in each of the temporal quintiles. The four deaths were related to intraoperative haemorrhage, ruptured aneurysm, acute myocardial infarction or unrelated infection. Angiographic cure was achieved in 244 of 246 surviving cases. The two cases with residual arteriovenous malformations underwent focussed irradiation. Permanent morbidity could be attributable to embolisation, intraoperative events (resection functional brain, arteriovenous malformation rupture, aneurysm rupture or myocardial infarction) or postoperative events (arterio-capillary-venous hypertensive syndrome or infection). Of these 29 patients 14 had undergone embolisation. Mortality and major morbidity (Modified Rankin scale score greater than 2 due to treatment) occurred in 8.8% undergoing embolisation compared with 1.9% not embolised. The cause for major morbidity in these four embolised cases was intraoperative or postoperative haemorrhage. CONCLUSIONS: These results reflect that cases selected for embolisation were those at most risk from intraoperative haemorrhage. Arteriovenous malformations that are less than 3 cm in maximal diameter should only rarely be considered for preoperative embolisation because of their low surgical morbidity. In the presence of a significant deep perforating artery contribution that cannot be effectively embolised the risks of operative haemorrhage is high irrespective of the effectiveness of embolising ancillary non-perforating arteries.

Telemedicine in neurosurgery using international digital telephone services between Japan and Malaysia--technical note.

A new image transmission and teleconference system using international digital telephone services was established between Japan and Malaysia. This new system consists of an ordinary personal computer, image scanner, and terminal adapter for digital telephone lines. The quality of images transferred using this system was high enough for diagnosis and discussion except for images such as radiographs requiring huge data transfer. Transmission of one image took approximately 20 seconds. The cost performance was almost equal to the conventional mailing system. The most remarkable advantage of this new system is the high quality of transferred images, the cost and time performance, and security of the medical information. New communication systems using international digital networks including the internet may allow re-distribution of medical resources between advanced countries and developing countries in neurosurgery.

Cerebral abscess as an unusual complication of coil embolization in a dural arteriovenous fistula. Case report.

This 63-year-old man presented with a right temporoparietal cortical infarction. A dural arteriovenous fistula involving the right transverse sinus was diagnosed on cerebral angiography. Transvenous embolization using detachable coils was performed; however, postembolization angiograms demonstrated retrograde filling of a cortical draining vein that was not seen on initial angiography. The patient subsequently developed a cerebral abscess in the region of the previous cortical infarction 2 months after the embolization. The abscess was successfully treated with drainage and antibiotic therapy. The authors report this case to illustrate an unusual complication associated with this procedure and the possible contribution of the cortical draining vein in the pathogenesis of the cerebral abscess.

Childhood ischemic stroke caused by fibromuscular dysplasia of the intracranial artery--case report.

An 8-year-old girl presented with fibromuscular dysplasia of the intracranial vessels manifesting as ischemic stroke. Neuroimaging showed infarction of the right putamen and ipsilateral frontal white matter. Angiography revealed "string of beads" sign involving the terminal portion of the right internal carotid artery and the horizontal segment of the ipsilateral middle cerebral artery. She was treated conservatively. Magnetic resonance angiography at 2 months post ictus showed similar findings in the middle cerebral artery but improvement of the stenosis of the internal carotid artery. Her neurological deficits had almost resolved. Fibromuscular dysplasia should be part of the differential diagnosis of ischemia in children.