Traumatic pseudoaneurysm of the middle meningeal artery and cerebral intraparenchymal hematoma: case report.

BACKGROUND: Pseudoaneuryms of the MMA are rare lesions, accounting for less than 1% of all intracranial aneurysms. CASE DESCRIPTION: We report a case of a spontaneous intracerebral hematoma that DSA revealed as ispilateral traumatic PMMA. The lesion was managed through an endovascular approach, and definitive embolization of pseudoaneurysm and parent vessel with histoacryl injection was carried out. Recovery and follow-up were uneventful. We discuss the management of those lesions, emphasizing the current neuroendovascular tools and techniques. CONCLUSION: Pseudoaneurysm of the MMA is uncommon but has a potential aggressive natural history. As it can occur with different patterns of intracranial hemorrhage, the external carotid arteries have to be included in hemorrhagic investigational DSA. Once diagnosed, it must be treated. The minimally invasive endovascular approach and definitive embolization of pseudoaneurysm and parent vessel with histoacryl injection are safe and effective.

Endovascular treatment of bifurcation intracranial aneurysms with the WEB SL/SLS: 6-month clinical and angiographic results.

BACKGROUND: The WEB device is a recent intrasaccular flow disruption technique developed for the treatment of wide-necked intracranial aneurysms. To date, a single report on the WEB Single-Layer (SL) treatment of intracranial aneurysms has been published with 1-months' safety results. The aim of this study is to report our experience and 6-month clinical and angiographic follow-up of endovascular treatment of wide-neck aneurysm with the WEB SL. METHODS: Ten patients with 10 unruptured wide-necked aneurysms were prospectively enrolled in this study. Feasibility, intraoperative and postoperative complications, and outcomes were recorded. Immediate and 6-month clinical and angiographic results were evaluated. RESULTS: Failure of WEB SL placement occurred in two cases. Eight aneurysms were successfully treated using one WEB SL without additional treatment. Three middle cerebral artery, four anterior communicating artery, and one basilar artery aneurysms were treated. Average dome width was 7.5 mm (range 5.4-10.7 mm), and average neck size was 4.9 mm (range 2.6-6.5 mm). No periprocedural complication was observed, and morbi-mortality at discharge and 6 months was 0.0%. Angiographic follow-up at 6 months demonstrated complete aneurysm occlusion in 2/8 aneurysms, neck remnant in 5/8 aneurysms, and aneurysm remnant in 1/8 aneurysm. CONCLUSIONS: From this preliminary study, treatment of bifurcation intracranial aneurysms using WEB SL is feasible. WEB SL treatment seems safe at 6 months; however, the rate of neck remnants is not negligible due to compression of the WEB SL. Further technical improvements may be needed in order to ameliorate the occlusion in the WEB SL treatment.

Utilização da osteotomia Le Fort I na abordagem cirúrgica de carcinoma epidermóide de base de crânio / Le Fort I Osteotomy as a Surgical Approach to Skull Base Epidermoid

O acesso para tratamento de lesões localizadas na região de base de crânio tem sido um desafio cirúrgico na história da neurocirurgia. A osteotomia Le Fort I é o resultado de décadas de aperfeiçoamento da Cirurgia Buco-Maxilo-Facial, que culminou numa osteotomia versátil, segura e satisfatória, a qual pode ser utilizada nos acessos para ressecções de tumores de base de crânio e seios paranasais, além de anomalias da coluna Buco-Maxilo-Facial, que culminou numa osteotomia versátil, segura e satisfatória, a qual pode ser utilizada abordagem cirúrgica no caso de um paciente com carcinoma epidermóide da região do clivo

The access to lesions located at the skull base has been a challenge in the history of neurosurgery. Le Fort I osteotomy resulted from the advancement of oral and maxillofacial surgery techniques which made the procedure flexible, secure and satisfactory. Osteotomy can be applied to resect central skull base and paranasal tumors as well as upper cervical spine anomalies. This paper describes in detail the use of Le Fort I osteotomy as a surgical approach to a patient with squamous cell carcinoma in clivus region

Dois casos de craniossinostoses e a importância do diagnóstico precoce / The two cases of craniosynostosis and the importance of early diagnosis

As craniossinostoses (CSO) ou, como säo classicamente denominadas, "cranioestenoses" säo entidades já bem conhecidas há mais de vinte séculos e que, se näo adequadamente manejadas, trazem inúmeras complicaçöes principalmente no que diz respeito à limitaçäo do espaço intracranial e deformidades craniais, hipertensäo intracraniana e retardo no desenvolvimento neuropsicomotor. Neste trabalho, os autores descrevem aspectos importantes sobre essa entidade no que se refere a: histórico, etiopatogenia, classificaçäo, tratamento cirúrgico e, ainda, através do relato de dois casos distintos de CSO, um de sutura sagital e outro de sutura bicoronal, demonstram a importância do diagnóstico do tratamento precoce de modo a otimizar os resultados cirúrgicos e prevenir as temidas complicaçöes.