Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsPial arteriovenous fistula as a cause of bilateral thalamic hyperintensities--an unusual case report and review of the literature.
Isolated bilateral thalamic congestion due to an arteriovenous malformation (AVM) is a rare entity. Few case reports of dural arteriovenous fistula associated with it have been reported in the literature. The association of pial arteriovenous fistula (pial AVF) with thalamic hyperintensities has never been described before. The pial AVF is a recently recognized lesion in which the multiple pial arterial feeders drain into a single venous channel without a nidus like in conventional AVM. In spite of being congenital in origin, these lesions may have expression in adulthood due to abrupt change in the venous drainage system. Successful management of pial AVF associated with bilateral thalamic hyperintensities is described here with review of the literature. ⋯ Strong suspicion of vascular malformation as a cause of bilateral thalamic hyperintensities helps in early detection. Such lesions like pial AVF presented here require active intervention by surgery or endovascular therapy. GKT is an important adjuvant in lesions refractory to either of them.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsIs it safe to sacrifice the superior hypophyseal artery in aneurysm clipping? A report of two cases.
Clipping of paraclinoid internal carotid artery aneurysms related to the superior hypophyseal artery (SHA) carries risk of occlusion of this artery when originating distal to the neck of the aneurysm. Sometimes it is inevitable to sacrifice the artery to achieve total aneurysm occlusion. Otherwise a residual aneurysm would remain, which may lead to aneurysm regrowth and subsequent rupture. ⋯ Intraoperative ICG angiography may help to estimate collateral blood flow but is not able to predict visual decline. Although final conclusions cannot be drawn from two patients, it seems that in case of multiplicity of superior hypophyseal complex, sacrifice of one even larger branch is safe. However, visual sequelae have to be taken into consideration when a single SHA has to be sacrificed for total aneurysm clipping.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsAkinetic mutism and parkinsonism due to subdural and intraventricular tension pneumocephalus.
Pneumocephalus may occur after intracranial surgery and is most often asymptomatic. It is usually associated with posterior fossa surgery. ⋯ As an emergency treatment, air was exchanged with saline via the drainage, which then was removed and a subduro-peritoneal shunt was implanted. The condition described here requires immediate attention and appropriate treatment.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsRuptured Rathke cleft cyst mimicking pituitary apoplexy.
Rathke cleft cysts (RCCs) are benign cystic lesions of the sellar and suprasellar region that are asymptomatic in most cases. Occasionally, compression of the optic pathway and hypothalamo-pituitary structures may cause clinical symptoms, such as headaches, visual deficits and endocrinopathies. ⋯ In retrospect, clinical symptoms, intraoperative appearance, and histologic examination were compatible with the diagnosis of nonhemorrhagic rupture of an RCC. Thus, the clinical presentation of "Rathke cleft cyst apoplexy" is not necessarily caused by hemorrhage.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsAcute decompensation of noncommunicating hydrocephalus caused by dilated Virchow-Robin spaces type III in a woman treated by endoscopic third ventriculostomy: a case report and review of the literature.
Even though dilated Virchow-Robin spaces (VRS) are a very rare entity, they can compel the clinician to start immediate intervention in the case of acute onset of symptoms. To allow a well-balanced management decision, we compiled a summary of all cases published in the literature and discuss the different methods and indications for neurosurgical intervention in relation to dilated VRS. ⋯ To the best of our knowledge, the case presented here is the first case of acute decompensation of a noncommunicating hydrocephalus caused by dilated VRS. Neurosurgical intervention is required in cases of noncommunicating hydrocephalus caused by giant tumefactive VRS. The treatment options are mono- or biventricular shunt surgery or ETV. Because ETV provides the possibility of cyst fenestration and membrane sampling, it appears to be the most advantageous treatment option.