Supratentorial Epidural Hematoma as a Complication of Acoustic Neurinoma Surgery

The authors report a case of postoperative supratentorial epidural hematoma as a complication of acoustic neurinoma surgery. The 43-year-old man presented with hearing difficulty on the left side and decreased facial sensation. MR imaging demonstrated a huge, cystic left acoustic neurinoma and the retromastoid suboccipital approach was used for gross-total resection of the tumor. Postoperatively, the patient was drowsy and showed right hemiparesis. Computed tomographic scanning revealed a huge epidural hematoma in the left parietooccipital convexity. The intraoperative course was uneventful. Immediate craniotomy was performed and the epidural hematoma was removed. Bleeding from the superior sagittal sinus occurred, but was completely controlled. Postoperatively, the patient was neurologically normal, except for mild left facial weakness. Remote postoperative intracranial hemorrhage is a rare complication of craniotomy with significant morbidity and mortality. Such hemo-rrhages are likely to develop at or soon after surgery and can be related to the craniotomy site, operative positioning, and nonspecific mechanical factors. In this case, mechanical displacement of the brain secondary to excessive dehydration and CSF drainage was thought to be the cause of postoperative epidural hematoma. Clinical awareness of this rare but potential complication is essential to its early diagnosis and treatment. Difficulty in awakening from anesthesia and the development of new neurological deficits not attributable to the operative site are the most important keys to early diagnosis. Computed tomography is the diagnostic method of choice.

Aneurysm at the Origin of the Uncal Artery Arising from the Internal Carotid Artery

An aneurysm arising from the intracranial portion of the internal carotid artery(ICA) is usually found at the junction of the ophthalmic, superior hypophyseal, posterior communicating or anterior choroidal artery, or at the bifurcation of the internal carotid, but very rarely at the junction of the persistent trigeminal artery. We present a case of a 49-year-old man who presented with a massive subarachnoid hemorrhage, with large intracerebral hematoma due to rupture of the aneurysm originating from the distal portion of the internal carotid artery. During surgery, we found that the aneurysm was originated at the junction of the internal carotid artery and the artery arising from the distal to anterior choroidal artery. We considered this artery to be an anatomical variant of the uncal artery(UA) arising from the internal carotid artery.