Endovascular Treatment for Ruptured Distal Anterior Inferior Cerebellar Artery Aneurysm

A 42-year-old woman presented with Hunt and Hess grade (HHG) III subarachnoid hemorrhage (SAH) caused by a ruptured left distal anterior inferior cerebellar artery (AICA) aneurysm. Computed tomography showed a thin SAH on the cerebellopontine angle cistern, and small vermian intracerebral hemorrhage and intraventricular hemorrhage in the fourth ventricle. Digital subtraction angiography revealed the aneurysm on the postmeatal segment of left distal AICA, a branching point of rostrolateral and caudomedial branch of the left distal AICA. Despite thin caliber, tortuous running course and far distal location, the AICA aneurysm was obliterated successfully with endovascular coils without compromising AICA flow. However, the patient developed left side sensorineural hearing loss postoperatively, in spite of definite patency of distal AICA on the final angiogram. She was discharged home without neurologic sequela except hearing loss and tinnitus. Endovascular treatment of distal AICA aneurysm, beyond the meatal loop, is feasible while preserving the AICA flow. However, because the cochlear hair cell is vulnerable to ischemia, unilateral hearing loss can occur, possibly caused by the temporary occlusion of AICA flow by microcatheter during endovascular treatment.

Sacral Perineural Cyst: Another Cause of Sciatica

About 25% of intrasacral perineural cyst cause sciatica resembling lumbar disc herniation or lumbar stenosis. We report a case of sacral perineural cyst in a 38-year-old female who complained of sciatica and neurogenic intermittent claudication. Delayed X-ray after 3 hours from initial myelogram revealed round cyst at the sacral canal. CT and MRI revealed a cystic mass which has cerebrospinal fluid(CSF) signal intensity. The patient underwent surgery via sacral laminotomy and ligation of cyst including S2 nerve root. The patient returned to work with complete relief of symptoms.

Vasospasm in Intracranial Aneurysm

The literature concerning cerebral vasospasm associated with subarachnoid hemorrhage(SAH) due to ruptured intracranial aneurysm contains no definitive study of patients to determine whether there is (1) any clinical picture consistently present coincident with known cerebral vasospoasm, (2) any relationship between mortality and known vasospasm, and (3) any relationship between serious brain damage(morbidity) and known vasospasm. To answer these important questions, experience with 138 consecutive acute SAH patients due to ruptured intracranial aneurysm was studied. The results were (1) The vasospasm was seen in 61 patients(44.2%) and the clinical vasospasm was seen in 41 patients(29.8%);(2) The average interval between last SAH and vasospasm was 8.3 days;(3) The most common neurological deficit was a hemiparesis or a hemiplegia;(4) There is no relationship between mortality and vasospasm.

Vasospasm in Intracranial Aneurysm

The literature concerning cerebral vasospasm associated with subarachnoid hemorrhage(SAH) due to ruptured intracranial aneurysm contains no definitive study of patients to determine whether there is (1) any clinical picture consistently present coincident with known cerebral vasospoasm, (2) any relationship between mortality and known vasospasm, and (3) any relationship between serious brain damage(morbidity) and known vasospasm. To answer these important questions, experience with 138 consecutive acute SAH patients due to ruptured intracranial aneurysm was studied. The results were (1) The vasospasm was seen in 61 patients(44.2%) and the clinical vasospasm was seen in 41 patients(29.8%);(2) The average interval between last SAH and vasospasm was 8.3 days;(3) The most common neurological deficit was a hemiparesis or a hemiplegia;(4) There is no relationship between mortality and vasospasm.

Computed tomographic findings of traumatic intracranial lesions

Traumatic intracranial lesion has been one of the most frequent and serous problem in neurosurgical pathology. CT made it possible to get prompt diagnosis and surgical intervention of intracranial lesions by its safety, fastiness and accuracy. Computed tomographic scan was carried out on 1309 cases at Soonchunhyang Chunan Hospitalfor 15 months from Oct. 1983 to Dec. 1984. We have reviewed the computed tomographic scans of 264 patients whichshowed traumatic intracranial lesion. The results were as follows: 1. Head trauma was the most frequentlydiagnosed disase using computed tomographic scans(57.8%), and among 264 cases the most frequent mode of injury wastraffic accident (73.9%). 2. Skull fracture was accompained in frequency of 69.7% and it was detected in CT in38.6%: depression fractue was more easily detected in 81%. 3. Countercoup lesion(9.5%) was usually accompained with temporal and occipital fracture, and it appeared in lower incidence among pediatric group. 4. Intracranial lesions of all 264 cases were generalized cerebral swelling(24.6%), subdural hematoma(22.3%), epiduralhematoma(20.8%), intracerebral hematoma(6.1%), and subarachnoid hemorrhage(3.0%). 5. The shape of hematoma wasusually biconvex(92.7%) in acute epidural hematoma and cresentic(100%) in acute subdural hematoma, but the morechronic the cases became, they showed planoconvex and biconvex shapes. 6. Extra-axial hematoma was getting decreased in density as time gone by. 7. Hematoma density was not in direct proportion to serum hemoglobin levelas single factor.

Metastatic carcinoma of the thyroid to the skull: report of 2 cases

Two cases of skull metastasis from thyroid carcinoma are presented. The one case shows multiple involvement inthe skull base with sphenoid sinus, frontal bone, and rib. The other case is solitary extensive involvement to theright parietal bone. The follicular caroinoma of the thyroid shows a strong tendency toward vascualr invasion and dissemination through blood stream to the lungs, bones, liver, brain, and other distant sites. The sternum, thevetebrae, and the pelvis are the most common sites in bone metastasis of thyroid carcinoma, followed by the femur,shoulder girdle, skull, and rib. Metastatic caroinoma to the skull base, including sphenoid sinus s extremelyrare. Authors experienced recently 2 cases of metastatic carcinoma of the thyroid to the skull and report withreview of literature.