Nonaneurysmal Subarachnoid Hemorrhage : Rare Complication of Vertebroplasty

On rare occasions, percutaneous vertebroplasty (PV) may be associated with adverse spinal and extraspinal events. Subarachnoid hemorrhage (SAH) has not been reported complication following a PV. This is a report of two elderly women with spine compressions who developed idiopathic SAH after injecting polymethylmethacrylate into the thoracolumbar region transcutaneously. PV was performed as an usual manner on prone position under local anesthesia for these patients. During the interventions, two patients complained of a bursting nature of headache and their arterial blood pressure was jumped up. Computed tomography scans revealed symmetric SAH on the both hemispheres and moderate degree of hydrocephalus. Any intracranial vascular abnormalities for their SAH were not evident on modern neuroangiography modalities. One patient received a ventricular shunt surgery, but both fully recovered from the procedure-related SAH. The pathophysiologic mechanism that induce SAH will be discussed, with suggesting the manner that prevent and minimize this rare intracranial complication after PV.

Spinal Epidural Cavernous Angioma: A Case Report

Spinal extradural cavernous angiomas(CAs) are apparently rare lesions. The author report a 67 year old man with an epidural CA at T9-10 space presenting with progressive leg weakness. Magnetic resonance imaging showed a thoracic epidural lesion appearing as isointense on T1-weighted with strong contrast enhancement and hyperintense on T2-weighted images. A moderate hyperdensity and foraminal widening was found on computed tomography. Hemilaminectomy was performed to relieve the spinal cord compression. A highly vascular tumor without bony involvement was observed in the epidural space. Histopathology of the lesion revealed a typical CA. The patient's symptoms resolved after treatment. Clinical aspect, radiological features, and surgical treatment of this rare entity will be reviewed.

Treatment for Recurrent Cerebral Aneurysm

OBJECTIVE: The aim of this study is to make a management strategy for the patients with recurrent cerebral aneurysm after surgery. METHODS: Over a 19-year period, 1, 546 patients were treated for a ruptured intracranial aneurysm surgically. Twenty-six of these patients(1.7%) were subsequently treated for regrowing aneurysm(8) or de novo aneurysm formation(26). Among them, twenty-three individuals who presented with recurrent subarachnoid hemorrhage underwent conventional angiography to detect the aneurysm recurrence. Three-dimensional computed tomographic angiography was performed in the remaining three patients who complained chronic headache. The mean age at the first surgery was 48.6 years. An interval ranging from 1 to 192 months(mean, 76.1 months) since the original treatment. RESULTS: Total 34 recurrent aneurysms in 26 patients were treated by microsurgical clipping(29 cases), wrapping(1 case), and endovascular coiling(4 cases) as a second procedure. A satisfactory outcomes were achieved in twenty-one patients(80.8%) during a mean 69.5 months follow-up period. The most common site of the recurrence was the internal carotid-posterior communicating artery. Patients with de novo aneurysms are frequently hypertensive(61.1%) and younger in age(55.6%). CONCLUSION: The treatment of recurrent cerebral aneurysm could be performed effectively using direct operations and/or endovascular procedures.