Intracranial parenchymal capillary hemangioma: A case report.

Background: Capillary hemangioma is a rare benign hemangioma that occurs in the soft tissues of the skin, orbit, head, and neck. Intracranial cases, especially intraparenchymal cases, are extremely rare. In this study, we report the course of an intracranial parenchymal capillary hemangioma with left mild motor paresis and involuntary movements of the left upper extremity and was successfully treated by surgical resection, including radiological and pathological examinations. Case Description: This is a case of a 60-year-old woman who presented with motor weakness and involuntary movement of the left upper extremity. Computed tomography and magnetic resonance imaging revealed the right frontal hemorrhagic mass lesion without enhancement of contrast medium. Cerebral digital subtraction angiography showed no vascular stain and abnormal arteriovenous shunt. Preoperatively, we diagnosed cavernous hemangioma with a hemorrhagic component located in the right motor cortex. Because this case was symptomatic, we performed a craniotomy and gross total resection of the right frontal lesion. The diagnosis of capillary hemangioma was made by histological examination, including immunohistological study. Conclusion: Because intraparenchymal capillary hemangiomas are difficult to diagnose with preoperative imaging, surgical treatment, and histopathological examination are important.

Late-onset aqueductal membranous occlusion treated neuroendoscopic procedure and consideration of its pathological findings: A case report.

Background: Aqueduct of Sylvius stenosis/obstruction interferes with cerebrospinal fluid (CSF) flow and leads to the non-communicating hydrocephalus. Acquired non-neoplastic causes of aqueduct of Sylvius stenosis/ obstruction include simple stenosis, gliosis, slit-like stenosis, and septal formation, but the detailed mechanisms are not clear. In the present study, we experienced a case of late-onset aqueductal membranous occlusion (LAMO) successfully treated by neuroendoscopic procedure, which allowed us to examine the pathology of the membranous structures of the aqueduct of Sylvius occlusion. Case Description: A 66-year-old woman presented with gradually progressive gait disturbance, cognitive dysfunction, and urinary incontinenc. Brain magnetic resonance imaging (MRI) showed enlargement of the bilateral lateral ventricles and the third ventricle without dilatation of fourth ventricle, and heavily T2-weighted images showed an enlarged aqueduct of Sylvius and a membranous structure at its caudal end. Gadolinium contrast-enhanced T1-weighted images showed no neoplastic lesions. We diagnosed this case that the hydrocephalus due to late-onset idiopathic aqueductal stenosis or LAMO and the patient underwent endoscopic third ventriculostomy and endoscopic aqueduct oplasty. Membranous tissue specimens were obtained from the occluded aqueduct of Sylvius at the time of treatment. Histopathological examination revealed gliosis, and inside the gliosis, there were cell clusters that appeared to be ependymal cells and were corpora amylacea. We confirmed CSF flow at the site of obstruction of the aqueduct of Sylvius and the stoma of the third ventricle floor by MRI images. Her symptoms were improved immediately. Conclusion: We experienced a case of LAMO successfully treated by neuroendoscopic procedure, which allowed us to examine the pathology of the membranous structure of the aqueduct of Sylvius. The pathological study of LAMO is rare, and we report it, including a review of the literature.

[A Case of Unruptured Internal Carotid Artery Aneurysm with Improved Endocrinological Function after Treatment].

We experienced a case of unruptured internal carotid artery aneurysm improved endocrinological function after the treatment. A 68-year-old woman was admitted to our hospital complaining of general fatigue, dizziness, and decreased visual acuity. Radiological examination revealed unruptured large aneurysm at the right anterior carotid artery compressing on the pituitary gland. We underwent right STA-MCA bypass and trapping of right internal carotid artery. Post-operative course was uneventful. Although visual function was not improved, her endocrinological function was improved 8 months after surgery by thrombosed and shrunken aneurysm. The mechanism of panhypopituitarism due to aneurysm has been suggested to involve mechanical compression on the pituitary gland, pituitary stalk, or hypophyseal artery. Although it was unclear about the improvement of endocrine function after the treatment of aneurysm, some cases could recover the hypopituitarism after enough follow-up period.

Trigeminal Neuralgia Due to Compression of Primitive Trigeminal Artery Variant: Usefulness of Fusion Images of Constructive Interference in Steady-State Magnetic Resonance Imaging and Computed Tomography Angiography.

BACKGROUND: Trigeminal neuralgia (TN) is one of the neuropathic pain syndromes, most commonly caused by vascular compression in the root entry zone of the trigeminal nerve in the cerebellopontine angle. It was rare as offending artery that primitive trigeminal artery and primitive trigeminal artery variant (PTAv) as an anomaly that occurs carotid-basilar anastomosis. We report a case of TN caused by the PTAv, and usefulness of fusion images of magnetic resonance imaging (MRI) and computed tomography angiography (CTA). CASE DESCRIPTION: A 65-year-old man presented with a 2-year history of left paroxysmal facial pain in the second division of the trigeminal nerve. We diagnosed left TN due to PTAv using constructive interference in steady state magnetic resonance imaging (CISS MRI) and CTA. Microvascular decompression surgery disclosed trigeminal nerve compressed by PTAv consisted with findings from preoperative neuroimaging. We report a case of TN caused by PTAv, and usefulness of fusion images of CISS MRI and CTA to understand the neurovascular and bony structure during the perioperative period. CONCLUSIONS: The fusion image created by CISS MRI and 3-dimensional CTA was useful to identify the offending vessel and to clearly understand the neurovascular structure preoperatively.

[A Case of Atypical Meningioma with Liver Metastasis at 9 Years after Initial Surgery].

Metastatic meningiomas are extremely rare, and generally have poor prognosis. We report a case of atypical meningioma with good clinical course despite metastasis 9 years after the initial surgery. CASE:A 58-year-old woman visited a nearby hospital with complaints of hemiplegia and aphasia. MRI showed a large left frontal meningioma;she was referred to our department where she underwent a tumor resection(Simpson Grade I). Histopathological finding revealed fibrous meningioma in the prominent part of the tumor. Additionally, a small lesion with high Ki-67 labeling index was identified;therefore, the final diagnosis was atypical meningioma. Nine years postoperatively, a hepatic mass found incidentally and was resected by digestive surgery;a histological diagnosis of metastatic atypical meningioma was established. Thirteen years after the first operation, routine MRI showed enlargement of the local recurrent lesions in the tumor resection cavity. She underwent a reoperation(Simpson Grade I)at our department, and subsequently, discharged without any neurological deficits. Findings were not suggestive of atypical meningioma. Studies report three good prognostic factors in patients with metastatic meningioma-histologically benign primary tumor, long interval between initial diagnosis and metastasis, and asymptomatic metastatic lesion.