ABSTRACT
BACKGROUND: Supraclinoid carotid aneurysms have traditionally been classified according to their relation to the major carotid branches, but considerable variation exists with respect to site of origin, projection, and relationship to the skull base. Distal internal carotid aneurysms with a superior or medial projection are uncommon vascular lesions, with an unusually high incidence of operative complications. METHODS: Surgical experience with five patients suffering from subarachnoid hemorrhage due to ruptured aneurysms of the dorsomedial wall of the distal internal carotid artery is presented, with emphasis on their angiographic appearance, anatomical features, and operative management. RESULTS: All five patients underwent surgical clipping. Intra-operative rupture occurred in two cases, with avulsion of the aneurysm from the internal carotid artery in both. A third patient experienced recurrent subarachnoid hemorrhage three days after uneventful surgery, due to the clip shearing off of the parent vessel. CONCLUSIONS: Distal internal carotid aneurysms do not conform to the usual principles of aneurysm formation and are unique in their dorsomedial location unrelated to an arterial bifurcation. Although their anatomy is straightforward and exposure is not restricted by bone or dural structures of the skull base, they possess extremely fragile necks which make surgical management particularly hazardous.
Subject(s)
Carotid Artery Diseases/pathology , Intracranial Aneurysm/pathology , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/pathology , Aneurysm, Ruptured/surgery , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/surgery , Cerebral Angiography , Female , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Male , Middle Aged , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/pathology , Subarachnoid Hemorrhage/surgery , Tomography, X-Ray ComputedABSTRACT
Immunostaining of synaptic terminals was studied in the hippocampus of 26 patients who had surgical resections for intractable temporal lobe epilepsy. Two monoclonal antibodies (EP10 and SP12) reactive with distinct synaptic antigens were used on paraffin-embedded tissues. The results indicated qualitative reductions on synaptic terminals in CA4 and other regions where cell loss is reported. The inner molecular layer of the dentate gyrus was observed to have increased synaptic immunostaining. Synaptic terminal loss in CA4 and redistribution in the molecular layer were most frequent in cases with hippocampal sclerosis. However, both forms of synaptic pathology were also noted in most cases where the pathological findings were classified as indefinite, and in some cases associated with mass lesions of the temporal lobe. These results support the importance of neuronal loss and synaptic reorganization as possible mechanisms of illness in epilepsy. They also indicate that synaptic immunostaining may be a useful adjunct to routine neuropathological diagnostic techniques.
Subject(s)
Epilepsy, Temporal Lobe/pathology , Hippocampus/pathology , Synapses/ultrastructure , Adolescent , Adult , Antibodies, Monoclonal , Female , Humans , Immunohistochemistry , Male , Middle Aged , Paraffin Embedding , Presynaptic Terminals/ultrastructure , Synapses/immunology , Temporal Lobe/pathologyABSTRACT
We report a case of multiple capillary hemangioblastomas of the liver occurring in a patient with von Hippel-Lindau disease and a history of previous cerebellar and spinal hemangioblastomas. Although rare examples of this tumor have previously been recorded in the pancreas, kidney, and urinary bladder, this appears to be the first recorded case with hepatic involvement. The histology and immunohistochemical appearance of this neoplasm are identical with those of the cerebellar tumor. We believe it represents a separate primary neoplasm rather than metastatic disease.
