Dissecting aneurysm of the middle cerebral artery treated with heparin infusion in a 6-year-old child; neurological recovery with delayed spontaneous thrombosis: case illustration and literature review.

Aneurysms in the pediatric population are a rare pathology with specific features which requires a deep knowledge of their pathogenesis for the best therapeutic choice; the authors report their experience with a patient presenting aneurysm of the middle cerebral artery (MCA) associated with proximal stenosis of the vessel. A six-year-old girl came to our observation after sudden onset of headache and left hemiparesis. Angio-MRI and angio-CT scan showed a right MCA dissecting aneurysms associated with proximal stenosis of the vessel. Patient started a therapy with low molecular weight heparin (LMWH), replaced, 15 days later, with acetyl-salicylic acid (ASA). Patient showed a rapid and almost complete neurological recovery, despite several radiological exams confirmed a complete occlusion of the right MCA. As many other authors noted, dissecting aneurysms in the pediatric population are probably due to a defect of the entire arterial wall. Combination of stenosis, turbulence and partial thrombosis of the aneurysm led to a complete occlusion of artery involved, leading to the formation of collateral circles. In our case, complete thrombosis was probably delayed with anticoagulant therapy and the progressive reinforcement of collateral circles lead to the patient's neurological recovery.

Use of 2-µm continuous-wave thulium laser for surgical removal of a tentorial meningioma: case report.

BACKGROUND: Since the early 1980s, CO(2), neodymium-doped yttrium aluminum garnet (Nd:YAG), and other laser prototypes have been widely used in neurosurgery as an intraoperative aid along with the cavitron ultrasonic surgical aspirator (CUSA), bipolar forceps, and microdissection. However, the English literature contains almost no reports on the use of thulium lasers during neurosurgical procedures. METHODS: We report our experience with a thulium laser during the surgical removal of a tentorial meningioma. The intraoperative technique utilized, as well as the clinical and radiological results of the procedure, are described. RESULTS: The thulium laser proved to be a useful tool during coagulation, shrinking, and resection of the basal implant of the tumor. Use of the laser made the surgical procedure faster and easier, and no intraoperative bleeding was noted. No side effects were observed. CONCLUSIONS: Our experience indicates that thulium lasers are a valid aid during resection of benign intracranial tumors under microscope magnification. Additional studies are required to define fully the role of these lasers in neurosurgical procedures.

Multiple disc herniations in a type II diabetic patient: case report and review of the literature.

Disc herniation is a common pathology associated with physical trauma or degenerative diseases. The authors present the case of a patient with 8 disc herniations without known risk factors or other associated pathologies except for a long story of type II diabetes. Basing on studies reported in literature, it can be assumed that diabetes may be the reason of multiple disc herniations in this case.

Neurinoma of the hypoglossal nerve in the submandibular space: case report and review of the literature.

Neurinomas of the hypoglossal nerve extending extra-cranially are rare; a schwannoma in a 63-year-old woman causing nerve palsy is reported. The tumour presented as a slow-growing mass in the right submandibular space; a surgical approach with transcervical exploration was performed. The post-operative course was uneventful.