Morphological differences between ruptured and unruptured cases in middle cerebral artery aneurysms.

OBJECTIVE: To elucidate the morphological differences between ruptured and unruptured aneurysms, three-dimensional digital subtraction angiography was performed in 44 cases (20 unruptured, 24 ruptured) of middle cerebral artery aneurysm. METHODS: When the neck was located on the extension of the midline of the parent artery, it was defined as Type C; when it was not, it was defined as Type D. Aspect ratio (AP ratio; dome/neck ratio) and daughter artery ratio (DA ratio; diameter of the larger daughter artery/diameter of the smaller daughter artery) were calculated, and these ratios were compared for ruptured and unruptured cases. RESULTS: Nineteen cases were Type C and 25 cases were Type D. chi2 test revealed that there were significantly more ruptured cases among Type C (14 out of 19) compared with Type D (10 out of 25) (P < 0.05). AP ratios were 2.24 +/- 0.75 for ruptured cases and 1.56 +/- 0.58 for unruptured cases. DA ratios were 1.53 +/- 0.54 in ruptured cases and 2.14 +/- 0.80 for unruptured cases. Both showed significant differences (P < 0.01). In cases with an AP ratio of 1.8 or greater and a DA ratio less than 1.7, 13 out of 15 (87%) were ruptured cases. On the contrary, in cases with an AP ratio less than 1.8 and a DA ratio of 1.7 or greater, 12 out of 13 (92%) were unruptured cases. CONCLUSION: Type C and equality of the diameters of two daughter arteries, together with high AP ratios, seem to be morphological factors that associate with aneurysmal rupture.

The characteristics of the anterior communicating artery aneurysm complex by three-dimensional digital subtraction angiography.

To elucidate the three-dimensional structure of the anterior communicating artery complex, we performed three-dimensional digital subtraction angiography in anterior communicating (Acom) aneurysm cases. Eighteen patients (six male and 12 female) with Acom aneurysms were studied. The total number of aneurysms was 18, of which three were unruptured and 15 were ruptured. Aneurysmal sizes and angles between the parent artery and each of the two daughter arteries were measured. Two types were defined, based on the daughter arteries. When the sizes of the two daughter arteries were the same, they were defined as AA' type, and when different, they were defined as AB type. Furthermore, aneurysms were classified into two types based on neck location. Thus, when the neck was located on the extension of the midline of the parent artery, it was defined as classical neck type, and when it was not, it was defined as deviating neck type. There were 11 cases of AA' type and seven of AB type. In AA' type all cases were of the classical neck type, and in AB type three cases were of the classical neck type and three were of the deviating neck type. In the deviating neck type, the necks were deviated to the smaller daughter arteries in all cases.

Solitary brain metastasis from renal cell carcinoma 15 years after nephrectomy: case report.

A 77-year-old man presented with a metastatic brain tumor 15 years after nephrectomy for a renal cell carcinoma. Neurological examination showed recent memory disturbance and slight right hemiparesis. Magnetic resonance imaging revealed a round well-demarcated mass extending from the left thalamus to the left trigone of the lateral ventricle. Preoperative angiography showed tumor staining. Surgery was performed by opening the inferior temporal sulcus. Only biopsy could be performed because of extensive bleeding from the tumor. Histological examination identified metastatic renal cell carcinoma. Gamma knife surgery was performed which resulted in resolution of his hemiparesis. Metastatic renal cell carcinoma should be considered even if nephrectomy was performed 10 or more years before presentation.

Reconstruction of pterional key hole using three-dimensional titanium plate: technical note.

Patients who have undergone pterional craniotomy sometimes complain about postoperative cosmetic impairment in the frontotemporal area. This problem occurs as a result of inappropriate repair or no repair of the pterional key hole. The authors have developed an intraoperative hand-made three-dimensional titanium plate, and as a result of using this plate the postoperative cosmetic appearance was satisfactory.

Evaluation of relation among aneurysmal neck, parent artery, and daughter arteries in middle cerebral artery aneurysms, by three-dimensional digital subtraction angiography.

Intracranial aneurysms usually occur at arterial bifurcations. However, in middle cerebral artery (MCA) aneurysms, we often find that the aneurysmal neck does not necessarily exist just on the arterial bifurcation. In this study, we have evaluated the relation among aneurysmal neck, parent artery, and daughter arteries in middle cerebral artery aneurysms, by three-dimensional digital subtraction angiography. Twenty consecutive patients (9 men and 11 women) with MCA aneurysms were examined. The total number of aneurysms was 22, of which 10 aneurysms were unruptured and 12 were ruptured. Aneurysmal sizes and angles between the parent artery and each of the two daughter arteries were measured. Furthermore, aneurysms were classified into two types based on neck location. Thus, when the neck was located on the extension of the midline of the parent artery, it was defined as a classical neck type aneurysm, and when it was not, it was defined as a deviating neck type aneurysm. There were 15 cases of deviating and 7 cases of classical neck type. Interestingly, in the deviating neck type, all the aneurysms existed on the side of the daughter arteries of which the angles between parent arteries were narrower, and in 93%, the sizes of the daughter arteries in which the neck existed were smaller compared with other daughter arteries.

Interhemispheric arachnoid cyst in the elderly: case report and review of the literature.

BACKGROUND: Preoperative differential diagnosis of interhemispheric cysts is sometimes difficult. CASE DESCRIPTION: We recently experienced a case of symptomatic interhemispheric arachnoid cyst in a 62-year-old woman. We reviewed interhemispheric arachnoid cysts in the elderly and the management of symptomatic interhemispheric arachnoid cysts in elderly patients. Symptomatic interhemispheric arachnoid cysts in the elderly are predominantly located on the right side, have a long history of progressive symptomology, occur predominantly in females, and have no communication with the subarachnoid space. Interhemispheric arachnoid cysts are usually not associated with agenesis of the corpus callosum in elderly patients, whereas interhemispheric nonarachnoid cysts are usually associated with agenesis of the corpus callosum, which will be clearly demonstrated on magnetic resonance imaging. CONCLUSIONS: It is highly possible that an interhemispheric cyst without agenesis of the corpus callosum in an adult is an arachnoid cyst.

[A case of subcutaneous malignant lymphoma with dura mater lesion].

A 63-year-old male was admitted to our hospital, complaining of a scalp mass located at the frontoparietal area of his head. He noticed that it had been growing for 2 months. The mass was elastic hard and non-moving. Computed tomography demonstrated a subcutaneous mass with low density and which was enhanced homogeneously. The skull just below the mass was slightly destroyed, but the structure remained. Magnetic resonance imaging (MRI) demonstrated a mass with low signal intensity on both the T1 weighted image and the T2 weighted image. Gd-DTPA study showed homogeneous enhancement and showed also that the dura just below the mass was enhanced. At this point we couldn't diagnose it confidently, but suspected this lesion to be a malignant lymphoma. We made a general examination, but no other lesion was found. A biopsy of the subcutaneous mass was performed under local anesthesia. The histological diagnosis was large-cell type B-Cell lymphoma. The tumor was treated with chemotherapy, CHOP (cyclophosphamid, doxorubicin, vincristin predonisolone). It responded to this chemotherapy and disappeared. We treated this lesion without radiation therapy. We report a case of subcutaneous malignant lymphoma treated successfully with a minimum invasive method.

A case of venous angioma with arteriovenous shunts--case report.

A 35-year-old man presented with a sudden headache and disturbance of consciousness. On admission, his consciousness level was Japan Coma Scale 100. Computed tomography disclosed a subarachnoid hemorrhage (SAH) and right cerebellar hematoma. Angiography was performed and, at first, arteriovenous malformation of the posterior fossa was diagnosed. Then external decompression of the posterior fossa and ventricular drainage were performed, followed by barbiturate therapy. Repeat angiography revealed that the lesion was a venous angioma with arteriovenous shunts. On day 37, subtotal removal of the lesion was performed. Intraoperatively, acute brain swelling emerged and partial internal decompression of the right cerebellar hemisphere was performed. The postoperative course was comparatively good and the patient was discharged with very mild ataxia. The patient is now being followed up in our outpatient clinic.

[An intradiploic epidermoid cyst of the skull in infancy: case report].

An intradiploic epidermoid cyst of the skull in infancy is rare. We report a case of a 7-month-old girl with an intradiploic epidermoid cyst of the left parietal bone. The patient was admitted to the department of pediatrics in, our hospital in March, 2000, complaining of a lump in the scalp with a diameter of 1.5 cm. The pediatrician doubted that it was a case of Langerhans cell histiocytosis (LCH). In addition, as a result of further tests there were no systemic findings to suggest LCH. The skull x-ray showed round radiolucency of the left parietal bone. CT scans showed an iso density intradiploic mass with destruction of the outer table. Because of the fact that the mass was enlarging, the patient was admitted to our neurosurgical service in April, 2000. We excised the lesion to confirm the histological findings. The histological diagnosis was epidermoid cyst. We discuss the clinical feature and treatment strategy for intradiploic epidermoid cyst in infancy.