Extensive titanium mesh invasive cranial fibrous dysplasia.

BACKGROUND: Craniofacial fibrous dysplasia (FD) is a benign lesion. It presents as bony swelling. Even after complete excision, it has a tendency to recur due to some residual lesion in normal bone. Recurrence at same site is common, but it recurs in bone. We are reporting a rare case of recurrent FD engulfing titanium mesh. CASE DESCRIPTION: A 22-year-old girl, who underwent frontal FD excision and reconstruction using titanium mesh surgery 2 years back, came with complaint of progressive bony swelling at same site for 1 year. CT head confirmed bony lesion involving mesh, frontal air sinus. She underwent complete excision of lesion and cranioplasty using bony cement. Biopsy confirmed recurrence of FD and invasion of titanium mesh. CONCLUSION: Recurrence of FD, involving cranioplasty titanium mesh, is extremely rare. It suggests local invasiveness of lesion. Recurrence can be prevented by excision of lesion with free bony margins.

Unilateral Fenestrated A1 Segment of Anterior Cerebral Artery Multiple Aneurysms: Case Reports and Literature Review.

The fenestration of the cerebral arteries is infrequent anomaly mostly occurring in the posterior communicating artery, the vertebral artery, the basilar artery, and the middle cerebral artery.[1] We report a case of unilateral A1 fenestration associated saccular aneurysm, focusing on its features of surgical treatment.

Ring graft technique for microvascular decompression.

INTRODUCTION: Various nerve compression syndromes, such as trigeminal neuralgia (TN), glossopharyngeal neuralgia (GN), and hemifacial spasm (HFS), are caused by compression of the concerned nerve by the adjacent vessel. Patients who do not respond to medical management are usually treated by "microvascular decompression (MVD) of the nerve." Teflon patch graft is the most commonly used material for MVD. This graft has been used in various shapes like a patch, in the shredded form, or as a sling. This is done to prevent recurrence because of graft failure. We used a teflon ring graft to perform a successful MVD in 10 patients. MATERIAL AND METHODS: Out of 10 cases, 6 cases were of TN, 2 of HFS, 1 of GN, and 1 case was of cochleovestibular nerve compression syndrome (CNCS). After MVD, every patient underwent a follow up assessment for 5 years. RESULTS: There was no major postoperative complication, except in the patient with CNCS who suffered from a temporary episode of facial palsy. All cases were symptom free at a follow-up duration of equal to or more than 5 years. CONCLUSION: Ring teflon graft may be used as an alternative as well as a safe method to perform MVD and has a good success rate.

Computational Fluid Dynamics Analysis and Correlation with Intraoperative Aneurysm Features.

INTRODUCTION: There are many controversies about computational fluid dynamics (CFD) findings and aneurysm initiation, growth, and ultimate rupture. The aim of our work was to analyze CFD data in a consecutive series of patients and to correlate them with intraoperative visual aneurysm findings. METHODS: Hemoscope software (Amin, Ziosoft Corporation, Minato ward, Tokyo, Japan) was used to process images from 17 patients who underwent clipping of 18 aneurysms. Pressure (P), wall shear stress (WSS) gradient and vectors, normalized WSS, and streamlines (SL) direction and velocity were assessed. CFD data were compared to intraoperative visual findings. A total of 39 aneurysm wall areas were assessed. RESULTS: Red, thin aneurysm wall areas were more often associated with low WSS. However, the association of low WSS with high P, diverging WSS vectors, direct impact of SL, and high SL velocity more frequently matched with yellow, atherosclerotic aneurysm walls. CONCLUSIONS: Low WSS alone is not sufficient to determine the thickness of an aneurysm wall. Its association with other parameters might enable one to distinguish preoperatively atherosclerotic, thick areas (high P, diverging WSS vectors, high flow velocity) from thin areas with higher rupture risk (parallel WSS vectors, lower flow velocity). The changing balance between these parameters can modify the features and the risk of rupture of aneurysm wall over time.

Occipital Intraparenchymal Myxopapillary Ependymoma: Case Report and Literature Review.

Myxopapillary ependymoma (MPE) is a histological variant of ependymoma found in the conus medullaris or filum terminale region. Intracranial occurrence of the tumor is a rarity. The most characteristic histological feature of myxopapillary tumors is the abundance of intercellular and perivascular mucin and the arborizing vasculature, which tends to form papillae. We are reporting a 14-year-old patient presented with seizures caused by the right occipital region intraparenchymal lesion. Histopathology confirmed it to be MPE. Lesion was excised completely. Literature reviews on the topic are discussed regarding the histological findings, natural history, and outcome of surgically treated MPE. This is the fifth reported case of cerebral intraparenchymal primary MPE.

Redo Microvascular Decompression in a Patient of Resistant Cochleovestibular Nerve Compression Syndrome.

Cochlea-vestibular nerve compression syndrome (CVCS) may present as recurrent attacks of vertigo, dizziness, imbalance, etc. Those patients who do not respond to medical management, are usually managed by "microvascular decompression (MVD) of cochlea-vestibular nerve." The success rate of MVD is not 100% and few patients present with the recurrence of symptoms. We are reporting management of one such resistant case of CVCS. A 40-year-old female patient who was a known case of CVCS, was managed by medical and surgical (MVD) management. She had no relief of symptoms. We did redo MVD of cochlea-vestibular nerve after full evaluation of symptomatology. Patient had complete relief in her symptoms. In failed MVD cases, redo MVD can be performed if patient is still having e/o nerve compression, adhesions on magnetic resonance imaging.

A rare case of solid calcified intramedullary neurenteric cyst: Case report and technical note.

Neurenteric cysts are rare lesions of the spinal cord, constituting less than 1.3% of all spinal cord tumors. Approximately 90% of neurenteric cysts are located in the intradural extramedullary compartment, while the remaining 10% are divided between an intradural intramedullary or extradural location. They are usually extramedullary and found in the lower cervical and thoracic spine. We report a case of 8 year old child with totally solid calcified intramedullary cyst which has hitherto not been reported in literature. We discuss the challenges faced in the diagnosis and surgical management of such lesions and a brief review of pertinent literature.

Usefulness of Embolization for Iatrogenic Dural Arteriovenous Fistula Associated with Recurrent Chronic Subdural Hematoma: A Case Report and Literature Review.

BACKGROUND: Refractory chronic subdural hematomas due to iatrogenic dural arteriovenous fistulas (dAVFs) are difficult to treat. We report our experience and propose a guideline on basis of a literature review for the usefulness of embolization of middle meningeal artery (MMA) for the treatment of the same. CASE DESCRIPTION: We report a case with right hemiparesis and aphasia 1 month after a fall from a bicycle. Computed tomography scan of the head showed left chronic subdural hematoma, which was evacuated by burr-hole drainage. The postoperative course was complicated by reaccumulation within short period of time. On superselective digital subtraction angiography of MMA, iatrogenic dAVF was found on left side. We embolized successfully it using n-butyl cyanoacrylate after a third irrigation. No reaccumulation found in the postoperative period or at last follow-up. We propose treatment protocol based on our experience and literature review. CONCLUSION: Refractory chronic subdural hematoma with reaccumulation within a short interval should be subjected to digital subtraction angiography of the MMA. Embolization of ipsilateral MMA is safe, effective, and a useful option for the treatment of iatrogenic dAVF and resolution of hematoma.