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Background: Subarachnoid hemorrhage (SAH) with an intracerebral hematoma (ICH) shows an unfavorable prognosis. In the present study, we examined the characteristics of SAH with ICH and its prognosis.Methods: Subjects comprised 218 patients with SAH who underwent surgery between January 2007 and December 2015. We compared age, sex, the location of the aneurysm, treatment procedures, medical history (hypertension, diabetes, and heart disease), the Glasgow Coma Scale (GCS) score on admission, rerupture rate, hydrocephalus, the diameter of the aneurysm, cerebral vasospasm, perioperative cardiopulmonary complications, and the Glasgow Outcome Scale (GOS) score after 2 months between patients with SAH with and without ICH. The interval from the onset of SAH until surgery, the location of ICH, and hematoma volume were investigated as prognostic factors for SAH with ICH.Results: Among all subjects, 82 had SAH with ICH. GCS scores on admission were poorer in patients with SAH with ICH than in those without ICH (P < .001), and middle cerebral artery aneurysms were more likely to form hematomas (P < .001). GOS scores after 2 months were also poorer in patients with SAH with ICH (P < .01). The size of aneurysms was larger in the 82 patients with SAH with ICH than in those without ICH (P < .001), and the rerupture rate was higher (P < .001). The unfavorable prognosis of patients with SAH with ICH was associated with age and GCS score on admission.Conclusions: A young age and a favorable GCS score on admission may be associated with a favorable prognosis for patients with SAH with ICH, and SAH with ICH may easily rerupture. [ABSTRACT FROM AUTHOR] more...

Background To investigate the association between subarachnoid hemorrhage-induced delayed cerebral vasospasm (DCVS) and oxidative stress, an oxidation product, hydroperoxide, was measured in 3 specimens: peripheral arterial blood, cerebrospinal fluid (CSF), and internal jugular venous blood (IJVB). Methods Hydroperoxide was measured using the diacron reactive oxygen metabolites (d-ROMs) test. The hydroperoxide levels were evaluated based on the rate of change in the d-ROMs test value on day 6 relative with that on day 3 (d-ROMs change rate). Results The subjects were 20 patients. The d-ROMs change rate in IJVB was significantly higher in patients with DCVS on day 6 than in those without it ( P < .01). When the patients were classified into the following 3 groups: Group A (no DCVS occurred throughout the clinical course); Group B (DCVS occurred, but no cerebral infarction [CI] was induced); and Group C (DCVS occurred and caused CI), the d-ROMs change rate in IJVB was the highest in Group C, followed by Group B then A ( P < .01). The d-ROMs change rates in peripheral arterial blood and CSF were not related to the development of DCVS. Conclusions It was concluded that the more severe DCVS occurs and is more likely to progress to CI as the IJVB hydroperoxide level rises early after the development of subarachnoid hemorrhage. [ABSTRACT FROM AUTHOR] more...

A 47-year-old man presented with a rare aneurysm arising from the posterior inferior cerebellar artery communicating artery (PICA com A), manifesting as subarachnoid with intraventricular hemorrhage. Cerebral angiography showed a defect of the left PICA, and the left PICA region was supplied by a communicating artery formed by the fusion of branches from the right PICA and right vertebral artery. Aneurysms arose in the communicating artery, and a small, unruptured fusiform aneurysm was observed adjacent to a ruptured aneurysm. Trapping was performed for the 2 aneurysms with occipital artery (OA)–PICA bypass. Six cases of aneurysms occurring in this vessel including ours have been reported, and hemodynamic factors and congenital fragility of the arterial wall have been suggested as causative factors. Ours is the first case in which a ruptured aneurysm of this vessel was treated surgically with concurrent vascular reconstruction. If the aneurysm has a shape that is difficult to clip, the affected vessel is difficult to preserve, and collateral blood flow to the affected PICA region is considered insufficient, trapping with OA–PICA bypass is recommended. [Copyright &y& Elsevier] more...

To prevent posterior transpetrosal approach-induced liquorrhea, we developed a method involving the double application of abdominal adipose tissue in the subdural and epidural spaces.The method was applied to 8 patients who underwent surgery under a posterior transpetrosal approach: 4 with petroclival meningioma and 1 each with tentorial meningioma, jugular foramen neurinoma, trigeminal neurinoma, and metastatic brain tumor. The combined transpetrosal approach was used for 6 patients and the combination with the lateral suboccipital approach was used for the other 2 patients. After tumor resection, the divided dura mater of the presigmoid space was closed as follows: first, a fat mass excised from the abdominal region was divided into 2 parts, and several excisions were made in each part to flatten them. The exposed brain surface was covered with the flattened fat, and the fat margin was circumferentially inserted under the dura mater. The division was then closed by suturing the dural stumps at several sites, loading tension to some extent. Finally, the other part of the adipose tissue was spread in the epidural space in the dural-defective region for double closure inside and outside the dura mater.Liquorrhea was prevented in all patients.It was concluded that this method is useful to prevent postoperative liquorrhea induced by a posterior transpetrosal approach. [ABSTRACT FROM AUTHOR] more...

Aneurysms associated with hemangioblastoma are very rare. We encountered a patient in whom an aneurysm of the distal superior cerebellar artery, the main feeding vessel of cerebellar hemangioblastoma, ruptured and caused hemorrhage. On the basis of the computed tomography findings, the superior cerebellar artery aneurysm was identified as the source of hemorrhage, and embolization using a Guglielmi detachable coil was performed in subsequent endovascular surgery. Endovascular embolization was applied to the artery feeding the tumor at 4 weeks after admission, and the tumor was removed using an occipital transtentorial approach. A favorable therapeutic outcome may be expected when using a combination of endovascular therapy and surgical craniotomy for aneurysms associated with hemangioblastoma. [ABSTRACT FROM AUTHOR] more...

An incidentally diagnosed unilateral orbital mass in a 34-year-old woman grew at an accelerated rate during pregnancy with deterioration of visual function. Removed early after delivery by a transcranial approach, the tumor was histologically diagnosed as a richly vascularized cystic schwannoma containing red blood cell components. The accelerated tumor growth was attributed to intratumoral hemorrhage. Although acoustic schwannomas have been reported to enlarge during pregnancy, this phenomenon has only been described once for orbital schwannomas. Because this type of tumor may enlarge during pregnancy and threaten visual function, surgery should not be delayed. [ABSTRACT FROM AUTHOR] more...