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Objective: This case study aims to present the Foreign Accent Syndrome (FAS) in a patient with Cerebral Arteriovenous Malformation (cAVM), considering neuropsychological, radiological and microsurgical aspects. Methods: The patient underwent preoperative neuropsychological assessment and MRI and Tractography were performed to identify fibers close to the lesion site. In the surgical procedure, a craniotomy was performed for excision of the cAVM. After surgery and 6 months after the surgical procedure, the patient underwent further and neuropsychological evaluations. Results: The presence of AVM located in the posterior part of the medial surface of the left superior frontal gyrus was identified and the neuropsychological evaluation found cognitive deficits and symptoms characteristic of FAS, which disappeared after resection. Conclusion: This report presented a case of cAVM in which symptoms were found even without rupture, which was no longer observed after the surgical procedure, demonstrating the relationship of cAVM with the symptoms and neuroanatomical bases of FAS. [ABSTRACT FROM AUTHOR]

Background: Sphenoid wing meningiomas present close contact with intracranial arteries and have great potential for vascular complications. Here, we describe the case of a patient who presented a medial left giant lesser sphenoid wing meningioma involving the supraclinoid carotid artery. One week after surgery, she developed vasospasm whose treatment using milrinone achieved excellent results. Case Description: This is the case of a 23-year-old female with a large meningioma of the middle third of the lesser wing of the left sphenoid. Furthermore, the patient had symptoms of headache, diplopia, and left amaurosis (Video 1). The lesion involved the supraclinoid left carotid artery, causing significant stenosis of the vessel. The patient underwent surgical treatment without complications. One week after the procedure, she evolved with lowered level of consciousness, complete, and proportionate right hemiparesis and right Babinski’s sign. Angiographic study demonstrated significant stenosis of the left supraclinoid artery. After endovascular treatment with milrinone, the patient evolved with immediate improvement of signs and symptoms. Conclusion: Giant meningiomas with vascular involvement involve a higher risk of postoperative vascular complications. Other studies should be carried out to predict these complications and thus develop preventive measures. [ABSTRACT FROM AUTHOR]

Aneurysms are the most frequent issue for the posterior inferior cerebellar artery (PICA). PICA aneurysms account for 1.4% to 4.5% of all intracranial aneurysms. 1-3 Although the majority of PICA aneurysms arise from their junction with the vertebral artery, they can be found in any of 5 segments. 4,5 Although PICA is more prone to form nonsaccular aneurysms than other intracranial arteries, ruptured aneurysms are usually saccular. 6 Nearly all PICA aneurysms are located intracranially, above the foramen magnum. Extracranial PICA aneurysms are rare, with few reports in literature. 7 Microsurgical clipping remains a good treatment alternative for these aneurysms. Higher risk of rerupture has even been reported with embolization of the distal PICA aneurysm with parent artery preservation. 8 Here we present the case of a 64-year-old male patient who presented right after a thunderclap headache, followed by a temporary loss of consciousness and disorientation. He was diagnosed with a modified Fisher 4 and Hunt and Hess 2 subarachnoid hemorrhage and found to have a partially thrombosed left PICA saccular aneurysm of the caudal loop just below the foramen magnum. The lesion was approached via a midline suboccipital craniotomy with C1 laminectomy. Microsurgical clipping of the aneurysm was performed without any complications (Video 1). Postoperatively, the patient was discharged without neurologic deficits. We present the first surgical video of the necessary steps in order to perform a microsurgical clipping of an extracranially located caudal loop PICA aneurysm through a midline suboccipital craniotomy with C1 laminectomy. [ABSTRACT FROM AUTHOR]

Arteriovenous malformations (AVMs) are congenital neurovascular disorders frequently manifested in young adults. The clinical presentation is variable and depends on its location, size, and ability to steal flow from adjacent areas, but it depends mainly on the occurrence of bleeding. 1 The treatment of these lesions when located in eloquent areas, especially around the central sulcus, is controversial. Surgical resection of an AVM in the central lobe may cause postoperative sensorimotor deficits because this anatomic region includes the precentral and postcentral gyri on the lateral surface and paracentral lobule on the medial surface. 2 AVMs can be successfully treated by surgery, but this treatment may pose unacceptable risks to the patient if the AVM involves an eloquent cortex. We consider that surgical removal of many of these lesions is feasible when preoperative planning is performed, 3 when it is based on deep anatomic knowledge, and particularly when using a refined microsurgical technique. 1 In this 3-dimensional Video 1, we present a case of a cerebral AVM of the central sulcus in which we achieved complete resection with microsurgical treatment without any neurologic sequelae for the patient. The patient consented to publication of images. [ABSTRACT FROM AUTHOR]

Cavernous malformations (CM) affect approximately 0.5% of the population, with only a limited portion being located in the optic nerve and chiasma. The clinical presentation is determined by their locations. In the optochiasmatic CM, the acute visual disturbance is the most common presentation. Chronically, many show a progressive visual loss, chronic headache, and pituitary disturbances. The differential diagnosis includes optic glioma, arteriovenous malformations, aneurysm, craniopharyngioma, pituitary apoplexy, and inflammatory conditions. In Video 1, we present the case of a 39-year-old woman with a history of a hemorrhagic optochiasmatic cavernoma in 2016, who started using propranolol to reduce the lesion and symptoms of visual loss. Moreover, the first microsurgical resection of the cavernoma and evacuation of the hematoma were performed in the same year. Owing to evolvement from a partial to a total vision loss in the left eye and presentation of new symptoms in the right eye, the patient underwent microsurgical resection. The surgery was performed sequentially. An awake craniotomy was performed to monitor the chiasma and right optic nerve. The postoperative magnetic resonance imaging showed complete resection of the CM, and the patient fully recovered. The patient signed the institutional consent form, stating that he or she accepts the procedure and allows the use of his or her images and videos for any type of medical publications in conferences and/or scientific articles. [ABSTRACT FROM AUTHOR]