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Background Chiari malformations, usually congenital, can rarely be associated with arteriovenous (AV) fistulas. We present the first case involving a type IV dural AV fistula with a Chiari type I malformation. Methods Retrospective chart review was performed to obtain pertinent details regarding history and examination, pathologic findings, and treatment course. Results A 63-year-old woman with a 2-year history of migraines presented with 5 months of occipital, right-sided headaches and neck pain exacerbated by Valsalva maneuvers. Computed tomography (CT) and magnetic resonance imaging (MRI) of the head showed a possible right occipital AV malformation, bilateral cerebellar subdural hygromas, and tonsillar crowding at the foramen magnum indicating an acquired Chiari type I malformation. Angiography demonstrated a Cognardtype IV right posterior occipital dural AV fistula supplied by bilateral middle meningeal and posterior meningeal arteries. Conclusion After treatment of the dural AV fistula, hygroma evacuation, and decompression of the acquired Chiari malformation, the patient's Valsalva-induced headaches abated. [ABSTRACT FROM AUTHOR]

Introduction Previous studies have suggested relationships between the rupture of intracranial aneurysms and meteorological variables such as season, barometric pressure, and temperature. Our objective was to examine the relationship between the incidence of hospital admissions secondary to aneurysmal subarachnoid hemorrhage (aSAH) and meteorological variables in central New Jersey. Methods The study population consisted of 312 patients who presented to University Hospital in Newark, New Jersey, between January 1, 2003, and December 31, 2008, with aSAH. Days in the 6-year period were classified as nonbleed days (no aSAH), bleed days (one or more aSAHs within 1 calendar day), cluster days (two or more aSAHs within 2 calendar days), and multiple-bleed days (two or more aSAHs within 1 calendar day). Results The only significant meteorological risk factor for the occurrence of multiplebleed days was high barometric pressure (1018.5 versus 1016.5 millibars [mbars]; p < 0.04), but an increase in barometric pressure (+ 2.8 mbars) over the 2 days prior to the multiple-bleed day, although not statistically significant, may be a risk factor (p < 0.09). Barometric pressure was also noted to be increased on bleed days (1017.2 versus 1016.5 mbars) and cluster days (1017.7 versus 1016.5 mbars), but this relationship was not significant (p < 0.1 and p < 0.1, respectively). Although aSAH days demonstrated consistently lower temperatures than non-aSAH days and dropping temperatures were consistently found in the days preceding the aSAH, these relationships were not significant. Conclusion Among meteorological factors, high barometric pressure and low temperature may be risk factors for the onset of aSAH. [ABSTRACT FROM AUTHOR]

Spinal vascular malformations, although rare, cause devastating disease. These malformations are commonly categorized as follows: spinal arteriovenous malformations (AVMs), dural arteriovenous fistulas (DAVFs), spinal hemangiomas, cavernous angiomas, and aneurysms. Spinal DAVFs (SDAVFs), or type 1 spinal AVMs, occur most frequently, representing 60 to 80% of vascular malformations of the spinal cord. While previously microsurgical treatment was considered the gold standard in the treatment of SDAVFs, recent advancements in technology--advancements of magnetic resonance imaging as a screening examination, contrast-enhanced magnetic resonance angiography, multidetector computed tomography as preangiographic evaluations, digital subtraction angiography, diagnostic catheters, and embolization materials--have made endovascular treatment a possible option. We review the treatment of SDAVFs, primarily discussing the endovascular management of these lesions. [ABSTRACT FROM AUTHOR]

Background and Study Aims Postoperative pneumocephalus is commonly observed after neurosurgical intracranial procedures and is usually of little consequence. Intraventricular tension pneumocephalus, however, is a rare complication and a neurosurgical emergency that requires immediate intervention. We describe the first case of intraventricular tension pneumocephalus that developed 1 week following an expanded endoscopic endonasal approach for resection of a suprasellar mass. Patient A patient who underwent an endoscopic transplanum transtuberculum approach for resection of a suprasellar epidermoid tumor developed a sudden change in mental status, with imaging consistent with intraventricular tension pneumocephalus. Immediate endotracheal intubation and placement of an external ventricular drain prevented further deterioration. Endoscopic exploration of the skull base reconstruction revealed a one-way ball valve mechanism as the source of pneumocephalus. The skull base reconstruction was revised with autologous fascia lata and repositioning of the pedicled nasoseptal flap. Conclusion Intraventricular tension pneumocephalus is a rare neurosurgical emergency that may develop after endoscopic skull base surgery. Initial management includes endotracheal intubation and placement of an external ventricular drain to decompress the ventricles. Endoscopic exploration and revision of the skull base repair is imperative to obliterate the ball-valve fistula to prevent further entrapment of air. [ABSTRACT FROM AUTHOR]