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Abstract: Background: Tentorial dural arteriovenous fistula is uncommon but is a life-threatening lesion. We present our experience with 5 patients with TDAVFs, review the relevant literature, and present the rationale of our current management strategy. Method: The data of 5 patients with TDAVFs treated in Huashan Hospital, Shanghai, China, between June 2002 and May 2003 were reviewed retrospectively, including their illness history, neuroimaging, operation records, and follow-up data. Results: There were 3 females and 2 males with ages from 25 to 52 years (average, 38 years). Clinical manifestations were acute SAH in 2 patients and progressive neurologic deficits in 3 patients. Magnetic resonance imaging and DSA were major diagnostic and follow-up modalities. All cases belonged to Borden classification type 3. A tentorial marginal type was present in 3 cases, a tentorial lateral type in 1 case, and a tentorial medial type in 1 case. Preoperative transarterial embolization was done in 3 patients. All patients underwent craniotomy with the coagulation of the fistulas and surrounding tentorial dura mater, and the disconnection of leptomeningeal venous drainage. The surgical approaches were via transanterior petrous approach in 3 cases, subtemporal intradural approach in 1 case, and unilateral occipital and transtentorial approach in 1 case. All patients had clinical improvement. There was no surgical mortality and morbidity. Postoperative DSA confirmed obliteration of TDAVFs in 3 cases; MRI demonstrated the thrombosis of venous aneurysm and disappearance of previous brainstem edema in 1 case, and partial thrombosis of venous aneurysm in another case. Follow-up study ranging from 2 to 3 years (average, 2.5 years) showed no recurrence, and all patients have resumed their normal activities. Conclusions: Tentorial dural arteriovenous fistulas are aggressive vascular lesions causing SAH and progressive neurologic deficits. Prompt diagnosis and definite treatment are mandatory. Obliteration of the fistulas and/or leptomeningeal venous drainage should be the goal of treatment. Microsurgical procedures with/without endovascular intervention are the best choice of treatment. [Copyright &y& Elsevier]

Abstract: Objective: Intracranial papillary endothelial hyperplasia (PEH) is rare, and only 13 cases have been reported intracranially in the literature. In this article, we present a case of PEH involving petrous and jugular foramen region due to the uncommon incidence. Case Description: A 49-year-old female patient with a 4-year history of left-sided hearing loss and facial palsy. Magnetic resonance (MR) imaging disclosed the presence of a 6 × 6 × 5 cm lobular mass occupying the left petrous and jugulare region. This mass was hyperintense on both T1 and T2 weighted MR images and was enhanced strongly with gadolinium. No edema was found around the lesion. Preoperative digital subtraction angiogram examination showed that the lesion had a rich blood supply. Therefore, polyvinyl alcohol embolization was carried out to reduce bleeding during operation. A left-sided suboccipital extreme lateral approach was applied for craniotomy. The lesion was extradural and highly vascular with extension into the petrous bone. It was subtotally removed. Postoperative course of the patient was stable. Her neurologic evaluation was the same as preoperatively. Conclusion: Surgical excision of the lesion is the main therapy. Radiotherapy should be given to patients whose lesion cannot be totally removed. [Copyright &y& Elsevier]

Abstract: Background: Cavernous malformations have generally been viewed as fairly benign vascular lesions with low potential for causing massive hemorrhage. Case Description: We present an interesting case of multiple CMs, several of which were formed de novo and exhibited aggressive biological behavior resulting in recurrent episodes of intracranial hemorrhage over a 10-year period. This case illustrates a dynamic and aggressive form of CMs. Recent advances in our understanding of the molecular pathogenesis of CMs implicate genetics as an important pathogenic factor, which is the most likely etiology of this patient''s presentation. Conclusion: Special challenges exist in managing young children with multiple, highly aggressive CMs. [Copyright &y& Elsevier]

Abstract: Background: Although patients with MCMs have increasingly been found in clinics, little has been focused on them. Thus, we intended to investigate these patients'' clinical presentations, family history, radiological characters, and treatment strategy. Methods: A retrospective review of the files and family investigations were conducted for 30 patients with MCMs. All patients underwent MRI examination. Symptomatic patients underwent the surgical treatment with image-guided technique. Results: There were 19 male and 11 female patients with a total 79 lesions. The common presentations were seizures, hemorrhages, or focal neurological deficits. Nine patients had positive or doubtful family history. The FLAIR sequence of MRI showed the highest sensitivity in the detection of CM lesions. In 27 symptomatic patients with 69 lesions, total removal was achieved in 19 patients with 48 lesions. In the other 8 patients with 21 lesions, 13 lesions were removed. Preoperative symptoms were improved in 21 patients and unchanged in 5. Preoperative neurological deficits temporarily worsened in one, and a new onset of seizure occurred in other one; but both gradually improved during the follow-up period. Among 3 patients with asymptomatic MCMs, one patient had hemorrhage during the follow-up period and underwent surgical operation. Conclusions: Because a high frequency of family CM occurs in MCMs, a detailed family investigation is mandatory for each patient with MCM. Selection of higher sensitive MRI sequence would contribute to detection of more CM lesions. Microsurgery assisted with the neuroimaging techniques is the treatment of choice for symptomatic MCMs. [Copyright &y& Elsevier]