Search

Background Capillary hemangiomas of spinal nerve root, mostly affecting the cauda equina, are extremely rare. Case presentation A 20-year old man was presented with back pain, radiculopathy, and urogenital symptoms. Magnetic resonance images revealed an intradural extramedullary mass, isointense in T1-weighted and hyperintense in T2-weighted images, with noticeable post injection enhancement. The clinical and radiological findings simulated neurinoma. However, a pinkish lesion was removed surgically and histopathological examination revealed lobules of capillary vessels separated by fibrous tissue, suggesting capillary hemangioma. Conclusion Although rare and sometimes indistinguishable from more common lesion, capillary hemangioma should be in differential diagnosis of any enhancing intradural extramedullary mass at the level of cauda equina or conus medullaris.

Background Traditionally, surgery of the anterior circulation aneurysms of the cerebral vasculature is dictated by the site of the lesion, excluding such midline lesions as anterior communication artery aneurysms. Few reports address the issue of using a single craniotomy to obliterate multiple aneurysms located in both hemispheres. Case presentation A 51 year-old Caucasian right handed housewife lady (weight 61 kg, height 159 cm) presented with a headache of acute onset which proved to be caused by acute subarachnoid hemorrhage. Cerebral computed tomographic angiography revealed multiple aneurysms. The patient underwent a right pterional craniotomy to obliterate right middle cerebral, distal basilar and left carotid bifurcation aneurysms. The post-operative course was uneventful. Conclusion Despite technical difficulties of approaching cerebral vasculature through a contralateral craniotomy, this policy is advised in selected cases in which the benefits of unilateral craniotomy outweigh the risks of brain retraction.

OBJECTIVE: Aneurysms of the extracranially originating posterior inferior cerebellar artery are very rare. An anatomic insight of its possible course and variations is necessary when confronting such extraordinary lesions. CLINICAL PRESENTATION: A 19-year-old man presented with the sudden onset of severe headaches. A physical examination was positive only for neck rigidity. Computed tomographic scans of the brain depicted intraventricular hemorrhage. TECHNIQUE AND INTERVENTION: Four-vessel brain digital subtraction angiography revealed an extracranial posterior inferior cerebellar artery arising extradurally from the right vertebral artery between the C1 and C2 vertebrae, bearing a saccular aneurysm in an upper cervical intradural location. An anterior inferior cerebellar artery-posterior inferior cerebellar artery variant was also found on the left side. Computed tomographic angiography failed to unmask the lesion. The aneurysm was clipped through a suboccipital craniectomy and C1 laminectomy. CONCLUSION: The patient did well after surgery and was discharged from the hospital without neurological deficit. One can conclude that a comprehensive diagnostic approach oriented to the patient history and clinical data is mandatory to preclude such lesions evading the vigilant surgeon.

Extradural spinal arachnoid cysts are rare lesions, which may become symptomatic due to mass effect. Multiple cysts are even rarer of which few are reported to date. A 17-year-old male with acute onset urinary retention and progressive paraparesis is presented. Magnetic resonance imaging of spine revealed multiple spinal extradural arachnoid cysts located dorsal to the spinal cord, causing mass effect. The patient underwent surgery for excision of the cyst and closure of dural defects. He gained urinary continence and near normal muscle strength of lower extremities over a period of two weeks following operation. Up to date, there have been only sixteen reported cases of multiple spinal extradural arachnoid cysts in the literature and the present case appears to be the second most extensive one reported so far. Appreciation of the rarity of such lesions as well as the importance of surgical planning (especially pre-operative localization of the dural defects) is highlighted.

Nongalenic intradural arteriovenous fistulas, although uncommon, are clinically important. Choosing the appropriate therapeutic approach has been a controversial issue within the last decade. A 15-year-old male was presented with a calcified nongalenic arteriovenous fistula in the left parietal region, supplied by the left middle cerebral artery, and draining into the left lateral sinus. The patient was managed surgically with traditional clipping the feeder artery, along with piecemeal resection of the huge calcified mass. Although endovascular methods may be the treatments of choice in similar cases, in such huge calcified lesion, non-amenable to endovascular occlusion, open surgery seems to be preferred.

Primary intraosseous meningiomas are uncommon. The osteolytic variants of these tumors are even rarer. When one reviews a bony skull lesion, the differential diagnosis is very wide and includes both malignant and benign diseases. In case of primary skull meningioma, correct diagnosis and total resection of the lesion ensures curative therapy. Presented is a case of osteolytic skull lesion not invading the dura that was proved to be a fibrillary meningioma with regions of syncitial pattern.