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Neonatal ruptured intracranial aneurysms: case report and literature review
Abstracts / Surgical Neurology 72 (2009) 515–529 Keyword: Intracranial leiomyoma review case-report doi:10.1016/j.surneu.2009.08.050
Supra-orbital approach in resection of anterior fossa tumours Weyns F, MD, Daenekindt Th, MD, Deckers J, MD, Engelborghs K, MD, Wuyts J, MD [ZOL St Jan Genk]
Introduction: For some years the minimal invasive supra-orbital approach is used in our department for the treatment of a variety of neurosurgical conditions: meanly anterior circulation aneurysms but also anterior fossa tumors such as meningeomas, craniopharyngeomas and some suprasellar pituitary tumors Material and methods: We present a series of 10 patients with diaphragm sellae meningeomas and craniopharyngeomas treated by this supra-orbital approach. Surgical OR time, neurological complications, completeness of resection and postoperative hospital stay were investigated. Results: Complete resection of the tumors was possible in all cases, without major complications. Time of surgery and hospital stay were shorter in this patient group. Conclusion: The minimal invasive supra-orbital approach offers us perfect visualisation off all neurological structures involving these lesions and therefore is a worthwhile alternative for the classical pterional or even bifrontal approaches. Less local wound complications, shorter surgical OR time and shorter hospitalization are the most important advantages. Keywords: Brain tumour; Supra-orbital approach; Minimal invasive surgery doi:10.1016/j.surneu.2009.08.051
Recurrence of parasagittal meningioma in the dural sinuses— a neurosurgical challenge Scholtes F, MD, Laungani A, MD, Nguyen-Khac MT, MD, Racaru T, MD, Martin D, MD [Centre Hospitalier Universitaire de Liège]
Introduction: Management of intracranial parasagittal meningiomas may be challenging because of their potential to invade the superior sagittal sinus (SSS). Radical excision (Simpson grades I and II) results in low recurrence but high complication rates. An alternative surgical approach is resection of the extrasinual part followed by radiation therapy on the residual intrasinual tumour. Material and methods: We present the case of an 61-year-old female patient who presented in 2002 with cognitive dysfunction and hemiparesis. A bifrontal cystic meningioma (WHO grade II) of the falx was resected (macroscopic Simpson grade I). Neurological recovery was complete. The patient was followed clinically and with annual MRI. Results: In 2005, MRI showed recurrence posterior to the initial tumour site and invasion of the SSS. The recurring meningioma was resected until reaching a permeable sinus lumen. Part of the invaded SSS was resected. Histology confirmed WHO grade II. Post-operative radiotherapy
529
(33 × 1.8 Gy) was centred on the SSS. In May 2008, increasing SSS filling was described at follow-up MRI and suspected to be a thrombus. In December 2008, MRI showed an extensive recurrence in the SSS and transverse sinus. Conclusion: This case illustrates the risks of recurrence associated with parasagittal meningiomas. Sinus invasion combined with cellular atypia may lead to aggressive, rapid, and surgically inaccessible recurrence. In this case, resection of the recurrence was considered to carry an unacceptable risk of postoperative neurological deterioration due to changes in venous return, and radiotherapy was initiated. Keywords: Meningioma; Superior Sagittal Sinus; Recurrence doi:10.1016/j.surneu.2009.08.052
Neonatal ruptured intracranial aneurysms: case report and literature review Van Raay Y, MD a, Di Rocco F, MD a, Brunelle JF, MD b, Sainte-Rose C, MD a, Zérah M, MD a [ aDepartment of Paediatric Neurosurgery, Hôpital Necker Enfants-Malades, Paris, bDepartment of Neuroradiology, Hôpital Necker Enfants-Malades, Paris]
Introduction: Intracranial aneurysms are exceptional in neonatal patients: there are only 16 cases previously reported. We describe the first case of a neonatal posterior inferior cerebellar artery (PICA) aneurysm and review the literature. Case report: A 7-day-old girl presented with irritability, anorexia, fever and abnormally enlarging head circumference. Computed tomography (CT) and magnetic resonance (MR) imaging demonstrated intraventricular haemorrhage, secondary hydrocephalus, and a pontine cistern haematoma. A PICA aneurysm was suspected on the CT angiogram (CTA) and the diagnosis was confirmed by a conventional cerebral angiography. She was successfully treated by surgical clipping of the parent vessel and excision of the aneurysm. Post-operatively she experienced transient swallowing difficulties and also required a ventriculo-peritoneal shunt for hydrocephalus. Histopathological evaluation demonstrated a calcified arterial wall with thrombosis and signs of prior haemorrhage, and the absence of the internal elastic lamina. Conclusion: Neonatal intracranial aneurysms are rare. Clinical presentation of SAH in this age group is often non-specific. First-line investigation should be transfontanelle cranial ultrasound, followed by MR angiography then CTA if necessary. Posterior circulation aneurysms and large or giant aneurysms are more frequent in neonates and children than in adults. Early diagnosis and treatment are important for improved outcome. Surgery is better tolerated than in adults. Keywords: Intracranial aneurysm; Posterior inferior cerebellar artery; Neonate; Paediatric neurosurgery doi:10.1016/j.surneu.2009.08.053
Supra-orbital approach in resection of anterior fossa tumours Weyns F, MD, Daenekindt Th, MD, Deckers J, MD, Engelborghs K, MD, Wuyts J, MD [ZOL St Jan Genk]
Introduction: For some years the minimal invasive supra-orbital approach is used in our department for the treatment of a variety of neurosurgical conditions: meanly anterior circulation aneurysms but also anterior fossa tumors such as meningeomas, craniopharyngeomas and some suprasellar pituitary tumors Material and methods: We present a series of 10 patients with diaphragm sellae meningeomas and craniopharyngeomas treated by this supra-orbital approach. Surgical OR time, neurological complications, completeness of resection and postoperative hospital stay were investigated. Results: Complete resection of the tumors was possible in all cases, without major complications. Time of surgery and hospital stay were shorter in this patient group. Conclusion: The minimal invasive supra-orbital approach offers us perfect visualisation off all neurological structures involving these lesions and therefore is a worthwhile alternative for the classical pterional or even bifrontal approaches. Less local wound complications, shorter surgical OR time and shorter hospitalization are the most important advantages. Keywords: Brain tumour; Supra-orbital approach; Minimal invasive surgery doi:10.1016/j.surneu.2009.08.051
Recurrence of parasagittal meningioma in the dural sinuses— a neurosurgical challenge Scholtes F, MD, Laungani A, MD, Nguyen-Khac MT, MD, Racaru T, MD, Martin D, MD [Centre Hospitalier Universitaire de Liège]
Introduction: Management of intracranial parasagittal meningiomas may be challenging because of their potential to invade the superior sagittal sinus (SSS). Radical excision (Simpson grades I and II) results in low recurrence but high complication rates. An alternative surgical approach is resection of the extrasinual part followed by radiation therapy on the residual intrasinual tumour. Material and methods: We present the case of an 61-year-old female patient who presented in 2002 with cognitive dysfunction and hemiparesis. A bifrontal cystic meningioma (WHO grade II) of the falx was resected (macroscopic Simpson grade I). Neurological recovery was complete. The patient was followed clinically and with annual MRI. Results: In 2005, MRI showed recurrence posterior to the initial tumour site and invasion of the SSS. The recurring meningioma was resected until reaching a permeable sinus lumen. Part of the invaded SSS was resected. Histology confirmed WHO grade II. Post-operative radiotherapy
529
(33 × 1.8 Gy) was centred on the SSS. In May 2008, increasing SSS filling was described at follow-up MRI and suspected to be a thrombus. In December 2008, MRI showed an extensive recurrence in the SSS and transverse sinus. Conclusion: This case illustrates the risks of recurrence associated with parasagittal meningiomas. Sinus invasion combined with cellular atypia may lead to aggressive, rapid, and surgically inaccessible recurrence. In this case, resection of the recurrence was considered to carry an unacceptable risk of postoperative neurological deterioration due to changes in venous return, and radiotherapy was initiated. Keywords: Meningioma; Superior Sagittal Sinus; Recurrence doi:10.1016/j.surneu.2009.08.052
Neonatal ruptured intracranial aneurysms: case report and literature review Van Raay Y, MD a, Di Rocco F, MD a, Brunelle JF, MD b, Sainte-Rose C, MD a, Zérah M, MD a [ aDepartment of Paediatric Neurosurgery, Hôpital Necker Enfants-Malades, Paris, bDepartment of Neuroradiology, Hôpital Necker Enfants-Malades, Paris]
Introduction: Intracranial aneurysms are exceptional in neonatal patients: there are only 16 cases previously reported. We describe the first case of a neonatal posterior inferior cerebellar artery (PICA) aneurysm and review the literature. Case report: A 7-day-old girl presented with irritability, anorexia, fever and abnormally enlarging head circumference. Computed tomography (CT) and magnetic resonance (MR) imaging demonstrated intraventricular haemorrhage, secondary hydrocephalus, and a pontine cistern haematoma. A PICA aneurysm was suspected on the CT angiogram (CTA) and the diagnosis was confirmed by a conventional cerebral angiography. She was successfully treated by surgical clipping of the parent vessel and excision of the aneurysm. Post-operatively she experienced transient swallowing difficulties and also required a ventriculo-peritoneal shunt for hydrocephalus. Histopathological evaluation demonstrated a calcified arterial wall with thrombosis and signs of prior haemorrhage, and the absence of the internal elastic lamina. Conclusion: Neonatal intracranial aneurysms are rare. Clinical presentation of SAH in this age group is often non-specific. First-line investigation should be transfontanelle cranial ultrasound, followed by MR angiography then CTA if necessary. Posterior circulation aneurysms and large or giant aneurysms are more frequent in neonates and children than in adults. Early diagnosis and treatment are important for improved outcome. Surgery is better tolerated than in adults. Keywords: Intracranial aneurysm; Posterior inferior cerebellar artery; Neonate; Paediatric neurosurgery doi:10.1016/j.surneu.2009.08.053