AIM: To evaluate fundus findings in patients with intracranial aneurysm (ICA) to determine the relation between ICA and distinguishable retinal features.METHODS: We analyzed the medical records and ocular images of 46 patients with previously diagnosed ICA referred from the Neurosurgical Department.All patients underwent ophthalmologic evaluation including fluorescein angiography (FAG).Furthermore, the presence of drusen, macular degeneration, cotton wool spot, hard exudates, retinal hemorrhage, arteriolar attenuation, A-V crossing signs, arm-to-retina time, and A-V transit time were evaluated.The results of ICA patients (Group 1) were compared with those of 22 idiopathic epiretinal membrane patients with unaffected eyes (Group 2).RESULTS: Mean ages were 60.02y (Group 1) and 60.68y (Group 2) respectively (P=0.70).The prevalence of hypertension was similar in both groups.No case with retinal macroaneurysm was found in either group.The presence of drusen, macular degeneration, cotton wool spot, hard exudates, retinal hemorrhage, arteriolar attenuation, and A-V crossing sign was not significantly different between the two groups.Mean arm-to-retina time was not significantly different in two groups, either.CONCLUSION: We cannot find any evidence that the patients with ICA shows specific changes in the FAG and fundus.

The author has encountered a 67-year-old man with dural arteriovenous fistula (AVF) presenting as a non-traumatic chronic subdural hematoma (CSDH). This previously healthy patient was hospitalized due to progressive headache with subacute onset. He underwent burr-hole surgery twice for evacuating the left CSDH that was thickest at the posterior temporal area. The operative procedure and finding was not extraordinary, but subdural hematoma slowly progressed for days following the revision surgery. After investigation by super-selective external carotid angiography, a dural AVF found near the transverse-sigmoid sinus was diagnosed. Dural AVF was completely occluded with trans-arterial injecting polyvinyl alchol particles into the petrosquamosal branch of the middle meningeal artery. The patient showed a good neurological outcome with no additional intervention. Brain surgeons have to consider the possibility of dural AVF and perform cerebral angiogram if necessary when they manage the cases that have a spontaneously occurred and repeatedly recurring CSDH.
Aged ; Angiography ; Arteriovenous Fistula* ; Brain ; Central Nervous System Vascular Malformations ; Headache ; Hematoma, Subdural ; Hematoma, Subdural, Chronic* ; Humans ; Meningeal Arteries ; Polyvinyls ; Surgeons ; Surgical Procedures, Operative

Clip compression injury of oculomotor nerve (ON) is a preventable complication of aneurysm microsurgery. The author illustrates this condition in which ON was inadvertently occluded by the clip during repairing posterior communicating artery (PcoA) aneurysm. The report indicates that the surgeon should be meticulous in identifying and protecting ON at clipping stage when PcoA aneurysm prematurely bursts.

Glioependymal cyst (GEC) is an uncommonly observed clinical entity in the posterior cranial fossa. A 36-year-old female with cystic lesion in the right cerebellum was hospitalized for evaluating headache and dizziness. Brain images showed a well-defined, ovoid mass adjacent to the fourth ventricle. After drainage and excision of the cyst, the patient became symptom free. Pathology examination disclosed low cuboidal epithelium and glial cells in the cyst wall. The radiological features, neurological manifestations, and the operations for GECs of the present localization are described in this short communication.

Glioependymal cyst (GEC) is an uncommonly observed clinical entity in the posterior cranial fossa. A 36-year-old female with cystic lesion in the right cerebellum was hospitalized for evaluating headache and dizziness. Brain images showed a well-defined, ovoid mass adjacent to the fourth ventricle. After drainage and excision of the cyst, the patient became symptom free. Pathology examination disclosed low cuboidal epithelium and glial cells in the cyst wall. The radiological features, neurological manifestations, and the operations for GECs of the present localization are described in this short communication.

Surgery for the placement of a ventriculoperitoneal shunt incurs numerous procedure-related complications. Distal dislodgment of the device from the cranial insertion site after pumping of the shunt chamber has rarely occurred and it has not been evaluated to date. Herein, we report an interesting case of a 20-year-old man who underwent shunt revision for ventricular catheter migration after a manual pumping test. We reviewed previously reported cases related to such rare conditions and described a simple method of valve fixation for preventing disconnection and migration of the proximal shunt system.

We report a rare case of pericatheter abscess formation after scalp acupuncture in a 25-year-old woman who had a history of meningitis and hydrocephalus, which were treated using ventriculoperitoneal shunt placement at the age of 5 years. Prior to the current hospitalization, the patient received acupuncture therapy for a subgaleal hematoma. Clinical and laboratory examinations revealed a retained catheter and an associated abscess in the lateral neck. The abscess was immediately treated with radical debridement, washing of the cavity, and removal of the implant. Culture studies of the pus drainage yielded Staphylococcus aureus. The patient recovered well after active antibiotic treatment. Considering the increasing application of this alternative medicine modality by practitioners, careful interventions are required to minimize acupuncture-related infections and other serious complications.

Meningitis is a rare and potentially serious complication in children with temporal bone fractures. We present an unusual case of a 7-year-old girl with pneumococcal meningitis complicated by cerebrospinal fluid (CSF) leakage following transverse fracture in the left temporal bone. She had an otorrhea resolved spontaneously in the early stage of hospitalization. At 4 days post-discharge, the patient returned with headache, fever, neck stiffness, voiding difficulty, and bilateral abducens nerve palsy. Magnetic resonance images demonstrated an intense uniform contrast enhancement in the cerebral cisterns and the sacral nerve roots. Laboratory analysis and culture diagnosed meningitis caused by Streptococcus pneumonia. She was discharged home after getting intravenous ceftriaxone for 5 weeks. Follow-up for the patient required constant vigilance and included a multidisciplinary approach. At 7 months after head trauma, the child was well with no neurological and auditory deficits. This case illustrates a previously unreported complication in pediatric patient of temporal bone fracture associated with CSF otorrhea.

An isolated ventricular abscess is a rare event, and its treatment is a real challenge. We report such case in a 52-year-old man that was successfully managed with aid of occipital approach and ventricular access device. This patient presented with the chief complaint of headache and fever of 3-day duration. Magnetic resonance imaging showed fluid-filled layering within the posterior horns of the lateral ventricle without contrast enhancement. Blood test and cerebrospinal fluid analysis was consistent with acute bacterial ventriculitis. Using stereotactic technique guided by electromagnetic navigation, the occipital horns were bilaterally targeted and catheterized, and then the abscess and debris was evacuated. The Ommaya reservoir implanted at the left entry was intermittently punctured for preventing the recollection. The pus culture was positive for Streptococcus pneumoniae. He received an antibiotic therapy and the reservoir aspiration leading to rapid recovery and remission of clinical manifestations. There was no evidence of the recurrence within the ventricles on follow-up scans after discharging. This modification, occipital approach and reservoir placement, is effective treatment for improving the cure rate in the selected cases with intraventricular cerebral empyema.

The vast majority of intracranial chondromas are located in the base of the cranium. Their presentationas an intracerebral neoplasm is considered to be extremely rare. A previously healthy 45-year-old manexperienced recurrent seizure attacks over a period of 6 months. Imaging studies of the brain revealedan ovoid and calcified mass which involve the cortex in the left frontal lobe. Intraoperatively, the masshad no adhesion to the dura and arachnoid membrane. The tumor was completely removed and thefinal diagnosis was intracerebral chondroma. The patient remained free of disease over the period of18-years follow-up. This communication adds an unusual case to the literature on the chondroma thatexpressed in the form of an intra-axial space-occupying lesion in the frontal lobe.