Hemangioblastomas (HBMs) in the cerebellopontine angle (CPA) have rarely been reported. When they are within the CPA, they may be misdiagnosed as vestibular schwannoma (VS) or cystic meningioma. Therefore, differential diagnosis is important for the safe treatment of the lesion. Large solid HBMs, similar to intracranial arteriovenous malformations (AVMs), are difficult to surgically remove from an eloquent area because of their location and hypervascularity. We report a case of an HBM in the CPA, which manifested as a hearing impairment or VS. Similar to AVM surgery, the tumor was widely opened and removed en bloc without a new neurological complication using the modified transcondylar fossa approach without resection of the jugular tubercle. Accurate diagnosis, pre-operative embolization, and a tailored approach were essential for the safe treatment of the HBM in the CPA.
Cerebellopontine Angle* ; Diagnosis ; Diagnosis, Differential ; Hearing Loss ; Hemangioblastoma* ; Intracranial Arteriovenous Malformations ; Meningioma ; Neuroma, Acoustic

This report concerns a 4-month-old infant with progressive prominent and redness of his left eye since birth. This report concerns a 4-month-old infant with progressive prominent redness of his left eye since birth. Angiography revealed a congenital pial arteriovenous fistula between the temporal branch of the left posterior cerebral artery and left cavernous sinus through the sphenoparietal sinus, a condition not reported in the literature. The fistula was successfully occluded with two micro-coils by vertebrobasilar approach.
Arteriovenous Fistula/*diagnosis/therapy ; *Cavernous Sinus/radiography ; Embolization, Therapeutic/methods ; Humans ; Infant ; Intracranial Arteriovenous Malformations/*diagnosis/therapy ; Magnetic Resonance Imaging ; Male ; Posterior Cerebral Artery ; Temporal Lobe/blood supply

We present a case of developmental venous anomaly associated with arteriovenous fistula supplied by a single arterial feeder adjacent to a large acute intracerebral hemorrhage. The arteriovenous fistula was successfully obliterated by superselective embolization while completely preserving the developmental venous anomaly. Two similar cases, including superselective angiographic findings, have been reported in the literature; however, we describe herein superselective angiographic findings in more detail and demonstrate the arteriovenous shunt more clearly than the previous reports. In addition, a literature review was performed to discuss the association of a developmental venous anomaly with vascular lesions.
Adolescent ; Arteriovenous Fistula/*radiography/*therapy ; Cerebral Angiography ; Cerebral Hemorrhage/*radiography/*therapy ; Diagnosis, Differential ; Embolization, Therapeutic/*methods ; Humans ; Intracranial Arteriovenous Malformations/*radiography/*therapy ; Male ; Tomography, X-Ray Computed/*methods

BACKGROUNDIntraoperative Doppler sonography has been used in the neurosurgical operating room for the localization and description of cerebral arteriovenous malformations (AVMs). This study aimed to investigate the clinical value of contrast-enhanced intraoperative Doppler sonography, including its ability to assess the location and identify of feeding arteries in patients with AVMs and to compare this method with angiography.

METHODSTwenty-three patients with cerebral AVMs who were diagnosed using angiography, were examined with contrast-enhanced intraoperative Doppler sonography. As an echo-enhancing agent, Sulphur Hexafluoride Microbubbles for Injection ("SonoVue") was administered intravenously in all patients. Sonogram results were reviewed and correlated with angiographic findings. For statistical analysis, the Wilcoxon signed-rank test was applied.

RESULTSAngiography identified 20 AVM lesions in the anterior or middle fossa and 3 in the posterior fossa. Contrast-enhanced intraoperative Doppler was somewhat less sensitive for only detecting 21/23 (91.3%) of the AVM lesions. Additionally, contrast-enhanced intraoperative Doppler slightly underestimated AVM size compared with angiographic findings but showed feeding arteries with sufficient acoustic properties. In 15 patients, angiography revealed a coincidental blood supply from another intracranial vessel, which was missed by contrast-enhanced intraoperative Doppler sonography.

CONCLUSIONSIn a limited group of patients with AVMs, contrast-enhanced intraoperative Doppler sonography was a less sensitive but useful and simple method for the detection of AVMs in contrast to angiography. No specific untoward effects were attributed to the use of "SonoVue" as a contrast-enhancing substance.

Adolescent ; Adult ; Cerebral Angiography ; methods ; Contrast Media ; Humans ; Image Enhancement ; Intracranial Arteriovenous Malformations ; diagnosis ; Male ; Middle Aged ; Phospholipids ; Sulfur Hexafluoride ; Ultrasonography, Doppler, Transcranial ; methods

Subarachnoid hemorrhage (SAH) can be classified as traumatic SAH or spontaneous SAH based on etiology. The traumatic SAH is the common manifestation of head injury and difficult to make a diagnosis in forensic investigation. Based on practical experiences of forensic investigation and relevant references, the main points (SAH identification, examination, death mechanism) were summarized in this article. For the understanding, we try to classify the traumatic SAH into three subtypes: brain injury associated SAH, traumatic rupture of basal cerebral vessels SAH and traumatic focal SAH.
Aneurysm, Ruptured/complications* ; Cause of Death ; Craniocerebral Trauma/complications* ; Diagnosis, Differential ; Forensic Pathology ; Hematoma, Epidural, Cranial/complications* ; Humans ; Intracranial Aneurysm/complications* ; Intracranial Arteriovenous Malformations/complications* ; Rupture/complications* ; Subarachnoid Hemorrhage/pathology* ; Subarachnoid Hemorrhage, Traumatic/pathology*

OBJECTIVE: Although three-dimensional time-of-flight magnetic resonance angiography (3D TOF-MRA) is used frequently as a follow-up tool to assess the response of arteriovenous malformations (AVMs) after radiosurgery, the diagnostic accuracy of 3D TOF-MRA is not well known. We evaluated the diagnostic accuracy of contrast-enhanced 3D TOF-MRA at 3.0 Tesla for the detection of residual AVMs. MATERIALS AND METHODS:This study included 32 AVMs from 32 patients who had been treated with radiosurgery (males/females: 21/11; average patient age, 33.1 years). The time interval between radiosurgery and MRA was an average of 35.3 months (range, 12-88 months). Three-dimensional TOF-MRA was obtained at a magnetic field strength of 3.0 Tesla after infusion of contrast media, with a measured voxel size of 0.40 x 0.80 x 1.4 (0.45) mm3 and a reconstructed voxel size of 0.27 x 0.27 x 0.70 (0.05) mm3 after zero-filling. X-ray angiography was performed as the reference of standard within six months after MRA (an average of two months). To determine the presence of a residual AVM, the source images of 3D TOF-MRA were independently reviewed, focusing on the presence of abnormally hyperintense fine tangled or tubular structures with continuity as seen on consecutive slices by two observers blinded to the X-ray angiography results. RESULTS: A residual AVM was identified in 10 patients (10 of 32, 31%) on X-ray angiography. The inter-observer agreement for MRA was excellent (kappa= 0.813). For the detection of a residual AVM after radiosurgery as determined by observer 1 and observer 2, the source images of MRA had an overall sensitivity of 100%/90% (10 of 10, 9 of 10), specificity of 68%/68% (15 of 22, 15 of 22), positive predictive value of 59%/56% (10 of 17, 9 of 16), negative predictive value of 100%/94% (15 of 15, 15 of 16) and diagnostic accuracy of 78%/75% (25 of 32, 24 of 32), respectively. CONCLUSION: The sensitivity of contrast-enhanced 3D TOF-MRA at 3.0 Tesla is high but the specificity is not sufficient for the detection of a residual AVM after radiosurgery.
Adult ; Contrast Media ; Female ; Humans ; Intracranial Arteriovenous Malformations/*diagnosis/*surgery ; Magnetic Resonance Angiography/methods/*standards ; Male ; *Radiosurgery ; Sensitivity and Specificity

A 36-year-old man was diagnosed with a right temporal lobe grade II cerebral arteriovenous malformation (cAVM) and was treated with radiosurgery. At nine months after the cAVM radiosurgery, the patient began to develop bilateral focal narrowing at the M1 segments of the bilateral middle cerebral arteries. The narrowing progressively deteriorated as was demonstrated on longitudinal serial follow-up MR imaging. X-ray angiography performed at 51 months after radiosurgery confirmed that the cAVM was cured and a diagnosis of moyamoya disease. To the best of our knowledge, this is the first case of cAVM-associated moyamoya disease that developed after radiosurgery. Given the chronological sequence of disease development and radiation dose distribution of radiosurgery, it is proposed that humoral or unknown predisposing factors, rather than direct radiation effects, are the cause of moyamoya disease associated with cAVM.
Adult ; Humans ; Intracranial Arteriovenous Malformations/diagnosis/*surgery ; Magnetic Resonance Imaging ; Male ; Moyamoya Disease/*etiology ; Postoperative Complications ; Radiosurgery

A 12-week-old baby with a vein of Galen aneurysmal malformation (VGAM) was successfully treated with performing transarterial microcatheter-directed embolization with Berenstein Liquid Coils and n-butyl cyanoacrylate in the feeding arteries. Post-procedure angiography showed a marked decrease of the blood flow into the dilated vein of Galen. Three months later, follow-up angiography showed that the vein of Galen aneurysmal malformation had totally disappeared, and the baby recovered very well without any sequelae. We report here on this interesting case along with a review of the relevant literature, and we aim to enhance physicians' awareness of the treatment for VGAMs.
Catheterization/*instrumentation ; Cerebral Angiography ; *Cerebral Veins ; Cyanoacrylates/*administration & dosage ; Embolization, Therapeutic/*instrumentation/methods ; Humans ; Infant ; Intracranial Arteriovenous Malformations/diagnosis/*therapy ; Magnetic Resonance Imaging ; Male

Over the past 50 years, more advancement has been made in cerebrovascular surgery (CVS) than in any other field of medicine. The author was to describe development of CVS in Korea by reviewing this country's history of neurosurgery, and his own personal experience as a vascular neurosurgeon. The first CVS was performed in 1948 on a patient with an intracerebral hematoma. Open carotid angiography was first performed in 1956, but was soon replaced with a percutaneous procedure. In the 1960s, several passionate neurosurgeons made attempts to treat ruptured cerebral aneurysms by carotid ligation in the neck or by a direct approach, however the outcomes were less than optimal. Aneurysm clips with springs were not available until late in that decade. In the 1970s, great strides were made in aneurysm surgery, thanks to the revolutionary introduction of the surgical microscope and refined microsurgical techniques. Microvascular anastomosis also became possible for cerebral blood flow augmentation. In the late 1970s, CT scan and 4-vessel angiography were introduced to improve the diagnosis of cerebrovascular disease. Also at this time, there was great interest among vascular neurosurgeons in the treatment of arteriovenous malformations (AVMs) and intracerebral hemorrhage. Korean vascular neurosurgeons began presenting their papers at international meetings. At that time, most of the basic researches were focused on cerebral vasospasm and ischemia. By the 1980s, major health care centers in the country had the resources to perform both aneurysm and AVMs surgery. Surgery of the posterior circulation aneurysms became commonplace. In addition, radiosurgery became available for the treatment of AVMs. In 1986, vascular neurosurgeons organized a study group on cerebrovascular disease, which eventually developed into the Korean Society of CVS. A partnership was formed with Japanese neurosurgeons to create a biannual Korean-Japanese Friendship Conference on Surgery for Cerebral Stroke. In the 1990s, a new era in CVS was opened with advanced neuro-imaging technology, skull base surgery, endovascular surgery, neuro-navigation, and reappraisal of carotid surgery. The International Workshop on CVS was proudly hosted in Seoul in the year 2000. The present advanced state of CVS in Korea was made possible only by the selfless efforts of devoted neurosurgeons, neurologists, and neuroradiologists who had limited resources to work with. Long recognized as possibly the most technically challenging medical field requiring the most precision, CVS has come of age in the struggle to improve the outcome of patients with cerebrovascular disease.
Aneurysm ; Angiography ; Arteriovenous Malformations ; Asian Continental Ancestry Group ; Cerebral Hemorrhage ; Delivery of Health Care ; Diagnosis ; Education ; Friends ; Hematoma ; Humans ; Intracranial Aneurysm ; Ischemia ; Korea* ; Ligation ; Neck ; Neurosurgery ; Radiosurgery ; Seoul ; Skull Base ; Stroke ; Tomography, X-Ray Computed ; Vasospasm, Intracranial

Multiple cerebral aneurysms reportedly account for 14-33 % of all cerebral aneurysms. The incidence of multiple aneurysms has been increasing with development of radiological diagnostic tools such as magnetic resonance angiography, digital subtraction angiography and three dimension computed tomography. However, multiple aneurysms arising from same parent artery are uncommon. We have found only a few references as to diagnosis and surgical treatment of such lesions in the literature. Multiple separate aneurysms on same parent artery have been found most frequently on internal carotid artery 2, and then from middle cerebral artery (MCA). Those lesions arising from anterior communicating artery (ACoA) are rare. We report 7 cases (5.21%) of multiple aneurysms developed separately on ACoA and describe angiographic and operative finding of these rare lesions. One hundred and thirty four ACoA aneurysms were operated in our hospital from May 1997 to November 2004. There were only 7 patients with multiple aneurysms on ACoA. Out of 7 cases, four were diagnosed preoperatively and the other 2 were found intraoperatively. Multiple aneurysms may be associated with familiar aneurysms or arteriovenous malformations, however, there was no such case in our series. All patients were treated successfully with single or multiple clippings. Despite the advanced technology in radiological examinations, these lesions may not be detected on preoperative study. Close proximity or smaller size of the lesion may be responsible for the preoperative false negative angiographic findings. It is recommended to keep this possibility in mind during aneurysm surgery. Careful dissection is mandatory to ensure the completeness of aneurysm surgery.
Aneurysm* ; Angiography ; Angiography, Digital Subtraction ; Arteries* ; Arteriovenous Malformations ; Carotid Artery, Internal ; Diagnosis ; Humans ; Incidence ; Intracranial Aneurysm ; Magnetic Resonance Angiography ; Middle Cerebral Artery ; Parents