Kazuhiro Kusumoto

Angiographically occult arteriovenous malformations.

Angiographically occult arteriovenous malformations not associated with clinically recognizable intracranial hemorrhage appear to be rare. We are reporting three cases of histologically proven arteriovenous malformations of the brain that were angiographically occult. These cases presented with seizures or attacks of dizziness, and were detected by computed tomography scan, radionuclide scan, or both. The preoperative diagnosis was granuloma in the first case and meningioma in the other two. After surgical exploration, biopsy revealed an arteriovenous malformation in each case. A review of 47 cases in the literature is tabulated and etiologies of the angiographically occult arteriovenous malformations are discussed. The routine use of computed tomography scan and timely, appropriate surgical intervention with the operating microscope for the removal of these deeply situated lesions is necessary for the diagnosis and therapy.

Transorbital Intracranial Penetration by Chopstick

A 38-year-old female was struck in the eye with a wooden chopstick during a quarrel with her husband. The chopstick penetrated and lodged in her brain. Neurological examination revealed left hemiparesis and hemihypesthesia and right cranial nerve palsy of the 2nd, 3rd, 4th, and 6th nerves and the 1st branch of the 5th nerve. Computed tomography revealed a narrow, straight, low-density extending from the right orbit via the right parasellar region to the pons. A right carotid angiogram revealed a traumatic low flow/low pressure carotid-cavernous fistula. Magnetic resonance imaging yielded a low signal intensity image passing through the orbit and extending to the pons. A craniotomy was performed by the pterional approach. So that the pons and neighboring structures would not be damaged, the chopstick was first gently divided into two portions at the prepontine cistern by a high-speed airdrill and then resected piece by piece. The intraorbital portion of the chopstick was lodged firmly in the bony structure of the superior orbital fissure and could not be removed. The authors discuss the characteristics of transorbital intracranial foreign bodies, with particular emphasis on diagnostic procedures and the indications for and timing of their surgical removal.