Román Garza-Mercado

Cerebral arteriovenous malformations in children and adolescents

A series of 19 juveniles with cerebral arteriovenous malformations is reported. The group is composed of 8 children and 11 adolescents, aged 9-18 years, with an average age of 14.5 years. There were 10 males and 9 females. Twelve juveniles were treated by operation. Ten patients were operated upon electively; one of these died as a direct consequence of excision of the arteriovenous malformation--a female patient with an arteriovenous malformation of the corpus callosum. One other patient in this category expired 3.5 months after the removal of the arteriovenous malformation, from unrelated infectious complications arising from a preoperational ventriculo-peritoneal shunting procedure. Two patients were operated upon on an emergency basis because of an associated intraparenchymal hematoma; both of these patients died. All surgical survivors are leading independent lives. The postoperative observation period ranges from 6 months to more than 17.5 years, with an average of 6.6 years. Of the seven patients treated by nonsurgical means, one was hospitalized in a coma after rupture of the arteriovenous malformation and died shortly after admission; another--a girl in the fifth month of her first pregnancy--was admitted in a stupor and expired from a recurrent subarachnoid hemorrhage 3 weeks after the first occurrence. Five nonsurgical patients left the hospital in good condition, but one died at home 2 years later from intractable cardiorespiratory insufficiency associated with an aneurysm of the vein of Galen.

Traumatic Extradural Hematoma of the Cervical Spine

An example of a traumatic extradural hematoma of the cervical spine that occurred in a 32-year-old man who suffered from chronic ankylosing spondylitis is reported. Progressive sensory and motor deficit ensued some 3 hours after the patient fell from a standing position. The patient landed on his back, striking his head on the floor. After being helped up, he was able to walk unassisted to a nearby chair, where he sat down until his left lower extremity--and shortly afterwards, the right one--became numb and weak. On admission, the patient was found to have tetraparesis that was more pronounced in the lower extremities and associated with incomplete sensation to pinprick at level T7-T10. He also had painless distention of the urinary bladder. After a few hours, the weakness in his limbs increased and his sensory level rose to C5 bilaterally. A horizontal diastatic fracture across the vertebral body of C7 was discovered on plain x-ray films of the spine, and an extradural hematoma extending dorsally from C5 to T1 was revealed by emergency magnetic resonance imaging. After an emergency decompressive cervical laminectomy and removal of the clot, the patient rapidly regained complete neurological function, except with regard to both the urinary bladder and the rectum, which remained abnormal for almost 7 weeks after the operation.

Giant cell reparative granuloma of the cranial vault: exceptional bone lesion.

Giant cell reparative granuloma (GCRG) is an uncommon nonneoplastic lesion of bone. It is even rarer in the bones of the skull, particularly in the calvarial bones. Originally considered to be peculiar to the jawbones, GCRG has been described in some other locations, such as the short tubular bones of the hand and the facial (paranasal) bones. Only one GCRG has been found in the skull, this one in the temporal bone. The authors were unable to find a report of such a lesion in the bones of the calvarium. The etiology of GCRG is unknown, but it is believed to result from a traumatic intraosseous hemorrhage or periosteal reaction. A GCRG was diagnosed in a 31-month-old male infant who presented with a nonpainful, slow-growing, right frontal swelling, apparently related to a head contusion that had occurred 21 months earlier. The lesion was removed surgically. The main differential diagnosis is giant cell tumor.

Extradural hematoma associated with traumatic middle meningeal artery pseudoaneurysm: report of two cases.

Two new cases of extradural hematoma associated with traumatic middle meningeal artery pseudoaneurysm are presented. Sixteen such cases have previously been reported in the literature. A 22-year-old man and a 17-year-old woman each developed marked neurological deficits after head injury. In each case percutaneous common carotid angiography demonstrated a conspicuous aneurysmatic sac on the middle meningeal artery, as well as displacement of major intracranial vessels and a surrounding avascular area. At operation the extradural clot was removed and the middle meningeal artery sac was verified. Both patients recovered uneventfully. Histological analysis of one of the specimens was performed.

Pseudomoyamoya in sickle cell anemia.

Sickle cell (drepanocytic) anemia is a hereditary blood disease occurring very rarely in Mexico. A 13-year-old Mexican boy with sickle cell anemia eventually died of a cerebrovascular accident of the brain stem, as shown by computerized tomography (CT). A characteristic moyamoya-like angiographic pattern was demonstrated on bilateral carotid and left vertebral arteriograms. Moyamoya disease has no known etiology, but the characteristic angiographic features of moyamoya have been observed in conjunction with some other disease of known origin (including sickle cell anemia). It is therefore my belief that these latter cases should be referred to as pseudomoyamoya and not true moyamoya.

Congenital Subgaleal (Epidermoid) Inclusion Cyst of the Anterior Fontanel in a Mexican Female Child: Case Report

A 30-month-old Mexican girl with an inclusion subgaleal cyst located over the anterior fontanel is described. This is the first such case ever diagnosed at our institution and, we believe, the first reported from Mexico. Radical excision of the lesion was accomplished. The internal table of the skull was eroded, but no intracranial extension was noticed. As the cyst contained no hair follicles nor any sebaceous or sweat glands, it was histologically classified as an epidermoid cyst. This is another example of such a lesion in an infant of non-African descent.

Development of contralateral symmetric (mirror) aneurysm after a trapping procedure. An 18-year observation.

An 18-year-old male medical student presented with subarachnoid hemorrhage. Other than stiffness of the neck, the neurological examination yielded normal findings. Bloody cerebrospinal fluid was obtained by lumbar puncture. Bilateral carotid arteriography revealed a right internal carotid artery aneurysm at the level of the posterior communicating artery. The angiogram of the left carotid artery was entirely normal. A right trapping procedure followed. The patient was asymptomatic for 4 years, when a repeat subarachnoid hemorrhage occurred. A new (mirror) aneurysm on the opposite (left) internal carotid artery was at this time demonstrated by repeat bilateral carotid arteriography. The newly developed aneurysm was successfully clipped. The patient has led a normal, useful life, with no recurrent episodes of subarachnoid hemorrhage in the next 18 years.

Primary oligodendroglioma of the septum pellucidum.

The oligodendroglioma is an infrequent cerebral tumor of glial ancestry. It is even rarer when primarily arising within the confines of the ventricles and particularly if originating from the septum pellucidum. A 22-year-old man harboring a primary oligodendroglioma of the septum pellucidum was successfully treated by intraventricular tumor removal through a left transcortical-transventricular approach, using microsurgical technique. A brief review of relevant data about both intraventricular oligodendrogliomas and tumors of the septum pellucidum is presented.

Coexistence of bilateral aneurysms of the internal carotid arteries and an arteriovenous malformation of the left frontal lobe

A 44-year-old right-handed man was hospitalized because of a subarachnoid hemorrhage. He was drowsy on admission and exhibited a left partial third nerve palsy, right hemiparesis, and selective motor aphasia. A large subcortical arteriovenous malformation involving the left frontal lobe was demonstrated by angiography. The malformation filled from either carotid system and from the vertebrobasilar system as well. In addition, there were two bilaterally symmetrical (mirror) aneurysms of each internal carotid artery. Computed axial tomography revealed a left intratemporal-intraventricular hematoma. Deterioration of the patients clinical condition occurred a few days after admission. Improvement was obtained after removal of the hematoma at a left subtemporal craniectomy, at which time the ruptured aneurysm arising from the left internal carotid artery was clipped. Sixteen months later, the intact aneurysm of the right internal carotid artery was clipped, and the arteriovenous malformation was radically excised through a bifrontal (Pool) craniotomy with microsurgical technique and with the aid of intraoperative angiography. The patient remained with a fixed neurological deficit, as observed preoperatively.