Seigo Koyama

Giant basilar artery aneurysm with intramural hemorrhage and then disastrous hemorrhage: case report.

OBJECTIVE AND IMPORTANCE Intracranial giant aneurysms have been considered to grow by recurrence of intramural hemorrhage of the aneurysmal wall. However, it remains uncertain whether rupture of giant aneurysms is brought about by the same mechanism that causes the rupture of smaller saccular aneurysms. It is also unclear whether intramural hemorrhage is correlated with the rupture of giant aneurysms. CLINICAL PRESENTATION A 67-year-old woman was admitted with symptoms of gait disturbance and dementia. Computed tomographic scans revealed a large mass located in the prepontine region and extending into the third ventricle as well as moderate dilatation of the lateral ventricles. Angiography demonstrated a giant basilar tip aneurysm and multiple aneurysms located in the bilateral anterior and middle cerebral arteries. INTERVENTION Ventriculoperitoneal shunting was scheduled, but subarachnoid and intraventricular hemorrhage occurred and the patient died. Computed tomographic scans, performed immediately before the disastrous hemorrhage, displayed intramural hemorrhage in the wall of the giant basilar tip aneurysm. Ventricular drainage was performed, but the patient died. CONCLUSION It seems probable that intramural hemorrhage of the aneurysmal wall may cause both the growth and rupture of intracranial giant aneurysms.

A Huge intracranial xanthogranuloma in the middle cranial fossa : case report

Xanthogranulomas of the dura presenting with clinical symptoms are rare. We report here a case of a huge dural xanthogranuloma in the middle cranial fossa, which caused hemiparesis through marked displacement and stenosis of the middle cerebral artery. Although such tumors usually arise in association with histiocytosis X or familial hyperlipoproteinemia, the present case was not associated with these diseases.

Choriocarcinoma of the septum pellucidum: Case report

A case of choriocarcinoma of the septum pellucidum is presented. The patient, a 6-year-old boy, demonstrated high levels of human chorionic gonadotropin in his urine, serum, and cerebrospinal fluid, and precocious puberty. The physical conditions and laboratory data returned to normal after surgical removal of the tumor, whole brain irradiation, and chemotherapy. Currently, there is no evidence of recurrence at 5 months after surgery.

Delayed intracerebral hemorrhage following VP shunt operation

Three cases of communicating hydrocephalus after subarachnoid hemorrhage are reported that underwent ventriculoperitoneal shunt and suffered from delayed intracerebral hemorrhage along the ventricular catheter. Ventricular catheters were inserted into the posterior horn with minimal brain damage by our method, in case 1 and 2, 3 times try of ventriculostomy, in case 3, replacement along the same route on the shunt revision. Blood pressure control after the operation was good and bleeding tendency was not observed. Vascular anomaly was not found in preoperative angiography in any case. In case 1, 60 year-old man, intracerebral hemorrhage occurred on the 7th-9th postoperative day as the result of respiratory acidosis and generalized convulsion which needed assisted ventilation for two days. In case 2, 54 year-old man and case 3, 59 year-old woman, headache and hemiparesis suddenly developed immediately after micturition 4 days after operation. Postoperative CT scan revealed that cranioplasty, performed at the same time as shunt operation, caused mass effect on the shunted side of the brain in case 2. In case 3, VP shunt system revised did not seem to function so well. These conditions might predispose the shunted brain to bleed, in addition to the increased intracranial pressure or blood pressure probably produced by Valsalva effect at micturition. These cases indicate that the small surgical wound in the brain induced by shunt procedure could cause progressive degenerative vascular change and bring about delayed intracranial hemorrhage under some predisposing factors.