Takanobu Iwata

Trochlear nerve neurinoma associated with a giant thrombosed dissecting aneurysm of the contralateral vertebral artery

The authors encountered the unusual case of a 57-year-old man with a right trochlear nerve neurinoma associated with a giant thrombosed dissecting aneurysm of the left vertebral artery. The right trochlear nerve neurinoma was subtotally removed via the right subtemporal transtentorial route. The trochlear nerve entered the tumor directly posterolaterally. The left vertebral artery was clipped just proximal to the thrombosed dissecting aneurysm via the left lateral suboccipital approach. The patient was discharged without neurologic deficits except for the right trochlear nerve palsy. To our knowledge, this seems to be the first reported case of such an occurrence.

Unsuccessful consequence of optic canal decompression for a case of craniometaphyseal dysplasia.

We have described a case of craniometaphyseal dysplasia in which decompression of bilateral optic canals for treatment of threatened damage of the optic nerve resulted in bilateral visual loss. We speculate that a specific mechanism exists whereby decompression of the optic canal can cause blindness.

Dorsum sellae meningioma mimicking pituitary macroadenoma: case report.

BACKGROUND A dorsum sellae meningioma is a rare occurrence. It is difficult to evaluate dorsum sellae meningiomas preoperatively from the viewpoint of neuroimaging. We report a rare case of dorsum sellae meningioma mimicking pituitary macroadenoma in a 73-year-old woman. CASE PRESENTATION The patient presented with bitemporal hemianopsia and panhypopituitarism. Magnetic resonance imaging demonstrated a bright, homogeneously enhancing intra- and suprasellar mass and a hypointense region in this mass, which was interpreted as a dorsum sellae. Transsphenoidal extirpation was used because of a suspicion of nonsecreting pituitary macroadenoma. Histopathologically, the tumor was diagnosed as a meningioma. Superselective external carotid angiography before the second surgery revealed that the mass was supplied by the left accessory middle meningeal artery and appeared to originate from dorsum sellae. After preoperative embolization, the patient developed hyponatremia. The tumor was subtotally removed via a transcranial route, and the attachment to the dorsum sellae was coagulated extensively. She did well after a second surgical procedure. CONCLUSION These radiologic findings may be useful in differentiating dorsum sellae meningioma from pituitary macroadenoma.

Cranial reshaping of rare concordant dizygotic twins with trigonocephaly

Craniofacial surgery for craniosynostosis is now often performed, and many cases have been reported. Twinning among these cases is of particular interest. An extremely rare case of cranial reshaping of concordant dizygotic twins with trigonocephaly is described in this report.

A case of de novo aneurysm rupture

We report a case of ruptured aneurysm arising de novo from a previously angiographically normal vessel.