Velimir Lupret

Cerebral venous angiomas: Surgery as a mode of treatment for selected cases

SummaryEleven patients with venous angiomas, 6 males and 5 females ranging in age from 4 to 58, are presented. Four patients presented with intracerebral haematoma and 3 patients had associated cavernous angioma, respectively. Patients with intracerebral haematoma had signs and symptoms due to the localication of the haematoma. The other patients presented with headache, seizures, vertigo, ataxia and mental disturbances. Pre-operative diagnosis was based on computerized tomography, magnetic resonance imaging and cerebral angiography. In 9 surgical cases it was confirmed by histopathological examination of operative specimens.After establishing the type, size and location of the lesion decision for operative treatment was made in nine cases, in four of them because of the presence of an intracerebral haematoma and in 5 of them due to severe disability. Eight of these 9 patients recovered completely and one improved. No severe cerebral oedema was encountered after converging medullary veins were excised and main draining veins partially coagulated.In this small series we encountered an unexpectedly large percentage of venous angiomas causing intracerebral haemorrhage which are commonly considered more benign than other vascular malformations. After reviewing previously reported cases of venous angiomas causing intracerebral haemorrhage and severe neurological deficit we think that the term “benign” is worth reconsidering. We propose a thorough examination of each case of venous angioma and the operative treatment when appropriate taking into account patients state and location of angioma.

Cerebral Cysticercosis and Echinococcosis: a Preoperative Diagnostic Dilemma

BACKGROUND Seven cases of neurocysticercosis and three cases of neuroechinococcosis with symptoms of elevated intracranial pressure requiring urgent neurosurgical treatment are described. No neuroradiologic procedure established exact diagnosis preoperatively; this was achieved by pathohistologic analysis of bioptic material. METHODS Ten patients with duration of clinical symptoms ranging from 1 week to 1 month were operated on at the Department of Neurosurgery of Sestre Milosrdnice University Hospital in Zagreb, Croatia during the period 1988-2000. On receipt, bioptical material was examined pathohistologically at the Ljudevit Jurak Clinical Department of Pathology of the same hospital. We compared our data with facts collected by reviewing the pertinent literature over the past 10 years. RESULTS The most common localization of parasitic cysts in our study was posterior cranial fossa, i.e., subtentorial, which, according to the literature, is a rare localization. Due to this unusual localization, dominant clinical symptoms included elevated intracranial pressure, requiring urgent surgical removal of parasitic cysts. CONCLUSIONS With the exception of the epidemiologic aspect, cerebral cysticercosis and echinococcosis are important as a true diagnostic and therapeutic problem. These human parasitic zoonoses are rarely diagnosed preoperatively despite newly developed neuroradiologic and serologic methods, especially in cases of primary appearance in brain when exact diagnosis reveals adequate surgical removal with subsequent complete recovery.

Spinal spindle cell haemangioma: an atypical location

SummaryWe present a case of the 31-year-old male patient who complained of weakness in both legs and progressed slowly. Neuroimagine of the thoracic spine showed an intraspinal, extradural mass lesion, measuring 5.3 × 1.2 cm at the Th1–Th3 level. Histologically the lesion was a spindle cell haemangioma composed of dilated vascular spaces and a proliferation of bland appearing interspersed spindle cells. Immunohistochemical analysis was diffusely positive for VIM, SMA and focally for CD34. This lesion is uncommon and shows a predilection for distal extremities. Spindle cell haemangioma within the spine has not been previously reported in the literature.

Intracerebral haematoma in an infant with haemophilia A

SummaryA nine-weeks-old infant with haemophilia A developed an intracerebral haematoma. Intracranial operation and removal of the haematoma were performed safely under the cover of highly potent AHF cryoprecipitate. Computerized tomography of the brain is very useful for neurosurgical care of the haemophiliac patients as a noninvasive and atraumatic method of examination. The literature of intracranial operations in infants with haemophilia A under the age of one year is reviewed.