Yanming Ren

Meningeal melanocytoma of the middle cranial fossa (the Meckel's cave)

Neurology India / March 2015 / Volume 63 / Issue 2 nerve. Since the afferent fibers of the lingual nerve travel in the hypoglossal nerve,[3] there is a possibility that they may also possess connections with the C2 spinal nerve roots. The greater and lesser occipital nerve also arise from the second spinal nerve. The steroid block for the occipital neuralgia stabilized the transmission of impulses within the related interconnected nerves including the occipital nerve, the C2 spinal nerve root, the hypoglossal and the lingual nerve (the latter containing the afferent fibers from the chorda tympani nerve that carry taste sensations from the anterior two‐thirds of the tongue) leading to improvement in dysgeusia.[3,8] Post‐traumatic misdirectional regeneration of facial nerve fibers can result in a cross‐talk between the facial nerve and the cervical plexus (and the occipital nerve in particular).[8] Suppression of these direct interneural connections by an occipital block could have resulted in the recovery of the dysgeusia.

Microsurgical versus Endovascular Treatments for Blood-Blister Aneurysms of the Internal Carotid Artery: A Retrospective Study of 83 Patients in a Single Center

BACKGROUND Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality. Both surgical and endovascular approaches have been used to treat BBAs; however, little is known about their safety and efficacy. OBJECTIVE To review our experience with the treatment of BBAs and explore the optimal treatment strategy. METHODS A total of 83 patients with BBAs were reviewed retrospectively. The characteristics of the patients and the aneurysms, treatment results, and follow-up outcomes were analyzed. RESULTS The cohort comprised 52 females and 31 males with a mean age of 46.6 years; 33 patients were assigned to the microsurgical therapy. Subsequently, 27/33 patients underwent surgical clipping, 4/33 underwent trapping without bypass, 2/33 underwent wrapping, and 50 patients underwent endovascular therapy, including stent-assisted coiling (49 patients) and coiling (1 patient). Intraoperative rupture occurred in 14 and 4 patients in the microsurgical and endovascular groups, respectively. Ischemic events occurred in 16 and 8 patients in the microsurgical and endovascular groups, respectively. At 1-year follow-up, a favorable clinical outcome was achieved in 18 (54.5%) and 38 (76.0%) patients in the microsurgical and endovascular groups, respectively. The multivariate regression model showed that the treatment strategies, Fisher grade, and vasospasm contributed significantly to the prediction of outcome for 1 year. CONCLUSIONS BBAs are challenging vascular lesions with poor prognosis. Endovascular treatment may be more effective and safer with better outcomes than surgical approaches.

Risk Factors of Rehemorrhage in Postoperative Patients with Spontaneous Intracerebral Hemorrhage : A Case-Control Study

Objective Rehemorrhage is the most severe complication of postoperative patients with spontaneous intracerebral hemorrhage. The aim of the present study was to assess independent predictors of rehemorrhage and find the possibility of preventing rehemorrhage in postoperative patients with spontaneous intracerebral hemorrhage (sICH). Methods Medical records of 263 postoperative patients with sICH from our Hospital were reviewed. The relationships between rehemorrhage and parameters were examined by univariate and multivariate analyses. The parameters include time from onset to surgery, hematologic paremeters, neuroimaging characteristics, level and variability of systolic blood pressure, medical histories, operation duration, and blood loss. In addition, relationship between rehemorrhage and clinical outcome were analyzed by using multivariate analyses. Results Thirty-five (13.31%) patients experienced rehemorrhage after operation. Multivariate analyses indicated that the following factors were independently associated with rehemorrhage : history of diabetes mellitus (odds ratio [OR], 2.717; 95% confidence interval [CI], 1.005–7.346; p=0.049), and midline shift (for every 1 mm increase, OR, 1.117; 95% CI, 1.029–1.214; p=0.009). Rehemorrhage was an independent risk factor of poor functional outcome (OR, 3.334; 95% CI, 1.094–10.155; p=0.034). Conclusion Our finding revealed that history of diabetes mellitus and admission midline shift were possibly associated with rehemorrhage in postoperative patients with sICH.

Radiologic Characteristics and High Risk of Seizures in Infants with Ruptured Intracranial Aneurysms: Case Report and Review of the Literature

OBJECTIVE To evaluate the parameters related to the high risk of preoperative seizures in infants (1 year or younger) with ruptured intracranial aneurysms. METHODS Infants with ruptured intracranial aneurysms treated at our institution from January 2012 to January 2018 were retrospectively analyzed. Seventeen similar cases of infant patients with seizures reported in published studies were reviewed. RESULTS The mean age of the 7 infant patients treated at our institution was 4.1 ± 3.3 months (range, 28 days to 11 months), with 2 male and 5 female subjects. One patient (14.3%) had an internal carotid artery aneurysm with subarachnoid hemorrhage, and the remaining 6 patients (85.7%) had middle cerebral artery (MCA) aneurysms in the distal arterial region with lobe hemorrhage. Five of the 7 infants (71.4%) had seizures, 4 of whom (4/5, 80.0%) had MCA distal arterial aneurysms with lobe hemorrhage. Management was successful for all patients with aneurysm clipping or resection surgery, and one patient experienced postoperative seizures. Of the 17 reviewed cases of infant patients with seizures, 10 patients (58.8%) exhibited the typical distal arterial aneurysm with lobe hemorrhaging, and 6 (60%) of them had aneurysms in MCA. CONCLUSIONS Infant patients with ruptured intracranial aneurysms have a high risk of preoperative seizures. The typical radiologic finding of distal arterial aneurysm with lobe hemorrhage was frequently observed in the MCA, and it might be related to the high risk of preoperative seizures in this population. Microsurgical techniques effectively control postoperative seizures in infants with ruptured intracranial aneurysms.

Successful Surgical Resection of Spinal Artery Aneurysms: Report of 3 Cases

BACKGROUND Spinal artery aneurysms (SAAs) are extremely rare lesions that can occur in isolation or associated with vascular malformations. Herein, we present 3 unusual cases of SAAs and discuss imaging, diagnosis, and surgical management strategies. CASE DESCRIPTION The first patient was a 57-year-old woman who presented with sudden onset of severe headache. Spinal angiography demonstrated an isolated anterior spinal artery (ASA) aneurysm at the level of the craniocervical junction. The second patient was a 27-year-old woman who presented with progressive bilateral pain of her lower limbs. The result of spinal angiography was consistent with an aneurysm at the level of L1. The third patient was a 26-year-old man who presented with bilateral weakness and numbness of the lower limbs. Spinal angiography revealed a conus medullaris aneurysm associated with an arteriovenous malformation (AVM). All these lesions were successfully managed with clipping or resection, and good outcomes were achieved. CONCLUSION Spinal artery aneurysms are rare lesions. Herein, we report 3 such cases and emphasize the importance of surgical management.

Efficacy of Closed Continuous Lumbar Drainage on the Treatment of Postcraniotomy Meningitis: A Retrospective Analysis of 1062 Cases

BACKGROUND Postcraniotomy meningitis is a severe complication in neurosurgery, and can result in high morbidity and mortality. Closed continuous lumbar drainage (CCLD) as an adjuvant method for treating postcraniotomy meningitis in adults is rarely assessed. This study aimed to evaluate the efficacy of CCLD in the treatment of postcraniotomy meningitis. METHODS A total of 1062 patients older than 16 years with postcraniotomy meningitis were included, between January 2000 and December 2015. Of these, 474 received intravenous antibiotic therapy, steroid administration and adjuvant CCLD (experimental Group). The remaining 588 patients only received intravenous antibiotic and steroid therapies (control Group). Data were extracted from medical records. RESULTS In the experimental group, meningitis-related mortality was 2.7%, and 77.4% individuals achieved a Glasgow Outcome Scale of 4-5. In the control group, meningitis-related mortality reached 11.6%, with only 61.1% of patients achieving a GOS of 4-5. The time to negative cerebrospinal fluid laboratory test and the duration of meningitis-related symptoms were significantly shorter in the experimental group compared with controls (P < 0.05). CONCLUSIONS Intravenous antibiotic and steroid therapies, assisted by CCLD, can lead to lower mortality and improved Glasgow Outcome Scale score in patients with meningitis after craniotomy. Laboratory results negative for cerebrospinal fluid leak and meningitis-related symptom relief occurred faster in the experimental group. Intravenous antibiotic and steroid therapies combined with CCLD appear to be an effective and safe treatment for postcraniotomy meningitis.

A prepontine subarachnoid abscess by Escherichia coli

A 53-year-old man had 6 months of intermittent fever and worsening headache, with 4/5 left hemiparesis and new unsteady gait, without other deficits. His immune status was normal, and he had self-treated with paracetamol-caffeine-aspirin powder. Two years prior he had purulent meningitis diagnosed by lumbar puncture with negative CSF culture, treated with ceftriaxone/vancomycin for 2 weeks.