Calvarial cavernous hemangiomas may bleed precociously, even before birth, and manifest as large intraosseous hematomas. Differential diagnosis against ossified cephalhematoma can only be established through histopathological study.

Arteriovenous malformations of the temporalis muscle (TM-AVMs) are rare lesions commonly considered as a variant of scalp AVMs. A study was designed in order to analyze TM-AVMs features and to confirm them as a certain entity different from scalp AVMs. Seven TM-AVMs cases (5 from literature plus 2 from our database) were studied. Clinical, epidemiological, radiological, and therapeutic data were analyzed and compared to common scalp AVMs features. All TM-AVMs presented as large soft tumor-like masses on the temporal region (mean diameter: 6 cm). Pain was referred in half of cases, while overlying cutaneous stigmas were described only once. No masticatory malfunction was reported. TM-AVMs tend to appear in young patients (mean: 29 yr), commonly as longstanding and slow-evolving lesions (mean evolution time before diagnosis: 5 yr). All cases displayed a diffuse slow-flow blush on angiogram. All TM-AVMs were completely located within the TM, with no involvement of scalp or bone. The pathological analysis of all cases demonstrated the presence of striate muscular bundles intermingled with fairly mature arterial and venous vessels. No clearly distorted vessel was found within the TM-AVMs. Surgery was performed for all cases with complete removal. Preoperative embolization was done in 4 cases to reduce blood loss during surgery. No clinical/radiological recurrence was reported. Opposite to TM-AVMs, scalp AVMs commonly present as high-flow lesions with no evident tumor mass, mainly located in the subcutaneous tissue. TM-AVMs present clearly distinct features compared to scalp AVMs, for which they should be considered as a certain pathological entity and not as a variant of scalp AVMs.

Background Completely thrombosed aneurysms of the posterior cerebral artery (CTPCAAs) are rare lesions with different characteristics and clinical behavior when compared with other intracranial aneurysms. Objective To describe and analyze the main features of CTPCAAs. Material and Methods Fifteen CTPCAAs were studied (14 literature cases plus one illustrative case). Clinical, radiologic, pathologic, and therapeutic data were obtained and analyzed. Results CTPCAAs are large (mean: 2.43 cm), located proximally (80% at P1–P2 segments), and show a slight predominance of a fusiform appearance. Posterior cerebral artery (PCA) occlusion ensued after aneurysm complete thrombosis in 73% of patients (11/15). However, only 33% of patients developed a PCA territory stroke, due to a rich distal arterial collateral network. Three mutually exclusive clinical presentations were observed: subarachnoid hemorrhage (SAH) (n = 3), “stroke-like” syndrome (n = 7), and “tumor-like” syndrome (n = 4). One case was incidental. Three treatments were performed: conservative (n = 7), endovascular (n = 1), and surgery (n = 7). CTPCAA exclusion was the goal of surgery. Neural structures decompression was also sought in tumor-like cases. CTPCAA elimination as a potential bleeding source was the target in stroke-like cases. General outcome among CTPCAAs was good (73% of cases scored Glasgow Outcome Scale 4–5/Modified Rankin Scale 0–2). Conclusions CTPCAAs are characterized by young age at presentation, male predominance, proximal location on PCA, and tendency to cause PCA occlusion. The PCAA clinical presentation depends on the mechanism of complete thrombosis. SAH and stroke-like syndrome CTPCAAs harbor a less organized thrombus than tumor-like CTPCAAs, which makes the aneurysm more prone to hemorrhagic/ischemic complications. Thus clinical presentation may indicate the clinical evolution in CTPCAAs. The management of CTPCAAs varied according to the patient's clinical condition and the risk evaluation for future complications derived from the aneurysm. Clinical surveillance and surgical removal were the most frequent treatment options performed. Surgery was focused on neural decompression and/or CTPCAA elimination as a potential source of bleeding.