✓ The authors report a retrospective study of 146 patients to assess the extent to which aneurysms, arteriovenous malformations, and pregnancy interact. The natural history of the lesions was modified if the women became pregnant. Clinical syndromes, diagnosis, neurosurgical and obstetrical management, and treatment are discussed.
The authors report their experience with 124 cases of intracranial hemorrhage in children and adolescents; the study includes 25 cases first reported in 1958. Fifty aneurysms with a mortality rate of 28% and 33 arteriovenous malformations with a mortality rate of 21% are included; 32 cases had no angiographically demonstrable lesion, six had miscellaneous lesions, and three primary cerebral hemorrhage. Specific programs for therapeutic management based on this experience are discussed. KEY Woaosintracranial hemorrhage children congenital aneurysms arteriovenous malformations adolescents angiography].
S U M MARY Six patients with arachnoidal cysts of the middle cranial fossa who presented with raised intracranial pressure are described. All of them had a history of trauma though in two of them it was a remote incident. They all showed radiological changes of an expanded middle cranial fossa and temporal lobe agenesis. The relationship of trauma to these congenital lesions is discussed.Cysts overlying the temporal lobes have been well described in the literature. These are often associated with agenesis of the temporal lobe and their association with epilepsy and asymmetry of the skull is well known. We report our experience with six such cases, all of whom sustained minor trauma and suffered haemorrhagic complications.Case I A 24 year old male nurse was admitted to a medical ward with a three day history of severe headaches and vomiting. He had marked nuchal rigidity with Kernig's sign. There were no lateralising signs or papilloedema. A provisional diagnosis of subarachnoid haemorrhage was confirmed when the CSF obtained at lumbar puncture was found to be xanthochromic. On later questioning he recalled a blow to the right temporal region sustained during a game of football a year previously. He had not lost consciousness or been otherwise disturbed. Skull radiographs showed thinning and outward bulging of the right temporal bone with expansion of the middle cranial fossa. Right carotid angiogram showed medial shift of the middle cerebral artery with appearances suggestive of a right temporal extracerebral collection. Operation A right temporal burr hole was made and on incising the dura xanthochromic fluid gushed out under pressure. A right temporal craniotomy was then performed and a cystic cavity exposed. The superficial part of the cyst wall was adherent to the dura and the deep layer to arachnoid from which it was easily stripped. There appeared to be a direct communication between the cyst and the chiasmatic Address for reprint requests: Mr TRK Varma, Department of Neurosurgery, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF. Accepted 30 July 1980 cistern. The temporal lobe was hypoplastic and the internal carotid artery, the optic nerve and the third nerve were easily visible without retraction. The patient recovered completely and ten years later was symptom free.Case 2 A 7 year old boy was admitted with a six weeks history of headaches and vomiting. Two days prior to the onset of symptoms he had fallen from a fence and bumped his head. He had not lost consciousness and was not taken to hospital. There was no significant past illness and his development had been normal. He was fully conscious but had bilateral papilloedema though no lateralising signs. Skull radiographs showed expansion of the right middle cranial fossa with outward bulging of the squamous temporal bone.Bilateral carotid angiogram showed the midline vessels to be shifted to the left with evidence of an extracerebral collection in the right front temporal region. Operation A right temporal burr hole was made and on open...
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