Giant cell reparative granuloma (GCRG) is an uncommon nonneoplastic lesion of bone. It is even rarer in the bones of the skull, particularly in the calvarial bones. Originally considered to be peculiar to the jawbones, GCRG has been described in some other locations, such as the short tubular bones of the hand and the facial (paranasal) bones. Only one GCRG has been found in the skull, this one in the temporal bone. The authors were unable to find a report of such a lesion in the bones of the calvarium. The etiology of GCRG is unknown, but it is believed to result from a traumatic intraosseous hemorrhage or periosteal reaction. A GCRG was diagnosed in a 31-month-old male infant who presented with a nonpainful, slow-growing, right frontal swelling, apparently related to a head contusion that had occurred 21 months earlier. The lesion was removed surgically. The main differential diagnosis is giant cell tumor.
Two patients with persistent trigeminal artery associated with a ruptured arterial intracranial aneurysm arising from the ipsilateral internal carotid artery at the level of the posterior communicating artery are presented. One patient underwent successful clipping of the aneurysm. The other patient died on the x-ray table shortly after admission during the performance of emergency carotid angiography. In each patient, the anomalous vessel was considered to be incidental.
The persistence of embryonic cerebral vessels in the adult is not a frequent occurrence, neither is the presence of multifocal arteriovenous malformations (AVMs) of the brain. The most commonly reported type of persistent carotid-basilar anastomosis is the primitive trigeminal artery, followed by the primitive hypoglossal artery (PHA). In this report. a 30-year-old, right-handed woman hospitalized because of subarachnoid hemorrhage and harboring an intracerebral-intraventricular hematoma resulting from the rupture of one of two independent AVMs of the left cerebral hemisphere, was found also to have a right persistent PHA. One AVM was intraventricular and had ruptured: the other was subcortical, intact in the parietal lobe. The PHA originated as a large anomalous branch of the right internal carotid artery in the neck and joined the basilar artery after entering the posterior fossa through the ipsilateral anterior condyloid foramen, which was enlarged. At craniotomy, the two AVMs were successfully excised with the aid of microsurgical technique. These two independently rare conditions, namely, multifocal cerebral AVMs and persistent PHA, warrant our desire to report this case.
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