Ruptured BBAs were successfully treated with a trapping/EC-IC bypass during the acute SAH period. This surgical strategy for treating BBAs during the acute period might be a promising option for these rare but high-risk lesions.
A 31-year-old woman with moyamoya disease presented with choreiform movements persisting for 4.5 years. Magnetic resonance imaging showed a fine vascular plexus in the base of the brain but no parenchymal brain damage. Cerebral angiography revealed intracranial vascular abnormalities compatible with moyamoya disease. Single photon emission computed tomography with N-isopropyl-p-123 I-iodoamphetamine showed definite reduction of the regional cerebral blood flow (rCBF) in the bilateral striata and frontotemporoparietal cortex. rCBF study with acetazolamide administration indicated marked decrease of rCBF reserve in those regions. She underwent indirect bypass surgery (encephalo-duro-arterio-myo-synangiosis) under a diagnosis of moyamoya disease. The choreic involuntary movements disappeared shortly after surgery. Postoperative angiography showed neovascularization in the extracranial to intracranial direction, associated with dramatic increase in rCBF in the involved regions.
A 27-year-old woman presented with vertebral hemangioma manifesting as sudden onset of paraplegia, and bladder and bowel dysfunction during pregnancy. Magnetic resonance imaging revealed a mass lesion that had infiltrated into the entire T2 vertebral body and expanded to the vertebral canal. Laminectomy from T1 to T3 and biopsy of the lesion were performed. Biopsy confirmed the diagnosis of vertebral hemangioma, but laminectomy resulted in no neurological changes. The patient was transferred to our hospital, where radical treatment comprising embolization of the feeding arteries, posterior stabilization of the vertebrae, and anterior excision of the tumor was performed. Symptoms resolved gradually but steadily, and she made a full recovery by 18 months postoperatively. Radical operation might be extremely effective for extradural vertebral hemangioma, even in the delayed phase or in the presence of severe neurological deficit.
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