Fig. 1 Axial computed tomography scan on admission demonstrating broad diffusion of subarachnoid hemorrhage within the sylvian fissure, basal cistern, and fourth ventricle, and a slightly hyperdense mass in the suprasellar cistern.

Application of sutures between expanded polytetrafluoroethylene (ePTFE) dural substitutes and the dura mater is often frustrating in posterior fossa surgery because of the difficulty in holding the elastic graft in a deep and narrow field. To resolve this problem, we have developed a boat-shaped graft made from a triangular ePTFE sheet by pinching each angle using a suture. Formation of standing edges of the sheet facilitates holding of the flaps for secure and more rapid suturing than the conventional approach using a flat sheet.

We describe the first example of an LSA aneurysm without occlusion or severe stenosis of the VA and PICA. This extremely rare lesion illustrates how knowledge of the angiographic features and super-selective cerebral angiography aids the precise diagnosis and the prevention of surgical complications.

We present two cases in which the diagnosis was complicated by the presence of a weak muscle innervated by a compressed motor root in the intervertebral foramen (IVF) at an atypical level. The patients were 59- and 53-year-old men; they presented with marked atrophy and weakness predominantly in a unilateral deltoid. Neuroimaging revealed narrowing of the nerve root sleeve at the C5/6 IVF due to a herniated disk or osteophyte. Predominant atrophy and weakness of the deltoid were not consistent with radiculopathy at the C5/6 IVF, i.e. C6 radiculopathy. During an extended observation period to rule out motor neuron disease, their weakness did not spread and the patients underwent posterior medial facetectomy and anterior foraminotomy. This produced marked improvement of the deltoid weakness soon after the operation. We considered unexpectedly wide motor innervation of the C6 nerve root predominantly in the deltoid, anatomic variations in the C5 root such as the trunk of the C5 root entering into the C5/6 IVF, and descending anastomoses connecting the C5 and C6 rootlets as possible explanations. Awareness of this rare presentation may aid in the diagnosis and surgical management of these patients.

No abstract