This study was designed in an attempt to identify the risk factors that could be significantly associated with angiographic recurrences after selective endovascular treatment of aneurysms with inert platinum coils. A retrospective analysis of all patients with selective endovascular coil occlusion of intracranial aneurysms was prospectively collected from 1999 to 2003. There were 455 aneurysms treated with inert platinum coils and followed by digital subtraction angiography. Angiographic results were classified according Roy and Raymond's classification. Recurrences were subjectively divided into minor and major. The most significant predictors for angiographic recurrences were determined by ANOVAs logistic regression, Cochran-Mantel-Haenszel test, Fisher exact probability. Short-term (4.3±1.4 months) follow-up angiograms were available in 377 aneurysms, middle-term (14.1±4.0 months) in 327 and long-term (37.4±11.5 months) in 180. Recurrences were found in 26.8% of treated aneurysms with a mean of 21±15.7 months of follow-up. Major recurrences needing retreatment were present in 8.8% during a mean period follow-up of 17.9±12.29 months after the initial endovascular treatment. One patient (0.2%) experienced a bleed during the follow-up period. Recurrences after endovascular treatment of aneurysms with inert platinum coils are frequent, but hemorrhages are unusual. Single aneurysm, ruptured aneurysm, neck greater than 4 mm and time of follow-up were risk factors for recurrence after endovascular treatment. The retreatment of recurrent aneurysm decreases the risk of major recurrences 9.8 times. Long-term angiogram monitoring is necessary for the population with significant recurrence predictors.

Intracranial arachnoid cysts are congenital collections of fluid that develop within the arachnoid membrane because of splitting or duplication of this structure. It corresponds to 1% of all non-traumatic intracranial mass lesions 1 . Arachnoid cysts most frequently occur in the middle cranial fossa, followed by the posterior fossa, convexity, and suprasellar region. Middle cranial fossa cysts are more often associated with subdural hematoma, subdural hygroma, and intracystic hemorrhage. Usually, the patients present with signs and symptoms of intracranial hypertension, mainly headache and vomiting 2 .We report two cases of arachnoid cysts associated with concurrent subdural collections, describing their clinical presentation, radiographic findings and neurosurgical management. CaSeS Case 1A 15-year-old male patient presented with a 3-day history of headache and vomiting. He reported an episode of mild head trauma without loss of consciousness four days before the admission. There was no history of drugs, alcohol abuse or previous neurological illness. The Glasgow coma score was 14 (confused conversation). Pupil reactions were normal and there was no other abnormality in the neurologic examination. Computed tomography (CT) revealed an arachnoid cyst in the left middle cranial fossa ( Fig 1A) and a low-density crescentic collection across the entire left hemispheric convexity, corresponding to a chronic subdural hematoma, with signs of acute hemorrhage (Fig 1B). The patient underwent surgical treatment with evacuation of the subdural hematoma and endoscopic fenestration of the cyst to obtain communication with the chiasmatic cistern. The recovery was uneventful and an eight months follow-up CT showed a residual non-hypertensive cyst. There was no evidence of any subdural collection. Case 2A healthy 5-year-old male patient presented with a six-day history of intense headache and drowsiness. There was no history of head trauma, hematologic disease or use of any medication that could have possibly caused hemorrhage. The physical examination demonstrated a localized left temporal skull bulging. The

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Initially designed for the treatment of functional brain targets, stereotactic radiosurgery (SRS) has achieved an important role in the management of a wide range of neurosurgical pathologies. The interest in the application of the technique for the treatment of pain, and psychiatric and movement disorders has returned in the beginning of the 1990s, stimulated by the advances in neuroimaging, computerized dosimetry, treatment planning software systems, and the outstanding results of radiosurgery in other brain diseases. Since SRS is a neuroimaging-guided procedure, without the possibility of neurophysiological confirmation of the target, deep brain stimulation (DBS) and radiofrequency procedures are considered the best treatment options for movement-related disorders. Therefore, SRS is an option for patients who are not suitable for an open neurosurgical procedure. SRS thalamotomy provided results in tremor control, comparable to radiofrequency and DBS. The occurrence of unpredictable larger lesions than expected with permanent neurological deficits is a limitation of the procedure. Improvements in SRS technique with dose reduction, use of a single isocenter, and smaller collimators were made to reduce the incidence of this serious complication. Pallidotomies performed with radiosurgery did not achieve the same good results. Even though the development of DBS has supplanted lesioning as the first alternative in movement disorder surgery; SRS might still be the only treatment option for selected patients.

The femoral approach has been considered the preferred technique for the endovascular treatment of intracranial aneurysms. Occasionally, aneurysms are not amenable to the standard femoral approach. We describe four cases of basilar artery aneurysm that were treated by the direct vertebral artery access of V1 at the cervical region. The direct vertebral artery access technique can provide an alternative route in selected cases for the treatment of basilar artery aneurysms.

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Nasal hemorrhage or epistaxis is a common finding in the emergency department. The causes of epistaxis are varied and can be classified as local, systemic or a combination of both. The aim of this study was to report a case of embolization of branches of the maxillary artery for treatment of epistaxis secondary to facial trauma. A 43-year-old man suffered blunt trauma in the frontonasal area as a result of a bicycle accident. It presented with amnesia, severe epistaxis, panfacial edema and nasal deformity. The patient was hypotensive and hypothermic, with evidence of hemorrhagic intracranial. Orotracheal intubation was performed immediately to protect the airways and prevent aspiration of blood to the lower respiratory tract. The occlusion of the artery was successful and was immediately followed by cessation of oronasal bleeding. The patient was discharged after ten days. Arterial embolization should be the gold-standard treatment, which provides a safe and effective alternative for the control of epistaxis.