We present a case of a subdural osteoma. A 29-year-old female presented with a 3-year history of headaches. Computed tomography scan revealed a homogeneous high-density lesion isolated from the inner table of the frontal bone (a lucent dural line) in the right frontal convexity. Magnetic resonance imaging revealed an extra-axial lesion with a broad base without dural tail sign and punctate enhancement pattern characteristic of abundant adipose tissue. Upon surgical excision, we found a hard bony mass clearly demarcated from the dura. The mass displayed characteristics of an osteoma upon histological examination. The symptom was relieved after operation.
Rupture risk of the paraclinoid aneurysm is very low. However, superiorly located paraclinoid aneurysms appear more likely to rupture than other locations. Angiographically, more conservative indication for the treatment of paraclinoid aneurysm should be recommended except for superior located lesions.
6lected single-center experiences are extremely rare. The objective of this report was to review and discuss the clinical aspects of our single-center experience with 23 cases of SAH associated with an aSDH originating from a ruptured intracranial aneurysm. MATERIALS AND METHODSAll patients with ruptured intracranial aneurysms who were admitted to our department between January 2005 and December 2010 were identified. The medical records and films of the patients were retrospectively reviewed. We selected cases of aSDH secondary to a ruptured intracranial aneurysm. The criteria for selection were; 1) no history of head trauma, 2) radiologist-confirmed definitive subdural hematoma on initial computed tomography (CT) imaging, 3) CT angiography or digital subtraction angiography (DSA) demonstrating an intracranial aneurysm, and 4) a visible subdural hematoma with evidence of a ruptured aneurysm by operative report. The following information was collected and assessed : 1) patient demographic data; 2) clinical status on admission according to the Glasgow Coma Scale (GCS) and the World Federation of Neurosurgical INTRODUCTIONSubarachnoid hemorrhage (SAH) caused by a ruptured intracranial aneurysm is a devastating disease with high mortality and morbidity 7) . SAH associated with acute subdural hematoma (aSDH) originating from ruptured intracranial aneurysms is rare and carries a poor prognosis 8,15,20,24) . The majority of posttraumatic aSDH result from vascular injury in the brain cortex. Because of rapid clinical deterioration, early decompression is mandatory, but the prognosis remains poor in many cases. Previous investigators have reported small case series of spontaneous aSDH caused by an aneurysmal rupture 2,12,20,24) . The majority of these series reported poor clinical grades and suggested the use of various detecting modalities and treatment plans 5,8,11,15,18) . However, these cases were not numerous and consistently col-J Korean Neurosurg Soc 50 : 6-10, 2011 10.3340/jkns.2011.50.1.6 Copyright © 2011 The Korean Neurosurgical Society
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