Tools are needed to quantify and qualify the morphogenesis and variations of the middle meningeal artery. Supposing these vessels are not strictly necessary in the adult age, the evolutionary pressure shaping their structure may have been associated with early life stages. Apart from oxygenation, another function which deserves attention is thermoregulation, considering the metabolic loadings of the cerebral mass.
The evidence does not support a thermoregulatory role for the meningeal vascular network, at least in adult normal blood flow conditions. On the other hand, biomechanical protective functions (hydraulic skeleton for shock adsorption) cannot be ruled out.
The vertebral artery (VA), whose embryogenesis differs from that of any other vessel, is characterized by a great variety of malformations and anomalies. Some of the malformations are truly pathological (that is symptomatic); the anomalies are either found by chance postmorten or by angiography. All of these should be kept in mind by the surgeon approaching the deep cervical and craniospinal regions as well as by the interventional radiologist. In the context of a literature review we discuss the width and length anomalies of the VA, tortuosity and kinking, course anomalies, duplication and fenestration, persistence of primitive arteries, and anomalies of collateral branches. Other pathologies of the cervical VA associated exclusively with genetic diseases, such as spontaneous aneurysms and arteriovenous fistulae in neurofibromatosis type 1 are also considered.
Intracranial aspergillosis is a rare pathologic condition, difficult to treat and often fatal, which generally affects irnmunodepressed patients. A case of brain abscess secondary to pulmonary localization in a patient with a non-Hodgkin lymphoma is described. The most significant clinico-pathological findings of intracranial aspergillosis are examined in the light of the relevant literature.
Intraoperative positioning still constitutes a basic problem in the microsurgical removal of intracerebral lesions, either deep-seated or without cortical appearance. We treated different types of lesions (cavernous angiomas, intraventricular tumors, gliomas, and metastases), by combining stereotactic targeting with the standard microsurgical technique. The dedicated software for the three-dimensional reconstruction of stereotactic CT images allowed us to determine the least traumatic surgical trajectory and the exact location of the lesion intraoperatively, with minimum manipulation of healthy cerebral tissue. We believe that the main indication for this technique is the removal of small, encapsulated or well-defined lesions without cortical appearance or in critical areas, while a direct inspection of the area is still essential in order to evaluate surgical removal in the case of infiltrating tumors.
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