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Intracranial pial arteriovenous fistulas (AVFs) are rare vascular lesions, of which fewer than 90 cases have been reported in the literature. They are composed of one or more arterial feeding vessels and a single draining vein that usually result in a huge varix. Because of the high-flow shunting, a poor prognosis is associated with conservative treatment. Surgical or endovascular treatment also poses various challenges. The authors present the cases of three patients in whom N-butyl-2-cyanoacrylate-assisted embolization was performed. Outcome in all three cases was good. The necessity of staged procedures to obliterate the AVF is also discussed.

Prediction of recurrence remains a challenge in histopathological benign/grade I tumors. Osteopontin (OPN) plays important roles in tumorigenesis, invasion, and metastasis of several human cancers. In this study, we investigated OPN protein expression by evaluating the differences between recurrent and non-recurrent histologically benign meningiomas. Thirty-two patients were enrolled, and 23 benign non-recurrent meningiomas and 9 benign recurrent meningiomas were followed for a mean of 34 months after complete surgical resection (Simpson grades I and II). Cytoplasmic OPN staining was evaluated by means of immunohistochemistry (IHC) score and by use of the Allred-8-unit system. We examined clinical biological data, their relationship with tumor recurrence, and the expression of OPN. Our results showed that meningioma recurrence correlated significantly with OPN IHC score (P = 0.001). An OPN Allred score between 0 and 3 was associated with a recurrence-free time of more than 25 months. In comparison, an OPN Allred score from 4 to 8 was indicative of a shorter average recurrence-free time. We concluded that OPN IHC score may play a role in prediction of the recurrence of the grade I meningiomas. Moreover, determination of the OPN Allred score is a reliable, quantitative tool for predicting recurrence-free time in benign meningioma patients.

Traumatic vertebral artery (VA) injury has been neglected and mistaken to be innocuous. Herein, we present a rare case with a as subarachnoid hemorrhage (SAH) following blunt suboccipital trauma. Initially, it was mistaken as a saccular aneurysm and was just coincident with traumatic SAH. Surgical clipping was performed by our senior neurosurgeon and looked secure. But massive bleeding occurred before complete closure of the dura wound. Opening the wound again, blood gushed out from the junction of the aneurysm and the parent artery. Because preoperative angiography evaluation had revealed good collateral flow from the contralateral VA, the involved segment of VA was trapped. The patient recovered well with uneventful course. Blunt suboccipital trauma may result in traumatic VA injury which may cause catastrophic complications if neglected. The incidence, risk factors, the pathophysiology of traumatic VA aneurysm, and the treatments are reviewed.

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