Fig. 1 T 2 -weighted magnetic resonance images revealing an intradural well-circumscribed mass displacing the cervical spinal cord dorsally and laterally at the C4 segment. Abstract A 14-year-old girl presented with a rare case of spontaneous bilateral supratentorial epidural hematomas which developed rapidly following cervical surgery. The hematomas presumably resulted from dural dynamics changes secondary to cerebrospinal fluid loss and intracranial hypotension. Intracranial epidural hemorrhage after spinal surgery is extremely uncommon with only one previous case report. Spontaneous intracranial epidural hematoma is an extremely rare complication, but should be considered as a possible complication of spine surgery, especially in adolescents complicated by delayed consciousness and breathing restoration from anesthesia. This case report expands the presently known clinical spectrum of this uncommon complication.
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CASE REPORT
Almost all intracranial dermoid cysts typically display low-density lesions on plain computerized tomography (CT) scans due to abundant lipids content. CT hyperattenuating dermoid cyst (CHADC) is very uncommon with only nine case reports in the literature update, which occurs exclusively in the posterior fossa. Moreover, CHADC with mural nodule is exceptionally rare, and only one such case was documented previously. Here, we report a new case of cerebellar CHADC with mural nodule in a 14-year-old male patient who presented with a 4-week history of dull headache and 5-day history of gait disturbance. With an average attenuation value of 89.9 Hounsfield units on CT scans, the lesion mainly displayed T1 hyperintensity, T2 hypointensity, and FLAIR hypointensity on magnetic resonance imaging. The patient underwent lesion gross total resection and symptomatic improvement, and final pathology was consistent with dermoid cyst. For further clarifying the mechanism of unusual CT hyperdensity, we sampled the cystic content and quantified its protein, calcium, and cholesterol, and our result suggested the high protein, high calcium, and low lipids in contents was the main mechanism of increased CT attenuation for CHADC.
To investigate the diagnosis and microsurgical treatment of cavernous sinus hemangioma, the clinical data, including pathology, epidemiology, medical imaging, operation procedure, and post-operational complication of 12 cavernous sinus hemangioma patients undergoing operations in Affiliated Hospital of Medical College of Qingdao University from 1999 to 2008, were analyzed. There were 2 males and 10 females. The patients were aged from 28 to 61 years. Headaches and deficits of the cranial nerves coursing through the cavernous sinus were the principal symptoms at presentation. The common clinical manifestations were visual loss, diplopia, facial numbness, and extraocular muscle palsy. The radiological features in all patients were similar with a characteristic pattern of extension and encasement of carotid artery. CT showed the lesion as hypodense to isodense with marked enhancement after contrast administration. T1-weighted MR imaging showed the lesions as hypointense with marked enhancement after contrast administration. T2-weighted MR imaging showed the lesions as hyperintense. The maximum size of the lesion was 9 to 57 mm (mean 45 mm). Basal pterional craniotomies were used for eight patients. Orbitozygomatic osteotomies were used for two patients. Pterional approach was used for two patients. The lesions were removed through incising the lateral wall of the cavernous sinus. The tumor was totally removed in five cases, subtotally removed in four cases, and partially removed in two cases. The main post-operational complications included oculomotor nerve paralysis (four cases) and trigeminal nerve lesions (three cases). No postoperative death occurred. Operation is the best choice for cavernous sinous hemangioma. It was helpful to control bleeding through intradura and incising the lateral wall of the cavernous sinus.
Clipping bilateral middle cerebral artery (bMCA) aneurysms via unilateral approach in a single-stage operation is considered as a challenge procedure. To our knowledge, there is no study in surgical management of patients with bMCA aneurysms by fully endoscope-controlled techniques. The author reported a patient with bMCA aneurysms who underwent aneurysms clipping via a unilateral supraorbital keyhole approach by endoscope-controlled microneurosurgery, and the patient had an uneventful postoperative course without neurologic impairment and complication. Furthermore, the author discussed the advantages and adaptation of endoscope-controlled clipping bMCA aneurysms via unilateral supraorbital keyhole approach.
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