Unruptured untreated intracranial aneurysms: a retrospective analysis of outcomes of 445 aneurysms managed conservatively.

Background: Factors predicting the growth or rupture of unruptured intracranial aneurysms (UIAs) remain under debate. Increased availability of neuro-imaging has led to increasing incidental findings, therefore understanding the natural history is vital to make appropriate management and follow-up decisions. We analysed a large dataset of UIAs to better identify patients at increased risk, therefore requiring enhanced monitoring and/or prophylactic intervention.

Spontaneous obliteration of brain arteriovenous malformations: illustrative cases.

Background: Spontaneous angiographic obliteration of a brain arteriovenous malformation (AVM) is considered a rare outcome, with most cases in the literature related to prior hemorrhage in small brain AVMs. The authors present a prospective, single center, consecutive case series. The clinical course and radiographic features of four cases with spontaneous obliteration of brain AVM were analyzed.

First reported case of hydrocephalus in jointly diagnosed bacterial meningitis and a colloid cyst: how Ockham's razor became Hickam's dictum.

We report the first case in the literature of acute hydrocephalus due to a simultaneous diagnosis of bacterial (not asceptic) meningitis and a colloid cyst. Diagnosing disease is the cornerstone skill of a medical practitioner. Both education and experience allow for sharpening of this skill throughout years of medical practice.

Spinal paraganglioma presenting with raised intracranial pressure: a note on the diagnosis and post-operative management.

Background: Spinal paragangliomas are tumors of neuroendocrine origin that present with symptoms of mass effect or neurosecretion but rarely involve the central nervous system. Raised intracranial pressure and papilledema are therefore unusual presentations of a spinal paraganglioma.

Methods: We review the case of a 54-year-old man who presented with headache and visual disturbance.

Fifteen-Year Institutional Retrospective Case Series of Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction.

Objective: In the present study, we updated our previously reported case series of patients who had undergone decompressive craniectomy for malignant middle cerebral artery infarction (mMCAI) (2005-2020). To the best of our knowledge, the present case series constitutes the largest reported series from a UK neurosurgical unit of decompressive craniectomy for mMCAI.

Methods: We extracted data regarding the clinical discriminators, surgical timescales, and functional outcomes of patients.

External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk.

Background And Purpose: Prediction of intracranial aneurysm growth risk can assist physicians in planning of follow-up imaging of conservatively managed unruptured intracranial aneurysms. We therefore aimed to externally validate the ELAPSS (Earlier subarachnoid hemorrhage, aneurysm Location, Age, Population, aneurysm Size and Shape) score for prediction of the risk of unruptured intracranial aneurysm growth.

Methods: From 11 international cohorts of patients ≥18 years with ≥1 unruptured intracranial aneurysm and ≥6 months of radiological follow-up, we collected data on the predictors of the ELAPSS score, and calculated 3- and 5-year absolute growth risks according to the score.

Trans-Cranial Embolisation of a Complex Transverse Sigmoid Sinus Dural Arteriovenous Fistula by Direct Puncture of the Superior Sagittal Sinus.

This technical note describes a direct puncture of the superior sagittal sinus (SSS) to treat a complex dural arteriovenous fistula (dAVF). A 40-year-old female was admitted having a history of increasing confusion. Computer tomography revealed enlargement of the right superior ophthalmic vein and magnetic resonance imaging demonstrated extensive bilateral hemispheric venous engorgement.

Comparative surgical outcome associated with the management of brain arteriovenous malformation in a regional neurosurgical centre.

Objectives: Microsurgical resection of brain arteriovenous malformation (AVMs) is challenging, however, expert surgical series from large volume centres, have reported over 95% occlusion rates with 2 to 8% risk of morbidity & mortality. Data from a regional neurosurgical unit was analysed and compared with published series for the purposes of quality control. We also compared our surgical result with other treatment modalities from the whole AVM cohort managed over the same study period.

10-Year Institutional Retrospective Case Series of Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction (mMCAI).

Background: A 10-year (2005-2015) retrospective case series of patients undergoing decompressive craniectomy for malignant middle cerebral artery infarction (mMCAI) was undertaken.

Methods: Patient demographics, comorbidities, pre- and postoperative neurologic state, operative timescales, craniectomy dimensions, and Glasgow Outcome Scale scores were analyzed.

Results: Overall 40 patients underwent a decompressive craniectomy for mMCAI with a 30-day mortality of 17.

Radiologic Surveillance of Untreated Unruptured Intracranial Aneurysms: A Single Surgeon's Experience.

Background: The management of untreated unruptured intracranial aneurysms remains controversial. The natural history is still not well understood and many patients are not routinely followed up. We present a single surgeon's data on radiologic surveillance of these lesions.

Defending a traditional practice in the modern era: The use of lumbar puncture in the investigation of subarachnoid haemorrhage.

Introduction: Acute severe headache is a common medical presentation, and a common area of diagnostic uncertainty. Subarachnoid haemorrhage (SAH) is the cause in a minority of patients and has a high rate of morbidity and mortality. Therefore, its conclusive diagnosis with computed tomography (CT) or lumbar puncture (LP) is paramount.

Atypical adult medulloblastoma.

Medulloblastomas are malignant primitive neuro-ectodermal neoplasms of childhood. In adults, clinical manifestations, imaging and prognosis can be different from that observed in children. Three adult patients with confirmed diagnoses of medulloblastoma are discussed in this report.

Carotico-cavernous fistula secondary to Varicella zoster?

We describe the case of a previously well, 73-year-old male patient who presented with a spontaneous high flow, carotico-cavernous fistula, 1 month following an attack of herpes zoster. We postulate that the zoster virus was the underlying cause, given the history and time frame between the preceding shingles and the subsequent development of the fistula. The literature supporting this hypothesis is reviewed.

Case report of transient acquired Foix-Chavany-Marie syndrome following sequential trauma.

Foix-Chavany-Marie Syndrome (FCMS) or bilateral opercular syndrome is characterised by faciopharyngoglossomasticatory diplegia with automatic voluntary dissociation and is a rare form of pseudobulbar palsy most commonly associated with occlusive cerebrovascular disease. We present a transient manifestation of the syndrome, in a patient who suffered two sequential traumatic brain injuries.

Familial Dandy-Walker syndrome: a case report supporting an autosomal inheritance.

Introduction: We report an isolated pedigree in which a consanguineous couple had twin sons with Dandy-Walker malformation (DWM). The mother is similarly affected with the disorder.

Discussion: DWM is an abnormality of the central nervous system, which leads to hydrocephalus and is associated with other abnormalities.

Stereotactic radiosurgery XVI: Isodosimetric comparison of photon stereotactic radiosurgery techniques (gamma knife vs. micromultileaf collimator linear accelerator) for acoustic neuroma--and potential clinical importance.

Purpose: Two stereotactic photon radiation therapy methods are currently in practice for the treatment of acoustic neuroma. In the 1990s, our data and those of others demonstrated isodosimetric advantages for gamma knife technology over linear accelerator methodology. Since then, the introduction of micromultileaf collimator technology has improved the conformity of the linear accelerator method such that the isodosimetric differences between the two techniques have narrowed.