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Background: The resection of tuberculum sellae meningiomas poses a challenge particularly when dealing with the medial aspect of the optic nerve. Dissection of the tumor off the optic nerve is usually carried out in the blind spot "behind" the optic nerve. We describe a contralateral approach for asymmetric tuberculum sellae meningiomas, allowing direct visualization of the medial optic nerve. Method: Contralateral lateral supraorbital approach was performed, and complete tumor resection was achieved without any injury to the optic nerve. Conclusion: The contralateral approach for asymmetric tuberculum sellae meningioma is an efficient technique allowing improved visualization of the medial optic nerve. [ABSTRACT FROM AUTHOR]

We describe a patient with a symptomatic left giant carotido-ophthalmic aneurysm who initially underwent coil embolization with subtotal obliteration. The patient’s symptoms were initially stable, but 1 year later, she presented with a rapidly progressive contralateral visual deficit. Although angiogram showed a stable neck remnant, MR confirmed aneurysm growth and showed a new peripheral hematoma in the wall of the thrombosed aneurysm. Surgical exploration was undertaken, and even after trapping and intra-aneurysmal thrombectomy, constant bleeding was observed from the wall of the thrombosed aneurysm consistent with the vasa vasorum. Bleeding stopped after cauterization and partial resection of the aneurysm dome, and the aneurysm was clipped. The patient’s recent visual deficit markedly improved, and the angiogram did not reveal any residue. Giant aneurysms may continue to grow due to a hypertrophic vasa vasorum and subadventitial hemorrhages. Surgery should be considered if complete thrombosis of the aneurysm does not alleviate patient’s symptoms. [ABSTRACT FROM AUTHOR]

Endovascular embolization is being increasingly used to treat cerebral arteriovenous malformations. Common complications associated with embolization include intracranial hemorrhage and ischemic stroke; intracranial infections seldomly occur and are even less frequently reported. Although abscess formation after embolization is exceedingly rare, it is a serious condition that warrants immediate attention. This 53-year-old male with a ruptured left temporal-occipital arteriovenous malformation. He underwent uncomplicated 2-stage embolization with Onyx and was discharged. Five weeks after embolization, he returned to the hospital with worsening aphasia and contralateral hemiparesis, and a cerebral abscess was detected at the site of embolization. Bacterial cultures were positive for Escherichia coli , and he was treated successfully with surgical excision of the abscess and Onyx material, followed by long-term antibiotics. Although rare, formation of an intracranial abscess after endovascular embolization is a potential complication in the treatment of arteriovenous malformations. [ABSTRACT FROM AUTHOR]

Background The endoscopic endonasal approach for pituitary neoplasms has shown similar efficacy compared with the microscopic approach. However, outcomes and complication rates with larger macroadenomas is not as well documented. This study addresses the efficacy and outcome of the fully endoscopic endonasal approach for large and giant pituitary adenomas. Methods Endoscopic endonasal resection was performed in 39 patients with large (>3 cm) or giant (>4 cm) pituitary macroadenomas. Outcomes were assessed using formal visual examinations, endocrine status, and neurologic examinations. Statistical analyses of multiple variables were addressed for correlation to visual, endocrine, and neurologic outcomes. Results Gross total resection of the pituitary macroadenoma was achieved in 22 of 39 (56.4%) patients based on postoperative magnetic resonance imaging. Higher Knosp grade was associated with near-total resection or subtotal resection ( P = 0.0004). All patients had improved or stable visual symptoms. Time to diagnosis, preoperative visual deficit, and tumor size were not significant predictors of visual outcome. Of patients, 34 (87.1%) had a “good” endocrine outcome, whereas 5 did not. Among the 5 patients who did not have a good outcome, 1 had new hypopituitarism, and 4 required increased dosages of pharmacologic therapy. All patients with recurrent tumors had stable visual and good endocrine outcomes. Postoperative cerebrospinal fluid leak occurred in 4 patients; lumbar drainage resolved the leak in 3, and reoperation was performed in 1 patient. There were no new cranial nerve deficits, new neurologic deficits, or mortality. Conclusions Endoscopic endonasal resection of large and giant pituitary macroadenomas is safe and efficient. Postoperative complications, including cerebrospinal fluid leak, are low. Surgical efficacy of the fully endoscopic endonasal approach for large and giant macroadenomas makes the technique a preferable option in this subset of patients. [ABSTRACT FROM AUTHOR]

A 79-year-old woman presented to the emergency department following multiple falls in the previous week. Her past medical history was unremarkable except for chronic obstructive pulmonary disease. She was neurologically intact on arrival with normal laboratory data. Brain imaging revealed a right-sided sphenoid wing meningioma with considerable edema around it. Owing to her cognitive decline and recent symptoms, it was decided to proceed with surgical resection of the lesion. Considering her age and underlying disease, we planned to avoid probable complications of an aggressive resection. She underwent preoperative transarterial embolization with particles. In the supine position, a right pterional craniotomy with orbital extension was performed followed by tumor resection under microscopic magnification. One of the branches of the middle cerebral artery was engulfed by the tumor and could not be separated; therefore, the artery was cut to resect the tumor and then mobilized and reanastomosed under microscope. Doppler probe confirmed patency of the anastomosis. The patient recovered well from the surgery, experienced an uneventful hospital stay, and was discharged on postoperative day 10 after completely controlling her chronic obstructive pulmonary disease. Postoperative imaging did not show any signs of infarction, and the revascularized artery was patent on postoperative computed tomography angiography (Video 1). [ABSTRACT FROM AUTHOR]