Search

Ganglioneuromas, which arise from neural crest cells, are typically seen in adolescent and young adults. We describe an unusual case of posterior mediastinal ganglioneuroma with a large fatty component in a middle-aged male. This imaging feature has only been reported in five published manuscripts in the English literature.

Introduction. The best treatment for unruptured middle cerebral artery (MCA) aneurysms is unclear. We perform a meta-analysis of recent publications to evaluate the results of unruptured MCA aneurysms treated with surgical clipping and endovascular coiling.Methods. A PubMed search for articles published between January 2004 and November 2013 was performed. The R statistical software package was used to create a random effects model for each desired incidence rate. Cochran’sQtest was used to evaluate possible heterogeneity among the rates observed in each study.Results. A total of 1891 unruptured MCA aneurysms, 1052 clipped and 839 coiled, were included for analysis. The complete occlusion rate at 6–9 months mean follow-up was 95.5% in the clipped group and 67.8% in the coiled group (P<0.05). The periprocedural thromboembolism rate in the clipping group was 1.8% compared with 10.7% in the aneurysms treated by coiling (P<0.05). The recanalization rate was 0% for clipping and 14.3% for coiling (P=0.05). Modified Rankin scores of 0–2 were obtained in 98.9% of clipped patients compared to 95.5% of coiled (NS).Conclusions. This review weakly supports clipping as the preferred treatment of unruptured MCA aneurysms. Clinical outcomes did not differ significantly between the two groups.

Background Although angiography does not generally lead to increased clinically significant neurologic deficits, it has been reported that angiography for spinal dural arteriovenous fistulas (SDAVFs) can lead to acute neurologic decline. This has been rarely reported, and outcome after decline and the subsequent intervention performed have not been clarified. We describe a patient with SDAVF who experienced acute neurologic decline shortly after spinal angiography. Acute surgical treatment resulted in improvement of symptoms. Case Description A 70-year-old woman presented following 5 months of progressive numbness and weakness in her lower extremities. Spinal magnetic resonance imaging revealed thoracic spinal cord edema. Spinal angiography revealed a type 1 SDAVF. Several hours after spinal angiography, the patient's lower extremity motor strength declined significantly. This neurologic change led to emergent surgical intervention and ligation of the SDAVF. The patient's neurologic decline subsequently improved and ultimately resolved completely. Conclusions Although acute worsening of neurologic deficits is a rare complication following angiography of SDAVFs, the reversibility of these deficits by emergent intervention argues for careful surveillance after angiography with protocols in place to rapidly intervene if needed. Warming and diluting the contrast agent should be considered to reduce contrast viscosity, a potential aggravating factor to the venous congestion of spinal fistulas.