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Teratoma is defined as a neoplasm that is composed of a variety of parenchymal cell types derived from three germinal layers (endoderm, mesoderm and ectoderm). Teratomas of the spinal cord constitute 0.1-0.5% of all spinal tumors, and these lesions are extremely rare in adults. Intramedular spinal teratoma is the most common type of spinal teratomas. The main spinal teratoma symptoms are pain, weakness and numbness of the legs, sphincter and/or gait dysfunction; intramedullary teratomas present early with increased reflexes and loss of vesical and rectal control. Histopathologic examination is the gold standard for definite diagnosis. Teratomas are diagnosed when remnants of all three germ layers are present. MRI is the gold standard diagnostic technique for spinal teratoma. The tumor presents as inhomogeneus intensities in both T1- and T2-weighted images due to teratoma’s tissue heterogeneity. Surgical resection is the first line treatment for spinal teratoma, usually decompressive laminectomy is performed. The goal of surgery should always be the most radical removal possible with relieve of the nerve compression with the aim of preventing progressive deterioration. The authors describe the first case of intradural intramedullary teratoma in Lithuania, which did not present with typical spinal teratoma symptoms and signs, its successful diagnosis and treatment; literature review of adult-onset spinal teratomas is also presented.

Background This case presents unexpected association between diseases and symptoms. We believe that it should compel clinicians to rethink the known behaviors of the benign tumors, in particular meningioma which can gain independent metastatic potential. This report aims to increase the awareness of clinicians toward patients with this unusual and clinically isolated pattern, because metastases can remain misdiagnosed for a long period of time. This case contributes to medical knowledge, diagnostic and prognostic approaches. This is also the first case of metastatic meningioma reported in Lithuania. Case presentation We report a 66-year-old woman who presented with persistant productive cough, dyspnea, fever and weakness during physical activity. Chest radiographs revealed multiple small round shaped pulmonary nodules. Thoracoscopic resection and histopathology showed a benign meningioma. Magnetic resonance imaging scan of the brain demonstrated a small dural based mass in the left pontocerebellar angle connected with deep dilated cerebral venous network and superior petrosal sinus. Morphological findings of the session were consistent with a World Health Organization grade I fibrous meningioma.Conclusion Meningiomas are usually non-invasive tumors and do not metastasize and hence, are perceived as benign tumors. Patients with this uncommon and clinically isolated pattern of metastases can remain misdiagnosed for a long period of time, due to unexpected behavior of this particular tumor. This case report denies most of the criteria of possible risk factors for the development of metastases from a meningioma what allows to consider it as tumor with unpredictable behavior.

Inroduction. This case presents unexpected association between disease and symptoms. We believe that it should compel clinicians to rethink the known behaviors of the benign tumors, in particular meningioma which can gain independent metastatic poten­tial. This report aims to increase the awareness of clinicians toward patients with this unusual and clinically isolated pattern, because metastases can remain misdiagnosed for a long period of time. This case contributes to medical knowledge, diag­nostic and prognostic approaches. This is also the first case of metastatic meningioma reported in Lithuania. Case report. We report a 66-year-old woman who presented with persistent productive cough, dyspnea, fever and weakness during physical activity. Chest radiographs revealed multiple small round shaped pulmonary nodules. Thoracoscopic resection and histopathology showed a benign meningioma. Magnetic resonance imaging (MRI) scan of the brain demonstrated a small dural-based mass in the left pontocerebellar angle connected with deep dilated cerebral venous network and superior pe­trosal sinus. Morphological findings of this tumor were consistent with a World Health Organization (WHO) grade I fibrous meningioma. Conclusion. Meningiomas are usually non-invasive tumors and do not metastasize and hence, are perceived as benign tumors. Patients with this uncommon and clinically isolated pattern of metastases can remain misdiagnosed for a long period of time, due to unexpected behavior of this particular tumor. This case report denies most of the criteria of possible risk factors for the devel­opment of metastases from a meningioma what allows to consider it as tumor with unpredictable behavior.

Tikslas. Sukurti ir aprašyti kraujagyslių su intrakranijine aneurizma in vitro modelį, kuris atitinka žmogaus galvos smegenų arterijų anatomiją ir gali būti taikomas radiologiniams tyrimams. Tyrimo medžiaga ir metodai. Modelių gamybai naudotas vaškas („K2 exact“, „S-U-CERAMO-CAPS-WAX“), Girtlio masė, želatina bei silikonas („Silicone 10015 Den Braven“, „Elastosil 7683/25“, „Elite Double 32 Shore-A“, „Rema-Sil“). Taikytos dvi modelių gamybos technologijos: plastikinių vamzdelių sujungimo būdas bei atliejimo (angl. lost core) technika. Smegenų arterinio žiedo bei aneurizmos eskizams naudoti rotacinės trimatės angiografijos vaizdai su vidinės miego arterijos smegeninės dalies išsišakojimo į priekinę ir vidurinę smegenų arterijas aneurizma, stikliniai aneurizmos modeliai bei anatominiai žmogaus galvos smegenų arterijų preparatai. Rezultatai. Pirmą kartą Lietuvoje sukurti ir aprašyti aštuoni dirbtiniai žmogaus galvos smegenų arterijų su aneurizmomis modeliai. M1 modelis sukurtas pagal smegenų arterinio žiedo anatomiją su pamatinės arterijos aneurizma, M2 – pagal rotacinės angiografijos vaizdus su vidinės miego arterijos smegeninės dalies išsišakojimo į priekinę ir vidurinę smegenų arterijas aneurizma, BM1, BM2 – pagal stiklinius šoninės aneurizmos maketus. M3 pagamintas iš plastikinių vamzdelių, aneurizma sukurta sudarius T formos jungtį. M4, M5 bei M6 suformuoti iš anatominių žmogaus galvos smegenų arterijų preparatų atliejų, su nulipdytomis pamatinės arterijos aneurizmomis. Išvados. Dviejų komponentų silikonas yra tinkamas anatominių arterijų preparatų atliejų gamybai. Tinkamas silikono kietumo koeficientas yra 32. Želatinos tirpalas 50°C temperatūros santykiu 1:1 su vandeniu gali būti naudojamas kraujagyslių kopijų gamybai. Vaškas ir jo pagrindo masės lengvai formuojamos gaminant kraujagyslių modelius rankomis, tačiau netinka anatominių arterijų preparatų užpildymui., in English. Objective. To delineate technical aspects of vascular models with intracranial aneurysm in vitro production, suitable for angiographic imaging. Material and methods. Wax (K2 exact, S-U-CERAMO-CAPS-WAX), Girtl’s mass, gelatin, and silicone (Silicone 10015 Den Braven, Elastosil 7683/25, Elite Double 32 Shore-A, Rema-Sil) were used for model production. Construction of models was based on T-shaped plastic tube connections and lost core techniques. Images of rotational angiography, glass tubes with aneurysm, and casts obtained in human specimen were used as samples of cerebral arteries. Results. Technical aspects of vascular models production were delineated in experience of eight silicone models produced. M1 was hand made with basilar tip aneurysm; M2 was obtained according to angiography images with internal carotid artery supraclinoid part bifurcation to anterior and middle cerebral artery aneurysm. BM1 and BM2 casts were made using glass tubes with lateral aneurysm, M3 – from T-shaped plastic tubes with lateral aneurysms. M4, M5, and M6 were formed using casts obtained in human specimen with basilar tip aneurysm. Conclusions. Silicone of two components is practical for casts of cerebral arteries in human specimen production. Gelatinous solution 50°C diluted 1:1 with water can be used for copies of arterial casts production. Wax materials are unsuitable for making casts in a human specimen.

Background / objective The present prospective study was undertaken to assess the reliability of the aspect ratio (i.e. aneurysm deph to aneurysm neck width) for predicting aneurysm rupture. Unruptured aneurysm, ruptured aneurysm and rebleeded aneurysm patient groups are compared. Aneurysm size, site, patient age and gender also are taken into account. Patients and methods Intraoperative measurements were made of consecutive patients with 265 aneurysms in three patient groups admitted between 2000 and 2006 to Department of Neurosurgery, Vilnius University Emergency Hospital. 23 unruptured aneurysms, 206 ruptured and 36 which rebled where included into the study. Giant and fusiform aneurysms were excuded from the study. Results Aspect ratio was 1.83 ± 0.2 (p < 0.01) for unruptured aneurysms, 2.36 ± 0.05 (p < 0.01) for ruptured and 3.1 ± 0.08 (p < 0.01) which rebled. Aneurysm size has not to be found significant factor for aneurysm rupture in our study. Aneurysm neck was wider on high flow arteries (i.g., MCA and ICA) to compare with low flow arteries (i.g., ACom and PCom) respectively 3.45 ± 0.17 mm and 3.01 ± 0.07 mm (p < 0.05). Conclusion The aspect ratio was found to be a statistically significant important index to calculate for predicting aneurysm rupture.