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Subdural contrast effusion secondary to endovascular treatment is exceptionally rare and might be mistaken as subdural hematoma because of similar hyperattenuation on computer tomography. The authors present the case of a 13-month-old girl with a history of increased head circumference and developmental retardation. Cerebral digital subtraction angiography showed a high-flow pial arteriovenous fistula fed by multiple arteries on the right cerebellar surface, with occlusion of the right sigmoid sinus and severe stenosis of the left sigmoid sinus. Staged endovascular treatments were performed to eliminate the fistula. Follow-up head computer tomography scans performed 3 h after both procedures demonstrated typical high-density subdural effusion with computer tomography attenuation value similar to hemorrhage. These effusions did not aggravate the condition and disappeared spontaneously 32 h after the first treatment and 29 h after the second, respectively. [ABSTRACT FROM AUTHOR]

Objective To investigate and summarize the microsurgical technique for hypervascular neoplasms in the jugular foramen area after preoperative embolization therapy, so as to improve the surgical effect. Methods A total of 17 patients with hypervascular neoplasms in the jugular foramen area after preoperative embolization therapy undergone microsurgical operations from June 2016 to June 2019 were analyzed. The suboccipital retrosigmoid aproach (n = 4), infratemporal fossa approach (n = 3), transmastoid infralabyrinthine approach (n = 3), subtemporal transpetrosal approach (n = 3), combined subtemporal and retrosigmoid approach (n = 2), and far lateral approach (n = 2) were performed according to Samii classification. Results The total resection was achieved in 10 patients, subtotal resection in 4 patients and partial resection in 3 patients. Intraoperative blood loss ranged from 100 ml to 2300 ml, with an average blood loss of 1042 ml. Postoperative clinical symptoms improved in 9 cases. The new-developed and/or worsen lower cranial nerves dysfunction were observed in 5 cases. The new-developed and/or worsen facial paralysis were seen in 6 cases, hearing loss emerged in one case and incision exudation in 2 cases. No intracranial hematoma and death cases were found. Seventeen patients were followed up from 6 months to 3.50 years varied persisted hoarseness or dysphagia were seen in 5 cases. Three cases of recurrence and no death case were observed. Conclusions Intraoperative bleeding can be effectively controlled after preoperative embolization therapy of hypervascular neoplasms in the jugular foramen area. According to the classification of tumors, the surgical approaches are selected individually under the multi-disciplinary cooperation. To remove the tumor safely to great extent can achieve a better therapeutic effect. [ABSTRACT FROM AUTHOR]