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This report presents a patient with a cerebellar hemangioblastoma associated with obstructive hydrocephalus and a saccular superior cerebellar artery (SCA) aneurysm who was successfully treated using a three-stage approach that included ventriculoperitoneal shunting, preoperative endovascular embolization of the tumor vasculature and aneurysm with a low viscosity non-adhesive liquid embolic agent, and total microsurgical tumor removal. Removal of these tumors is associated with a high risk of profuse intraoperative blood loss, cerebral edema, and other equally dangerous complications. Our case was complicated by a tumor feeder aneurysm, which increased the risk of spontaneous subarachnoid hemorrhage and intraoperative aneurysm rupture. A three-stage approach allowed radical and safe removal and resulted in improved neurological symptoms.

Summary: Successful step-by-step treatment of a combined gunshot shrapnel injury of the brain, damaging the left middle cerebral artery (MCA) branches, and penetrating myocardium injury is discussed. Open brain and heart surgeries were performed. A left MCA pseudoaneurysm was formed postoperatively. Endovascular exclusion of the left MCA pseudoaneurysm was performed using detachable micro coils. Finally, plastic reconstruction of the posttraumatic cranial vault defect was performed using a dynamic titanium plate.Treatment of severe combined gunshot shrapnel brain injury with formation of MCA pseudoaneurysm and a penetrating myocardium injury requires a multimodal approach involving related specialists (neurosurgeon, cardiosurgeon and interventional radiologist). Keywords: Gunshot wound, Craniocerebral shrapnel injury, Shrapnel injury of the heart, False aneurysm, Dissectional aneurysm, Middle cerebral artery

Here we report the case of a 56-year-old woman who presented with a highly unusual combination of three pathologies, namely a giant left-sided vestibular schwannoma, severe stenosis of the left internal carotid artery, and a right anterior cerebral artery aneurysm. The chosen approach comprised three consecutive surgical procedures, namely (1) aneurysm embolization, (2) carotid stenosis stenting, and (3) vestibular schwannoma excision. This approach avoided complications and achieved a satisfactory functional outcome. To the best of our knowledge, this combination of three conditions has not been previously reported in the English-language literature.

Objective. Determination of the optimal strategy of surgical treatment of patients with a combination of cerebral aneurysms and head magistral arteries stenosis.Methods. 26 patients with combination of cerebral aneurysms and head magistral arteries stenosis, whose age was between 44 and 84 years, have been examined and treated in the Cerebrovascular Clinic of the Dnipropetrovsk Regional Hospital for the last 4 years. 21 of them were operated, 5 – abstained. 24 endovascular and 8 open operations were performed in different combinations.Results. All cases were divided into 3 groups according to the application different tactics of surgical treatment. Group 1 - 10 patients were operated in order to exclude cerebral aneurysm and revascularize head magistral arteries. Group 2 - 5 patients were operated to remove only the head magistral arteries stenosis. Group 3 - 6 patients were operated to exclude cerebral aneurysm alone. Functional outcomes evaluated by the modified Rankin scale and were the best in group 1.Conclusion. Surgical risks in case of treatment only one of pathology in case of combination of head magistral arteries stenosis and cerebral aneurysms may cause clinical manifestation of the other one. One-session surgical treatment of cerebral aneurysms and head magistral arteries stenosis based on data about the peculiarities of collateral bloodcirculation, cerebrovascular reserves, degree hemoperfusion deficit in different arterial basins is the best strategy of surgical treatment.

Introduction. The problem of surgical treatment of brain aneurysms is unsolved, and results of treatment don’t satisfy neurosurgical community. The indications and terms of surgery performing are most discussed.Purpose. To determine main causes of unfavorable outcomes of surgical treatment of patients with brain aneurysms rupture on the base of analysis of our own clinical experience.Materials and methods. The results of treatment of 1099 patients with ruptured brain aneurysms were analyzed. 99 patients died without surgery. Microsurgical approach was used in 706 patients, endovascular — in 294.Results. The cause of death of 50% patients who died without surgery was brain aneurysms re-rupture. Postoperative lethality was 9.0% after microsurgical technique use, and 9.2% — after endovascular one. Lethality when using both methods differed significantly depending on terms after brain aneurysm rupture.Conclusion. In the acute period of brain aneurysm rupture (1–3 days) the surgery has to be performed just in patients without clinical signs of angiospasm. Lethality after endovascular surgery in this period is 2.5 times lower than after microsurgical operations.