Temporary vessel occlusion is an effective technique used by neurosurgeons to facilitate dissection and permanent clipping of cerebral aneurysms. However, there are certain questions regarding the overall safety and risk of this technique. In the 1980s, mild hypothermia at the core temperature of 33-35℃ was demonstrated to have a brain-protecting in a global cerebral ischemic model, and this technique is currently being applied clinically. We operated intracranial aneurysms using the temporary vessel occlusion technique in 15 out of 46 cases under mild hypothermia for intracranial aneurysms. We obtained the following results: 1. There were no adverse effects and complications intraoperatively; 2. Mild hypothermia prolonged neither the operating nor anesthetizing time; 3. There was no permanent neurological deficit after using temporary occlusion under mild hypothermia in all cases, including 6 cases in which the occlusion time exceeded 20 minutes. The present review discuss the effectiveness and validity of temporary vessel occlusion under mild hypothermia in the surgery of intracranial aneurysms.

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Interventional MRI, an advanced neuroimaging system, was used to perform stereotaxic needle biopsy of brain tissue(AIRIS, 0.3 Tesla, Hitachi)in 12 patients(9 males, 3 females)with intraparenchymal abnormal lesions. This system permits accurate and safe biopsy of brain tissue in real time. Patient ages ranged from 31 to 79 years(mean 61.5 years). We evaluated the abnormal lesion and dominant hemisphere of these patients preoperatively by using CT, MRI and cerebral angiography. Lesions were located in the left frontal lobe in 3 cases, the right frontal lobe in 1 case, the left temporal lobe in 1 case, the right temporal lobe in 1 case, the left parietal lobe in 2 cases, the right parietal lobe in 1 case, the left occipital lobe in 1 case, the bilateral basal ganglia in 1 case and the corpus callosum in 1 case. The sampling points were in the dominant hemisphere in 7 cases and in the non-dominant hemisphere in 5 cases. The diagnosis based on stereotaxic needle biopsy using this system were 4 gliomas, 1 brain abscess, 1 metastatic brain tumor, 1 granuloma, 2 cerebral infarctions, 2 malignant lymphomas and 1 normal brain tissue. Success rate of biopsy for our 12 cases using this system was 91.7%. Brain hemorrhage was a complication in 1 case but there was no case of meningitis or convulsion. This method is useful in patients with inoperable lesions, including deep lesion or lesions in the brainstem diencephalon or dominant hemisphere, in patients with serious complications, and in geriatric patients. In the future, this MRI system may be applied to minimally invasive therapies such as tumor ablation, cryosurgery, chemoablation, and ventrolateral thalamotomy for parkinsonism.

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We have treated 92 vascular territories in 48 patients with symptomatic vasospasm after subarachnoid hemorrhage(SAH)using intraarterial infusion of papaverine and transient or permanent neurological deficits due to the infusion of papaverine occurred in 10 patients. By means of analyzing these 10 neurological complications due to the infusion of papaverine, we discussed the problem on papaverine treatment. Since highly concentrated papaverine of more than 0.4%(weight/volume)had a higher risk of neurological deterioration, appropriate attention to the papaverine concentration may help decrease the incidence of side effects and the papaverine concentration of 0.4%(w/v)infused at the top of the internal carotid artery(ICA)may be a safe and adequate concentration. However, the infusion of 0.4%(w/v)papaverine is not always effective in any symptomatic cerebral vasospasm. In case the infusion of adequate papaverine concentration has few influences on cerebral vasospasm, we should take balloon angioplasty as well as the infusion of papaverine into consideration.

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A surgical case of cerebellopontine angle(CPA)lipoma with hemifacial spasm is reported. A 50-year-old woman with a 5-6 year record of left hemifacial spasm was admitted to our hospital. CT scan showed a homogeneous low density mass in the left CPA without bony destruction. T1-weighted and proton magnetic resonance image(1.5T)showed a hyperintense mass lesion in the left CPA. Fat suppression image demonstrated a negative intensity. A yellowish tumor encompassed the proximal portions of the seventh and eighth cranial nerves completely. Partial removal(about 10%)of the tumor was performed because of tight adhesion to the seventh nerve and brain stem. The root exit zone of the seventh nerve was released from the tumor partially. Pathological examination revealed a lipoma. The patient's symptoms disappeared and neurological examination showed no neurological deficit postoperatively. A summary of the reported cases of CPA lipoma with hemifacial spasm is provided.

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A 66-year-old female was admitted for evaluation of visual disturbance. Preoperative diagnosis showed an intrasellar arachnoid cyst. Surgery was performed using the transsphenoidal approach. Postoperative course was uneventful and the visual field defect was improved. Intrasellar arachnoid cysts are very rare. The origin and the mechanism of their formation are different from other intracranial arachnoid cysts. We were able to treat the intrasellar arachnoid cyst using the transsphenoidal approach without any complications such as CSF rhinorrhea, blindness, or diabetes insipidus. We believe that the transsphenoidal approach is less invasive for patients with intrasellar arachnoid cysts, especially for elderly patients.

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We reported a multi-infarct patient with a sudden onset of right hemiparesis and dysarthria, who was determined an acute ischemic lesion among multiple infarcts using echo planar diffusion-weighted magnetic resonance images(DWI). Two days after the onset, T2-weighted fast spin echo images showed only multiple lesions shown as same high signal lesions in the territory of left middle cerebral artery, not showing any lesion which was responsible for the present symptoms. However, DWI using multi-shot echo planar imaging clearly demonstrated an acute ischemic lesion in precentral cortex as a very high signal area with good contrast. The regional apparent diffusion coefficient in the precentral lesion was decreased to 0.65±0.21×10^<-3>mm^2/sec. Echo planar DWI obtained for short acquisiton time is very useful for distinguishing an acute ischemic lesion from chronic lesions.

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This case of multiple intracranial aneurysms associated with a persistent trigeminal artery variant refers to a 43-year-old woman suspected of having a middle cerebral artery aneurysm following magnetic resonance imaging. Carotid angiography confirmed that multiple aneurysms in the bilateral middle cerebral arteries were present at their bifurcation and in the left internal carotid artery at the junction of the posterior communicating arteries. On examination, a persistent trigeminal artery variant, originating from the cavernous portion of the right internal carotid artery, supplying the right anterior inferior cerebellar artery, was also revealed. During surgery, two additional microaneurysms were found in the horizontal portions of the bilateral middle cerebral arteries. Fifteen cases of persistent trigeminal artery variant associated with cerebral aneurysm have been reported, including this case. The possibility of multiple cerebral aneurysms should always be considered in patients with persistent trigeminal artery variant.

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we report 2 cases of surgically treated headache caused by the expanded cavum septi pellucidi(CSP). The first case was a 44-year-old female and the second one a 23-year-old male, both presenting with obstinate headache resistant to medical treatment. Width of expanded cavum septi pellucidi, namely the septal cyst, was 18 mm and 17 mm in diameter, respectively, There were no signs of hydrocephalus but cavum vergae was associated in the first case. CT cisternography demonstrated no direct communication between the cyst and the cerebrospinal fluid space, but revealed slight accumulation and stasis of the contrast medium in the cyst after 6 and 24 hours. Stereotactic direct puncture of the cyst was done from the right frontal cortex through the corpus callosum. The cyst was drained into the frontal subdural space, using a catheter(internal cyst-subdural drainage). Headache disappeared immediately after surgery in both cases and the width of the cyst decreased 9 mm and 8 mm, respectively.

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