4 days of visual changes

Presentation: A patient presented with a four day history of visual changes.  A brain MRI was performed revealing a large sellar abnormality.  

Left: Preoperative, Right: Gross total tumor removal after endoscopic pituitary resection. Drs. Clark Chen and Bob Carter performed an endoscopic pituitary tumor resection of the lesion using a binostral technique.  Endoscopy allows for large field visualization of the tumor and sellar structures. 

A collapse into coma and a ruptured right internal carotid artery aneurysm

Symptoms: A patient was found down in coma.

Imaging:  Diffuse subarachnoid hemmorrhage and hydrocephalusCerebral angiogram revealing aneurysm of supraclinoid carotid.

Treatment: Right external to internal carotid artery bypass with clip trapping of dissecting internal carotid artery segment.  Graft donor vessel: right radial artery. 

Radial artery to M2 graft.

A left temporal mass and symptoms of speech hesitation

Left temporal mass T2 sequenceSymptoms:  Difficulty in word choice

Brain MRILeft temporal mass post gadolinium T1 sequence   shows a left temporal mass without enhancement.  Preoperative MEG reveals expressive speech area just superior to tumor. 

Procedure: Awake craniotomy with intraoperative speech mapping.

Findings: Intraoperative speech mapping revealed complete speech arrest just outside margin of tumor. 

Pathology: oligoastrocytoma

Outcome: Patient with preserved speech function via awake craniotomy technique.

A posterior fossa arteriovenous malformation-AVM

Presentation: A mid-twenties pregnant woman presented in coma.

Imaging:  CT scan (Figure 1).  Cerebral Angiography. (Figure 2. ) 

Figure 1. Posterior fossa hemorrhage

Figure 2. Cerebral angiogram

Treatment:  Two stages of embolization followed by posterior fossa craniotomy for resection of AVM.

A cortically based tumor.

Description: A young man in his late teens presents with a cortically based lesion and seizures. 

Procedure Performed:  Right frontal awake craniotomy with motor mapping.

Pathology:  DNET tumor - DYSEMBRYOPLASTIC NEUROEPITHELIAL TUMOR