Direct carotid cavernous sinus fistula is a common delayed complication of head trauma, particularly in patients with skull base fractures. When carotid cavernous sinus fistula occurs together with carotid artery dissection, it poses a big challenge regarding successful treatment. Endovascular treatment options include occlusion with detachable balloons, coils, and Pipeline flow diverters (Chestnut Medical Technologies, Menlo Park [CA], USA). Here we describe the successful management of a patient with dual pathology with traumatic carotid cavernous sinus fistula and internal carotid artery dissection with multiple pseudoaneurysms using flow diverters and detachable coils.

Lipoblastoma is a rare benign adipocytic tumour that usually occurs in children younger than 3 years, with male predominance. Lipoblastoma usually presents as a slowly enlarging soft tissue mass in the extremities although other sites of involvement have been reported. We report three cases of lipoblastoma in a lower limb with different magnetic resonance imaging features, some of which are shared by malignant soft tissue tumours.

Objective: To investigate the procedural complication rate, restenosis rate, and clinical outcomes after carotid angioplasty and stenting in patients with radiation-associated carotid stenosis. Methods: All patients with a history of head and / or neck radiation referred to Queen Elizabeth Hospital, Hong Kong, for carotid angioplasty and stenting for carotid artery stenosis between January 2008 and December 2013 were identified. Their clinical information, and procedural and imaging findings were reviewed. All procedures were performed by a dedicated team of neurointerventionists. The mean degree of stenosis was 75.1% (range, 50.0%-94.1%). Standardised, regular postoperative follow-up with clinical and Doppler ultrasound assessments was scheduled for all patients. Results: Forty-five carotid arteries in 40 patients with a history of head and neck irradiation were stented in this study. The mean age was 63.3 years; 36 (90.0%) patients had radiotherapy for nasopharyngeal carcinoma. The mean time interval between radiotherapy and carotid angioplasty and stenting was 228.8 months (range, 8-487 months). The mean degree of stenosis was 75.1%. Fourteen (31.1%) patients who underwent carotid angioplasty and stenting had contralateral carotid artery occlusion. Embolic protection devices were used in 37 (82.2%) procedures. There was one (2.2%) procedural complication, with dissection of the left common carotid artery during catheterization for left internal carotid artery stenting. The mean follow-up period was 29 months (range, 1-66 months). The ipsilateral stroke-free survival rates were 97.8% at 6 months, 95.1% at 1 year, and 84.0% at 5 years. The restenosis-free survival rates were 95.0% at 6 months, 92.5% at 1 year, and 74.0% at 5 years. No 30day mortality was identified. Two subarachnoid haemorrhages and one transient ischaemic attack occurred in the 30-day postoperative period. On subsequent follow-up, four (10.3%) patients died at a mean interval of 19 months after the procedure. Conclusion: We demonstrated that carotid angioplasty and stenting is safe in patients with radiation-associated carotid artery stenosis. The long-term clinical outcomes of ischaemic neurological event and restenosis were satisfactory.

Lipoblastoma is a rare benign soft tissue tumour that presents in early childhood. It is an encapsulated tumour arising from embryonic white fat. Lipoblastoma is composed of an admixture of mature and immature adipocytes, and usually has a myxoid appearance with fine vascular network. Although benign, lipoblastoma has a tendency to recur, and complete excision with follow-up is essential. Lipoblastoma usually presents as a painless enlarging mass in the extremities and trunk. We herein present a case of lipoblastoma in a rare location-within the cervical spinal canal.

A 28-year-old gentleman with good past health was found unconscious lying on bed in the morning. There was evidence of incontinence and vomiting. On arrival to the accident & emergency department, he was afebrile.