Computational fluid dynamics (CFD) studies on cerebral aneurysms have attempted to identify surrogate hemodynamic parameters to predict rupture risk. We present a case of bilateral mirror image aneurysms, one of which ruptured soon after imaging. Wall shear stress values of the ruptured aneurysm changed by 20-30% after rupture because of change in the aneurysm shape. Findings from our case suggest that CFD studies comparing unruptured and ruptured aneurysms may not yield valid estimation on aneurysm rupture risk because of changes in aneurysm shape after rupture. Changes in aneurysm shape after rupture should be considered in CFD research.

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Although the number of patients in the Y-stent group is small, this group had a significantly higher risk of thromboembolic complications. While our protocol of a routine dose of dual antiplatelet therapy may be sufficient for single stent therapy, our protocol of a routine dose of triple antiplatelet therapy for Y-stents may not prevent thromboembolic events. This suggests that evaluation of platelet function may be essential, especially for Y-stents.

We report on the case of a huge varix that developed after the endovascular embolization of a cerebellar arteriovenous malformation (AVM) with a single drainer. A 21-year-old male presented with trigeminal neuralgia which was caused by the dilated drainer of the AVM. A varix was found at the basal vein of Rosenthal 2 months after an initial stage of embolization with polyvinyl alcohol particles; it diminished after the surgical extirpation of the AVM. The varix formation might have been facilitated by the stenosis in the vein of Galen and by the dynamic changes that followed the embolization. This rare complication should be kept in mind when embolization is performed for AVMs with impaired venous outlets.

Background:Cerebral cavernous malformations (CCMs, also known as cavernous hemanigiomas) of the third ventricle are uncommon. Here, we present a rare case of a CCM that caused the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).Case Description:A 68-year-old man presented with acute-onset cognitive and memory disturbance. Endocrinological examinations revealed hyponatremia due to SIADH. Computed tomography indicated a high-density mass in the third ventricle that caused left unilateral hydrocephalus due to obstruction of the foramen Monroe. On magnetic resonance imaging, the mass showed high intensity in both T1 and T2-weighted images and low intensity in susceptibility-weighted images, suggesting subacute intralesional hemorrhage. We completely excised the mass via a basal interhemispheric translamina terminalis approach. Intraoperatively, the mass adhered tightly to the left hypothalamus, which was supposed to the origin and was well circumscribed from the surroundings. The histopathological diagnosis was CCM, and his SIADH improved after the operation.Conclusion:We presented a rare case of a CCM in the third ventricle that caused SIADH, which improved after complete excision of the mass via a basal interhemispheric translamina terminalis approach.