Background:Intracranial aneurysms most commonly present following rupture causing subarachnoid hemorrhage. Mental disorders are common among patients with unruptured intracranial aneurysms and in aneurysmal subarachnoid hemorrhage survivors. However, to the best of our knowledge, there is no published report of unruptured intracranial aneurysm presenting as a mental disorder.Case Description:A 69-year-old male without a past history of mental disorders and neurological symptoms presented with a 2-month history of anxiety, sadness, lack of pleasure in usual activities, fatigue, difficulties falling asleep and waking up early in the morning, reduced appetite, and weight loss. The patient was diagnosed with major depressive disorder and antidepressant treatment was initiated. Subsequent non-contrast computed tomography (CT) of the head demonstrated hypointense oval-shaped lesion within the projection of the anterior communicating artery. CT angiography confirmed the diagnosis of a 0.8 × 0.6 cm saccular aneurysm originating from the anterior communicating artery and anterior cerebral artery. The patient underwent microsurgical clipping of the aneurysm. On psychiatric assessment 1 month after the surgery, there were no signs of depressive disorder and antidepressive treatment was discontinued. On follow-up visit 1 year after the surgery, the patient did not have any mood symptoms.Conclusions:The case indicates that organic brain lesions, including intracranial aneurysms, should be suspected in elderly patients presenting with their first episode of mental disorder.

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Arvydas Danilevičius, Juozas Šidiškis, Paulius ČikotasKauno medicinos universiteto klinikų Neurochirurgijos klinikaEivenių g. 2, LT-3007 KaunasEl paštas: adanilevicius@yahoo.com Įvadas / tikslas Straipsnyje aptariami veiksniai, kurie turi įtaką veidinio nervo funkcijai priešoperaciniu, ankstyvuoju ir vėlyvuoju pooperaciniu laikotarpiu, taip pat siekiama apibrėžti prognozės kriterijus, kurie padėtų pagerinti pooperacinius rezultatus išsaugant veidinio nervo funkciją. Ligoniai ir metodai Buvo tiriami ligoniai, gydyti nuo klausos nervo neurinomų (KNN). Iš jų 130 operuoti naudojant retrosigmoidinę (RS), 21 – vidurinės kaukolės daubos ir 23 – subokcipitalinę operacinę prieigą (SB). Veidinio nervo funkcija prieš operaciją ir po jos buvo vertinta pagal House-Brackmanno (H/B) skalę. Rezultatai vertinti atsižvelgiant į amžių, lytį, klausos lygį, smegenų kamieno pažeidimo lygį, likvoro cirkuliacijos sutrikimus, naviko dydį ir operacinę prieigą. Rezultatai Diagnozuotų 83,5% KNN buvo III–IV stadijų. Veidinio nervo funkcijos sutrikimas prieš operaciją tiesiogiai siejosi su klausa (p < 0,05), pusiausvyros sutrikimu (p < 0,01), KNN stadija (p < 0,05), bulbariniais simptomais (p < 0,05), piramidinio trakto pažeidimu (p < 0,05) ir okliuzinės hidrocefalijos išreikštumu (p < 0,05). Veidinio nervo funkcijos pablogėjimas po operacijos dažniau pasitaikė naudojus subokcipitalinę, rečiau – retrosigmoidinę ir rečiausiai – vidurinės kaukolės daubos operacinę prieigą (p < 0,05). Vėlyvuoju pooperaciniu laikotarpiu veidinio nervo funkcijos pablogėjimo tikimybė yra didesnė vyresniems nei 70 metų ligoniams, kuriems prieš operaciją diagnozuota okliuzinė vandenė (p < 0,05) ar III–IV stadijos KNN. Išvados Kad išsaugotume nepažeistą pooperacinę veidinio nervo funkciją ir likusią klausą, pasirenkant chirurginę prieigą ir operacijos dydį labai svarbu atsižvelgti į klausos sutrikimo lygį operuojamoje pusėje, naviko dydį ir ligonio amžių. Prasminai žodžiai: klausos nervo neurinoma, vestibulinė švanoma, veidinis nervas, tilto-smegenėlių kampo navikai, chirurginis gydymas Prognostic factors for facial nerve preservation in vestibular schwanomma surgery Arvydas Danilevičius, Juozas Šidiškis, Paulius Čikotas Background / objective Factors that may influence the function of the facial nerve before the operation in the early and late postoperative periods are discussed, with the aim of estimating the prognostic criteria, that may help to preserve the facial nerve function and thus to improve the postoperative results. Patients and methods The study cohort comprised consecutively treated patients with vestibular schwanomma (VS), of whom 130 underwent operation via retrosigmoid (RS) approach, 21 by middle fossa (MF) and 23 by suboccipital (SO) approach. Facial nerve function, before the surgery and after it, was evaluated according to the House-Brackmann grade. The results were evaluated taking into consideration the patient's age, sex, hearing level, the degree of brainstem damage, cerebrospinal fluid circulation disorders, tumor size and surgical approach. Results 83.5% of the VS were diagnosed in III–IV stages. The level of facial nerve function disorders before the operation had a direct relationship with hearing (p < 0.05), balance disorders (p < 0.01), stage of VS (p < 0.05), bulbar symptoms, (p < 0.05), pyramidal tract injury (p < 0.05) and occlusive hydrocephalus intensity (p < 0.05). Worsening of the facial nerve function after surgery was more frequently observed when the suboccipital surgical approach was used; it was less frequent after retrosigmoid and least after middle fossa surgical approach (p < 0.05). There is a greater possibility of worsening the facial nerve function in the late postoperative period among older patients and if occlusive hydrocephalus (p < 0.05) and the III–IV stage of VS had been been diagnosed before the operation. Conclusions Incomplete hearing loss on the VS side, tumor size and the age of patients are very important factors for the choice of surgical approach and surgery extent because, if it is possible, we must save not only the facial nerve function, but also hearing. Keywords: acoustic neuroma, vestibular shwanomma, facial nerve, cerebellopontine angle tumors, surgical treatment