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We review our experience with patients harbouring putaminal intracerebral haematoma treated by intraoperative ultrasound guided aspiration and thrombolysis with Urokinase. We assessed the feasibility and safety of the procedure and compared the results with a similar group of patients previously treated in our unit by craniotomy and clot evacuation. From September 1998 to May 2000, eighteen consecutive patients with putaminal haemorrhage without suspected underlying structural aetiology or coagulopathy were included. Under general anesthesia, a catheter was inserted into the centre of the haematoma through a frontal burr hole under ultrasound guidance. An external ventricular catheter was also inserted for intracranial pressure monitoring. After maximally aspirating the haematoma, the catheter was left in place and 30 000 units of urokinase instilled. Further instillation of 20 000 units of urokinase was performed every 12 hours. The resolution of haematoma was followed with serial CT scan. The mean age was 55 years; mean haematoma size was 50 mL. The mortality rate was 11% (2/18); both deaths were not procedure related. Twenty-four patients were in the craniotomy; there were three deaths (13%). Other outcomes of the two groups were similar. We concluded that ultrasound guided aspiration and thrombolysis appears safe and effective in treating putaminal haemorrhage.Various methods and material have been used to treat cranium bifidum. We report the use of split calvarium bone graft in the treatment of the condition in a 3-year-old girl with a large bilateral parietooccipital defect. Early follow up reveals satisfactory results. 4.

The performance of color velocity imaging quantification for evaluating cerebral vasoreactivity is comparable to that of transcranial Doppler sonography. Because color velocity imaging quantification is not as limited as transcranial Doppler sonography, it could be an ideal complementary tool to transcranial Doppler sonography. More studies are required to define its clinical value.

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.

Objectives:The Vascular Anomalies Multidisciplinary Team at the Queen Elizabeth Hospital, Hong Kong, delivers one-stop integrated care by a comprehensive team of specialists and nurses to paediatric patients with vascular anomalies. This study aimed to review the efficacy, safety, and outcomes of percutaneous sclerotherapy performed at our centre for low-flow vascular malformations in paediatric patients. Methods: A retrospective study of 49 paediatric patients who underwent sclerotherapy from 1 June 2009 to 30 June 2015 was performed. Of the patients, 25 were male and 24 were female, with a mean age of 6.3 years (range, 2 months to 17 years). In all, 29 (59%) patients had venous malformation and 20 (41%) had lymphatic malformation. The location of lesions included 25 (51%) in the head and neck, 11 (22%) in the trunk, and 13 (27%) in the extremities. The outcomes of treatment were reviewed from electronic patient records. Results: A total of 98 sclerotherapy sessions were performed (mean, 2.0 sessions per patient; range, 1-8 sessions) by an interventional radiologist. Some procedures were performed in collaboration with paediatric surgeons, head and neck surgeons or ophthalmologists. The mean follow-up duration was 39.7 months (range, 1-75 months). The most commonly used sclerosants were sodium tetradecyl sulphate alone in 28 (39%) sessions, alcohol (ethanol) and lipiodol mixture in 24 (34%) sessions, and ethanolamine oleate in 10 (14%) sessions. For lymphatic malformations, doxycycline was used as the sclerosant in 27 (100%) sessions. General anaesthesia was administered in 85 (87%) sessions and local anaesthesia in 13 (13%). Among 46 patients, 35 (76%) reported a decrease in swelling and eight (17%) had complete resolution of symptoms. There were no major complications; 10 minor complications, including skin blistering and pneumonia, subsequently resolved. Conclusion: A multidisciplinary approach in treating low-flow vascular malformations can offer patients an optimal and individualised treatment plan. Percutaneous sclerotherapy is an effective and safe therapy for certain vascular malformation lesions in paediatric patients.