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The patient was transferred from another
hospital due to progressing deterioration of his condition. He got
insult 22-January-2005 for what he was admitted to that hospital and
MRI and repeated CT-scans were performed several times and the
hematoma in the upper vermis with a mass compression at the
aqueduct is not resolving and progressing hydrocephalus taking
place.
The patient was not to be known hypertensive, nor
diabetic, and considering the localization of the lesion and the
persistence of the mass, cavernous hemangioma was suspected and
planned for direct surgery.
In the setting position, midline suboccipital
approach with reflection of the bony flap down, the dura was opened
v-shaped. Transvermian attack was performed and the cavernous
hemangioma was resected easily and three tiny feeding arteries were
identified and coagulated. The mass was extending to the forth
ventricle, after removal of what, it was possible to see the
posterior commissure and the widened aqueduct. The mass was sent for
histological verification. Due to technical problems the video was
recorded to a missing partition and the material was with luck
retrieved from the camcorder trash.
Comments:
1. Hypertensive encephalopathy with secondary bleeding can happen at
any site in the brain, but there are certain areas were mostly
common, the upper vermis is not among them.
2. When a mass with apoplexy persist for several weeks without
gradual resolution, and more it has direct connection with
ventricular system, but without evidence of slippage of the
hematoma to the ventricular system, must hold suspicion with nature
of the origin of bleeding. The cavernous hemangioma as in this case
was sent for histological verification.
3. Instead of placing VPS, it is more wise to eliminate the cause of
the hypertensive-hydrocephalic syndrome, if the procedure is
surgically safe and effective.
The patient came 23-August-2006 with almost complete normalization
of his neurological status, complaining of disturbed memory for
recent events with control MRI showing normalization of the vermian
area with some scattered old lacunar infarcts both periventricular
localization, more in the left. | 
