Radiological parameters noted were midline shift, types of intracranial haemorrhage such as epidural haematoma, subdural haematoma, intracerebral haematoma, fracture and diffuse brain injury, area of brain involved, status of total 9 cisterns (Interpeduncular, two crural, two ambient, Quadrigeminal, sellar and two Sylvian cistern
) whether opened or closed.
Follow up MRI at 6months after surgery demonstrated persistence of meningeal nodularity around the left temporal lobe at the level of the left parasellar and Sylvian cistern, a finding consistent with hypertrophic pachymeningitis.
MR imaging performed 6 months after surgery demonstrated persistence of meningeal nodularity, around the left temporal lobe at the level of the left parasellar and Sylvian cistern, a finding consistent with hypertrophic pachymeningitis.
The microsurgical dissection of sylvian cistern is essential for the basic approach of middle cerebral artery (Figure 2E).
He was submitted to a pterional craniotomy approach and after a careful Sylvian cistern dissection(Figures 4C-4F), the aneurysm was identified (Figures 4G-41) and clipped (Figures 4J and 4K) without the necessity of temporary clipping.
A computer tomography (CT) scan of the brain was performed and showed air collections in the subarachnoid space of prepontine, suprasellar, left sylvian cistern
and in the sulci of left temporal and frontal regions.
MRI of the brain showed multiple linear and nodular leptomeningeal enhancing lesions scattered in basal and left sylvian cisterns (Figure 1(c)).
MRI of the brain surface revealed extensive progression of diffuse leptomeningeal enhancement in the basal and left sylvian cisterns (Figure 1(d)).
Conscience depression progressed to a deeper level, and a computed tomography scan of the brain showed dilatation of the temporal ventricles and compression of the peritroncal and sylvian cisterns
. During the next 48 hours, the coma level went deeper, reaching 6 on the Glasgow Scale.