Resection of Intracranial Giant Cavernous Malformation: Case Report and Literature Review

Cerebral cavernous malformations are a rare and congenital vascular malformation that can present as a challenge in neurosurgical management. The term “giant cerebral cavernous malformations” still does not have a clear definition in the literature, with a wide variety of results. It is known, however, that there is an association between the size of the cavernoma and postoperative sequelae, especially in those with a size greater than 3 cm in its largest diameter. We present a case report of resection of a giant brain cavernoma measuring approximately 8 cm in its largest diameter, emphasizing on clinical presentation, diagnoses and postoperative evolution. Additionally, we performed a comprehensive review of the existing literature on the subject, addressing the epidemiology, pathophysiology, diagnostic methods, treatment options, and prognosis associated with this condition.

Comparative analysis of thermodynamic and mechanical responses between underground hydrogen storage and compressed air energy storage in lined rock caverns

Underground hydrogen storage(UHS)and compressed air energy storage(CAES)are two viable largescale energy storage technologies for mitigating the intermittency of wind and solar power.Therefore,it is meaningful to compare the properties of hydrogen and air with typical thermodynamic storage processes.This study employs a multi-physical coupling model to compare the operations of CAES and UHS,integrating gas thermodynamics within caverns,thermal conduction,and mechanical deformation around rock caverns.Gas thermodynamic responses are validated using additional simulations and the field test data.Temperature and pressure variations of air and hydrogen within rock caverns exhibit similarities under both adiabatic and diabatic simulation modes.Hydrogen reaches higher temperature and pressure following gas charging stage compared to air,and the ideal gas assumption may lead to overestimation of gas temperature and pressure.Unlike steel lining of CAES,the sealing layer(fibre-reinforced plastic FRP)in UHS is prone to deformation but can effectively mitigates stress in the sealing layer.In CAES,the first principal stress on the surface of the sealing layer and concrete lining is tensile stress,whereas UHS exhibits compressive stress in the same areas.Our present research can provide references for the selection of energy storage methods.

Endovascular treatment of direct carotid cavernous fistula resulting from rupture of intracavernous carotid aneurysm: A case report

BACKGROUND Direct carotid cavernous fistulas(CCFs)are typically the result of a severe traumatic brain injury.High-flow arteriovenous shunts secondary to rupture of an intracavernous aneurysm,resulting in direct CCFs,are rare.The use of a pipeline embolization device in conjunction with coils and Onyx glue for treatment of direct high-flow CCF resulting from ruptured cavernous carotid artery aneurysm in a clinical setting is not well documented.CASE SUMMARY A 58-year-old woman presented to our department with symptoms of blepharoptosis and intracranial bruits for 1 wk.During physical examination,there was right eye exophthalmos and ocular motor palsy.The rest of the neurological examination was clear.Notably,the patient had no history of head injury.The patient was treated with a pipeline embolization device in the ipsilateral internal carotid artery across the fistula.Coils and Onyx were placed through the femoral venous route,followed by placement of the pipeline embolization device with assistance from a balloon-coiling technique.No intraoperative or perioperative complications occurred.Preoperative symptoms of bulbar hyperemia and bruits subsided immediately after the operation.CONCLUSION Pipeline embolization device in conjunction with coiling and Onyx may be a safe and effective approach for direct CCFs.

Intrahepatic portal venous systems in adult patients with cavernous transformation of portal vein: Imaging features and a new classification

Background: Cavernous transformation of the portal vein(CTPV) due to portal vein obstruction is a rare vascular anomaly defined as the formation of multiple collateral vessels in the hepatic hilum. This study aimed to investigate the imaging features of intrahepatic portal vein in adult patients with CTPV and establish the relationship between the manifestations of intrahepatic portal vein and the progression of CTPV. Methods: We retrospectively analyzed 14 CTPV patients in Beijing Tsinghua Changgung Hospital. All patients underwent both direct portal venography(DPV) and computed tomography angiography(CTA) to reveal the manifestations of the portal venous system. The vessels measured included the left portal vein(LPV), right portal vein(RPV), main portal vein(MPV) and the portal vein bifurcation(PVB). Results: Nine males and 5 females, with a median age of 40.5 years, were included in the study. No significant difference was found in the diameters of the LPV or RPV measured by DPV and CTA. The visualization in terms of LPV, RPV and PVB measured by DPV was higher than that by CTA. There was a significant association between LPV/RPV and PVB/MPV in term of visibility revealed with DPV( P = 0.01), while this association was not observed with CTA. According to the imaging features of the portal vein measured by DPV, CTPV was classified into three categories to facilitate the diagnosis and treatment. Conclusions: DPV was more accurate than CTA for revealing the course of the intrahepatic portal vein in patients with CTPV. The classification of CTPV, that originated from the imaging features of the portal vein revealed by DPV, may provide a new perspective for the diagnosis and treatment of CTPV.

Endoscopic ultrasound-guided lauromacrogol injection for treatment of colorectal cavernous hemangioma:Two case reports

BACKGROUND Colorectal cavernous hemangioma is a rare vascular malformation resulting in recurrent lower gastrointestinal hemorrhage,and can be misinterpreted as colitis.Surgical resection is currently the mainstay of treatment,with an emphasis on sphincter preservation.CASE SUMMARY We present details of two young patients with a history of persistent hematochezia diagnosed with colorectal cavernous hemangioma by endoscopic ultrasound(EUS).Cavernous hemangioma was relieved by several EUS-guided lauromacrogol injections and the patients achieved favorable clinical prognosis.CONCLUSION Multiple sequential EUS-guided injections of lauromacrogol is a safe,effective,cost-efficient,and minimally invasive alternative for colorectal cavernous hemangioma.

A preliminary site selection system for underground hydrogen storage in salt caverns and its application in Pingdingshan,China

Large‐scale underground hydrogen storage(UHS)provides a promising method for increasing the role of hydrogen in the process of carbon neutrality and energy transition.Of all the existing storage deposits,salt caverns are recognized as ideal sites for pure hydrogen storage.Evaluation and optimization of site selection for hydrogen storage facilities in salt caverns have become significant issues.In this article,the software CiteSpace is used to analyze and filter hot topics in published research.Based on a detailed classification and analysis,a“four‐factor”model for the site selection of salt cavern hydrogen storage is proposed,encompassing the dynamic demands of hydrogen energy,geological,hydrological,and ground factors of salt mines.Subsequently,20 basic indicators for comprehensive suitability grading of the target site were screened using the analytic hierarchy process and expert survey methods were adopted,which provided a preliminary site selection system for salt cavern hydrogen storage.Ultimately,the developed system was applied for the evaluation of salt cavern hydrogen storage sites in the salt mines of Pingdingshan City,Henan Province,thereby confirming its rationality and effectiveness.This research provides a feasible method and theoretical basis for the site selection of UHS in salt caverns in China.

Intermittent melena and refractory anemia due to jejunal cavernous lymphangioma:A case report

BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymphangiomas can give rise to complications such as abdominal pain,bleeding,volvulus,and intussusception.Here,we report a case of jejunal cavernous lymphangioma that presented with intermittent melena and refractory anemia in a male adult.CASE SUMMARY A 66-year-old man presented with intermittent melena,fatigue and refractory anemia nine months prior.Esophagogastroduodenoscopy and colonoscopy were performed many times and revealed no apparent bleeding.Conservative management,including transfusion,hemostasis,gastric acid secretion inhibition and symptomatic treatment,was performed,but the lesions tended to recur shortly after surgery.Ultimately,the patient underwent capsule endoscopy,which revealed a more than 10 cm lesion accompanied by active bleeding.After singleballoon enteroscopy and biopsy,a diagnosis of jejunal cavernous lymphangioma was confirmed,and the patient underwent surgical resection.No complications or recurrences were observed postoperatively.CONCLUSION Jejunal cavernous lymphangioma should be considered a cause of obscure gastrointestinal bleeding.Capsule endoscopy and single-balloon enteroscopy can facilitate diagnosis.Surgical resection is an effective management method.

Giant cavernous aneurysms occluded by aneurysmal thrombosis,calcification,parent artery occlusion:A case report and review of literature

BACKGROUND Patients with giant intracranial aneurysms(GIAs)are at a high risk of rupture,morbidity,and mortality even after surgical or endovascular treatment.We described a case of a spontaneously occluded GIA secondary to gradual growth of the GIA,continuously progressed aneurysmal thrombosis,complete aneurysmal calcification and complete occlusion of the parent artery-the right internal carotid artery(RICA).CASE SUMMARY A 72-year-old female patient complained of sudden pain in her right eye upon admission to our hospital.She had been diagnosed with a GIA[30 mm(axial)×38 mm(coronal)×28 mm(sagittal)]containing an aneurysmal thrombus located in the cavernous sinus segment of RICA diagnosed by magnetic resonance imaging(MRI),enhanced MRI,and magnetic resonance angiography more than 14 years ago.Later,with slow growth of the cavernous carotid GIA,aneurysmal thrombosis progressed continuously,spontaneous occlusion of the RICA,complete aneurysmal calcification,and occlusion of the GIA occurred gradually.She had no history of subarachnoid hemorrhage but missed the chance for endovascular therapy at an early stage.As a result,she was left with severe permanent sequelae from the injuries to the right cranial nerves Ⅱ,Ⅲ,Ⅳ,V1/V2,and Ⅴ.CONCLUSION The risk of rupture of the cavernous carotid GIAs was relatively low and possibly further be reduced by the stasis flow and spontaneous occlusion of the parent artery internal carotid artery(ICA)induced by the mass effect of the cavernous carotid GIAs and the extremely rare aneurysmal calcification.However,nowadays,it is advisable to recommend early endovascular treatment for the cavernous carotid GIAs to prevent injuries to the surrounding intracranial nerves and occlusion of the ICA,mainly caused by the mass effect of the cavernous carotid GIAs.

Distribution and exploration direction of medium-and large-sized marine carbonate gas fields in Sichuan Basin, SW China

Based on the analysis of the basic characteristics of medium-and large-sized marine gas fields in Sichuan Basin, combined with the division of major reservoir forming geological units in the marine craton stage and their control on key hydrocarbon accumulation factors, the distribution law of medium-and large-sized marine carbonate gas fields in the basin was examined and the exploration direction was pointed out. Through the analysis of the periodic stretching-uplifting background, it is concluded that five large scale paleo-rifts, three large scale paleo-uplifts, five large scale paleo erosion surfaces were formed in the marine craton stage of Sichuan Basin, and these geological units control the key reservoir forming factors of medium and large sized gas fields:(1) Large-scale paleo-rifts control the distribution of high-quality hydrocarbon generation centers.(2) The margin of large-scale paleo-rifts, high position of paleo-uplifts and paleo erosion surfaces control the distribution of high-quality reservoirs.(3) Large-scale paleo-rifts, paleo-uplifts, paleo erosion surfaces and present tectonic setting jointly control the formation of many types of large and medium-sized traps.(4) Natural gas accumulation is controlled by the inheritance evolution of traps in large geological units. Based on the comparative analysis of the distribution characteristics of medium-and large-sized gas fields and large geological units, it is proposed that the superimposition relationship between single or multiple geological units and the present structure controls the distribution of medium-and large-sized gas fields, and the "three paleo" superimposed area is the most advantageous. According to the above rules, the main exploration fields and directions of medium-and large-sized marine carbonate gas fields in Sichuan Basin include periphery of Deyang-Anyue paleo-rift, eastern margin of Longmenshan paleo-rift, margins of Kaijiang-Liangping oceanic trough and Chengkou-western Hubei oceanic trough, the high part of the subaqueous paleo-uplifts around Central Sichuan, paleo erosion surfaces of the top boundary of Maokou Formation in eastern and southern Sichuan Basin, paleo erosion surfaces of the top boundary of the Leikoupo Formation in central and western Sichuan Basin.

Modeling and simulation of 3D thermal stresses of large-sized castings in solidification processes

When heavy machines and large scaled receiver system of communication equipment are manufactured, it always needs to produce large-sized steel castings, aluminum castings and etc. Some defects of hot cracking by thermal stress often appear during solidification process as these castings are produced, which results in failure of castings. Therefore predicting the effects of technological parameters for production of castings on the thermal stress during solidification process becomes an important means. In this paper, the mathematical models have been established and numerical calculation of temperature fields by using finite difference method (FDM) and then thermal stress fields by using finite element method (FEM) during solidification process of castings have been carried out. The technological parameters of production have been optimized by the results of calculation and the defects of hot cracking have been eliminated. Modeling and simulation of 3D thermal stress during solidification processes of large-sized castings provided a scientific basis, which promoted further development of advanced manufacturing technique.

Rolling Fatigue Test of Large-Sized UHPC Member for Cable Stayed Bridge

Recently, research strives to apply Ultra High Performance Concrete (UHPC) to large-sized structures owing to its remarkable mechanical performance and durability compared to normal concrete. The Korea Institute of Construction Technology proposed SuperBridge800, an edge girder type UHPC cable stayed bridge with central span of 800 m, through its detailed design. The bridge is designed to be erected through the connection of precast UHPC segments. The precast UHPC segment is monolithically composed of one ribbed deck slab and edge girders at each side. The connection between the precast segments is achieved by steel bars at the edge girders and by UHPC cast-in-place wet joint at the slab. Despite of the outstanding mechanical performance of UHPC, the fabrication of large-sized members is a difficult task since UHPC hardens faster than normal concrete and requires a special curing process. Therefore, the constructability of large-sized UHPC segment should be secured to achieve SuperBridge800. Besides, the performance of the connection between segments should also be guaranteed, especially in terms of the fatigue performance of the UHPC cast-in-place joint, which constitutes a weak point. To that goal, two half-scaled UHPC segments are manufactured and the constructability is examined by fabricating a large-sized UHPC member connected with respect to the design conditions. This study conducts rolling fatigue test on the so-fabricated large-sized UHPC member. Rolling fatigue test is carried out up to 2 million cycles considering actual vehicle load at each center and quarter points of the member. The test results confirm that the service limit state is satisfied.

Study on cavern evolution and performance of three mixers in agitation of yield-pseudoplastic fluids

The hydrodynamic performance of three mixers single shaft central mixer(SSC), single shaft off-centred mixer(SSO), dual shaft off-centred mixer(DSO), was investigated in the mixing of yield-pseudoplastic fluids(xanthan gum solutions) in the laminar regime. To explore and determine the efficiency of three mixers, both numerical and experimental approaches were adopted. The fluid rheology was described by the Herschel–Bulkley rheological model. Computational fluid dynamics was employed to simulate the apparent viscosity distribution, mixing time, and the flow pattern inside the stirred tank. The developed model was validated through experimentally measured torque. The influence mechanism of the rotational speed and fluid rheology on the cavern evolution was explored deeply. The performances of three mixers in this work were compared at the constant power input and fluid rheology with respect to the flow pattern, mixing time, and mixing efficiency. The results verify that the faster the rotating speed, the greater influence of the fluid rheology on the cavern evolution, and the more uniform apparent viscosity distribution. Moreover, the mixing time decreases continuously as the increasing power consumption per unit volume, and the dimensionless mixing time of DSO mixer was nearly 42.8% and 6.1% shorter than that of SSC and SCO mixer at the same Reynolds number, respectively. According to the mixing efficiency criteria, these data also revealed that DSO was more efficient than SSC and SSO.

Experimental investigation and numerical simulation of large-sized aluminum tube extrusion forming

Large-sized aluminum tube has big section effect, aspect ratio and thin thickness, so that the extrusion technology is complex and the large specific pressure is generated in extrusion cavity. The temperature variation and velocity effect is difficult to control. The extrusion forming of large-sized aluminum tube was researched and simulated. Three-dimensional thermo-mechanical coupled finite element model was constructed and appropriate boundary conditions were given out. The results show that large-sized aluminum tube can be formed by isothermal extrusion through controlling the extrusion velocity and founding the relationship between extrusion velocity and extrusion temperature.

Rock mass response for lined rock caverns subjected to high internal gas pressure

The storage of hydrogen gas in underground lined rock caverns(LRCs)enables the implementation of the first fossil-free steelmaking process to meet the large demand for crude steel.Predicting the response of rock mass is important to ensure that gas leakage due to rupture of the steel lining does not occur.Analytical and numerical models can be used to estimate the rock mass response to high internal pressure;however,the fitness of these models under different in situ stress conditions and cavern shapes has not been studied.In this paper,the suitability of analytical and numerical models to estimate the maximum cavern wall tangential strain under high internal pressure is studied.The analytical model is derived in detail and finite element(FE)models considering both two-dimensional(2D)and three-dimensional(3D)geometries are presented.These models are verified with field measurements from the LRC in Skallen,southwestern Sweden.The analytical model is inexpensive to implement and gives good results for isotropic in situ stress conditions and large cavern heights.For the case of anisotropic horizontal in situ stresses,as the conditions in Skallen,the 3D FE model is the best approach.

Spalling failure of deep hard rock caverns

Spalling is a typical brittle failure phenomenon of hard rock in deep caverns under high geostress.In this study,key issues are systematically studied concerning the spalling failure of deep hard rock caverns.First,the prismatic rock specimens with small thicknesses(i.e.width×thickness×height:20 mm×50 mm×100 mm)are employed in our tests which not only successfully simulate the spalling failure of hard rock in the laboratory but also obtain a reasonable spalling strength similar to that of the rock mass.Then,a series of spalling experiments is carried out to investigate the mechanism of spalling failure of deep hard rock caverns.Our results show that the intermediate principal stress,weak dynamic disturbances,and rock microstructure have significant effects on the spalling failure.The spalling strength is approximately(0.3–0.8)UCS,where UCS is the uniaxial compressive strength of the cylindrical rock sample with a diameter of around 50 mm.The spalling strength increases first and then decreases with increasing intermediate principal stress.Moreover,an empirical spalling strength criterion and a numerical method of spalling failure are proposed.This numerical method can not only simulate the spalling failure zone formed by tangential compressive stress concentration after excavation under different intermediate principal stresses,but also successfully simulate the failure transition from tensile mode to shear mode associated with confinement change in deep hard rock caverns.Furthermore,an acoustic emission-based early warning method using neural network is proposed to predict the spalling failure.Finally,a technical roadmap for preventing and controlling spalling failure of deep hard rock caverns is presented after summarizing the successful experiences in a typical engineering case.

Application of transmesenteric vein extrahepatic portosystemic shunt in treatment of symptomatic portal hypertension with cavernous transformation of portal vein

Purpose:To evaluate the feasibility and efficacy of a transmesenteric vein extrahepatic portosystemic shunt(TmEPS)for the treatment of cavernous transformation of the portal vein(CTPV).Materials and methods:The clinical data of 20 patients with CTPV who underwent TmEPS between December 2020and January 2022 at Henan Provincial People’s Hospital were retrospectively collected.The superior mesenteric vein(SMV)trunk was patent or partially occluded in these patients.An extrahepatic portosystemic shunt between the inferior vena cava and the SMV was established using a stent graft through an infraumbilical median longitudinal mini-laparotomy.The technical success,efficacy,and complication rates were evaluated,and the preand postoperative SMV pressures were compared.Patients’clinical outcomes and shunt patency were assessed.Results:TmEPS was successfully performed in 20 patients.The initial puncture success rate of the balloon-assisted puncture technique is 95%.The mean SMV pressure decreased from 29.1±2.9 mmHg to 15.6±3.3 mmHg(p<0.001).All symptoms of portal hypertension resolved.No fatal procedural complications occurred.During the follow-up period,hepatic encephalopathy occurred in two patients.The remaining patients remained asymptomatic.All shunts were patent.Conclusions:TmEPS is a feasible,safe,and effective treatment option for patients with CTPV.

Determination of convergence of underground gas storage caverns using non-invasive methodology based on land surface subsidence measurement

Undergroundgas storage caverns aremonitoredfor environmental safety in termsof equipmentandpotential emissions,particularly methane emissions from the underground and above-ground parts of the storage facility.Periodical measurements of land surface deformations and costly echometric measurements of convergence of individual storage facilities are carried out.The aims of environmental monitoring are:(1)to eliminate potential hazards in the shortest time,(2)assess the overall impact of intensive operation of storage facilities on the environment,(3)developmonitoringmethods relevant to environmental protection,and(4)take actions in case of failure.The paper presents a solution to the problem of determination of the convergence of underground caverns in a salt rock mass based on the results of land surface subsidence measurements carried out using the Gauss-Markov equalization algorithm.Themethod makes it possible for ongoing control of cavern volume convergence after each subsidence measurement on the ground surface and determining the actual impact of the use frequency(injection-mediumconsumption)on the convergence in time.The presentedmethodology is universal and verified on caverns located in a salt rockmass.The Gauss-Markov inversion model is the first used in this area,hence its application is significant.

Retroperitoneal cavernous hemangioma misdiagnosed as lymphatic cyst:A case report and review of the literature

BACKGROUND Primary abdominal and retroperitoneal cavernous hemangioma is a vascular tumor and rarely seen in the clinic.Due to the lack of specific imaging features,retroperitoneal cavernous hemangioma cannot be diagnosed accurately.Some symptoms may develop with the enlargement of lesion volume or the occurrence of complications such as rupture or oppression.We report here a special case who was admitted with chronic abdominal pain.Admission examination suggested a retroperitoneal lymphatic duct cyst.Laparoscopic resection of the retroperitoneal mass was performed,and histological examination confirmed retroperitoneal cavernous hemangioma.CASE SUMMARY The patient was a 43-year-old Tibetan woman with intermittent left lower abdominal pain and discomfort 3 years ago.Ultrasonography revealed a cystic mass in the retroperitoneum with clear boundaries,internal septa,and no blood flow signal.Computed tomography(CT)and magnetic resonance imaging(MRI)showed an irregular space-occupying mass in the retroperitoneum,and retroperitoneal lymphatic cyst was considered.Plain CT scanning showed multiple cystlike hypo-intense shadows in the retroperitoneum,partially fused into a mass,and no obvious enhancement was found on enhanced scanning.MRI showed multiple irregular clump-like long T1 and long T2 signal shadows above the pancreas,within which linear short T2 signal shadows were seen.Diffusionweighted imaging sequence showed hypo-signal shadows,without obvious enhancement on enhanced scanning.Ultrasound,CT,and MRI all suggested the possibility of retroperitoneal lymphatic cyst.However,the patient was finally diagnosed with retroperitoneal cavernous hemangioma by pathological examination.CONCLUSION Retroperitoneal cavernous hemangioma is a benign lesion,and it is difficult to make a diagnosis preoperatively.Surgical resection may be the only treatment,which not only allows histopathological confirmation as a diagnostic purpose and excludes any risk of malignancy,but also avoids invasion of adjacent tissues,oppression,and other complications as a therapeutic goal.