UNASSIGNED: Endoscopic transnasal optic canal decompression is widely used in the treatment of traumatic optic neuropathy (TON) following head and craniofacial trauma. Intraoperative hemorrhage is a catastrophic surgical complication during optic canal decompression.
UNASSIGNED: We present two cases of patients with TON who suffered unexpected intra-operative massive bleeding during endoscopic transnasal optic canal decompression. After intraoperative hemostasis was achieved, emergent cerebral angiograms demonstrated the formation of internal carotid pseudoaneurysms, which were immediately embolized with coils combined with or without Onyx with balloon assistance. One of these cases was also complicated by a postoperative cerebrospinal fluid leak, which failed to be treated with lumbar drainage but was successfully repaired with endoscopic transnasal surgery.
UNASSIGNED: The intra-operative rupture of ICA pseudoaneurysm is a rare but catastrophic complication in TON patients. Intraoperative massive bleeding indicates rupture of ICA pseudoaneurysm. Postoperative emergency angiography and endovascular therapy should be arranged to evaluate and repair the cerebral vascular injury. Endoscopic trans-nasal surgery repairing CSF leaks resistant to lumbar drainage could be efficient and safe following pseudoaneurysm embolization.

UNASSIGNED: Bronchial arterial racemose hemangioma is considered to be a type of pulmonary arteriovenous malformation (PAVM). We encountered an extremely rare case of racemose hemangioma, which was identified because of massive bleeding during lung cancer surgery.
METHODS: A 71-year-old man was suspected of having lung cancer and underwent a right upper lobectomy. During the dissection of the peribronchial connective tissue around the upper lobe bronchus, a sudden massive hemorrhage occurred after separation of the pulmonary artery and vein. Hemostasis was difficult to achieve with compression hemostasis and the point of bleeding was unknown; thus, we were called in to search for the source of the bleeding, which was identified as the bronchial artery. Postoperatively, a racemose hemangioma was diagnosed via preoperative chest computed tomography and imaging analysis with the Ziostation2® (Ziosoft Inc. Tokyo, Japan).
UNASSIGNED: Racemose hemangioma has weaker blood vessel walls than normal blood vessels. Once bleeding occurs, it is very difficult to stop. However, once the bleeding point was identified, hemostasis via suturing and cutting was possible.
CONCLUSIONS: As hemorrhaging from a racemose hemangioma is very difficult to stop, preoperative imaging retrieval is very important.

Excessive intraoperative hemorrhage in the management of a giant neurofibroma can be reduced with ancillary procedures such as ligation of the feeding/nutrient artery, adopting proper intraoperative hemostatic methods, and by staging the surgery.

We report a rare case of cerebral amyloid angiopathy (CAA) causing large contralateral hemorrhage during surgery for lobar hemorrhage. A 62-year-old woman presented with lobar hemorrhage in the left frontal and parietal lobes recurring over the previous 1 month. Because we could not detect the origin of the lobar hemorrhage, we performed a biopsy around the lobar hemorrhage site with the removal of a hematoma. During the surgery, we identified acute brain swelling without bleeding from the operative field. Intraoperative computed tomography demonstrated new large lobar hemorrhage of the right parietal lobe, which we could promptly remove. Specimens around hematomas on both sides were pathologically diagnosed as CAA on immunohistochemical examination. After the surgery, she suffered from lobar hemorrhage three times in the space of only 3 months. To the best of our knowledge, there has been no reported case of CAA causing intracranial hemorrhage of another lesion during surgery. Neurosurgeons should know a possibility of intraoperative hemorrhage in surgeries for lobar hemorrhage caused by CAA.