Chronic Intraventricular Encapsulated Hematoma in an Adult: A Case Report.

This case report is a presentation of a chronic intraventricular encapsulated hematoma in an adult who presented with gait disturbance, fever, palsy of N. III, N. VI and N. VII, and photophobia. Ophthalmoscopy revealed a bilateral papilledema. Computed tomography scans and magnetic resonance imaging revealed an intraventricular mass in the lateral ventricle. Preoperative diagnosis could not rule out a neoplasm. The lesion was totally removed with open surgery and was found to be a chronic intraventricular encapsulated hematoma. A chronic intraventricular encapsulated hematoma is a rare entity. After the removal of the mass, the clinical symptoms of the patient gradually resolved.

Subependymomas of the lateral ventricle: tumor recurrence correlated with increased Ki-67 labeling index.

Subependymomas of the lateral ventricles are rare tumors. We present two patients with subependymomas of the lateral ventricle, who underwent gross total resection of the tumor via transcallosal approach. The patient, with increased Ki-67 labeling index had recurrence of tumor two years after the initial operation. We emphasize at the risk of recurrence which is probably correlated with Ki-67 labeling index.

Giant Intradural Mucocele in a Patient with Adult Onset Seizures.

A rare case of mucopyocele in a patient who presented with epileptic seizures is reported. The computed tomography scan (CT) and the magnetic resonance (MR) imaging revealed an intradural extension of a giant fronto-ethmoidal mucopyocele, eroding the cribriform plate and compressing both frontal lobes. The lesion was removed by craniotomy with elimination of the mass effect and reconstruction of the anterior skull base. An intracranial-intradural mucopyocele is an extremely rare cause of generalized convulsion as a presenting symptom, with only 6 cases reported in the literature. The total removal of the lesion associated with anterior fossa reconstruction is the treatment of choice.

Trans-Sylvian selective amygdalohippocampectomy for medically intractable temporal lobe epilepsy: a single-centre experience.

Selective amygdalohippocampectomy (SelAH) is now widely used in the surgical treatment of patients with medically intractable medial temporal lobe epilepsy (MTLE). We present our single-centre experience of a uniform series of drug-resistant MTLE patients treated exclusively with SelAH. A retrospective study of 50 adult patients (25 males, 25 females, mean age 34 years) suffering from medically intractable MTLE was conducted. All patients has been investigated under the same protocol and operated by SelAH performed by one surgeon. Immediate and long-term follow-up was also available and is presented. Forty-two patients (84%) became seizure free (Engel's I); eight of them (16%) were classified as Engel's II; four (8%) as Engel's III; and one as Engel's IV (2%). In 42 of them the final result has been achieved after a single operation, while in the rest eight after a second or third surgical procedure. The mean follow-up period was 6.2 years. Two permanent complications (4%) with no treatment-related mortality have been detected. SelAH performed in well selected cases, where concordance between electrophysiological and MR findings exists, can be a safe and effective surgical treatment method for medically intractable MTLE.

Vagus nerve stimulation for intractable epilepsy: outcome in two series combining 90 patients.

Vagus nerve stimulation (VNS) is the most widely used non-pharmacological treatment for medically intractable epilepsy and has been in clinical use for over a decade. It is indicated in patients who are refractory to medical treatment or who experience intolerable side effects, and who are not candidates for resective surgery. VNS used in the acute setting can both abort seizures and have an acute prophylactic effect. This effect increases over time in chronic treatment to a maximum at around 18 months. The evidence base supporting the efficacy of VNS is strong, but its exact mechanism of action remains unknown. A vagus nerve stimulator consists of two electrodes embedded in a silastic helix that is wrapped around the cervical vagus nerve. The stimulator is always implanted on the left vagus nerve in order to reduce the likelihood of adverse cardiac effects. The electrodes are connected to an implantable pulse generator (IPG) which is positioned subcutaneously either below the clavicle or in the axilla. The IPG is programmed by computer via a wand placed on the skin over it. In addition, extra pulses of stimulation triggered by a hand-held magnet may help to prevent or abort seizures. VNS is essentially a palliative treatment and the number of patients who become seizure free is very small. A significant reduction in the frequency and severity of seizures can be expected in about one third of patients and efficacy tends to improve with time. Vagus nerve stimulation is well tolerated and has few significant side effects. We describe our experience on the use of VNS on drug-resistant epilepsy in 90 patients treated in two departments (in Athens, Greece and Newcastle, England).

Hemifacial spasm associated with focal bone hyperostosis.

We present a very rare case of hemifacial spasm in a 58-year-old patient who was predisposed by focal temporal bone hyperostosis. The patient presented with a 6-year history of progressive left hemifacial spasm, unresponding to the conservative treatment. She underwent a typical microvasular decompression procedure, during which an unusual local hyperostosis of the interior surface of the left temporal bone was found, distorting the adjacent AICA and causing significant pressure on the facial nerve. The postoperative course was uneventful and in the 24-month follow up, the patient is spasm free.

Hypothalamic hamartomas causing gelastic epilepsy: two cases and a review of the literature.

Two cases of hypothalamic hamartomas causing gelastic epilepsy are described. The clinical presentations and the radiological features are presented, and the mechanisms involved in laughing attacks are discussed. The literature is reviewed and it is suggested the complete extirpation of the hamartomas is the treatment of choice in gelastic epilepsy.