Aspiration of parafalcine empyemas with flexible scope.

PURPOSE: Subdural empyemas are considered neurosurgical emergencies, and the parafalcine location is particularly insidious. We revised the experience of general surgeons who are used to manage chronic pleural purulent collections with video-assisted thoracoscopy. METHODS: With a similar technique, we successfully aspirated a parafalcine empyema using a flexible scope avoiding a more invasive craniotomy. A review of the treatment options of empyematous collections is also provided, focusing particularly on the hazardous parafalcine location. RESULTS: The management of subdural empyemas poses different decision-making problems compared to common brain abscesses, urging a more rapid and holistic surgical treatment with minimally invasive approach. Endoscopic aspiration of parafalcine empyema was followed by complete recovery in our patient. CONCLUSIONS: Flexible endoscopy is a promising method to obtain complete pus removal even from loculated collections through a bur hole, avoiding large craniotomies and consequent potential complications.

Amaurosis in infancy due to craniopharyngioma: a not-exceptional but often misdiagnosed symptom.

Since children may not be able to complain of progressive reduction in optic acuity, visual assessment in infancy may present practical difficulties. The authors report a case of craniopharyngioma, which led a young child to early blindness before the correct diagnosis could be made. Similar to other reported cases, the authors found that surgery did not substantially modify the preoperative visual deficit. They conclude that minimal improvement in visual acuity can be expected despite successful microsurgical removal of the tumor.

Pseudotumor cerebri in pediatric age: role of obesity in the management of neurological impairments.

Pseudotumor cerebri occurs quite rarely in the pediatric population and its clinical features differ from adults in many ways. Intracranial hypertension with papilledema should obviously be treated promptly to avoid permanent visual damage, but various more or less invasive options have been proposed over the years, from bariatric surgery for obesity to optic nerve sheath fenestration. We report a prospective study on a group of 15 children, aged 3-16 years, with clinical and instrumental diagnosis of pseudotumor cerebri. All the patients were treated simply by external lumbar cerebrospinal fluid drainage with a mean volume of 10 ml/h for 3-5 days, with hypocaloric diet and with appropriate dosages of acetazolamide. All had immediate relief of headache, a considerable reduction in papilledema and marked improvement of both visual loss and cranial nerve palsies within 2 months. None of the patients relapsed during the follow-up period, ranging from 12-48 months.

Osteoblastoma Mimicking an Idiopathic Intracranial Hypertension Syndrome.

Osteoblastomas are rare, benign bone tumors mainly arising from the long bones and the posterior vertebral arches. Skull localizations account for approximately 15% of cases. A total amount of thirty cases involving the temporal bone are reported in the literature. Clinical presentation of temporal osteoblastomas often includes local pain and swelling, while 7th and 8th cranial nerve impairment is rare. We report the novel finding of increase intracranial pressure syndrome secondary to dominant transverse-sigmoid sinus junction compression caused by a small temporal bone osteoblastoma. Excision of the tumor with the restoration of venous flow in the sigmoid sinus was followed by a prompt clinical improvement. In the management of patients with a venous sinus compression, restoration of venous drainage should be a priority.

Hydrocephalus onset after microsurgical or endovascular treatment for acute subarachnoid hemorrhage. Retrospective italian multicenter study.

BACKGROUND: Chronic shunt-dependent hydrocephalus is a complication of aneurysmal subarachnoid hemorrhage (aSAH). Its incidence and risk factors have been described while the hydrocephalus onset in terms of days after treatment (microsurgical or endovascular) has not been yet analyzed. MATERIALS AND METHODS: 45 patients, treated for aSAH in 4 Italian Neurosurgical Departments, were retrospectively analyzed. It was calculated the time that elapses between treatment and hydrocephalus onset in 36 patients. RESULTS: Of the 45 shunted patients, 15 (33.3%) were included in the microsurgical group (group A) and 30 (66.6%) were in the endovascular one (group B). There was no difference of the hydrocephalus onset between the two groups (24,1 days, group A vs. 27,7 days, group B). The presence of intracerebral hematoma (ICH) caused a delay in the hydrocephalus onset after endovascular treatment in terms of 11,5 days compared to microsurgical group as well the absence of vasospasm determined a delay of 13,7 days (not statistically significant). CONCLUSION: No difference in terms of hydrocephalus onset after microsurgical or endovascular treatment has been demonstrated. Only the presence of ICH or the absence of vasospasm can cause a slight delay in the time of hydrocephalus onset in the endovascular series (not statistically significant). Long-term follow-up studies involving higher numbers of subjects are needed to better demonstrate this issue.