[Vagoglossopharyngeal neuralgia]. / Nevralgia vagoglossofaringea.

Review of current opinions concerning clinical presentation, etiology, differential diagnosis and management of vagoglossopharyngeal neuralgia. Three cases are reported, treated by intracranial section of n. IX (alone in one case) and upper rootlets of n. X. In two patients no vascular compression of the nerves was observed. In one case an atheromatous elongated basilar artery was observed compressing and deforming the medulla oblongata at the entry zone of nerves IX-X. In this case, pain paroxysms recurred some weeks after surgery, and the patient underwent re-operation (microvascular decompression of the medulla) with good outcome. Clinical implications of the complex sensitive innervation of profound regions of the face and cervicofacial region are emphasized. Certain circumstances, such as gustatory pain due to sympathetic denervation of parotid gland, the neck-tongue syndrome and oropharyngeal pain by irritation of the first cervical spinal nerve (during lateral suboccipital puncture), point to the fact that in this region similar symptoms may be provoked by mechanisms involving different peripheric pain pathways. The theory of microvascular compression in the pathogeny of cranial nerve "hyperactive" dysfunctions is critically commented.

[Brief comments on the pathogenesis of spinal cysticercosis]. / Breve comentário sobre a patogenia da cisticercose espinhal.

The spinal forms of neurocysticercosis are rather rare. The more common presentation is the leptomeningeal form. We have reported two patients with an exclusively spinal involvement verified through surgery. The current theory of downward migration of the parasites from the cerebral to the spinal subarachnoid space cannot explain primary spinal forms, and it is suggested that retrograde flow through the epidural vertebral veins provides an alternative route.

[Cystic meningioma]. / Meningiomas císticos.

Cystic meningiomas are uncommon lesions. CT image may simulate a glial or a metastatic tumor with cystic or necrotic changes. The correct radiological evaluation and the recognition of this kind of tumor are important for surgical treatment since they are potentially curable neoplasms. In this paper the authors report their experience with the treatment of three cases of cystic meningiomas, and discuss some characteristics of these lesions.

[Brain metastasis of malignant melanoma. Analysis of 13 cases]. / Melanomas metastáticos intracranianos. Análise de 13 casos.

The authors present a retrospective review of 13 patients with the diagnostic of intracranial metastatic malignant melanoma. Their ages ranged from 28 to 84 years. The time interval from diagnosis of primary tumor to development of cerebral metastases ranged from 6 to 60 months. There was preoperative evidence of extracranial disease in 9 patients. All patients underwent craniotomy, and the 30-day mortality was zero. The patients survived 2 to 55 months after surgery. Medium survival time for all patients was 14 months. The excision of metastatic melanoma from the brain, although not curative, may increase survival in patients with this metastatic cancer. The criteria for consideration of surgery, radiotherapy and chemotherapy are discussed.

[Malignant course of a ganglioglioma: case report]. / Evolução maligna de um ganglioglioma. Relato de caso.

We present the case of a 8-years-old boy, admitted with a history of headache, nausea and vomiting. Cerebral angiography showed a non-vascular mass on frontal lobe. The patient underwent craniotomy and the lesion was removed. Neuropathological study revealed that the tumor was a ganglioglioma. The patient received pos-operative radiotherapy. On follow-up, 16 years after, a computed tomographic scan showed a recurrence of the tumor, and a second surgery revealed a glioblastoma multiform. Gangliogliomas are rare tumors of the central nervous system containing neoplastic ganglion cells and low grade neoplastic glial cells. The malignant degeneration occurs only in the glial component, so the prognosis of these tumors is related to the grade of that component.

[Dura mater displacement in lateral cisternal punctures]. / Observações sobre o deslocamento da dura-máter nas punções cisternais laterais.

Report of an anatomic study of the lateral cisternal punctures (at the atlanto-occipital and C1-2 interspaces), carried out on fresh cadavers. Direct visualization of the internal surface of the dura mater (DM) at the cranio-cervical junctions was possible by removing the calvarium and brain (sectioned at the upper cervical spinal cord). Dislocation ("tenting") of the DM over the needle was observed in all occasions (n = 42), measuring 3.46 mm (2-6 mm).

[Lumbosacral neoplastic radiculopathy]. / Radiculopatia neoplásica lombossacral.

Lumbar-disc protrusions (LDP) constitute well-defined syndromes on clinical and anatomical grounds, and neurosurgeons are prone to rely upon the clinical signs to identify the level of disc protrusion when a "typical" case is found. Sometimes, non-contrasted computerized tomographic (CT) scans centered on the L5-S1, L4-L5 and L3-L4 interspaces and spine roentgenograms are the only special ancillary means in presurgical evaluation. We report three patients from our series, in which neoplastic spinal disease presented as classic LDP (one patient with a cauda equina schwannoma, and two with metastatic carcinoma). The cases were chosen because they posed special problems to the referred radiodiagnostic routine. Systematic CT-evaluation of the sacrum and conus medullaris zone is recommended in every patient with lumbosacral radiculopathy, and intrathecal contrast should be employed in patients with unreliable findings or normal CT-scans.

[Giant intracranial aneurysm in a 9 year-old child. Case report]. / Aneurisma intracraniano gigante em criança de nove anos. Relato de caso.

The case of a 9-year-old girl with intracranial hemorrhage due to a giant aneurysm of distal middle cerebral artery is reported. Cerebral aneurysms are rare in children, particularly in the first decade of life. Aneurysms in childhood occur more frequently in peripheral branches and they are more often giant in size. Clinical features and pathogenesis of this lesion are discussed.

[Pure spinal leptomeningeal cysticercosis]. / Cisticercose espinhal leptomeníngea pura.

An adult female patient presented with an exclusively spinal leptomeningeal infestation by cysticercosis (restricted to the cauda equina), verified in surgery. The rôle of the vertebral vein system in the spread of cysticercosis larvae is discussed. A commentary on the possibility that cysticercosis of the basal cisterns may be due to ascending migration of primarily spinal cysticerel, as originally proposed by Isamat de la Riva, is stated.

An arachnoid cyst extending above and below the foramen magnum.

A case of progressive bulbar and long tract symptoms with hydrocephalus of eleven years duration in a 23-year-old man, in whom an arachnoid cyst of the cisterna magna cerebellomedullaris was disclosed at operation.

Breve comentário sobre a patogenia da cisticercose espinhal / Brief comments on the pathogenesis of spinal cysticercosis

A hipótese de que embriöes cisticereóticos possam alcançar os espaços subaracnóideos espinhais por migraçäo descendente a partir de espaços intraxcranianos previamente infestados näo é compatível ao acometimento leptomeningeo espinhal primário, que observamos em duas pacientes. É sugerido que nesses casos os embriöes invadem o sistema nervoso central através do fluxo sangüíneo retrógrado pelo plexo venoso vertebral interno e veias intervertebrais, e que o compartimento intracraniano do líqüido cefalorraqueano possa ser secundariamente invadido pelos cisticercos

Meningiomas císticos / Cystic meningiomas

A ocorrência de meningiomas císticos é incomum. As imagens destas lesöes obtidas pela tomografia computadorizada de crânio (TC) podem lembrar lesäo cística de origem glial ou metastática, sendo necessário realizarmos, além da TC, angiografia cerebral e ressonância magnética do crânio para firmarmos diagnóstico correto pré-operatório. O diagnóstico incorreto de glioma pode resultar em tratamento paliativo, ao invés da remoçäo radical desta neoplasia potencialmente curável. Três casos säo relatados, ilustrando o problema

Cisticercose espinhal leptomeníngea pura / Pure spinal leptomeningeal cysticercosis

Relato de um caso com verificaçäo cirúrgica de cisticercose espinhal, forma leptomeníngea restrita à cauda eqüina, em paciente adulto. E discutido o papel do sistema venoso vertebral na infestaçäo dos espaços subaracnóideos na neurocisticercose, originando formas clínicas primariamente espinhais