Intradiploic meningioma of the skull. Case report and review of literature.

A case of a patient with an accidentally discovered scalp mass is presented. Radiological investigation documented an osteolytic intradiploic lesion of the cranial vault. The lesion was surgically removed and histological examination revealed a meningioma. The literature concerning these uncommon tumours of the skull is reviewed, and the differential diagnosis is discussed.

Radiologic and surgical aspects of pure spinal epidural cavernous angiomas. Report on 5 cases and review of the literature.

BACKGROUND: Cavernous angiomas (CAs) that are localized completely in the spinal epidural space are uncommon vascular malformations. Although they have increasingly been reported in the literature in recent years, diagnostic and surgical features are not clearly defined. METHODS: We report five patients with pure spinal epidural cavernous angiomas (PSECAs) and review the literature, focusing on their radiologic and surgical characteristics. We also compare these tumors with other extra-axial CAs as well as with their intra-axial counterparts. RESULTS: PSECAs, like all other extra-axial CAs, differ from intra-axial ones on MRI: the hemorrhagic variant is less frequent, hemosiderin rim is rare, the signal is different, and contrast enhancement is the rule. They are very similar to spinal meningiomas but they differ in their growth pattern and morphology, since they infiltrate intervertebral foramina and have an oval shape. In PSECA, intraoperative bleeding is rarely profuse, in contrast to other extra-axial CAs, especially those of the cavernous sinus. CONCLUSIONS: On MRI, PSECAs and other extra-axial CAs constitute a homogeneous group since they enhance significantly. At operation, since there is rarely enough bleeding to limit removal, radical excision of PSECAs can be achieved with good results.

Nonoperative treatment of cerebellar abscesses. A case report and review of the literature.

A case of a 5-year-old child presenting with a cerebellar abscess occupying the ponto-cerebellar region, who was treated with antibiotic therapy alone, is reported. Symptomatology, radiological findings, and antibiotic regimens are presented, and the literature is reviewed from the viewpoint of therapeutic management.

Infraoptic course of the anterior cerebral artery associated with an anterior communicating artery aneurysm: anatomic case report and embryological considerations

OBJECTIVE AND IMPORTANCE: An infraoptic course of the proximal anterior cerebral artery is a rare anomaly that has been reported in 32 cases to date, often in association with cerebral aneurysms. This anomaly represents a maldevelopment in the embryogenesis of the anterior circle of Willis, resulting from the persistence of the primitive prechiasmal arterial anastomosis or an error in the development of the definitive ophthalmic artery (OphA). The case of a patient with a ruptured middle cerebral artery aneurysm and an anterior communicating artery aneurysm associated with this anomaly is described, and the anatomic features are outlined. CLINICAL PRESENTATION: A 30-year-old male patient with a right temporal hematoma and subarachnoid hemorrhage was admitted to our department 4 days after the hemorrhaging episode, with normal neurological examination results. Angiography revealed a right middle cerebral artery aneurysm and an anterior communicating artery aneurysm with an anomalous precommunicating tract. INTERVENTION: The patient was surgically treated 14 days after the hemorrhaging episode, through a right frontopterional craniotomy; both aneurysms were excluded by clipping. The anomalous infraoptic proximal tract of the anterior cerebral artery was well documented, with its origin adjacent to the OphA. The patient remained neurologically intact after surgery and was discharged 8 days later. CONCLUSION: The anomalous infraoptic course of the proximal anterior cerebral artery was associated with a low bifurcation of the ipsilateral internal carotid artery and the absence of the contralateral precommunicating tract in this patient. The strict anatomic relationship with the origin of the OphA suggests an error in the development of the definitive OphA, with persistence of an anastomotic loop between the primitive dorsal and ventral OphAs. It is concluded that, for aneurysm surgery, careful angiographic evaluation and an understanding of the neurovascular relationships in the circle of Willis are essential for a successful postoperative course, especially when very rare vascular anomalies are treated.

Dumbbell-shaped hypoglossal neurinoma: surgical removal via a dorsolateral transcondylar approach. A case report and review of the literature.

A case of dumbbell-shaped hypoglossal neurinoma with intra- and extracranial extension is reported. The tumour was surgically completely removed in a one-stage operation via a dorsolateral sub-occipital transcondylar approach. Clinical presentation and the role of high-resolution CT-scan, MRI and angio-MRI in diagnosis and surgical planning are discussed. We include a review of the literature concerning these rare tumours of the foramen magnum region.

Conservative treatment of a traumatic direct low-flow carotid-cavernous sinus fistula: a case report.

A case of a 17-year-old boy presenting with a traumatic carotid-cavernous sinus fistula (CCSF), associated with an intracavernous pseudo-aneurysm, is reported. On angiography, the CCSF proved to be a direct and low-flow shunt. Conservative management was chosen and definitive closure of the fistula was obtained in two months by daily self-compression of the common carotid artery.