Extracerebral hematoma in association with dural substitute.

The authors present a patient who developed an acute hemorrhage around a Silastic dural substitute 13 weeks after excision of a meningioma and implantation of the graft. The relevant literature is reviewed.

De novo saccular aneurysms.

The authors report two patients with aneurysmal subarachnoid hemorrhage in whom carotid arteriography revealed aneurysms that had developed at previously normal locations and from infundibula during the years since initial angiography. Neither of these patients had congenital anomalies of the cerebral circulation and, apart from smoking in excess of 30 cigarettes a day, there were no common clinical features. The role of congenital and environmental factors in the formation of aneurysms and the enlargement of infundibula are reviewed.

Pleomorphic xanthoastrocytoma. Report of four cases.

Four cases of pleomorphic xanthoastrocytoma (PXA), a low-grade leptomeningeal glioma with a reported favorable prognosis affecting young patients, are reported together with a discussion and review of management and prognosis. A literature review has confirmed a favorable prognosis in at least 50% of patients with this disorder. Seventeen of 35 reported patients are still alive and often seizure-free for a mean period of 7.4 years (range 2 to 18 years) after diagnosis. Five patients have died within 2 years and four between 9 and 25 years after diagnosis of PXA. In some cases in which death followed shortly after diagnosis, there may have been histological confusion between PXA and a malignant glioma with heavily lipidized tumor cells. Nonetheless, transformation of PXA into a malignant astrocytoma or glioblastoma with eventual death may occur many years after initial diagnosis. From the currently reported cases it does not appear possible on clinicopathological grounds to predict which patients will have a favorable prognosis. Optimal management of PXA seems to be primary surgical resection with later surgery for residual or recurrent tumor. The role of radiotherapy in the management of PXA is at this time uncertain.

Craniospinal and spinal enterogenous cysts--report of three cases.

We report three cases of enterogenous cyst, one craniospinal and two spinal manifesting with features of spinal cord compression. In one the cyst was intramedullary in location and in the other two it was intradural, extramedullary. The unusual clinical presentation, location and magnetic resonance imaging (MRI) characteristics are discussed. None of the three patients had any vertebral anomaly or other congenital malformation. All patients had excellent outcome following surgery.

Tension pneumocephalus following nasal polypectomy.

Subdural tension pneumocephalus in a 80-year-old man following nasal polypectomy, presenting clinically with progressive weakness of both legs, is reported and the pathogenesis is discussed. The diagnosis of tension pneumocephalus and the options of management are considered.

Multicentric glioma presenting with hemorrhage.

We report a case of multicentric malignant astrocytoma occurring simultaneously in both cerebrum and cerebellum, presenting with hemorrhage into the cerebellar tumor. Hemorrhage into a cerebellar glioma in an adult is very rare. None of the cases of multicentric glioma described in the literature presented with intratumoral hemorrhage. This combination in our patient has prompted us to report this case and to reaffirm the need to consider the diagnosis of malignant glioma in patients with multiple intracranial tumors.

Pineal region cavernoma--case report.

A 45-year-old male presented with a rare pineal region cavernoma. Magnetic resonance (MR) imaging confirmed the preoperative diagnosis. The tumor was totally excised. The patient was subsequently cured. Analysis of 15 reported cases found a slight female preponderance. The second and third decades were the most common age group. The course of pineal cavernomas can be complicated by hemorrhage, occlusion of cerebrospinal fluid pathways, and focal neurological and neuroendocrine symptoms but no specific clinical features. However, MR imaging has high sensitivity and the specificity for the diagnosis of pineal cavernoma. Total microneurosurgical excision is the treatment of choice, and patients had an excellent outcome. Stereotactic biopsy can be potentially dangerous because of the risk of hemorrhage. The use of radiosurgery requires evaluation of long-term risks and safe dose levels. Total excision of the pineal cavernoma using microsurgical techniques is the choice of treatment in young and healthy patients since there is an increased risk of recurrent hemorrhage and progressive neurological decline. A conservative approach is preferred in older patients.

Transcallosal approach to anterior and mid-third ventricular tumors--a review of 62 cases.

Sixty-two consecutive patients with anterior and mid-third ventricular lesions were operated on by a limited anterior transcallosal approach from 1987 to 1992. Fifty-six cases were operated on by B K M. Following lateral ventricular entry, transforaminal route to the third ventricle was preferred and utilised in 44 cases. An interfornicial or subchoroidal approach was employed only if transforminal entry was not adequate and was the route in 16 and two cases respectively. Enlargement of the foramen of Monro by incising its margins was not resorted to in any case. The age of the patients ranged from six to 64 years, (mean 29 years). Males were twice as often affected as females. There were 50 benign lesions: 43 colloid cysts, two craniopharyngiomas, one arachnoid cyst and four cysts of uncertain histology, and 12 malignant tumours: eight intrinsic astrocytomas, two oligodendrogliomas, one ependymoma and one primary lymphoma. The outcome in the benign cases was excellent in 42, good in six and poor in one. There was one post-operative death due to meningitis.

Effect of temporary vascular occulsion during surgery of cerebral aneurysms.

Temporary vascular occulsion during surgery for cerebral aneurysms has been slow to gain acceptance as an elective procedure. This study presents the outcome in 115 cases in whom temporary vascular occulsion was needed during aneurysmal surgery. Elective temporary clipping was used in 55 cases and emergency temporary vascular occulsion was performed in 60 cases. Judicious use of temporary clips did not increase the overall morbidity or mortality. Rescue temporary clipping as an emergency measure inthe face of intraoperative rupture has a deleterious effect as against elective use on the immediate as well as long term outcome of the patient. Use of elective temporary clipping in conjunction with adequate cerebral protective measures in advocated indifficult cases to facilitate definitive clipping of the aneurysm in order to improve the overall outcome.

Gliomatosis cerebri--a case report.

Gliomatosis cerebri is a vary rare neoplastic lesion of the central nervous system. An intra-vitam diagnosis of gliomatosis cerebri can be suggested with a steleolactic biopsy of the lesion in conjunction with Magnetic Resonance Imaging (MRI) findings in the brain.

Intraventricular neurocytoma: a report of two cases.

Central neurocytomas are uncommon intracranial neoplasms. More than one hundred cases are documentated in the literature. In this report we describe the clinical and histopathological features in two patients with intraventricular neurocytoma. As the light microscopic features of neurocytoma resemble with that of an oligodendroglioma, it is essential to differentiate these two tumours, using either ultrastructural or immunohistochemical techniques.

Central nervous system ganglioglioma. A clinicopathologic study.

Gangliogliomas are one of the uncommon tumours of central nervous system. Since these tumours have been associated with an indolent clinical course and benign biological behaviour, it is essential to make an accurate histopathological diagnosis of ganglioglioma. In this study the salient clinical and histopathological features in six patients with intracranial ganglioglioma are described.

Granular cell tumour (choristoma) of the neurohypophysis--a report of two cases.

Granular cell tumours of the neurohypophysis are uncommon and only 30 cases are documented in the literature till 1994. In this communication, the salient clinical and histomorphological features in two patients with granular-cell tumour of the neurohypophysis are described.

Primary lymphoma of the brain.

In this study, clinical and histopathological features of primary lymphomas of the brain have been described in eight patients. The primary nature of lymphoma in these patients was confirmed by extensive clinical as well as radiological investigations and supported by a detailed histopathological examination. Computerised tomography (CT) scan showed multiple intra-cerebral lesion in two patients and in six patients the lesion was solitary. Although primary lymphoma of the brain carries poor prognosis, it is essential that these tumours should be accurately diagnosed as well as should be distinguished from secondary tumours.

Primary Ewing's sarcoma of the base of skull: a case report.

Primary cranial Ewing's sarcoma is an exceptionally rare lesion and only eleven cases have so far been reported. In this report we describe a case of primary Ewing's sarcoma arising from the floor of middle cranial fossa. Salient clinical, neuroradiological and light microscopic features in this case are described. A brief review of earlier published cases of primary cranial Ewing's sarcoma are also presented.

Nodular inflammatory mass of the dura mimicking a meningioma--a report of two cases.

Histopathological examination of surgical specimens in two patients with an operative diagnosis of meningioma, revealed the presence of dense nodular aggregation of lymphocytes, plasma cells and conspicious absence of meningothelial components. Possibilities of lymphoreticular malignancy, myeloproliferative disorders and other causes for various inflammatory diseases were excluded by appropriate investigation in these two patients. Pathogenesis of this localised lymphocyte-plasma cell aggreation in the dura manifesting as a space-occupying lesion could not be defined in these two patients. It is emphasised that this benign lesion should be recognised as well as distinguished from secondary lymphomatous deposits and solitary plasmacytoma of the dura.

Dysembryoplastic neuroepithelial tumour of the central nervous system--a case report.

Dysembryoplastic neuroepithelial tumour (DNT) of the central nervous system is a recently recognized entity. We describe the clinical and characteristic histomorphological features in a patient with DNT. As this lesion carries a favourable prognosis, it becomes essential to make an accurate histopathological diagnosis.

Nucleolar organizer regions in pituitary adenomas.

In this study, thirty-two non-functional and eighteen functional pituitary adenomas were analysed for the presence of argyrophilic nucleolar organizer regions (Ag-NORs) in paraffin sections, using an one-step silver-colloidal staining method. Differences in the mean Ag-NOR numbers of functional pituitary adenomas were statistically significant than those of non-functional pituitary adenomas. It is being emphasised that evaluation of Ag-NOR count is a more reliable index than the presence of mitotic figures in predicting the proliferative activity as well as possibility of recurrence in a patient with pituitary adenoma.