Case report: An epidural cavernous hemangioma mimicking a dumbbell-shaped neuroma.

INTRODUCTION AND IMPORTANCE: Spinal epidural cavernous hemangiomas are a rare occurrence. This particular case is made even more distinctive by the fact that the lesion mimicked a dumbbell-shaped neuroma. Moreover, it had a very unique localization (wholly epidural, at cervical-thoracic -C7-D1- level). The importance of this case is linked not only to its remarkable rarity, but also to the diagnostic avenues explored. The surgery was carried out by Prof. Riccardo Caruso, Head of the Neurosurgical Department of the Military Hospital of Rome and Professor of Neurosurgery of Sapienza University of Rome, assisted by Dr. Luigi Marrocco, Senior Neurosurgeon of the Military Hospital of Rome. Postsurgical recovery was managed by Dr. Venceslao Wierzbicki, Senior Neurosurgeon of the Military Hospital of Rome. CASE PRESENTATION: In 2020, a 71 year-old man, suffering from intense pain in the left scapular region and in the ulnar area of the left forearm, underwent surgery for the removal of a spinal epidural cavernous hemangioma involving the left C7-D1 foramen. Prior to surgery, the lesion had been misdiagnosed as a neuroma by a radiologist. CLINICAL DISCUSSION: In the Literature there are other, rare cases of hemangiomas partly located in the spinal canal, and partly located intra and extra foramen. In the case here presented, differential diagnosis as well as a potential Schwannoma, suggested by the dumbbell shape of the lesion, should have considered also the possibility of a meningioma. Two teams of radiologists examined the images, the radiologists of our team, Dr. Valentina Martines and Dr. Emanuele Piccione, thanks to a close inspection of the features of the lesion, postulated the extra-dural position. Other aspects of the scans were then analyzed to help guide future diagnosis of similar lesions. CONCLUSION: With a spinal tumor affecting the foramen, a close examination of the images allows for accurate presurgical differential diagnosis, differentiating between the more frequent neuroma and other rarer tumors, such as a hemangioma.

A Forgotten Tale from the Great War: General Lorenzo Bonomo and the Birth of Italian War Neurosurgery.

Little is known of the advances in battlefield medicine achieved in Italy before and during the Great War. Some deserve wider recognition; this is especially true for the field of neurosurgery. There are a limited number of historical records currently available, fewer still in English, and most of the systematic investigations on field surgery have been in the form of monographs within science history reviews, which obviously lack a strictly clinical perspective. Together with shell shock, the gunshot-related traumatic brain injury (GrTBI) is considered one of the typical, or signature, lesions of the Great War. It was intrinsically linked to trench and mountain warfare: to view the battlefield from a trench/hiding area, soldiers' heads and necks were repeatedly exposed, therefore making them the most likely target for snipers. Military physicians therefore focused their efforts in the clinical and experimental treatment of GrTBI. Among notable contributions of the military surgeons of the time, there is a volume of selected war-surgery lectures conserved in the archives of the Library of the Italian National Academy of Military Medicine. These lectures shed light over the work of General Dr. Lorenzo Bonomo. His incredibly advanced and modern ideas had unfortunately been forgotten. He pioneered research in the ballistic and forensic medical fields, building on first-hand experience, as he performed surgeries himself before the conflict and even while on the frontline, actively working to improve the chances of survival for the Italian troops fighting in the Great War.

A primary intraosseous cystic meningioma: Case report.

INTRODUCTION: This is a very rare case of intraosseous cystic meningioma. There have been no reports of similar cases in the last 30 years. PRESENTATION OF CASE: A 62-year-old man, suffering from a swelling of the lateral wall of the left orbit was admitted to our hospital. MRI and CT scan showed a large intradiploic lesion involving the lateral wall of the orbit and the greater wing of the sphenoid. The lesion was cystic with a mural nodule. We operated the patient and removed completely the mural nodule and the fibrous wall of cyst. Histological examination showed that the mural nodule was a benign meningothelial meningioma. DISCUSSION: Primary intraosseous meningiomas represent a subtype of primary extradural meningiomas; they comprise about 2% of all meningiomas and are therefore rare entities. Cystic meningiomas are rare, their incidence compared to all other types of meningiomas is of 2-4%. The presence of a meningioma with both characteristics: cystic and intraosseous, like in our case, is an exceptional occurrence. CONCLUSION: The surgical management of tumor was easy; its rarity means that the case is interesting.

Cerebellar hemisphere herniation in the neck: Case report of a very rare complication following a posterior fossa craniectomy.

This article presents a very rare late complication of surgery to the posterior fossa involving a craniectomy: cerebellar hemisphere herniation in the neck, through the craniectomy site. Here we also analyse the possible causes of such complication.

Surgical Approach to the Cavernous Sinus for a Trigeminal Schwannoma Resection: Technical Note and Case Report.

We report a rare case of schwannoma of the lateral wall of the cavernous sinus, an exceedingly rare lesion affecting this anatomical district, and discuss salient aspects of the surgical approach to the cavernous sinus, which are traditionally considered technically challenging due to the high risk of postoperative morbidity and mortality related to the presence of the cranial nerves and internal carotid artery.

Ancient Schwannoma of the Cauda Equina: Our Experience and Review of the Literature.

Ancient schwannomas (AS) are exceedingly rare variant of common schwannomas (CS). Only two cases involving the cauda equina region have been previously reported in literature. AS are typically associated with a higher histological degree of degenerative changes (Antoni B areas). It is of peculiar importance, according to our opinion, to outline that, because of their extremely slow growth (which explains the increase of the degenerative changes in respect to the CS) and their typical soft consistency in respect to their standard counterparts, AS usually imply an even better prognosis.

Supratentorial endodermal cysts: review of literature and case report.

Supratentorial endodermal cysts are very rare pathological entities. Their pathoembryology is largely unknown and they can represent a diagnostic challenge. A research performed on the PubMed database in December 2010, to screen for supratentorial endodermal cyst studies, demonstrated that since 1960 only 31 supratentorial endodermal cysts have been described in the literature, including our case: a 42-year-old woman with a parasellar endodermal cyst. These lesions are usually benign. As with other types of brain cysts, the signs and symptoms caused by supratentorial endodermal cysts are mainly linked to the compression or irritation of surrounding neural structures. Upon neuroimaging examination, they typically appear as a round or lobulated mass. The signal intensity may vary depending on the protein content of the cyst. The majority of reported supratentorial endodermal cysts were completely excised with good or excellent results. Incomplete excision can result in an increased risk of recurrence, infection, and dissemination.

Intramedullary melanocytoma: case report and review of literature.

We report on a very rare case of dorsal intramedullary melanocytoma in a 62-year-old man. The tumor was resected and gross total removal was achieved. During a 2-year follow-up period in which no radiotherapy was given, the tumor did not recur. We review the literature on these tumors and present disease criteria to distinguish melanocytoma from primary malignant melanoma. Patients and investigators should be cautioned that an intramedullary melanocytoma may recur and give rise to metastatic spread via the cerebrospinal fluid.