The adjustable proGAV shunt: a prospective safety and reliability multicenter study.

OBJECTIVE: To evaluate the reliability of the gravitation-assisted adjustable proGAV shunt system with a prospective multicenter study conducted in 10 German hospitals. METHODS: Enrollment for this observational study began in April 2005 and concluded in February 2006. The protocol required re-examinations 3 and 6 months postoperatively and fixed the endpoint of follow-up at 12 months after implantation. Patients with different types of adult, juvenile, and pediatric hydrocephalus were included and 165 patients were enrolled; 9 died and 12 had incomplete follow-up. RESULTS: Of the assessable 144 patients, 130 completed the protocol after 12 months, whereas 14 failed because of the need to explant the device, mainly because of infection. In 12 patients, components of the shunt, not the valve, were revised. In 65 of the 144 patients, there were 102 readjustments of the valve in 67 incidences because of underdrainage and in 35 because of overdrainage. In 1 case, readjustment was not possible. Determination of pressure level with the verification instrument was safe and corresponded to the required x-ray controls after adjustments. No unintended readjustments were noted. CONCLUSION: The proGAV is a safe and reliable device.

Collision tumor of meningioma and malignant astrocytoma.

The authors report a 12-year-old boy who was presented with headache, nausea, vomiting and seizure. His magnetic resonance imaging showed 2 adjacent tumors in the region of the left ventricular trigone. The pathology of tumors reported collision tumors composed of meningioma and malignant astrocytoma.

Intraneural perineurioma of the VIIIth cranial nerve: case report.

OBJECTIVE: The authors describe the clinical and pathological features of the second reported case of an intraneural perineurioma involving a major intracranial nerve and the first case of this entity involving the VIIIth cranial nerve. CLINICAL PRESENTATION: A 59-year-old woman presented with a long history of dizziness, tinnitus, hearing loss, and unstable gait. A magnetic resonance imaging scan revealed a small intrameatal lesion, which showed no clear progression from 2000 to 2006. INTERVENTION: As a result of worsening symptoms and a suspected vestibular schwannoma, an attempt of tumor resection through a retrosigmoid approach was performed. This revealed diffusely infiltrated and fusiform enlarged vestibular and cochlear nerves, with no identifiable border between the main tumor mass and normal nerve. An en bloc nerve-tumor mass excision was performed. The pathological findings confirmed the diagnosis of an intraneuronal perineurioma. CONCLUSION: The experience with this unique case and the experience of others with the management of extracranial intraneural perineuriomas lead the authors to conclude that the most reasonable surgical management of this tumor at this location is a nerve-tumor cross-section resection.

[Micro anatomy of the cavernous sinus]. / Mikroanatomie des Sinus cavernosus.

PURPOSE: The surgical anatomy of the human cavernous sinus has been described by several authors. A clearer understanding of the anatomy of the cavernous sinus has resulted in an increased interest in surgical approaches to this region. Regarding the anatomical concept of the cavernous sinus previous descriptions should be revised. METHODS: In our study, 35 skull-base blocks including both cavernous sinuses were investigated. RESULTS: There is considerable reason that the lateral wall of the cavernous sinus is covered by a "medial temporal dura layer" attached to the leptomeningeal pockets of the cranial nerves III-V1+2. There is no significant constance of the internal carotid artery within the cavernous sinus. All cranial nerves adjacent to or traversing the cavernous sinus are embedded within a leptomeningeal sheath similar to a pocket. The abducent nerve traverses a venous space, which should be named "petroclival venous confluence" rather than Dorello's canal. The extremely variable cavernous space is covered by a one-layer cell line. There is no evidence of any venous-plexus structure. Fibrose bands (trabecle) are present in different numbers.

Intracranial follicular dendritic cell sarcoma. Case report.

Intracranial occurrence of follicular dendritic cell (FDC) sarcoma, a rare tumor derived from dendritic cells of the lymphoid follicle, has not yet been described. Therefore, the case of a 53-year-old man presenting with an intracranial mass invading the clivus is reported. The diagnosis of FDC sarcoma was confirmed by immunohistochemical staining for dendritic cell markers, that is, CD21, CD23, and CD35. Due to some similarities with meningioma, intracranial FDC sarcoma might be an underdiagnosed disease.