Late-Onset Cervical Pseudomeningocele Following Ossification of the Posterior Longitudinal Ligament Surgery Successfully Treated With a Lumboperitoneal Shunt.

Pseudomeningocele (PMC) is a rare complication of anterior cervical procedures resulting in pain, headaches, nerve root entrapment, and in rare cases, spinal cord compression. Here we present a 57-year-old male with increasing myelopathy due to late-onset PMC that developed two years following a 360-degree cervical surgery for ossification of the posterior longitudinal ligament (OPLL). In this case, the PMC was successfully treated with a lumboperitoneal shunt. A 57-year-old male presented with worsening symptoms and signs of cervical myelopathy. He had undergone a multilevel anterior corpectomy/fusion (ACCF), along with posterior fusion, two years earlier for severe ossification of the posterior longitudinal ligament (OPLL). Now presenting with increased myelopathy, his cervical spine MRI demonstrated a PMC in the perivertebral space, extending to and compressing the anterior cervical cord. Following a lumboperitoneal shunt insertion, the patient's myelopathy resolved.  Acute, subacute, or chronic postoperative cervical pseudomeningoceles (PMC) may be readily managed with a lumboperitoneal shunt insertion.

Low-grade oligodendroglioma of the pineal gland: a case report and review of the literature.

BACKGROUND: Gliomas are a very rare subtype of pineal region tumours, whereas oligodendrogliomas of the pineal region are exceedingly rare, since there have been only 3 cases of anaplastic oligodedrogliomas reported this far. METHODS-RESULTS: We present a case of a low-grade oligodendroglioma arising in the pineal gland of a 37 year-old woman. The patient presented with diplopia associated with a cystic pineal region mass demonstrated on MRI. Total resection was performed and histological examination showed that the cystic wall consisted of tumour cells with a central nucleus a perinuclear halo and minimal pleomorphism. Immnunohistochemical analysis showed that these cells were diffusely positive for CD57, and negative for GFAP, CD10, CD99, cytokeratins, neurofilaments and synaptophysin. FISH analysis was performed in a small number of neoplastic cells, which were not exhausted after immunohistochemistry and did not reveal deletion of 1p and 19q chromosome arms. However, the diagnosis of a low grade oligodendroglioma of the pineal gland was assigned. CONCLUSION: Although the spectrum of tumours arising in the pineal gland is broad, the reports of oligodendrogliomas confined to this location are exceedingly rare, and to the best of our knowledge there is no report of a low-grade oligodendroglioma. However, they should be added in the long list of tumours arising in the pineal gland.

Brain CT scan indexes in the normal pressure hydrocephalus: predictive value in the outcome of patients and correlation to the clinical symptoms.

The aim of this study is to find out the correlation of the ventricular size of the brain, as it is estimated using brain computed tomography (CT) scan indexes in patients with normal pressure hydrocephalus (NPH), to: a) the clinical symptoms, and b) the results of cerebrospinal fluid (CSF) shunting procedures. We looked for any predictive value in the estimation of brain CT scan indexes, in patients as above, in whom a shunt is going to be placed. It is well known that it is very difficult to decide who is going to improve after shunting. We studied 40 cases of patients with the diagnosis "NPH" in whom the ventricular shunts were placed. Every symptom (motor disturbance, deficit of memory, incontinence) was separately evaluated preoperatively. The outcome of shunting was also evaluated and the patients were graded. The following CT scan indexes were estimated from the preoperative CT scans of the brain in every case: the ventricle-brain ratio (VBR), the bi-caudate and bi-frontal ratios, the third ventricle-Sylvian fissure (3V-SF) ratio, and the four largest cortical gyri. The method we have used for statistics is "one way analysis of variance", correlating the CT scan indexes to the symptoms of the patients preoperatively, and the outcome of them postoperatively. The main conclusion is that the size of the lateral ventricles of the brain preoperatively is not correlated to the outcome after CSF shunting surgery, but it is correlated to the symptoms of NPH preoperatively.