Conservative management of spontaneous posterior fossa subdural hematoma in a neonate.

Symptomatic intracranial hemorrhage in term neonates is uncommon, and is usually secondary to trauma, coagulation disorders and/or hypoxia. Posterior fossa hemorrhage in the neonate is a rare neurosurgical emergency and is usually associated with the same etiological factors. Diagnosis is with computed tomography and magnetic resonance imaging. We present a spontaneous posterior fossa subdural hematoma in a term neonate and discuss conservative management.

Giant cranial extradural primary fibroxanthoma: a case report.

Primary fibroxanthoma of the cranium is an extremely rare condition. Xanthomatous tumors of the central nervous system are occasionally associated with diseases such as Hand-Schuler-Christian disease, malignant fibrous histiocytoma, hyperlipidemia, and a complication of metabolic or storage disorders. However, until 2003, only a few cases of primary fibroxanthoma have been reported. We report a giant fibroxanthoma destroying the lateral skull base unaccompanied by a systemic or metabolic disease.

Clinical course of spontaneous spinal epidural haematoma mimicking Guillain-Barré syndrome in a child: a case report and literature review.

We describe a 9-year-old female with thoracic epidural haematoma. The clinical course simulated Guillain-Barré syndrome (GBS) so intravenous immunoglobulin therapy was started at the paediatric clinic. Magnetic resonance imaging (MRI) 3 days after admission showed thoracic epidural haematoma between T2 and T8. An emergency laminectomy was performed and the patient's neurological symptoms began to improve immediately after surgery and she made a full recovery during the 2 weeks of follow-up. Time is a very important factor in achieving reversibility of symptoms of compressive cord lesions, such as spinal epidural haematoma, and MRI is mandatory for patients with progressive paraplegia, even though the signs and symptoms might suggest GBS.

Intracavernous carotid artery aneurysms.

Six patients with intracavernous carotid artery aneurysms (ICCAAns) were seen at our department from 1998 to 2002. All patients had only one intracranial aneurysm and their ages at diagnosis ranged from 36 to 72 years (median 56). Five were women and four had a history of hypertension. One patient was pregnant. All of the ICCAAns were symptomatic at diagnosis. Duration of symptoms was 2-30 days. On admission to our department, initial symptom was headache in four patients, visual loss in two, eye pain in one, third nerve paresis in two and subarachnoid hemorrhage (SAH) in one. Spontaneous thrombosis was present in two patients. All of the ICCAAns were saccular. Computed tomography (CT) was superior when compared with magnetic resonance imaging (MRI) for diagnosis of ICCAAns on admission. Angiography remains the gold standard for diagnosis and determination of specific anatomical details, which are necessary to plan treatment.

Intratumoral haemorrhage: a clinical study.

Although the incidence of spontaneous intracranial haemorrhage associated with meningioma is 1.3%, the incidence of intratumoral haemorrhage could not be determined. The authors report on 11 patients, six men and five women, with meningiomas that presented as spontaneous intratumoral haemorrhage, among 126 meningioma cases which were evaluated radiologically and histopathologically. The average age of patients was 58.9 years (range 45-72 years). Two (1.5%) cases showed radiological, and nine cases (7.9%) showed microscopic bleeding. Most of these cases also showed microcysts (9.7%) and necrosis (6.3%). The location, histopathological types, sex, age, blood dyscrasia, hypertension do not influence the occurrence of intratumoral haemorrhages in meningiomas. We concluded that microcysts and necrosis are important in the occurrence of intratumoral haemorrhage in meningiomas.

Giant cystic primary cerebral neuroblastoma in a child and solid primary cerebral neuroblastoma in an adult: two case reports.

Primary cerebral neuroblastoma is a rare entity in neurosurgical practice. They occur primarily in young children and are extremely rare in adults. Primary cerebral neuroblastoma is one of a group of highly malignant undifferentiated primitive neuroectodermal tumours arising from germinal matrix cells of the embryonic neural tube. They are difficult to diagnose preoperatively and pathologically. We present two cases of primary cerebral neuroblastoma.

Spontaneous thrombosis of vein of Galen aneurysmal malformation after ventriculoperitoneal shunting.

Aneurysmal dilatation of the vein of Galen (AVG) is a common finding in vascular malformations that involve the Galenic system and spontaneous thrombosis is very rare. Although the presentation of the cases may differ with the age, the mortality and morbidity is high in all age groups. Here, we present a case of AVG in a six-month-old boy. The patient underwent insertion of a ventriculoperitoneal shunt. Surveillance of the lesion with subsequent MRI revealed spontaneous thrombosis of the AVG with excellent clinical outcome. Proposed mechanisms of spontaneous thrombosis include slow flow shunts, obstruction of the venous outflow or obstruction of the feeding artery. The case is discussed with the relevant literature.

Shunt dysfunction due to calcification of a ventriculo-peritoneal shunt: a case report.

Calcification and related dysfunction of ventriculo-peritoneal shunts are rare events in neurosurgical practice. Shunt calcification causes shunt dysfunction in two ways, namely disconnection and obstruction. We present a 16-year-old girl with shunt malfunction due to disconnection secondary to calcification. The shunt tubing fractured during attempted removal and some of the remaining components, including the ventricular catheter, had to be left in situ. The shunt was revised and the patients symptoms resolved. Replacement of the calcified and perished shunt components with a new shunt is essential. Aggressive surgical manipulation for removal of the remaining shunt components is not advisable as this may increase morbidity and mortality.

Ligamentum flavum cyst.

INTRODUCTION: Although magnetic resonance imaging (MRI) of ligamentum flavum and other spinal cysts have been well described, the role of contrast enhancement in this diagnosis has been neglected. We describe such a case and correlate the MRI findings with the histopathology. CASE REPORT: A 71-years-old woman was admitted with of neurogenic lumbar claudication. X-rays of the lumbar spine showed degenerative changes with scoliosis. Lumbar magnetic resonance imaging demonstrated a L3/4 extradural cystic mass. An L3 laminectomy was performed and the mass excised. The histopathological diagnosis was consistent with a ligamentum flavum cyst. Postoperatively, the patient's symptoms resolved completely. CONCLUSION: The possibility of a ligamentum flavum cyst should be considered whenever a hyperintense extradural mass with a peripheral hypointense rim on T2 weighted and slightly contrast enhanced peripheral rim on T1 weighted MRI is identified in a patient with degenerative changes of the lumbar spine.

Clear cell meningioma: case report and literature review.

The clear cell meningioma is rare and a recently described histologic variant of meningioma. The most interesting aspect of clear cell meningioma is the high recurrence rate and agressiveness. Until now 17 intracranial clear cell meningioma cases had been reported in the English language literature. We present 2 new cases of clear cell meningioma which is discussed with the relevant literature.

Solitary plasmacytoma with intracranial intraorbital and, paranasal sinus extension.

Intracranial solitary plasmacytomas (ICSPs) are extremely rare tumours in neurosurgical practice, and are often misdiagnosed preoperatively. Here we present a solitary intracranial plasmacytoma with orbital, nasal and paranasal sinus extension. A subtotal excision of the tumour was performed and the complete response was seen after postoperative radio-chemotherapy. The neuroradiological and neurosurgical features of the case are discussed with the pertinent literature.

Posterior epidural migration of lumbar disc fragments: report of three cases.

STUDY DESIGN: Report of three cases. OBJECTIVES: To describe a rare location of intervertebral disc migration. SUMMARY OF BACKGROUND DATA: Migration of sequestered disc fragments to the posterior extradural space is rare, and posterior migration of the free fragments causing cauda equina syndrome is exceptionally rare. METHODS: Three patients with posteriorly migrated epidural disc fragments were evaluated with radiograph, computed tomography, and magnetic resonance imaging and underwent surgery. RESULTS: All of the patients responded well to operative therapy with complete relief of symptoms. CONCLUSIONS: Early surgery should be the first choice of therapy in patients with large posteriorly migrated sequestered disc fragments, to prevent severe neurologic deficits such as cauda equina and conus medullaris syndromes.

Primary parenchymal cerebral cystic haemangiopericytoma: a 5-year follow up of disease progression.

Haemangiopericytoma (HPC) is a rare tumour of the central nervous system. Previously, HPCs were thought to originate from meninges and ventricular walls. Currently, they are accepted as distinctive mesenchymal neoplasms unrelated to meningiomas. Imaging appearances, clinical progression and haemorrhage into a cystic tumour is documented in an 18-year-old man where the final diagnosis, with histopathological verification, proved to be a cystic HPC. This interesting and illustrative case is discussed with the relevant literature.