Congenital inclusion cysts of the anterior fontanelle.

BACKGROUND: Congenital inclusion cysts of the anterior fontanelle are rare lesions. Both dermoid and epidermoid cysts are located in the midline of the scalp and occupy the subgaleal space. METHODS: We report 7 cases, 4 boys (57.1%), and 3 girls (42.9%), with ages ranging from 3 months to 16 years (mean 40.85 +/- 68.56 months; median 10 months). Four patients (57.1%) were white and 3 (42.9%) were Afro-Brazilian. RESULTS: The cysts had manifested soon after birth in all patients. They gradually enlarged, with no intracranial extensions. Four patients had dermoid cysts and the others had epidermoid cysts. All of them underwent surgery with complete excision of the cyst and no capsular rupture. There were no complications and no deaths. CONCLUSIONS: Congenital inclusion cysts of the anterior fontanelle are rare lesions that usually manifest at birth. The diagnosis is usually easy and surgery is mandatory, with a good prognosis. Recurrence is rare.

[Ganglioglioma of the pineal region: case report]. / Ganglioglioma da região da pineal: relato de caso.

Ganglioglioma are tumors presenting neoplastic glial cells and nerve cells, very rarely found in the pineal region. Only eight cases have been previously published in the literature. We present the case of a 14 years-old male patient with a ganglioglioma of the pineal region. The patient was treated surgically by a suboccipital transtentorial approach with complete removal. Histopathologic specimens with immunostaining revealed a ganglioglioma grade I. We conclude that these tumors are rare and should be treated surgically aiming total remove. If it is not possible or in case of reocurrence the patient should be followed and radiotherapy could be considered.

[Lipoma of the cerebellopontine angle: case report]. / Lipoma do ângulo pontocerebelar: relato de caso.

Lipoma of the cerebellopontine angle is a very rare tumor. We report the case of a 14-years-old female, with left side deafness during three years, associated with headache. CT scan showed an hypodense mass, without enhancement at the cerebellopontine angle. The patient was treated surgically by left retrosigmoid approach. The lesion involved the eighth and seventh cranial nerves and only a partial removal was performed. The postoperative course was uneventful. She had no more headache; the deafness of the left side remained unchanged. Asymptomatic lipoma of the cerebellopontine angle can be treated conservatively, although those with progressive symptoms should be treated surgically, with total or partial remove based on their neurovascular involvement.

[Cavernoma of the lateral ventricle: case report]. / Cavernoma do ventrículo lateral: relato de caso.

UNLABELLED: Cavernous malformations are uncommon lesions that are usually present in the cerebral hemispheres. They occur rarely in the ventricular system, and even more rarely in the lateral ventricle. Only 28 cases have been previously reported in the literature. CASE: We present one case of lateral ventricle cavernoma in a 15-years-old female patient, who suffered of mild chronic headache for 8 months, followed by two episodes of sudden intensive headache and stupor with complete recovery after 48 hours. CT scan was performed and revealed a voluminous size, hiperdense mass in the frontal horn of the lateral ventricle. The surgical access to site was through transcallosal interhemisphere approach. The patient had a good recovery without complications. CONCLUSION: Although lateral ventricle cavernomas are rare they should be considered in the differential diagnosis of intraventricular tumors. A wrong preoperative diagnosis has sometimes induced a wrong therapy, such as radiotherapy, for these surgically curable benign lesions.

[Carotid body tumors: review of 8 cases and surgical approach]. / Tumores do corpo carotídeo: revisão de oito casos e abordagem cirúrgica.

Carotid body tumors are rather uncommon. Even though there is a great amount of literature on the subject, the controversy regarding its biological behavior and therapeutics and mainly, the surgical management still remains. We present eight patients with carotid body tumors (total of 9 tumors, one bilateral) surgically treated at the Neurosurgery Department of Santa Casa in Belo Horizonte, from 1989 to 1999. The age ranged from 11 to 66-years-old (35,6+/-17.7). Four patients were women and four were men. We had satisfactory postoperative results with low morbidity and no deaths. Based on our experience and on the review of the literature, some aspects of this disease are discussed. We conclude that carotid body tumors are uncommon and should be treat with carefully surgery techniques to obtain low morbi-mortality rates.

[Giant cervical disc herniation: case report]. / Hérnia de disco cervical gigante. Relato de caso.

Disc herniation occurs commonly in neurosurgery. The Neurosurgery Department of Santa Casa de Belo Horizonte in 1997 had 17% of all surgeries for disc herniation and 7% of those were of cervical spine. We report a giant cervical disc herniation C4-C5 in a 72-year-old male patient, presenting with tetraparesis, sensory loss below C5 and urinary retention, who underwent microsurgical anterior decompression and internal fixation with iliac bone graft without plate fixation according Cloward. The patient had a satisfactory outcome. We propose a new classification for disc herniation according the dural compression: small (until 12%), medium (12 to 25%), big (25 to 50%) and giant (more than 50%).

[Tumor of ceruminous gland with intracranial invasion: case report]. / Tumor de glândula ceruminosa com invasão intracraniana: relato de caso.

Ceruminous glands are modified apocrine glands, confined to the skin lining of the cartilaginous part of the external auditory meatus. Tumors arising from these glands are rare. Controversy exists regarding the term "ceruminoma". Actually this neoplasia should be classified as adenoma, adenocarcinoma, adenoid cystic carcinoma and pleomorphic ceruminous adenoma. We report a 39-year-old woman first seen at Santa Casa of Belo Horizonte, in 1998, presenting with headache, nausea, vertigo, hearing loss and tinnitus on the right for the past two years. CT scan showed a tumor eroding cartilaginous and bony limits with intracranial invasion. She was submitted to multidisciplinary treatment with surgery followed by radiotherapy (6000 cG). Histology showed a ceruminous adenoid cystic carcinoma. The patient manifested a right peripheral facial palsy and had no recovery of the previous deficits. After one year from surgery she is clinically stable.

[Intramedullary cysticercosis: case report]. / Cisticercose intramedular. Relato de caso.

Cysticercosis is the most ordinary parasitary disease involving the nervous system. The involvement of the spine is rare, ranging from 0.7% to 5.8%, and the intramedullary incidence is rather uncommon. We report the case of a 52-year-old female patient with intramedullary cysticercosis at the C4-C5 level, treated at the Neurology and Neurosurgery Service of Santa Casa de Belo Horizonte. The patient was operated with the complete exeresis of the lesion and had a good outcome. Forty-five cases of intramedullary cysticercosis were found in the literature review. We conclude that although it is a rare pathology, intramedullary cysticercosis should be included in the differential diagnosis of intramedullary lesions, mainly in cases of patients with previous diagnosis for neurocysticercosis and also of those who live in endemic areas.

[Management of arterial hypertension in patients with acute ischemic stroke]. / Manejo da hipertensão arterial na isquemia cerebral aguda.

PURPOSE: We aimed with study to assess the current clinical practice about the management of high blood pressure in patients in the acute phase of ischemic stroke. We also comment some topics of ischemic stroke treatment. METHODS: A case report of a patient admitted 8 hours after onset of ischemic stroke and with blood pressure of 186 x 110 mmHg was presented to 120 surgeons and clinician. They were asked to decide the best therapeutic option: to increase, decrease or maintenance blood pressure. RESULTS: Thirty-eight physicians (31.7%) considered decreasing blood pressure the best therapeutics, 82 (68.3%) considered maintenance and none decided to increase it (p < 0.05). There was no difference between the two specialties conduct. The physicians, with more than 10 years of graduation, had a tendency to decrease the blood pressure (p < 0.05). CONCLUSION: The maintenance of blood pressure may present a sufficient blood support to compensate brain flow. A high percentage of the physicians (31.7%) do not know about the current concepts of therapeutics considering hypertension in acute ischemic stroke. The development on special units to treat these patients ("stroke units") may eventually decrease the morbimortality rates of ischemic stroke.