Bülent Boyar

The nonsurgical management of a penetrating orbitocranial injury reaching the brain stem: case report.

Penetrating and perforating periorbital puncture wounds by lead pencils are not rare, but ones that reach the brain stem are extremely unusual. We recently treated a patient with of this type of injury. A newly sharpened lead pencil was accidentally introduced through the subconjunctiva at the inner canthus of the right eye. It passed along the medial border of the globe transorbitally and went through the superior orbital fissure into the temporal fossa, then continued through the lateral side of the sella and posterior clinoid, reaching the brain stem. The entire pencil was removed inch by inch without incident under CT control. Meanwhile, the operative team remained ready in case of emergency bleeding. The patients postoperative course was uneventful, but the initial neurologic deficit of the patient remained fixed.

Arachnoid cyst with traumatic intracystic hemorrhage unassociated with subdural hematoma

Arachnoid cysts of the middle cranial fossa may manifest themselves in several different ways. Most often they remain asymptomatic and are only diagnosed incidentally on computed tomography or at autopsy. When they are symptomatic, headache, nausea, vomiting and seizures are most common in the patients with increased intracranial pressure. Increased intracranial pressure is caused by the ball-valve mechanism of the cysts membrane which is in communication with the general subarachnoid space or arachnoid cells which contain specialized membranes and enzymes which have secretory activity. A significant number of middle cranial fossa arachnoid cysts are associated with subdural hematoma which may, in turn, be associated with intracystic hemorrhage. We report an unusual case with posttraumatic, isolated intracystic hemorrhage of the arachnoid cyst in the sylvian area without subdural hematoma.

Combined occurence of primary cerebral lymphoma and meningioma

A unique combination of primary cerebral lymphoma and meningioma was encountered in a 38-year-old woman who recently presented clinically with headache and papilledema. The both tumors were identified by CT scan and diagnosed histopathologically after the surgery. The association of a highly malignant primary cerebral lymphoma and a slowly growing meningioma is extremely rare. The possibility of an unknown underlying pathologic mechanism predisposing to multiple tumors should be considered.

Unilateral hydrocephalus resulting from occlusion of foramen of Monro: a new procedure in the treatment: stereotactic fenestration of the septum pellucidum.

Obstruction at the foramen of Monro resulting in unilateral hydrocephalus is an uncommon entity that may be caused by a wide range of lesions including tumors, vascular malformations, and inflammatory conditions. A case of unilateral hydrocephalus secondary to congenital atresia of the foramen of Monro treated with stereotactic fenestration of the septum pellucidum is presented.

Intracranial tuberculous abscess mimicking malignant glioma

Brain abscess is probably the least common manifestation of tuberculous infection of the central nervous system; meningitis and tuberculoma are much more common.A case of tuberculous brain abscess in a 23-year-old man with previous history of Tbc meningitis is presented. The computerized tomographic scan demonstrated a unilocular space-occupying lesion in the left thalamic region, surrounded by a thick hyperdense enhancing rim. It is suggested that a relatively long clinical history and previous Tbc meningitis history together with the appearance of a thick-walled abscesslike lesion on the CT scan may indicate the diagnosis of a tuberculous brain abscess. Only after neurosurgical removal of the abscess, the pathohistological examination reveal tuberculous etiology of the abscess. The patient later died from aspiration bronchopneumonia. Only 28 instances of tuberculous abscess have been reported in the literature.

Intraventricular Meningiomas: A Review of the Literature and Report of 8 Cases

Intraventricular meningiomas are rare tumors, comprising only 0.5% to 5% of all intracranial meningiomas. In this article, 8 cases of histopathologically proven intraventricular meningioma that were treated at the Çukurova University Neurosurgery Department are discussed. The radiologic, histologic, and clinical findings of intraventricular meningiomas and the surgical approach to lateral intraventricular meningiomas were reviewed retrospectively. Our 8 patients ranged in age from 18 to 65 years (mean = 44.6 years). Two patients were male and 6 were female, for a 1:3 male-to-female ratio. Computed tomography and magnetic resonance imaging demonstrated the 7 tumors within the lateral ventricle and only 1 tumor within the third ventricle. All lateral ventricular tumors were located in the region of the trigone. Headache and hemiparesis were the most common presenting symptoms. Histologic studies revealed meningotheliomatous meningiomas in 5 patients, transitional meningioma in 2 patients, and anaplastic (malignant) meningioma in 1 patient. The superior parieto-occipital approach in 5 patients, posterior middle temporal gyrus approach in 2 patients, and posterior transcallosal approach in 1 patient were used for surgical therapy, and total resection was achieved in all patients. The overall neurologic outcome at follow-up (mean follow-up = 12 months, range: 1 month to 5 years) was excellent (no deficit) in 4 patients, good (some deficit but independent) in 2 patients, and poor (dependent) in 1 patient. One patient died after surgery. We conclude that intraventricular meningiomas are curable by complete surgical resection. This is possible with little neurologic morbidity when the neurosurgeon understands the surgical approaches available and the indications for those approaches.

Congenital Peripheral Facial Palsy Associated with Cerebellopontine Angle Arachnoid Cyst

Objects: A rare case of cerebellopontine angle arachnoid cyst leading to congenital peripheral facial palsy was presented. Clinical Presentation: A 1-year-old girl presented with peripheral facial paralysis since birth. Computed tomography and magnetic resonance imaging revealed left cerebellopontine angle arachnoid cyst causing moderate displacement of the brain stem. Intervention: Retrosigmoid suboccipital craniotomy was performed and microsurgical resection of the cyst wall and fenestration of the cyst to the basal cisterns were achieved. Conclusions: Cerebellopontine angle arachnoid cyst should be considered as a potential cause of congenital peripheral facial palsy.

Traumatic giant aneurysm of the intracavernous internal carotid artery causing fatal epistaxis: case report.

A patient with a giant intracavernous carotid aneurysm usually has symptoms and signs of a space-occupying lesion, producing one of a variety of types of cavernous sinus syndromes. Epistaxis is an unusual feature in these patients. A patient who noted the onset of repeated arterial epistaxis 2 years after a severe head injury was found to have a traumatic aneurysm of the cavernous portion of internal carotid artery. After angiography, he suddenly developed profuse, pulsatile, arterial epistaxis and had a cardiopulmonary arrest. This case and a review of previously reported cases emphasize the importance of early cerebral angiography in patients with posttraumatic recurrent epistaxis.

Colloid cysts of the third ventricle

Since computerized tomography scanning became available at the Division of Neurosurgery in July, 1979, 13 patients have undergone removal of colloid cysts of the third ventricle by transfrontal or transcallosal routes. Computerized tomography has increased the number of colloid cysts detected in the foramen of Monro during neurological diagnostic workups. The clinical and diagnostic aspects and changing concepts in the treatment of colloid cysts are reviewed.

Evolution of Thrombosis of the Vein of Galen in Sickle Cell Disease

To the Editor: The child in question presented at 3 years with generalized tonic seizures and brief episodes of staring with no associated features. Examination was unremarkable except for minimal right lower facial weakness. An electroencephalogram (EEG) showed a generalized dysrhythmia with no specific diagnostic pattern. Seizures remained refractory despite the use of combinations of anticonvulsant drugs with therapeutic blood levels. At 5 years of age, right-sided focal seizures began, and mild right hemiparesis with an increase in right facial weakness