J.M. Cabezudo

Ependymal Reaction After Experimental Spinal Cord Injury

SummaryImages of ependymal cell proliferation after experimental spinal cord injury in the rabbit are presented. This finding suggests that segmental central canal obliteration after injury could be considered in the pathogenesis of posttraumatic syringomyelia.

Symptomatic subependymomas of the lateral ventricles

SummaryA case of symptomatic subependymoma of the lateral ventricle in a 64-year-old-woman is presented. We have found only 12 cases of symptomatic subependymoma of the lateral ventricle reported in the literature.We think that this location denotes a specific anatomoclinical entity, with a histological picture and a surgical prognosis that are different from those of the symptomatic subependymomas located in other sites of the ventricular system.

Computed tomography with craniopharyngiomas: A review

A retrospective study of the computerized tomographic (CT) examinations of 20 children and 13 adults with craniopharyngiomas was undertaken, with special attention paid to the densitometric characteristics of the tumors (contrast enhancement and presence of cysts and calcifications). The aim was to quantify these characteristics and to assess their diagnostic reliability, both alone and together. In suprasellar tumors al three characteristics were present in 75% of the cases, with a diagnostic accuracy of 100%; two were present in 20.6%, with a diagnostic accuracy of 85%; and one was present in 3.4%, with a diagnostic accuracy of 50%. The unusual densitometric presentations of intrasellar tumors are discussed.

Traumatic aneurysm of the superficial temporal artery as a complication of pin-type head-holder device. case report

BACKGROUND Despite the widespread use of pin head-holder devices in neurosurgical procedures, associated complications are relatively infrequent and usually minor. Inadvertent puncture of a major scalp vessel is one of these complications. Usually it is not problematic but the injured vessel may develop a traumatic aneurysm with subsequent rupture. CASE DESCRIPTION We report the case of a 51-year-old man who underwent a left pterional craniotomy for intracranial aneurysm surgery. The head was fixed with the Sugita pin head-holder. Three weeks after discharge, the patient returned to the hospital after an enlarging and pulsatile mass in his left temporal region in one of the pin puncture wounds ruptured and bled. The angiogram revealed a traumatic aneurysm of the superficial temporal artery, which was ligated and excised. CONCLUSION The Sugita multipurpose head frame is one of the head-holders most frequently used in neurosurgical procedures. It provides some advantages over other pin head-holders, but its sharp point pins in addition to a rotational fixing mechanism instead of simple pressure might increase the risk of scalp vessel injury. A traumatic aneurysm should be suspected when a pulsating scalp mass develops in a patient who has recently undergone a surgical procedure with his head fixed in a pin head-holder device. Physicians must be aware of this possibility when considering the diagnosis of a temporal mass to avoid unexpected hemorrhage at the time of surgery.

Cystic cavernous haemangiomas of the brain

SummaryTwo cases of cystic cavernous haemangioma of the brain are reported. In both cases, an erroneous diagnosis of cystic glioma was made, because of the unusual CT scan findings.Cavernous haemangiomas should be included in the differential diagnosis of intracranial cystic lesions.

Recovery from locked-in syndrome after posttraumatic bilateral distal vertebral artery occlusion

A 55-year-old man developed a delayed locked-in syndrome after a mild head injury. Angiography showed bilateral distal vertebral artery occlusion. Anticoagulant therapy and energetic medical management to promote collateral circulation to the structures in the posterior fossa led to a functional recovery. A review of the reported cases of posttraumatic locked-in syndrome has allowed the authors to differentiate between two types: the first is due to primary brainstem injury and the second is due to secondary brainstem ischemia. Both types have different modes of onset, mechanisms of production, angiographic findings, and prognosis. It is concluded that, with early diagnosis and vigorous medical management, expectations for a useful recovery are high, especially in those cases of posttraumatic locked-in syndrome due to secondary brainstem ischemia.

Simultaneous posterior and middle cranial fossa neurinomas

SummaryA case of unilateral association of a neurinoma of the VIII nerve and a neurinoma of the temporal fossa in a 33-year-old woman without von Recklinghausen disease stigmata is presented.This uncommon association can mimic the picture of a trigeminal neurinoma with a dumb-bell extension into the posterior fossa.

Multiple filum terminale hemangioblastomas symptomatic during pregnancy : Case report

Hemangioblastomas are low-grade, highly vascular tumors commonly associated with von Hippel-Lindau (VHL) syndrome and most often appearing in the cerebellum. They very rarely occur in the spinal nerve roots, and an origin in the filum terminale is exceptional with no instances of multiple hemangioblastomas of the filum terminale reported in the literature. Because of their vascular nature, these lesions can enlarge and become symptomatic in the context of the changes that take place during pregnancy, as has been noted with cerebellar hemangioblastomas. In any case, the evolution of spinal hemangioblastomas during pregnancy is not well known given its rarity. The conjunction of both processes--that is, multiple hemangioblastomas arising in the filum terminale and pregnancy--is unique. The authors describe the case of a 41-year-old woman with multiple hemangioblastomas of the filum terminale and no other evidence of VHL syndrome, in whom pregnancy precipitated symptoms. The interruption of gestation led to a remission of the symptoms. The literature concerning filum terminale hemangioblastomas and pregnancy is also reviewed.

Meningioma of the anterior part of the third ventricle

SummaryThe authors report the clinical features, radiological findings, and surgical management in a case of meningioma of the anterior part of the third ventricle in a 59-year-old woman. The unusual fact in our patient compared with the other reported cases is that she never developed symptoms or signs of increased intracranial pressure. A review of the literature is presented. Ours is the second case in which CT scan has been used in the diagnosis.

Resolución precoz espóntanea de hematoma subdural agudo intracraneal

Resumen Los hematomas subdurales agudos en general constituyen una urgencia neuroquirurgica. En casos seleccionados, esta indicado como primera alternativa el tratamiento conservador con estrecha vigilancia neurologica. En algunos de estos pacientes se aprecia la resolucion progresiva del hematoma. Sin embargo, la resolucion precoz espontanea de un hematoma subdural agudo es un fenomeno muy poco frecuente. Se describe el caso de un paciente con antecedentes de alcoholismo cronico que sufrio traumatismo craneoencefalico con hematoma subdural agudo, en el que se aprecio resolucion espontanea del hematoma en menos de 18h, acompanado de mejoria clinica. Se discute la fisiopatologia de la resolucion precoz del hematoma. El desgarro de la aracnoides con fuga de LCR al espacio subdural junto con el control de la presion intracraneal y la atrofia cerebral, condicionarian el efecto de lavado y redistribucion del hematoma que provocan su desaparicion en la TC cerebral.