Walter José Fagundes-Pereyra

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.

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.

Cavernomas: conduta no serviço de neurocirurgia da Santa Casa de Belo Horizonte

The better understanding of the natural history of the cavernous malformations and the improvement of diagnostic methods and of microsurgical techniques have made the management of cavernous malformations possible through the conservative treatment, radiosurgery, and microsurgical resection. We present 33 cases operated at our service at Santa Casa Hospital, Belo Horizonte, from 1992 to 2001. Cortical and subcortical cavernomas manifested by epilepsy (57.5%) or mainly by hemorrhage (15.1%) were surgically approached. The deep lesions (basal ganglia, talamo and brain steam) represented 27.7% of our cases. They should only be operated when located near the pial or ependimary surface. The resection of spinal cord lesions (5.5%) and of deep brain lesions is also recommended when they present progressive focal deficit (13.8%) or recurrent episodes of hemorrhage (13.8%). Small and deep seated cavernomas that do not present bleeding must be conservatively treated. There has been no evident favourable result related to radiosurgery so far.

Tumores do corpo carotídeo: revisão de oito casos e abordagem cirúrgica

Os tumores do corpo carotideo sao pouco frequentes. Apesar disto, contam com vasta literatura, que reflete as controversias em relacao ao seu comportamento biologico e tratamento, especialmente no que se refere a abordagem cirurgica. Estudamos 8 pacientes com tumores do corpo carotideo (9 tumores, um bilateral), operados no servico de Neurocirurgia da Santa Casa de Belo Horizonte, entre 1989 e 1999. A idade variou de 11 a 66 anos (35,6±17,7 anos), sendo 4 mulheres e 4 homens. A unica alteracao ao exame fisico de todos os pacientes foi massa cervical palpavel. Obteve-se resultado pos-operatorio bastante satisfatorio, com baixa morbidade. Nao houve obito nesta serie. Baseados nessa experiencia e na literatura, discutimos os principais aspectos desses tumores, com enfase na abordagem cirurgica. Concluimos que os tumores do corpo carotideo sao lesoes incomuns, que devem ser tratadas com tecnica cirurgica cuidadosa, possibilitando baixo indice de morbi-mortalidade.

Ganglioglioma da regiäo 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 immunostainning 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 recorrence the patient should be followed and radiotheraphy could be considered.

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.