Neuroembolization may expose patients to radiation doses previously linked to tumor induction.

Objective: Epidemiological studies indicate a link between low-dose irradiation (<10,000 mGy) to the head and the local occurrence of tumors after decades of delay. Comparable radiation doses can be reached during neuro-endovascular procedures (NEP), but the incidence of similar exposures has not been completely delineated. We compared the levels of radiation to the head measured during NEP to those reported for patients developing radiation-induced cancers.

Adjuvant temozolomide chemotherapy for treatment of papillary tumor of the pineal region.

Background: We present a personal case of papillary pineocytoma in a 42-year-old woman.

Methods: The lesion was first treated surgically both for diagnostic aims and for resolution of the mass effect causing hydrocephalus and correlated neurological disturbances. Because the tumor recurred after surgery and radiotherapy, we decided to further treat the patient with chemotherapy, in particular with temozolomide.

Central and peripheral components of writing critically depend on a defined area of the dominant superior parietal gyrus.

Classical neuropsychological models of writing separate central (linguistic) processes common to oral spelling, writing and typing from peripheral (motor) processes that are modality specific. Damage to the left superior parietal gyrus, an area of the cortex involved in peripheral processes specific to handwriting, should generate distorted graphemes but not misspelled words, while damage to other areas of the cortex like the frontal lobe should produce alterations in written and oral spelling without distorted graphemes. We describe the clinical and neuropsychological features of a patient with combined agraphia for handwriting and typewriting bearing a small glioblastoma in the left parietal lobe.

EDG3 and SHC3 on chromosome 9q22 are co-amplified in human ependymomas.

By qPCR we found that EDG3 and SHC3 were amplified in 60% of ependymomas but none in choroid plexus papillomas. In ependymomas EDG3 and SHC3 amplification increased Shc3 protein levels while EDG3 was less affected. Both proteins were co-immunoprecipitated from ependymoma and Shc3 was tyrosine phosphorylated thus presumably active.

Total endoscopic approach to the cauda in a patient with a tight filum.

In this report we describe a patient with a tight filum associated with a small concentric lipoma that was treated by cutting the filum terminale through a totally endoscopic approach. Our approach required the creation of a midline surgical corridor provided by the placement of a telescopic self-retaining retractor over the ligamentum flavum at L5-S1, under endoscopic control. The ligamentum was partially removed, the dura and the arachnoid opened and the filum terminale and the roots of the cauda exposed.

[Angiomatous meningioma and epilepsy in a 2.6-years-old girl].

A case of meningo-angiomatosis (MA), in a 2.6 -years-old girl with refractory focal and secondary generalized seizures, starting at the age of 2 years, is presented. MRI evaluation revealed a lesion located at the left temporal lobe; the patient underwent surgical intervention.

Endoscope-assisted infratentorial-supracerebellar approach to the third ventricle: an anatomical study.

Object: The authors studied the microsurgical anatomy and endoscopic features of the pineal region and third ventricle to describe a combined microsurgical-endoscopic infratentorial-supracerebellar approach to the posterior third ventricle. Such an approach exposes the pineal gland and its complex neurovascular structures so that the third ventricle can be reached through a minimally invasive parapineal incision.

Methods: The approach was studied in 10 adult cadaveric heads, six fresh and four formalin fixed, by using an operative microscope with a magnification level of 6 to 40 and the assistance of an endoscope.

Two-level anterior cervical discectomy and cage-assisted fusion without plates.

Object: Anterior cervical discectomy (ACD) is an effective and safe treatment for nerve root or spinal cord compression caused by disc herniation or spondylosis. Cervical interbody fusion allows preservation of the physiological lordosis and stability of the cervical spine. Based on data reported in the literature, fusion rates decrease significantly when more than one level undergoes surgery, and some authors recommend the addition of a plate system to improve results.

Shc3 affects human high-grade astrocytomas survival.

A selective switch from expression of Shc1 gene to Shc3 occurs with maturation of neuronal precursors into postmitotic neurons. Previous studies showed that in the embryo, Shc1 is maximally expressed in dividing CNS stem cells while it is silenced in mature neurons, where it is replaced by Shc3. Under normal conditions Shc3 is never expressed by glial cells.

Acute brainstem dissection of syringomyelia associated with cervical intramedullary neurinoma.

Intramedullary tumors and syringomyelia typically present with slowly progressing deficits. More rarely, they are characterized by acute presentation or worsening, at times mimicking other more common etiologies. The acute onset of syringomyelia is most likely attributable to an acute increase in cerebrospinal fluid and epidural venous pressure that results in impulsive fluid movement and, ultimately, in the rupture of the syrinx and dissection into the spinal cord or brainstem.

Surgery for intracranial meningiomas in the elderly: a clinical-radiological grading system as a predictor of outcome.

Object: A grading system, called the Clinical-Radiological Grading System (CRGS), has been developed to standardize surgical indications in elderly patients harboring intracranial meningiomas. Patients with a score lower than 10 had a bad prognosis regardless of surgical treatment, those with a score between 10 and 12 had a prognosis positively influenced by surgery, and those with a score higher than 12 had a good prognosis regardless of surgical treatment. The authors performed a prospective cross-sectional study to validate further the use of the CRGS as a clinical tool to orientate surgical decision making in elderly patients and to explore prognostic factors of survival.

Intramedullary epidermoid cyst: preoperative diagnosis and surgical management after MRI introduction. Case report and updating of the literature.

Many patients with spinal tumours of developmental origin do not receive preoperative diagnosis and the surgical management, especially as for capsule resection, is often unplanned. Like other uncommon tumours, the intramedullary epidermoid cyst is often an operative or histological finding. Since magnetic resonance imaging (MRI) introduction, evidence has accumulated that they may be preoperatively suspected.

Multiple intracranial lesions in head injury: clinical considerations, prognostic factors, management, and results in 95 patients.

Background: The goal of this study was to identify clinical and radiological predictors of prognosis in patients with multiple post-traumatic intracranial lesions.

Methods: We reviewed 95 patients (75 male and 20 female) between the ages of 18 and 70 (average 38) admitted between 1993 and 2000 with multiple post-traumatic intracranial lesions. Intracranial pressure (ICP) monitoring was carried out in 67 patients (70%); 77 received intensive care unit (ICU) treatment.

Dorsally exophytic brain stem tumors: total removal of a medullary pilocytic astrocytoma in child. Clinicopathological considerations and case report.

The authors describe the case of 4-year-old girl who was operated on for a pilocytic astrocytoma of the brain stem, exophytic and protruded backward into the fourth ventricle. The removal through a suboccipital midline approach was performed and macroscopically complete. Postoperative complications compelled a heavy reanimation with a prolonged follow-up therapy.

Management of head-injured patients in the emergency department: a practical protocol.

Background: The management of head-injured patients admitted to emergency departments is not standardized.

Methods: The authors performed a retrospective analysis of 10,000 head-injured patients admitted to the Emergency Department of our hospital in a 21-month period and, on the basis of a statistical correlation between each clinical parameter (symptoms and signs upon arrival at the hospital or risk factors) and the presence of intracranial lesions, they propose a practical protocol in an attempt to avoid the overuse or radiologic examinations and yet identify patients with possible life-threatening complications.

Results: On the basis of this correlation the patients have been divided into four groups.

Enterogenous cyst of the cervical canal: report of a case in a 68-year-old woman and review of the literature.

A case of a cervical enterogenous cyst in a 68-year-old woman with associated vertebral malformation is presented. The diagnostic value of Magnetic Resonance Imaging, positive reaction to Periodic-Acid-Schiff and immunohistochemical staining for carcinoembryonic antigen are emphasized. The literature is reviewed: controversies about embryogenic theories and classification of these lesions are discussed.

Recurrence of brain abscess associated with asymptomatic arteriovenous malformation of the lung.

On the basis of the data provided by literature the majority of patients with an arteriovenous malformation of the lung who develop a brain abscess suffer from hereditary hemorrhagic telangiectasia, or Rendu-Osler-Weber disease. Only nine cases of brain abscesses in which the arteriovenous malformation of the lung was isolated have been described and in all of these, clinical signs and/or alterations in the laboratory data were detected which can be attributed to the arteriovenous malformation itself. The case taken in this article would seem to be the first case of a recurrent brain abscess in a patient not suffering from Rendu-Osler-Weber with a completely asymptomatic arteriovenous malformation of the lung, both from the clinical point of view and from laboratory data.

Intracranial meningiomas in patients over 70 years old. Follow-up in operated and unoperated cases.

Forty-six cases of intracranial meningioma in patients above 70 years of age form the basis of this study; 34 underwent surgery while 12 did not. The decision to operate was based on the general condition of the patient, evaluated according to the Karnofsky index, neurological conditions, the site and dimensions of the tumor, and the presence of peritumoral edema. The post-surgical mortality rate was 11.

Depletion of calcitonin gene-related peptide in perivascular nerves during acute phase of posthemorrhagic vasospasm in the rabbit.

The behaviour of various neuropeptides during early and late vasospasm following experimental subarachnoid hemorrhage has been investigated by several authors. Recently, a reduction of the content of vasodilatory neuropeptides (vasodilatory intestinal peptide, substance P and calcitonin gene-related peptide) has been demonstrated in the perivascular nerves of cerebral arteries after few days from induction of experimental subarachnoid hemorrhage. In the present immunohistochemical study, the authors investigated secretion and expression of CGRP a few minutes after injection of autologous blood into the cisterna magna of the rabbit.

A case of amnesia after excision of the septum pellucidum.

Tumours of the septum pellucidum (SP) are rare and seldom associated with memory impairment either before or after operation. A patient is described who developed amnesia after transcallosal excision of a tumour of the SP. Radiology did not show any major lesion of the brain areas traditionally associated with amnesia.

Treatment of intracranial meningiomas in patients over 70 years old.

The neurosurgeon often finds himself in the position to having to decide whether or not to operate on an elderly patient suffering from intracranial meningioma. The decision is rarely easy and the results often disappointing. We studied 46 cases of intracranial meningioma in patients over 70 years of age, 34 patients were operated on while 12 patients were not, although both groups were subjected to long term follow-up.

Clinical evaluation and long-term follow-up in 16 patients with pseudotumour cerebri.

Medical treatment must be promptly established in patients with pseudotumour cerebri. In fact, even though a spontaneous remission of the symptoms is recognized in the literature, we have not any predictive criteria of future visual impairment.

Cavernous angiomas of the central nervous system.

The histopathological, epidemiological, clinical and neuroradiological findings of the cavernous angiomas of the central nervous system have been reviewed, based on an analysis of the literature. C.A.