A simple method for stereotactic microsurgical excision of small, deep-seated cavernous angiomas.

Eight patients underwent microsurgical excision of small, deep-seated cavernous angiomas (maximum diameter, 0.9 to 2 cm; distance from cortical surface, 3.5 to 6.

Choice of neurosurgical approach in the treatment of cranial base lesions.

The authors describe a series of surgical approaches that they found particularly useful for the exposure and removal of lesions involving the skull base. These are: 1) fronto-naso-orbital approach; 2) fronto-temporo-orbito-zygomatic approach; 3) subtemporal transpetrosal approach; 4) temporo-suboccipital transpetrosal approach (retrolabyrinthine presigmoid; transsigmoid; translabyrintine amend transcochlear presigmoid); 5) dorsolateral approach to the foramen magnum and lower clivus. As the approaches are complex and carry potential risks of morbidity, not only it is important to have a good knowledge of basic anatomy but also to closely follow the indications for each one.

Medulloblastoma in late adults: report of two cases and critical review of the literature.

The authors describe two cases of medulloblastoma occurring in two men aged 71 and 67 years respectively. Medulloblastoma in late adults (older than 65 years) is an exceptional occurrence, and in this age group is generally of the classic type. Our first case was exceptional for the long survival of the patient compared with those so far reported for the same age group.

Metastasis of breast carcinoma to intracranial meningioma. Case report.

A case of metastasis from breast carcinoma found within a cerebral meningioma is reported. Histological diagnosis of the cerebral tumor prompted radiological investigation that visualized the asymptomatic malignant systemic tumor and excluded other metastases elsewhere. The pathogenetic aspects of this exceptional occurrence are discussed in the light of the relevant literature.

Epileptic seizures in intracerebral hemorrhage: a clinical and prognostic study of 55 cases.

Fifty-five cases of epileptic siezures associated with spontaneous intracerebral hemorrhage are reported. Seizures appeared as the first symptom in 23 patients, early (within two weeks after HI) in 18 and late (later than 2 weeks after HI) in 14. From the analysis of the observed cases we noticed that: 1) partial seizures were most frequent type (63%).

Solitary cerebral metastasis as first symptom of lung cancer.

The authors report 35 cases of solitary brain metastasis from lung cancer manifesting clinically before the primary tumor. Surgical removal was total in 27 cases and partial in 8. All patients received postoperative radiotherapy.

Late solitary cerebral metastasis from renal carcinoma.

The authors describe 2 patients with solitary cerebral metastasis occurring 13 years after treatment for a renal tumor in one and 17 in the other. Both patients are alive 30 and 36 months after surgery respectively. The pathogenetic and therapeutic features typical of this type of solitary metastasis with late-onset are discussed.

Spontaneous drainage of syringomyelia. Report of two cases.

Two cases are reported of Arnold-Chiari type I malformation associated with syringomyelia, in which magnetic resonance (MR) imaging revealed spontaneous decompression of the syrinx. In one case axial MR imaging sections showed a communication between the syrinx and the spinal subarachnoid space, which supports the hypothesis that fissuring of the cord parenchyma is instrumental in the spontaneous resolution of syringomyelia. The MR imaging changes were not accompanied by variations in the patients' clinical course.

Mucoceles of the paranasal sinuses with intracranial and intraorbital extension: report of 28 cases.

Twenty-eight patients received surgical treatment for a paranasal sinus mucocele with intracranial and/or intraorbital extension. The lesions were classified by site and extension: anterior without intracranial extension (Type 1), 7 patients; anterior with intracranial extension (Type 2), 11 patients; posterior midline without intracranial extension (Type 3), 5 patients; and posterior with intracranial extension (Type 4), 5 patients. The surgical approaches were: transnaso-orbital, transfrontonaso-orbital, transsphenoidal, transmaxillosphenoidal, and subfrontal transbasal; the choice depended on the site and extension of the lesion, with the aim of securing maximum exposure to ensure total removal of the lesion with its capsule.

Solitary brain metastases from carcinoma of the bladder.

We report 6 cases of solitary brain metastasis from bladder carcinoma. Although systemic metastases from this cancer are frequent, central nervous system metastases are rare. Analysis of our material and of published cases shows that the tumor is resistant to therapy and the prognosis is consequently very poor.

[Anterior approaches to the spinal column: considerations of the surgical technic].

The anterior approach to the vertebral column is indicated in the tumors or traumas of the vertebral body with prevalent anterior expression. This method allows to control easily all the structures in front of the rachis. Furthermore, the current reconstructive techniques require the exposure of a long tract of the vertebral column.

Meningiomas in elderly patients. Clinico-therapeutic considerations.

This study examines the immediate and long-term results of surgical treatment for intracranial meningioma in patients aged 65 and over. Average patient age was 69 years. The most frequent localizations were the convexity (29.

The acrylic-wire option in cervical spine fixation. A retrospective study.

This retrospective study was undertaken to assess the stability of the cervical spine after fixation with acrylic wire implants. Of the 44 patients with various pathological conditions of the cervical spine selected for this treatment in the course of 20 years, 36 were considered suitable for long-term follow-up evaluation. In 30 cases (83%) the stability of the spine was rated good.

Multiple intracranial aneurysms: surgical treatment and outcome.

We report a series of 41 patients with multiple intracranial aneurysms, analyzing them by type of surgical treatment and prognosis. We compare our findings with those of the largest published series and draw conclusions regarding the most appropriate treatment. The upshot would seem to be that morbidity and mortality depend chiefly on whether the aneurysms are bilateral or unilateral and on the patient's pre-operative status.

Cranio-facial approaches for tumours involving the anterior half of the skull base.

Teamwork between neurosurgeons and head and neck surgeons has increased the possibility of managing tumours involving the skull base. The authors distinguish the anterior half of the skull base into a median and two lateral portions and describe the surgical approaches utilized to expose it. The authors present their clinical experience in 27 patients with extensive lesions of the anterior half of the skull base and their results.

Meningiomas of Meckel's cave.

A series of 16 patients with meningiomas of Meckel's cave is reported. Trigeminal neuralgia, typical or atypical, was the initial symptom in 10 patients (62.5%).

A two-step supraorbital approach to lesions of the orbital apex. Technical note.

A two-step supraorbital approach to lesions of the orbital apex is described. This technique is easy and allows a satisfactory exposure of the region. In addition, the reconstruction resulting from the procedure is anatomically perfect.

[The osseous location of echinococcal cysts: comments on a clinical case].

Primary bone location of hydatid disease is extremely rare. The clinical case herein reported represents a primitive bone location of echinococcus in the ileal and sacral area. The aspecific symptoms did not allow for a preoperative diagnosis.

Surgical strategies in the treatment of symptomatic osteomas of the orbital walls.

We present a series of 19 surgically treated osteomas involving the orbital walls. Eight were localized at the junction of the frontal sinus and orbital roof, three were frontoethmoidal, two were of the orbital roof, one of the lateral wall, one of the orbital floor, and four involved all the walls of the orbit and were termed panorbital. All tumors at the junction of the frontal sinus and the orbital roof as well as those originating from the orbital roof proper were removed by frontal craniotomy.

Primary tumors of the cervical spine: surgical experience with 38 cases.

Thirty-eight primary tumors of the cervical spine were operated on in the Section of Neurosurgery, Department of Neurological Sciences, "La Sapienza" University of Rome between 1954 and 1988. Of these, 23 were malignant and 15 benign. The aims of surgical treatment in every case were tumor removal, decompression of the spinal cord, and conservation or restoration of vertebral stability.

Meningioma of the fourth ventricle: a case report.

A rare case of fourth ventricle meningioma with a combined intraventricular-intracerebellar localization, successfully removed by surgical treatment, is reported. The features of this type of meningioma as compared to the purely intra-ventricular variety are discussed.

Intramedullary metastasis of unknown origin: a case report.

We report a case of cervicothoracic intramedullary metastasis with long survival. The patient is in satisfactory neurological condition 18 months after operation and has resumed her normal lifestyle. Despite meticulous examinations, the primary lesion could not be identified.

Medulloblastoma in children and in adults: a comparative study.

We report on the clinical and pathological characters and factors influencing prognosis in a consecutive series of 20 cases of medulloblastoma presenting in childhood and of 20 cases of the tumour presenting in adulthood. The significant differences which emerged were compared with the findings of the largest published series. Medulloblastoma is more often lateral in site and desmoplastic in histology in adults than in children.