Craniocervical intradural neurenteric cyst

A crantocervial junction neurenteric cyst as a cause of bulbomedullary compression, is a very rare lesion. A failure during the third week of the embryogenesis may be responsible for its formation. A 38-year-old man displayed a progressive right hemiparesis associated wrth lower cranial nerve disorders, and acute bladder retention. Magnetic resonance imaging demonstrated an intradural extramedullary process of the craniocervical junction. Surgical posterior approach allowed a gross total resection of the lesion. Histological examination of the surgical specimen showed that the cyst wall consisted of fibrocollagen walls lined by partially ciliated columnar epithelium. In the postoperative course, clinical signs resolved completely Patient was symptom free after 2 years follow-up. The posterior surgical approach was safe and allowed a complete removal with a good long-term outcome. Early surgical removal is the therapy of choice

Treatment of large vestibular schwannomas: towards a compromise between recurrence and facial function preservation

Ideal treatment of large vestibular schwannomas [VS] is complete removal without significant morbidity. The aim of this study is to assess the long-term outcome of surgery, focusing on factors influencing facial function and recurrence. Large VS were removed from 76 consecutive patients, through the retrosigmoid approach, from 1990-2004. Prognostic factors evaluated were age, size hydrocephalus, IX[th] and X[th] nerve signs, extent of surgical removal, and tumours's consistency. Statistics were taken by assessment of Chi-square, Fisher, student t-test. The mean age was 40 +/- 14 years, and the mean diameter was 45 +/- 9 mm. Preoperatively, 93% had significant hearing loss, 74% had cerebellar ataxia, 77% had high intracranial pressure and 40% had IX[th] and X[th] nerve signs. The perioperative mortality dramatically decreased from 17.6% in the earlier period [1990-1996] to 4.5% in the latter period [1997-2004]. At long-term follow-up, 84% of the patients had a Karnofsky score superior to 80%. Mean facial function was better for solid tumours [mean House-Brackmann [HB] standard deviation [SD], 3.7 [1.7] vs. 4.5 [1.7], p = 0.035]. Facial anatomical continuity was preserved in 76% of the cases [n = 58] and was correlated with a better facial function [mean HB [sd], 3.1 [0.7] vs. 5.8 [1.3], p < 0.001]. Excluding patients with a preoperative facial palsy, good facial function was achieved in 58% of the patients, without statistical difference between gross total and subtotal resection [mean HB [SD], 4.3 [1.4] vs. 4.8 [1.9], p=0.229]. The method resulted in improved outcome. Subtotal resection is a good strategy with high likelihood of preserving facial nerve function, without significantly increasing the risk of recurrence. New strategies associating subtotal resection and radiosurgery must be evaluated

Pituitary metastasis of lung carcinoma about two cases]

Secondary tumours of the pituitary gland are said to be infrequently found at necropsies and are very rarely recognised clinically. Studies on necropsy material indicate that secondary tumour deposits occur in the pituitary gland in about 1-3%of all patients deceadet by cancer. Breast and lung are by far the most frequent primary sites in women and men, respectively. We report two cases of pituitary metastasis presented as primary pituitary tumour. In the two cases there was headache, impairment of visual acuity and visual field without hypopituitarism. The two patients were operated via a trans-sphenoidal approach. The histopathology made the diagnosis and oriented us to the lung. The bronchoscopy with biopsy confirmed a primary malignancy. Therefore clinicians and pathologists should consider a metastasis lesion in the differential diagnosis of a non-functioning pituitary tumours