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.

Distal anterior cerebral artery aneurysms.

BACKGROUND: The incidence of saccular aneurysms in the distal anterior cerebral artery (DACA aneurysms), also called pericallosal or A2 aneurysms, has been estimated to be from 1.5 to 9.0% of all intracranial aneurysms in large series in the literature [5,10,12,18]. All reported series of DACA aneurysms have shown a high association with intracranial aneurysms in other locations. These aneurysms are fragile, frequently rupture prematurely during exposure, and have a higher morbidity than expected from their angiographic appearance and location. METHODS: A total of 1,350 patients with cerebral aneurysms were operated in the Department of Neurosurgery at Santa Casa Hospital in Belo Horizonte from January 1982 to January 1998. Seventy-two of those 1,350 patients had DACA aneurysms (5.3%), 51 female and 21 male. The age ranged from 26 to 69 years, the mean age being 44 years. This group of patients is reported herein. We propose three different approaches to DACA aneurysms depending on their location, all of them performed through a unilateral triangular bone flap that can then vary from fronto-basal to parietal. RESULTS: There was no mortality among patients with a single DACA aneurysm. Five deaths in this series were cases of multiple aneurysms. In patients with preoperative Hunt and Kosnick grades I and II [9], we had 90% good results. In grade III patients, we achieved 68.4% good results. The only grade IV patient had a full recovery. All 74 DACA aneurysms in the 72 operated patients were completely clipped, including two giant aneurysms. CONCLUSION: DACA aneurysms have higher morbidity and mortality rates when compared to other supratentorial aneurysms. We recommend the use of a unilateral interhemispheric approach as the most appropriate for aneurysms in this location. In cases of patients with multiple aneurysms who require two different craniotomies, we propose two surgical stages, starting with the aneurysm that has bled. A high mortality rate was noted when two craniotomies were performed in the same sitting.

[Giant cervical disc herniation: case report]. / Hérnia de disco cervical gigante. Relato de caso.

Disc herniation occurs commonly in neurosurgery. The Neurosurgery Department of Santa Casa de Belo Horizonte in 1997 had 17% of all surgeries for disc herniation and 7% of those were of cervical spine. We report a giant cervical disc herniation C4-C5 in a 72-year-old male patient, presenting with tetraparesis, sensory loss below C5 and urinary retention, who underwent microsurgical anterior decompression and internal fixation with iliac bone graft without plate fixation according Cloward. The patient had a satisfactory outcome. We propose a new classification for disc herniation according the dural compression: small (until 12%), medium (12 to 25%), big (25 to 50%) and giant (more than 50%).

[Intramedullary cysticercosis: case report]. / Cisticercose intramedular. Relato de caso.

Cysticercosis is the most ordinary parasitary disease involving the nervous system. The involvement of the spine is rare, ranging from 0.7% to 5.8%, and the intramedullary incidence is rather uncommon. We report the case of a 52-year-old female patient with intramedullary cysticercosis at the C4-C5 level, treated at the Neurology and Neurosurgery Service of Santa Casa de Belo Horizonte. The patient was operated with the complete exeresis of the lesion and had a good outcome. Forty-five cases of intramedullary cysticercosis were found in the literature review. We conclude that although it is a rare pathology, intramedullary cysticercosis should be included in the differential diagnosis of intramedullary lesions, mainly in cases of patients with previous diagnosis for neurocysticercosis and also of those who live in endemic areas.

Giant posterior cerebral artery aneurysm in a 4-year-old child: case report.

Posterior cerebral artery aneurysms in children aged 5 years or less are very rare. We were able to find only 10 cases previously described in the literature. We present a case of giant bilobulated aneurysm of the distal right posterior cerebral artery in a 4-year-old child with an initial history of spontaneous subarachnoid hemorrhage. The aneurysm was clipped and the patient had full recovery. Based on the literature review, we discuss the characteristics of these rare aneurysms, making a comparison with different age groups.