Simultaneous presentation of symptomatic subependymomas in siblings: case reports and review.

Two young adult siblings independently developed similar neurological complaints that included headaches, photophobia, nausea, and intermittent lancinating facial pains. Magnetic resonance imaging revealed fourth ventricular lesions that required surgery in both patients. A pathological review revealed subependymomas with virtually identical histological features. The clinical features and common pathological findings of both patients suggest that familial subependymomas may have a maldevelopmental origin with genetic implications.

Posterior fossa partial trigeminal rhizotomy: an alternative to microvascular decompression.

Doctor Walter Dandy was a pioneer in the surgical treatment of trigeminal neuralgia. The Frazier-Spiller operation had been the standard operation for trigeminal neuralgia. Doctor Dandy pioneered the approach through the posterior fossa. He sectioned the lower-most 30 percent of the trigeminal nerve and found that trigeminal neuralgia was relieved. Anesthesia dolorosa did not develop, and the patients had only minimal sensory loss. Dandy's operation was not widely accepted, but microvascular decompression as described by Jannetta was developed by application of Dandy's principles. In twenty patients, we performed a partial trigeminal rhizotomy using Dandy's technique. A small sub-occipital craniectomy was performed and the trigeminal root entry zone exposed. The lowermost 30 percent of the trigeminal nerve was elevated with a blunt hook. The coagulating cautery was applied to the hook and the nerve partially sectioned. In each case, the trigeminal neuralgia was completely relieved. Each patient developed a minimal sensory loss in the second division of the trigeminal nerve. The corneal reflex was preserved in all cases. No patient has developed anesthesia dolorosa. Partial trigeminal rhizotomy is an alternative to microvascular decompression. The operation is technically easy to perform and should resume its rightful place in the neurosurgical treatment of trigeminal neuralgia.

Castleman's disease of the leptomeninges. Report of three cases.

Castleman's disease is a rare, benign lymphoproliferative disorder that usually arises in lymph nodes, most commonly in the mediastinum. The authors report the clinical and pathological features of three patients with localized Castleman's disease of the leptomeninges. There were two women, aged 63 and 82 years, and one 25-year-old man. Two patients had progressive focal motor seizures of 3 and 24 months' duration, and the third patient presented acutely with generalized seizures. The clinical diagnosis was meningioma in each case, based on computerized tomography scans, cerebral arteriography, and the operative findings. All three lesions arose in the leptomeninges, compressed the underlying cerebral cortex, and infiltrated the overlying dura to a variable extent. Surgical excision of the tumor resulted in marked clinical improvement in all three patients. Histologically, two cases were classified as the hyaline-vascular type and one as the plasma cell type. Immunohistochemical stains of the latter case revealed a monoclonal population of mature plasma cells. Only a few scattered polyclonal plasma cells were seen in the other two cases. The authors conclude that Castleman's disease involving the leptomeninges is a rare disorder that may mimic meningioma clinically and radiographically.

Acute herniated nucleus pulposus with cauda equina compression syndrome following chemonucleolysis. Report of three cases.

Three cases of acute disc herniation causing cauda equina compression syndrome after chemonucleolysis are described. All three patients had myelographic blocks and, despite emergency decompression procedures, were left with residual neurological deficits. Recommendations are made regarding evaluation and therapeutic intervention, and possible etiologies of this problem are reviewed.