Diffuse calvarial meningioma: a case report.

A rare case of a diffuse calvarial meningioma in a sixty-three year-old female is reported. The patient presented with headache, painful proptosis and chemosis of the left eye. Imaging showed that the frontoparietal calvarium on both sides and the left orbital roof were thickened. The thickened bone showed patchy rarefaction. In relationship to the thickened bone, there was an enhancing en-plaque meningioma. The tumour extended on to the superolateral aspect of the left orbit and resulted in proptosis. Excision of the left frontoparietal calvarium and the orbital tumour was performed. The management of diffuse calvarial meningioma is discussed and the relevant literature is briefly reviewed.

Middle fossa decompression of the trigeminal sensory root for trigeminal neuralgia--a re-appraisal and a modification of the technique.

Twenty-three patients with intractable trigeminal neuralgia were treated by a modified technique of middle fossa extradural decompression of the trigeminal sensory root at the petrous ridge. After exposing the ganglion and the root at the petrous ridge, by an extradural Frazier's approach a thin layer of autogenous fat was interposed between the dura propria and the middle fossa dura anteriorly, and between the petrous ridge and the root posteriorly. The fat layers were used to prevent dural adhesions and to maintain a space between the petrous ridge and the root. The dura propria was preserved intact. All patients obtained immediate relief of pain following surgery. Twenty patients continue to remain pain free. Two patients have mild occasional pains and one has a persistent pain of moderate intensity. One patient developed a dense sensory loss and two had delayed facial weakness which recovered completely within a month. The mechanism of trigeminal neuralgia is discussed on the basis of anatomical, histopathological and electrophysiological findings and the rationale of middle fossa decompression of the root is stressed. This method is short, simple and safe and may serve as an alternative to the more recent methods of treating trigeminal neuralgia.

Experience with brain abscesses.

Brain abscesses were studied in 47 patients. Thirty-four (72%) of them were between 5-15 years and 9 were infants. Otogenic source (34%) was the commonest predisposing factor, followed by scalp and face infection (21.3%) and congenital cyanotic heart disease (12.8%). Twenty (42%) patients had multiple abscesses. Supratentorial abscesses were commonest (75.9%). Predominant clinical features were fever (87.2%), raised intracranial tension (78.7%) and altered sensorium (53.2%). A total of 38.3% presented with focal neurological deficit and 34% were admitted in Grade III or IV coma. Diagnosis of abscess and monitoring of its evolution was done principally by CT scanning. Causative organisms were isolated in 54.8% of cases and Staphylococci, Proteus and Pseudomonas were the common pathogens. Therapy was most often a combination of surgical aspiration with or without excision in addition to antimicrobial therapy. The overall mortality in our series was 44.7%. Bad prognostic factors were Grade III/IV of coma at admission, age below 2 years and multiple abscesses.

Retropharyngeal leiomyoma: case report and review of the literature.

An 8-year-old girl was initially seen with dyspnea, drooling of secretions, and loss of weight. A large mass was seen protruding through the posterior pharyngeal wall, which was found to be a leiomyoma after excision. No previous case report exists of a retropharyngeal leiomyoma.

Percutaneous thecoperitoneal shunt for syringomyelia. Report of three cases.

Between January and April, 1990, three consecutive cases of syringomyelia were treated by percutaneous placement of thecoperitoneal shunts. Two of these patients had undergone craniovertebral decompression earlier at other centers and the third was treated primarily by a thecoperitoneal shunt. In each case, the syrinx was associated with Chiari I malformation, although the clinical presentation was due to a myelopathy. All three patients obtained unequivocal benefit from this simple procedure. Postoperative magnetic resonance images showed considerable shrinkage of the cysts corresponding with clinical improvement.

Interhemispheric empyema. An unusual form of subdural empyema.

A 16 year old male was admitted with a clinical picture suggesting an intracranial pyogenic infection. He also has focal convulsions and left abducens palsy. CT scan showed a subdural empyema with interhemispheric extension. Since the patient was improving clinically, neurosurgical intervention was deferred. Spontaneous interhemispheric empyema is an uncommon condition. In our case conservative management was curative in what is considered a neurosurgical emergency.

Intracranial tuberculoma and the CT scan.

Computerized tomography (CT) has greatly influenced the diagnosis and management of intracranial tuberculomas and has helped us to formulate guidelines for the management of these lesions. Solid and ring-enhancing lesions seen on CT scans are diagnostic of tuberculoma if supported by other clinical and ancillary criteria. Conservative management of intracranial tuberculoma is usually indicated because serial CT scans have shown complete disappearance of these lesions with antituberculous therapy. Only lesions associated with raised intracranial pressure and CT evidence of a mass effect should be considered for surgery. Nonresponse to antituberculous therapy, as judged by serial CT scanning, should raise doubts regarding the diagnosis of a tuberculomatous lesion, and therefore such lesions should be subjected to surgery and histopathological confirmation. Representative clinical cases illustrating the principles of diagnosis and management of intracranial tuberculoma with the help of CT scanning are briefly described and discussed.

Von Recklinghausen's disease with a malignant meningeal, cerebral and optic nerve tumour and bilateral vagal schwannomas. Possible mesenchymal histogenesis on light and electron microscopy.

The clinical, histopathologic and fine structural features of multiple unusual tumours detected in a 20-year-old patient with von Recklinghausen's disease, who died within a year of onset of symptoms of a rapidly expanding intracranial tumour, are described. The tumour was found to involve the falx cerebri, the basal leptomeninges and dura mater, both olfactory and optic nerves, both frontal lobes, the right temporal lobe and middle cerebral peduncle, both middle cerebellar peduncles, and with a metastasis in a cervical node. On light and electron microscopy this tumour appeared to be a fibroblastic meningeal sarcoma with giant cells, mitotic figures, a rich reticulin matrix throughout, and tumour cells full of rough ER but without any glial filaments. Also very unusual was the involvement of both vagus nerves in their cervical and intrathoracic portions, by a schwannomatous benign tumour and with a non-chromaffin paraganglioma at its termination in the oesophagus. One of the few cutaneous "neurofibromas" was also schwannian, containing tumour cells with a basement membrane on electron microscopy. Most, if not all, of these tumours appeared mesenchymal in origin, more aggressive in behaviour and carrying a graver prognosis in von Recklinghausen's disease.