An unusual case of a penetrating skull-base injury caused by a wild deer's antler.

Injuries relevant to neurosurgeons in central Europe are rarely caused by wild animal attacks, whereas dog bites in urban areas and farm-related attacks from cattle and horses are well-known to cause sometimes fatal head injuries. The authors describe the first case of a perforating frontobasal injury caused by a wild deer's antler. Associated lesions involved the endonasal area and the left orbit. A multidisciplinary approach was used to address all lesions in a one-stage operation resulting in a full recovery of the patient. Apart from the problem of a possible contamination of the head wound, injuries caused by wild animal attacks should be treated the same way as comparable "regular" cases. Adequate coverage of dural and bone defects with autologous material via a bifrontal intradural approach and meticulous debridement of the intracranial wound usually gives good functional and cosmetic results.

Image transfer by mobile phones in neurosurgery.

Image transfer by mobile phones with built-in cameras (1 Megapixel CCD digital camera, 7 stage digital zoom, max. picture size 858 x 1 144 pixels, display resolution 240 x 320 dots, 262 K colour system CGS LCD) was introduced into clinical practice in the author's department in July 2004 to improve communication between neurosurgeons. During the first 12 months of use 13-72 images per month with an average of 1.4 images/case were transmitted via the regular German mobile phone net (GRPS standard, 40 KBit/s) among all neurosurgeons. Most images were transferred from the resident on call to the senior neurosurgeon backing him up. Overall, the system was extremely reliable, quick, and enabled immediate decisions in all emergency situations. In conclusion, image transfer by mobile phones has significantly improved communication within our department.

[Rare pulmonary manifestation of an intracranial meningothelial meningioma]. / Seltene pulmonale Manifestation eines intrakraniellen meningothelialen Meningeoms.

HISTORY AND CLINICAL FINDINGS: A 53-year-old sailor was admitted to our department with the history of severe headache, dysphasia and mild psychotic behavior. Routine chest X-rays several weeks before had shown a focal lung lesion in the lower lobe of the right lung. The patient was without pulmonary symptoms. INVESTIGATIONS: Brain magnetic resonance imaging demonstrated a large intracranial extracerebral mass with perifocal brain edema in the right frontoparietal region. THERAPY: The patient was suspected of having a metastasis of an unknown primary tumor. Craniotomy and total removal of the tumor was performed. Histological examination revealed a meningothelial meningioma without signs of malignancy. 6 weeks later thoracotomy and total removal of the lung tumor were performed. Histological examination revealed a meningioma with the same histological pattern as the intracranial lesion. Postoperatively there were no complications, the physical examination at discharge was normal without any pulmonary or neurological deficits. Two years later, we found no evidence of an intracranial or pulmonary tumor recurrence. CONCLUSION: Pulmonary metastases of benign intracranial meningiomas are rare but should be considered in the differential diagnosis, especially in cases with an undiscovered primary tumor.

[primary and secondary malignant liver tumors at autopsy, biopsy and cytology: frequency and problems of differential diagnosis]. / Primäre und sekundäre maligne Lebertumoren in Autopsie, Biopsie und Zytologie: Hüfigkeit und differentialdiagnostische Probleme.

The frequency and ratio of primary and secondary malignant liver tumours were evaluated in the autopsy, biopsy and cytology files from 1980 to 1994. In 1008 necropsies with hepatic malignancies, 91 primary liver carcinomas and 917 metastatic liver tumours were observed. In a total of 2537 malignant neoplasias at autopsy, the overall-rate of liver metastases amounted to 36%. The four most frequent primary carcinomas of liver metastases found at necropsy were bronchial, colorectal, pancreatic, and breast carcinomas. In 193 liver tumour biopsies, 27 hepatic carcinomas and 160 liver metastases were diagnosed histologically, whereas in 6 biopsies only a differential diagnosis between primary/secondary carcinomas could be made. Histologically, adenocarcinomas were observed in 65% of the liver metastases under biopsy. The four most frequent primaries of hepatic metastases registered at biopsy were colorectal, biliary system, pancreatic, and gastric carcinomas, so that metastasis formation of the portal vein type predominated in the biopsy series with 73% of the cases. In spite of supplementary immunohistological examinations, the primary tumour remained unknown in 13% of the metastases studied at liver biopsy. In 58 fine needle aspirations of clinically suspected liver tumours, 11 hepatocellular carcinomas and 29 liver metastases were found cytologically, whereas 18 specimen showed differential diagnostically inconsistent tumour findings. Gastrointestinal and breast carcinomas were the two most often primaries of liver metastases diagnosed cytologically. The primary/secondary liver tumour ratio amounted to 1:10 at autopsy and shifted to 1:6 in the biopsy series as well as to 1:3 in the cytology material.