Extradural meningioma in the left fronto-temporo-parietal region.

A case of a 47-year-old male patient who presented with a history of complaints of headache, vertigo and an expanding painful swelling on the left side of the head over the last year is reported. The lump was 15 x 15 cm and protruded 1-3 centimeters. Neurological examination revealed the presence of a mild right hemiparesis with right central facial palsy. Plain skull X-ray film demonstrates a heterogeneous bone thickening in the left fronto-temporo-parietal region with a small osteolytic focus and spotted shadows. Computed tomography scan of the skull showed that a major part of the squamas of the frontal and temporal bones were transformed into spiculoform structures turned outwards and inwards. Thus the bone appeared thickened overall. There were no alterations in the cerebral structures. The tumour was completely removed. It was located extradurally and through the bones extended to the soft tissues under the skin. The histological findings showed a meningioma with hemorrhages and necroses and the presence of lipids containing xanthochromic cells. After a surgical extirpation of the tumour a reduction of the neurological symptomatology and subjective complaints was observed.

Traumatic intracerebral hematomas--diagnostic and therapeutic problem.

A retrospective analysis was performed of 79 patients with hematomas treated surgically or conservatively. The surgical modality was most often opted for in the following cases: patients with hematomas exceeding 4 cm in diameter; patients with hematomas causing a pronounced dislocation of cerebral structures; patients with multiple hematomas that can be accessed through a bone flap. Hematomas smaller than 4 cm in diameter as well as those located in several brain regions were found to tend easily to resorption at the control computer tomography due to which we preferred treating them using conservative therapeutic methods. This therapeutic approach to the patients with hematomas is supported by the statistical analysis. Comparison of the groups of survivors and nonsurvivors shows that the former predominated in cases of hematomas located in the frontal lobe; the latter are predominant when the hematomas are located in the temporal lobe of the brain. There was no difference between the groups of surgically and conservatively treated patients with respect to the outcome of the disease if it is improvement or death. In the group of patients who underwent conservative treatment there was a predominance of those patients that showed no improvement of the initial state. The following conclusions can be made: 1. Surgical treatment is most often administered to patients with hematomas greater than 4 cm in diameter and hematomas causing dislocation of the cerebral structures. 2. The patients at highest risk for adverse outcome are those with temporal location of the hematoma.