Symptomatic cysts of the pineal gland: stereotactic diagnosis and treatment of two cases and review of the literature

We report two cases of pineal gland cysts, both in young girls, causing aqueductal stenosis and symptomatic hydrocephalus, which were diagnosed and treated by Talairach's stereotactic method. This procedure permitted aspiration of the cyst content, normalization of aqueductal stenosis, and a differential histological diagnosis. Postoperative computed tomographic scan examination showed a stable reduction of the cystic volume and a complete clearance of the hydrocephalus. At present, the two patients are clinically normal and are leading a productive life (follow-up, 42 and 40 mo). It is important that this kind of nonneoplastic lesion be identified, in order to avoid confusion with pineal tumors and possible inappropriate treatment. Pineal cysts rarely become symptomatic. Up to the present, only 27 symptomatic cases have been described in the literature. Of those, signs of intracystic bleeding were found in 17 of the 21 cases in which the cyst contents were known. Moreover, in our own two cases, numerous hemosiderin-laden macrophages were present in the cystic fluid. We think, therefore, that intracystic bleeding has been the determining factor for the occurrence of symptoms in most of these cases. The authors underline the advantages of this type of stereotactic management, which can provide both diagnosis and treatment and thus avoid the possible risks of surgical excision and/or of radiotherapy.

Computerized use of ICP data. Preliminary elements on the shunt patient

An incorrect choice of valve may produce a delay in psychomotor development in shunted hydrocephalic children. The intracranial pressure was measured for 24 h in 20 subjects suffering from nontumoral hydrocephalus, obtaining a pressure/volume index with compliance and perfusion pressure data. Their data were entered into a computer and used to determine the correct valve to be chosen.

Ossified epidural hematoma. Report of a case with epilepsy

A case of post-traumatic ossified epidural hematoma associated to epileptic seizures is reported. After surgical treatment complete recovery was obtained.

Optical-chiasmatic region epidermoid with a suprasellar and prepontina region cysticercosis

The Authors report a case of epidermoid in the optical-chiasmatic region associated with a cysticercosis in the suprasellar and prepontal region. The patient was surgically treated with success: a bilobate cystic formation with ramifications adherent to the carotid siphon was found in front of optic nerves. Opening the arachnoid between the left optic nerve and carotid, a dysembriogenetic cystic formation was observed. Adherent to it there was the wall of a second parasitic cystic formation (probably cysticercosis) from which some small cysts slid away. After a review of the literature the Authors point out both the casual association of the two pathologies and the utility of C.T. scan in the diagnostic process of the above mentioned lesions.

Experimental endo-uterine hydrocephalus in foetal sheep and surgical treatment by ventriculo-amniotic shunt

After creating an experimental foetal hydrocephalus in sheep, we achieved its treatment utilizing the implantation of a ventriculo-amniotic shunt (mini-uni-shunt). The results obtained were satisfactory. However, it is evident that the application of an experimental technique in human foetuses requires maximum caution.

Calcified brain abscesses. Case report

A surgically treated case of multiple contiguous brain abscesses at different stages of calcification is reported. The patient, a man 48 years old, had been suffering from epilepsy for 34 years and he was complaining of headaches and fever for 15 days when admitted to our clinic. The post-operative neurological recovery was good.

Median third ventricle meningioma. Case report

A case of meningioma located in the median part of the third ventricle and revealed by autoptic examination in a patient who died for meningoencephalitis is reported.

Considerations on the operative results in a group of elderly neurosurgical patients

536 patients from 60 to 84 years old, operated on for neurosurgical lesions, are evaluated with reference to post-operative mortality rate related to the type of pathology. 83 deaths (15.6%) occurred in this series. Mortality rate increases progressively with advancing age. It is outlined that the aged patients have lesser chances of surgical success, but the present data induce to consider with greater favour the outcome of these patients.

[Anatomo-clinical considerations on cerebral sarcomas]

The Authors present six cases of sarcoma of the brain. After doing a short review of the cases described in literature, they discuss the clinical anathomo-pathological and terapeutic aspects of these peculiar tumours.

[Traumatic obliteration of the middle cerebral artery. Pathogenic considerations]

Report on one case of traumatic obliteration of the middle cerebral artery together with a review of the pathogenetic theories published till presently on this subject. Three factors are retained in the case object of the present work: --compression of the arterial wall in the Sylvian fissure, as a consequence of contusion and cerebral edema, --disorders in the platelets aggregation, --high blood pressure.