Giant Inflammatory Cervical Ganglion Due to Ectopic Rib Head: Report of a Rare Diagnosis Mimicking a Cervical Schwannoma

Cervical schwannomas may be common in patients with cervicobrachialgia. We report a case of an apparent C8 schwannoma in a 55-year-old female that was discovered to be an inflammatory enlarged cervical ganglion. Such a rare presentation may be explained by the particular conformation of the left C7-Th1 neuroforamen, compressed by an ectopic cranially located first rib head, which was visible only with a cervical computed tomography scan. No similar finding is reported in the literature, and this interesting case may provide new insight into the differential diagnosis of cervical spinal lesions.

Gelfoam Migration: A Potential Cause of Recurrent Hydrocephalus

BACKGROUND

Gelfoam is a simple and effective hemostatic agent that is used to seal brain corticotomies or skull burr holes. Owing to its low cost, it is one of the most widely used tools in neurosurgical daily practice. However, migration of Gelfoam fragments can cause occlusion of endoscopic third ventriculostomy (ETV) or shunt, leading to hydrocephalus recurrence.

CASE DESCRIPTION

Two cases of Gelfoam migration causing recurrent hydrocephalus are presented: a 12-year-old girl who underwent surgery for posterior fossa tumor removal and ETV for associated hydrocephalus, where a portion of Gelfoam (used to seal the burr hole) migrated up to close the ETV, and a preterm 8-month-old boy who was treated by neuroendoscopic brain lavage and afterward by ventriculoperitoneal shunt for posthemorrhagic hydrocephalus, where all the Gelfoam used to close the corticotomy migrated into the lateral ventricle, thus reopening the corticotomy and releasing small fragments that ultimately obstructed the shunt. A new endoscopic procedure was required in both patients (the second patient also required a shunt revision).

CONCLUSIONS

Review of the pertinent literature discloses other complications of Gelfoam migration (e.g., mass effect, granulomatous reaction) as well as other causes of uncommon ETV/shunt obstruction. Nonetheless, Gelfoam will remain an indispensable tool for neurosurgeons. The present report emphasizes the importance of its correct use to avoid complications.

Solitary Metastatic Melanoma of the Pituitary Gland: Report of Two Cases and Literature Review

BACKGROUND

Pituitary melanoma metastases (PMMs) are extremely rare and only a few cases are reported in the literature. PMMs can grow rapidly and present local invasiveness, leading to acute onset of neurological symptoms such as headache, visual and oculomotion disorders or endocrinological signs such as diabetes insipidus and hypopituitarism, and can be life-threatening. For this reason, PMMs must be recognized and treated promptly.

CASE DESCRIPTION

The authors present 2 cases of PMMs managed at their institution, performing a review of the dedicated literature and analyzing current therapeutic strategies.