-Background: Intrathoracic meningocele is a rare pathology, almost always associated with neurofibromatosis type I and with a few cases related in the literature. In the majority of cases cysts are small or asymptomatic, and the surgery is indicated when big or symptomatic cysts are present. We report a case of giant intrathoracic cysts surgically extirpated through out thoracotomy. Case: A 59-year-old male with familiar Von Recklinghausen´s disease which developed thoracic radicular pain after a fall. On examination he presented some difficulty in walking fast and dyspneia on small efforts. The chest plain x-ray showed the presence of 3 huge left side intrathoracic cysts (10 to 15cm). The patient was submitted to a surgical treatment and complete extirpation of the cysts was performed through a left side thoracotomy. During the surgery a fourth smaller cyst was detected and also extirpated. Evolution was uneventful and the patient remains well in these last 12 years. This finding of intrathoracic cysts related to neurofibromatosis type I is rare and is probably unique in the literature the presence of 4 huge cysts in one side of the thorax.KEY WORDS: intrathoracic meningocele, neurofibromatosis type I. Meningoceles intratorácicas gigantes associadas a neurofibromatose tipo I: relato de casoRESUMO -Meningocele intratorácica é patologia rara e, quando presente, está quase sempre associada a neurofibromatose tipo I. Há poucos casos descritos na literatura e em sua maioria destes são de cistos pequenos ou assintomáticos, sendo a cirurgia indicada quando são grandes ou sintomáticos. Relatamos o caso de um homem de 59 anos com a doença de Von Recklinghausen familiar, com cistos gigantes extirpados cirurgicamente através de toracotomia. PALAVRAS-CHAVE: meningocele intratorácica, neurofibromatose tipo I.

The authors present a case of a gigantic cystic craniopharyngioma that was treated with intratumoral injections of bleomycin. The mass had eroded the skull base and extended to the sphenoid bone. A total of eight intratumoral injections through an Ommaya reservoir were given. Six months after treatment, there was complete regression of the lesion and improvement in both visual and endocrinological symptomatology.

Summary:Purpose: To analyze the best surgical procedure for patients with epileptic seizures and cerebral lesions-i.e., resection restricted to the lesion or resection associated with the adjacent irritative area-based on the clinical evolution of patients' seizure outcome and electroencephalographic (EEG) and electrocorticographic (ECoG) findings.Methods: This study comprised 37 patients with epileptic seizures and cerebral lesions, ranging in age from 9 to 66 years. Patients were divided into two groups: Group 1 consisted of 21 patients with medically intractable epilepsy, Group 2 of 16 patients with medically controlled epilepsy. Eleven of the 21 patients in Group 1 (Subgroup A) underwent surgical resection of the cerebral lesion and adjacent irritative area as shown by ECoG. For the remaining 10 patients in Group 1 (Subgroup B), the resection was restricted to the lesion. The 16 patients in Group 2 all underwent lesionectomies.Results: Of the 11 patients in group 1 who underwent resection of the cerebral lesion and adjacent irritative area, 91% became seizure free. Sixty percent of the remaining patients in group 1 whose resections were restricted to the lesion also became seizure free, as did all the patients in group 2. An overall analysis of the EEGs for all patients showed a statistically significant decrease in paroxysmal activity.Conclusions: In patients with uncontrolled seizures, resection of the cerebral lesion associated with the irritative area shows a tendency to obtain better seizure-outcome results than restricted lesionectomy. Key Words: Epilepsy tumors-Epilepsy surgery-Lesionectomy-Electrocorticography .In 1887, Victor Horsley [as summarized by Taylor (l)] operated on a patient with partial motor seizures caused by a cerebral tuberculoma. The surgery resulted in a significant reduction in the patient's seizures, supporting a relationship between the lesion and the development of seizures. According to Foerster & Penfield ( 2 ) , the correlation between an irritative brain area and cortical scars caused by head trauma was associated with a good prognosis for control of seizures when the scars were surgically removed. Some authors, such as Falconer and Cavanagh (3) and Rasmussen (4), began additional procedures for surgery of cerebral lesions, not only to remove tumors and arteriovenous malformations (AVM), but not only tumoral resections but also lobectomies on the area that contained the lesion. Rasmussen (4) and Yeh et al.(1 2) sought to locate the irritative area [i.e., the cortical region that contains the epileptogenous area, as defined by Luders and Awad (13)] through electrocorticography (ECoG) and to perform the lesionectomy associated with the adjacent irritative area. Our objective was to analyze whether restricted lesionectomy or lesionectomy with resection of the adjacent irritative cortex is the best approach to treating patients with epileptic seizures and focal cerebral lesions, based on surgical outcome. PATIENTS AND METHODSalso to relieve patients from epileptic seizures. Thus...

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Object The aim of this study was to analyze cerebellar cavernous malformations (CMs) with respect to epide-miological, clinical, radiological, and therapeutic aspects. Methods Between 1984 and 2004, 100 patients were surgically treated for intracranial CMs at the Division of Neurosurgery of Federal University of São Paulo. The authors reviewed the records of 10 patients whose lesions were located in the cerebellum. There were four male and six female patients (ratio 1:1.5) whose ages ranged from 14 to 45 years (mean age 33 years). Clinical presentation was sudden or acute in all cases, and neuroimaging examinations performed in all patients demonstrated signs of bleeding. The mean size of the malformations was 4.6 cm, and in all but one patient the lesions were totally removed without complications. After a mean follow-up period of 70 months, all patients were considered to be in good or excellent clinical condition. Conclusions Cerebellar CMs should be analyzed separately from other posterior fossa CMs. These lesions can reach large sizes and cause massive hemorrhages, resulting in acute or sudden presentation. Surgery is a safe and effective option that provides a curative treatment when a complete removal is achieved.

Central nervous system actinomycosis is a rare but treatable chronic suppurative bacterial infection. The case of a young immunocompetent male with actinomycosis of the CNS is presented. The abscess originated from a primary cervico-facial infection and was located in the left parasellar region. After excision of the mass, that showed Actinomyces colonies, the patient was treated with intravenous Penicillin for 42 days followed by oral administration of the drug for 30 days. After surgery the patient was left with mild sequelae that had improved by the last follow-up, 7 months later. A new CT scan at that time revealed no residual disease or recurrence. The early diagnosis of cerebral actinomycosis relies essentially on a clinical suspicion. Hence it is imperative to be aware of the natural history of this infection and its various modes of presentation.

RESUMO -Angiomas cavernosos ou hemangiomas ou ainda cavernomas são malformações do sistema nervoso central, classificadas como lesões cerebrais vasculares ocultas, frequentemente assintomáticas, sendo relativamente raras. Definidas histologicamente como massas compactas cavernosas ou canais sinusoidais de vários tamanhos, com paredes finas no interior do parênquima cerebral e sem intervenção do tecido glial. Podem ocorrer em qualquer faixa etária inclusive em neonatos. Na maioria das vezes são lesões de tamanho reduzido, localizadas no interior do parênquima encefálico. Angiograficamente não mostram alterações com circulação patológica, podendo mesmo não ser diagnosticados pela tomografia, sendo o exame ideal para o seu diagnóstico a ressonância magnética de crânio. Os cavernomas são lesões histologicamente benignas mas, dependendo de sua localização, podem trazer grandes transtornos neurológicos e ser irressecáveis. A exérese cirúrgica da lesão é o tratamento de escolha se a lesão for única e em localização favorável e estiver desencadeando sintomatologia neurológica prejudicial ao paciente. Apresentamos dois casos de cavernomas gigantes que apresentaram boa evolução após ressecção cirúrgica completa. Descritos como gigantes, foram encontrados apenas três casos individuais na literatura .PALAVRAS-CHAVES: cavernoma, angioma cavernoso gigante.Giant cavernous angioma: report of two cases Giant cavernous angioma: report of two cases Giant cavernous angioma: report of two cases Giant cavernous angioma: report of two cases Giant cavernous angioma: report of two cases ABSTRACT -Cavernous angiomas or haemangiomas or yet cavernomas are malformations of the central nervous system classified as occult vascular brain lesions. These rare lesions are clinically silent. They are defined by the presence of abnormally large vascular cavities or sinusoids channels of variable size, with sharp walls, located inside but not invading the brain parenchyma. They can occur at any age, including the neonatal period. Most of the small lesions are located inside the brain parenchyma. No abnormal circulation can be demonstrated in angiography and CT scan can be helpful for diagnosis only in rare occasions. Magnetic resonance is the best exam to demonstrate the lesion. Despite the benign character some lesions may cause neurologic dysfunction when their removal may be difficult. Complete extirpation is the best treatment if the lesion is favorable located and is causing neurological dysfunction. Two cases of giant cavernomas with good outcome after total removal are present. Only three cases of giant cavernomas were reported in the literature.KEY WORDS: cavernoma, giant cavernous angioma.Cavernomas intracerebrais são malformações vasculares raras, angiograficamente ocultas 1 , com características histopatológicas próprias e distintas de outras malformações vasculares cerebrais (Tabela 1) 2 . De acordo com Russel e Rubinstein 3 , 75% são supratentoriais, podendo acometer qualquer lobo do cé-rebro. Apresentam localização preferencial na regi...

A series of 129 patients harbouring extradural hematomas was analysed considering the neurological state immediately before operation as the most consistent variable. Seventy eight patients were considered to be comatose (Group I) and 51 were noncomatose. Among the comatose group, 30 were investigated with computerized tomography (23.3% mortality, 50% good results), 31 were submitted to angiography (48.3% mortality, 38.7% good results), and 17 were operated based on the neurological examination and skull radiography (47% mortality, 35.2% good results). The presence or absence of skull fracture and the density of hematoma did not change the final outcome. Associated intracranial lesions increased the mortality and lowered the good results in both groups. Frontal hematomas (10 cases) in the comatose group were associated with high mortality (52.6%) due to bad neurological state (Glasgow 3-5) and to isolated or multiple intracranial associated lesions (6 patients).