The purpose of this retrospective study was to assess the effectiveness and safety of Percutaneous Vertebroplasty and Kyphoplasty, in the treatment of pain deriving from neoplastic vertebral compression fractures (VCF). We treated 33 oncologic patients with these new techniques (2 pts with aggressive haemangiomas, 8 pts with myelomas and 23 pts with metastases) suffering from severe motion pain in the back, notwithstanding conservative treatment with medication and corset therapy, in the absence of neurological signs. In 3 selected patients we associated radiofrequency heat ablation with vertebroplasty in the treatment of metastases. The aim is to destroy tumor tissue and to thrombose the paravertebral and intravertebral venous plexus before stabilizing the vertebra.

Study design: Cystic dilatation of the fifth ventricle on its own is an extremely rare pathological event in adults whose pathogenesis is uncertain. The authors describe a personal case of 'fifth ventricle' and review the pertinent literature. Objective: To emphasize the importance of including the fifth ventricle in differential diagnosis of lesions of the conus medullaris to ensure proper treatment. Setting: Italy. Methods: A 30-year-old woman was referred to us for recurrent low back pain. The patient was assessed by clinical, electrophysiological (motor evoked potential, somatosensorial evoked potential and electromyography of the perineal and lower limb muscles) and urodynamic investigations as well as a magnetic resonance imaging (MRI) of the lumbar-sacral segment with and without gadolinium enhancement, subsequently extended to the entire vertebral column and brain. Follow-up consisted of periodic clinical evaluation and lumbar-sacral MRI after 1 and 2 years. Results: General physical examination, electrophysiological and urodynamic investigations were all negative, confirming the subjective nature of the patient's symptoms. Lumbar-sacral MRI demonstrated the presence of a cyst lesion containing cerebrospinal fluid (CSF), which did not enhance after gadolinium, compatible with the diagnosis of the terminal ventricle. By extending the MRI investigation to the entire vertebral column and brain, it was possible to exclude an association with other malformations of the central nervous system. Clinical and radiological follow-up confirmed the nonevolutive nature of the lesion 1 and 2 years later. Conclusions: The lack of clinical symptoms and the stability of the radiological situation at 1 and 2 years follow-up motivated our choice of conservative treatment.Spinal Cord (2005) 43, 381-384.

OBJECTIVE AND IMPORTANCE Intrasphenoidal encephalocele is a rare clinical entity that is often complicated by rhinorrhea, recurrent meningitis, and headache, but in no case has the association of rhinorrhea with subdural hematomas been described. A surgical procedure to stop persistent cerebrospinal fluid leakage is reported. CLINICAL PRESENTATION A 59-year-old man sought care for intractable rhinoliquorrhea of 6 months' duration. Cranial computed tomographic and magnetic resonance imaging scans revealed a basal posterior frontal bony defect and an evocative image suggesting intrasphenoidal encephalocele. INTERVENTION A transnasal transsphenoidal surgical procedure was performed; the encephalocele was removed, and the sphenoid sinus was filled with an inflatable pouch made of synthetic dura mater containing abdominal fat. Postoperative reduction of the rhinoliquorrhea, but not its total disappearance, was observed. Total disappearance was achieved only after endonasal, transmucosal inflation of the pouch with human fibrin glue. One of the subdural hematomas disappeared spontaneously, and the other was treated by a surgical procedure. CONCLUSION The possible role of the presented technique in the treatment of cerebrospinal fluid leakage is discussed.

IntroductionCalcifying pseudo-tumor is a rare lesion, of which only a few cases localized in the spine have been described [1,2,3,4,5]. The most important case series is the one reported by Bertoni [1] and co-workers in 1990, comprising 14 cases, of which 8 were situated in the spine. In the present paper, we describe a case of calcifying pseudo-tumor of the thoracic spine. Case reportA 40-year-old man was referred to us with a 2-month history of thoracic pain radiating to the anterior surface of the chest, accompanied by progressive difficulty in walking. Neurological evaluation revealed a spastic paraparesis and a bilateral level of hypoesthesia at T8-T9. Results of routine laboratory tests were normal. Magnetic resonance imaging (MRI) of the thoracic spine documented an extradural lesion at T8-T9, occupying the lateral recess and the right conjugate foramen and extending cranio-caudally: this lesion was hypointense on both T1-and T2-weighted images and did not present enhancement after gadolinium administration (Fig. 1, Fig. 2). Contrast-enhanced computed tomography (CT) demonstrated, at the same site, a hyperdense, non-homogeneous lesion, compatible with calcified tissue (Fig. 3). At surgery, via a T8-T9 laminectomy, a nodular, encapsulated lesion with a maximum diameter of 5 cm was removed; its consistency was gelatinous and its contents were casseous and pearly. Histological examination showed the presence of a granulomatous infiltrate, characterized by giant cells and fine calcifications (Fig. 4), typical of calcifying pseudo-tumor [1, 2, 3, 4, 5]. The postoperative period was uneventful. At 36-month follow-up examination, the patient's clinical symptoms had entirely regressed and there was no evidence of recurrence on either MRI or CT scan. DiscussionCalcifying pseudo-tumor is a benign, non-neoplastic lesion with a probable inflammatory reactive origin [1]: involvement of the neural axis by this lesion has only recently been described. As we can see in Table 1, which summarizes the 13 cases reported in the literature and the case reported here, the spinal localization can be considered rare, and may represent a real surprise for the neurosurgeon. An analysis of these 13 cases shows that males Abstract A case of calcifying pseudo-tumor of the thoracic spine, a rare lesion with tumor-like behavior and a probable inflammatory-reactive origin, is described. The clinicalpathological and neuro-radiological aspects of this lesion are discussed in relation to surgical treatment. In accordance with the other cases reported in the literature, the case observed confirmed the benign behavior of the lesion and the effectiveness of surgical treatment for achieving complete resolution of clinical symptoms without any recurrences, even when removal is only subtotal.

Primary meningeal lymphoma is a rare occurrence. We present a case of an immunocompetent patient operated on for a fronto-parietal lesion similar to a meningioma, which the histological examination diagnosed as a mucosa-associated lymphoid tissue (MALT)-type lymphoma. She received no further post-operative treatment and after 36 months showed no evidence of disease. In a review of the literature, we identified 14 similar cases of MALT lymphoma pre-operatively diagnosed as meningioma. Recognition of this rare meningeal location of a lymphoma involving the central nervous system is useful for a proper diagnosis and adequate treatment.