Object Lipomas of the spinal cord are often a component of spinal dysraphic states. Nondysraphic intramedullary spinal cord lipomas are rare, and their presentation, in the form of gradually worsening myelopathy, is nonspecific. The authors report on the methods used for diagnosis and treatment in patients presenting with these lesions at their institution, and they review the relevant literature. Methods The authors treated 14 patients who presented with intramedullary lipomas over a period of 12 years. None of these patients had segmentation anomaly or dysraphism of the spine, or any hindbrain anomaly. Admission magnetic resonance images were diagnostic in all patients. All tumors were located dorsally in the spinal cord, the majority of them in the cervicodorsal cord. The lipomas were partially excised with the help of a carbon dioxide laser in all patients in an attempt to preserve neurological function. All patients attained improvement in their sensory and motor symptoms. Conclusions Because these lesions do not have a clear-cut margin, it is vital to preserve neurological function at the time of surgery, even if it entails incomplete resection.

Object Intraventricular meningiomas are rare tumors. The origin of these tumors can be traced to embryological invagination of arachnoid cells into the choroid plexus. The authors analyzed data that they had collected to study the clinicopathological aspects and review the origin, presentation, imaging, and management of these tumors. Methods In this retrospective analysis, the authors describe the cases of 12 patients who had received a diagnosis of intraventricular meningioma and underwent surgery for the tumors. Nine of these patients were men and three were women. Features of neurofibromatosis Type 2 were present in two of the women. Nine of the tumors were located in the lateral ventricles, one was in the third ventricle, and two were in the fourth ventricle. Raised intracranial pressure (ICP) was the universal presentation in all the patients, and the preoperative diagnoses were confirmed on neuroimaging studies. Excision was performed using the parietooccipital (trigonal) approach for lateral ventricle tumors, the transcortical–transventricular route for the third ventricle tumor, and suboccipital craniectomy for fourth ventricle tumors. Postoperatively, one patient died and the others experienced resolution of their symptoms. Histopathological features of these tumors were similar to those seen in meningiomas in other locations. Conclusions Intraventricular meningiomas are slow-growing tumors that become large prior to detection. Although they are commonly seen in the lateral ventricles, they occur in the third and fourth ventricles as well. Presentation is in the form of raised ICP with no localizing features; therefore the diagnosis is based on imaging studies. Hydrocephalus occurs due to obstruction of cerebrospinal fluid pathways. Excision requires planning to avoid eloquent cortex incision. The histopathological features are varied, although most of the tumors in the study were angiomatous meningiomas. These tumors are no different histologically from tumors that are dural in origin. No recurrence has been reported.

Pituitary is a rare site for metastases from thyroid cancer. Most reported cases have been of papillary and follicular carcinoma. Metastases from medullary thyroid carcinoma have not been reported. We report a case of intrapituitary metastasis from medullary carcinoma thyroid in a 38-year-old male, who had been operated for pituitary adenoma 5 years earlier. At the time of presentation in Nov 2006, he had visual field defects and a painless thyroid nodule. Further evaluation revealed medullary carcinoma thyroid, cervical and mediastinal lymphadenopathy, elevated serum calcitonin levels, and lobulated pituitary tumor. After surgical excision of thyroid and lymph node clearance, he underwent craniotomy and subfrontal excision of pituitary tumor. All the tumors were of identical histology, i.e., medullary carcinoma thyroid. Pituitary tumor was positive for calcitonin.

Primary Ewing's sarcoma of the cranium is extremely rare, with only 17 cases reported so far. We describe a further case with involvement of the frontotemporal region and the orbit. The patient, an adult male, was admitted with headache and papilloedema, and later developed localised swelling and proptosis. He was treated with surgery, radiotherapy and chemotherapy, and was free from metastases during a follow-up of 14 months. The prognosis of Ewing's sarcoma is improving with radiotherapy and chemotherapy. Further cases are needed to study the biological behaviour of primary cranial Ewing's sarcoma.

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AQP1-immunoexpression had a good correlation with high-grade tumors. AQP-upregulation in perilesional areas of high-grade tumors suggests its role in vasogenic edema. Further studies involving other AQP molecules, vascular endothelial growth factor (VEGF) and hypoxia inducible factor-1 α (HIF-1α) should be undertaken to evaluate its possible role as a potential surrogate marker of high-grade tumors heralding poor outcome, inhibition of which may serve as the basis for future targeted therapy.

Clear cell ependymoma (CCE) is an uncommon variant of ependymoma having a predilection for the supratentorial region. Histologically, it bears an uncanny resemblance to oligodendroglioma, central neurocytoma, hemangioblastoma and metastasis from clear cell carcinoma. Here, we report a rare case of clear cell ependymoma in a 45-year-old male, which histomorphologically resembled anaplastic oligodendroglioma on intraoperative smears, frozen section and routine light microscopy. Immunohistochemistry, however, helped to arrive at the correct diagnosis. Unlike other clear cell tumors of the brain parenchyma, CCE is known to follow an aggressive course and, hence, obtaining a correct diagnosis is imperative since it has a direct therapeutic and prognostic connotation.

Cranial nerve injury is often an overlooked aspect of neurotrauma, which is diagnosed later in the course of recovery. Most of these injuries do not require active intervention in the acute stage. Cranial nerve injuries are important cause of morbidity, which requires long-term management, repeated surgical procedures or reconstructive measures. Management of optic nerve injury remains controversial, and injury to lower cranial nerves may influence the ultimate outcome due to paralysis of aerodigestive passage. Cranial nerve injury in the setting of head injury should be diagnosed early, so that appropriate treatment can be planned early.