Radical removal of glomus jugulare tumor can be achieved without anterior transposition of the facial nerve. The extension of dissection, however, should be tailored to each case based on tumor blood supply, preoperative symptoms, and tumor extension. The operative field provided by the retrofacial infralabyrinthine approach, or the pre- and retrofacial approaches, with or without closure of the external acoustic meatus, allows a wide exposure of the jugular foramen area. Global functional recovery based on the KPS is acceptable in 94% of the patients.

-Pituitary abscesses are potentially life-threatening lesions if not appropriately diagnosed and treated. The authors have operated on more than five hundred cases of pituitary tumors and only one represented a case of pituitary abscess. A 35-year-old woman was investigated for chronic frontal headache. CT scan showed a cystic sellar lesion with ring enhancement after contrast injection leading to an initial diagnosis of pituitary adenoma. She underwent a sublabial transsphenoidal approach to the pituitary gland. After dural opening, purulent material was obtained and no tumor or other associated lesion was detected. There was no evidence of current or previous septicemic illness, meningitis, cavernous sinus thrombosis or sinus infection. Cultures were negative. She was put on antibiotics and discharged after 4 weeks. Nowadays, 10 years after treatment, she is doing well, with no anterior pituitary hormone deficit. MRI shows a partially empty sella without residual lesion and the pituitary stalck is in the midline. The early diagnosis and adequate treatment of this life-threatening lesion may result in excellent prognosis.KEY WORDS: abscess, pituitary gland, hypophysis. Abscesso primário de hipófise: relato de casoRESUMO -Abscessos pituitários são lesões potencialmente graves se não diagnosticadas e tratadas de maneira apropriada. Os autores têm mais de 500 casos de tumores pituitários operados e apenas um único caso de abscesso pituitário. Uma mulher de 35 anos foi investigada por cefaléia frontal crônica. A tomografia computadorizada de crânio mostrou uma lesão selar cística com captação de contraste levando à hipótese diagnóstica inicial de adenoma hipofisário. A paciente foi submetida a um acesso sublabial transesfenoidal para a hipófise. Após abertura dural, foi encontrado material purulento sem sinal de tumor ou outra lesão associada. Não havia evidência de doença séptica prévia ou atual, meningite, trombose de seio cavernoso ou sinusite. Culturas foram negativas. A paciente foi submetida a tratamento com antibióticos e recebeu alta após 4 semanas. Atualmente, após 10 anos do tratamento, encontra-se sem déficit hormonal hipofisário anterior. Sua ressonância magnética de crânio mostra uma sela parcialmente vazia sem lesão residual, com o talo hipofisário na linha média. O diagnóstico e tratamento adequado desta lesão potencialmente grave pode resultar em excelente prognóstico. PALAVRAS-CHAVE: abscesso, glândula pituitária, hipófise.

Objective To contribute our experience with surgical treatment of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH). Method This is a retrospective observational study. The sample included patients with medically refractory mTLE due to unilateral mesial temporal sclerosis who underwent either ATL or SelAH, at Hospital de Clinicas – UFPR, from 2005 to 2012. We report seizure outcomes, using Engel classification, cognitive outcomes, using measurements of verbal and visuospatial memories, as well as operative complications. Result Sixty-seven patients (33 ATL, 34 SelAH) were studied; median follow-up was 64 months. There was no statistically significant difference in seizure or neuropsychological outcomes, although verbal memory was more negatively affected in ATL operations on patients’ dominant hemispheres. Higher number of major complications was observed in the ATL group (p = 0.004). Conclusion Seizure and neuropsychological outcomes did not differ. ATL appeared to be associated with higher risk of complications.

The purpose of this report is to describe the unique cytological findings of a new recently characterized type of meningioma that has extensive noncalcifying collagenous whorls and glial fibrillary acid protein (GFAP) expression. This new entity, described by Haberler and colleagues, was named whorling sclerosing variant of meningioma. The patient was a 34-yr-old white man with a large tumor in the brainstem. Intraoperative smear preparations showed a tumor with a large number of solid hyaline masses in a loose background and in focal areas tumor cells formed cohesive nests with a somewhat whorling appearance. The histological sections showed a neoplasia composed of innumerable eosinophilic, collagenous, noncalcified round deposits, cuffed by scattered meningothelial tumor cells. The neoplastic cells showed diffuse cytoplasmic reactivity for EMA and vimentin, as well as positivity to GFAP. This is the first cytological description of this new entity in the literature.

The purpose of this study is to evaluate the efficacy of the endoscopic technique for the treatment of the colloid cysts of the third ventricle. Between August 1995 and October 1997 a series of nine patients with colloid cyst of the third ventricle (6 males and 3 females) were treated with this method. The technique, consisting of cyst fenestration, aspiration of the colloid, and coagulation of the internal layer of the wall, was always effective in restoring CSF circulation. Operating time was 54-120 min (median 67 min). We recorded only one post-operative septic complication but no signs of direct surgical morbidity. Post-operation hospital stay was 2-30 days (median 5 days). Follow up was 14-40 months (mean 27 months). We did not observe any clinical or radiological recurrence. Endoscopic treatment of colloid cysts of the third ventricle is a safe and effective alternative to the well-established approaches of microsurgical removal and stereotactic aspiration. Only a very long follow-up will answer the question of the long-term effectiveness of this method.

-Cerebellar hemorrhage is listed among the potential complications following neurosurgical procedures. In this scenario it is usually reported as a rare condition. However, it seems that epilepsy surgery patients are somewhat more prone to this kind of complication, compared to other surgical groups. Head positioning, excessive cerebral spinal fluid draining and the excision of non-expanding encephalic tissue (or combinations among the three) are likely to be cause underlying remote cerebellar hemorrhage. Out of the 118 ATL/AH performed at our institution, between 1996 and 2002, we identified 3 (2.5%) patients presenting with cerebellar hemorrhage. We report on such cases and review the literature on the topic.KEY WORDS: cerebellar hemorrhage, epilepsy surgery, neurosurgical complications.Hemorragia cerebelar como complicação de lobectomia temporal para epilepsia do lobo temporal medial: relato de três casos RESUMO -A hemorragia cerebelar faz parte das potenciais complicações dos procedimentos neurocirúrgicos. De forma geral, é considerada uma condição rara. Entretanto, há aparente propensão dos pacientes submetidos ao tratamento cirúrgico de epilepsia em apresentar este tipo de complicação, quando comparados com outros grupos cirúrgicos. O posicionamento da cabeça, excessiva drenagem de líquido cefalorraquidiano e a excisão de tecido cerebral não expansível (ou talvez combinações entre os três) constituem as potenciais causas da hemorragia cerebelar remota. Entre os 118 pacientes em nossa série de LTA ⁄ AH, identificamos 3(2.5%) casos de hemorragia cerebelar. Relatamos os três casos desta natureza, com revisão da literatura pertinente a esta complicação.PALAVRAS-CHAVE: hemorragia cerebelar, cirurgia de epilepsia, complicações neurocirúrgicas.Anterior temporal lobectomy (ATL) and amygdalohippocampectomy (AH) are effective treatment alternatives in patients with temporal lobe epilepsy refractory to medical treatment. Neuropsychological disturbances (language and memory) are the most common post-operatory derangements. Nevertheless, surgical complications are rarely expected, both locally and at remote sites. Recent papers have shed some light on the relative high frequency of cerebellar hemorrhage in patients submitted to anterior temporal lobectomy, when compared to other surgical groups. It seems that ATL/AH patients are particularly prone to this kind of complication. At our institution ATL ⁄ AH are always performed using the same surgical technique (that is, a trans-temporal approach). Out of the 118 ATL ⁄ AH performed at our institution we were able to identify 3(2.5%) patients presenting with cerebellar hemorrhage. Their cases are reported. CASESPatient 1. A 31 year-old male patient, presenting with a seizure disorder starting at the age of 9 y/o, characterized by an aura (epigastric sensation), shortly followed by a complex partial seizure and on occasion a generalized tonic-clonic seizure. He was tried on phenobarbital and carbamazepine, with unsatisfactory seizure control. A combination of valpr...

RESUMO -Cavernomas são malformações vasculares que frequentemente acometem a substância branca dos hemisférios cerebrais e tronco encefálico. São angiograficamente ocultas e têm como principal método diagnóstico a ressonância magnética, em que tipicamente se observa nas sequências ponderadas em T2, um halo perilesional hipointenso devido a deposição de hemossiderina no tecido adjacente. A localização ventricular é considerada rara, e suas características de imagem na ressonância magnética diferem, podendo não apresentar tal halo. Apresentamos dois casos nos quais o diagnóstico foi feito somente com exame histopatológico, devido a ausência dos critérios de imagem que permitiriam a suspeita de tal lesão. Os cavernomas devem ser incluidos no diagnóstico diferencial dos processos expansivos intraventriculares, sendo a ressecção cirurgica completa a melhor modalidade de tratamento para estas lesões.PALAVRAS-CHAVE: hemangioma cavernoso, cavernoma, neoplasias ventriculares cerebrais, ressonância magnética, malformações arteriovenosas cerebrais.Magnetic resonance imaging of the intraventricular cavernomas: diagnostic aspects Magnetic resonance imaging of the intraventricular cavernomas: diagnostic aspects Magnetic resonance imaging of the intraventricular cavernomas: diagnostic aspects Magnetic resonance imaging of the intraventricular cavernomas: diagnostic aspects Magnetic resonance imaging of the intraventricular cavernomas: diagnostic aspects ABSTRACT -Cavernomas are vascular malformations that typically affect the white matter of cerebral hemispheres and brain stem. They are angiographically occult lesions that depend on magnetic resonance imaging (MRI) for their diagnosis, presenting a hypointense perilesional ring caused by hemossiderin deposition as seen in T2 sequences. The ventricular location is rare, and image features may differ. We present two cases with diagnosis made only by histopathologic examination, due to a lack of classic image findings. Cavernous hemangiomas must be included in the differential diagnosis of intraventricular tumors, and total surgical resection is the treatment of choice. Perilesional ring as demonstrated by MRI, must not be expected when dealing with such lesions. KEY WORDS: cavernous hemangioma, cavernoma, cerebral ventricle neoplasms, magnetic resonance, cerebral arteriovenous malformations. Malformações vasculares se originam a partir do desenvolvimento anômalo da rede vascular no tecido nervoso durante a fase embrionária. Elas são classificadas em 4 grupos, sendo os cavernomas ou angiomas cavernosos um dos subtipos 1 . Eles tipicamente são encontrados na região subcortical próxima à fissura silviana, nos gânglios da base e no tronco encefálico [2][3][4] . A sintomatologia dessas lesões depende de sua localização e a história natural dos cavernomas tem sido melhor caracterizada nos últimos anos, especialmente após o advento da ressonância magnética (RM) 5-8 .Até recentemente, haviam sido relatados 45 casos de cavernomas localizados no interior do sistema ventricular, em revisão...

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