Primary cranial vault lymphoma is an extremely rare finding. It should be considered in the differential diagnosis of scalp masses. Although the analysis of outcome of the reported cases is difficult because of the small number of occurrences of this entity and the variability of follow-up, a combination of surgery, radiotherapy, and chemotherapy seems to offer better outcomes.

No abstract

Classically, treatment of intramedullary abscesses involves surgical drainage of the abscess cavity and administration of appropriate antibiotics, although medical therapy alone may be appropriate in some cases. If the diagnosis is unclear or patients do not respond to medical management, surgical decompression should be performed.

Intraradicular lumbar disc herniation is a rare complication of disc disease that is generally diagnosed only during surgery. The mechanism for herniated disc penetration into the intradural space is not known with certainty, but adhesion between the radicular dura and the posterior longitudinal ligament was suggested as the most important condition. The authors report the first case of an intraradicular lumbar disc herniation without subdural penetration; the disc hernia was lodged between the two radicular dura layers. The patient, a 34-year-old soldier, was admitted with a 12-month history of low back pain and episodic left sciatica. Neurologic examination showed a positive straight leg raising test on the left side without sensory, motor or sphincter disturbances. Spinal CT scan and MRI exploration revealed a left posterolateral osteophyte formation at the L5-S1 level with an irregular large disc herniation, which migrated superiorly. An intradural extension was suspected. A left L5 hemilaminectomy and S1 foraminotomy were performed. The exploration revealed a large fragment of disc material located between the inner and outer layers of the left S1 radicular dura. The mass was extirpated without cerebrospinal fluid outflow. The postoperative course was uneventful. Radicular interdural lumbar disc herniation should be suspected when a swollen, hard and immobile nerve root is present intraoperatively.

Predisposing factors for pituitary abscesses in primary lesions include immunosuppression and pituitary irradiation, surgery, or infarction. Approximately one-third of pituitary abscesses arise within other lesions. The clinical manifestations are non-specific. Magnetic resonance imaging shows a cystic lesion with central low intensity and rim enhancement after administration of contrast. When a pituitary abscess is diagnosed, surgical procedures should be performed promptly via a transsphenoidal (preferably) or transcranial approach.