Arteriovenous malformations (AVMs) of the scalp are rare lesions. The clinical picture presents with complaints of increased scalp, scalp disfigurement, pain and neurological symptoms. Its origin can be congenital or traumatic. We present a case of giant scalp AVMs and its management, followed by a brief literature review on the subject. The diagnosis of scalp AVMs is based on physical examination and confirmed by internal and external carotid angiography or computed tomographic angiography (CTA). Surgical excision is especially effective in scalp AVMs, and is the most frequently used treatment modality.

Pneumoventricle and liquoric fistula are possible complications of traumatic brain injury (TBI), the main cause of morbimortality related to trauma in Brazil. Liquoric fistulae are more common after direct trauma with skull base fractures. However, pneumoventricle is rare and occurs due to excessive cerebrospinal fluid (CSF) drainage in the presence of a poorly compliant ventricle system, resulting in the influx of air to its interior. The pathophysiology of tension pneumoventricle remains uncertain. However, the traumatic cause is certain and multiple bone fractures of the face and liquoric fistula may contribute to the process. If symptomatic, the tension pneumoventricle can cause rapid clinical deterioration. The authors aim to report a rare case of post-TBI tension pneumoventricle with complete resolution and without signs of recurrence of the liquoric fistula after surgical treatment. Palavras-Chave ResumoO pneumoventrículo e a fístula liquórica são possíveis complicações decorrentes do traumatismo cranioencefálico (TCE), principal causa de morbimortalidade relacionada ao trauma no Brasil. As fístulas liquóricas são mais comuns após traumas diretos, com fraturas da base do crânio. Já o pneumoventrículo é raro e ocorre após a drenagem liquórica excessiva, na presença de sistema ventricular pouco complacente, resultando em um influxo de ar para o seu interior. A fisiopatologia do pneumoventrículo hipertensivo permanece incerta. Entretanto, a causa traumática é certa, e múltiplas fraturas de ossos da face e a fístula liquórica podem ter contribuição no processo. Se for sintomático, o pneumoventrículo hipertensivo pode provocar rápida deterioração clínica. Os autores têm por objetivo relatar um caso raro de pneumoventrículo hipertensivo após TCE com completa resolução e sem sinais de recorrência da fístula liquórica após tratamento cirúrgico.

ResumoOs cistos epidermoides constituem lesões congênitas, benignas e raras, que correspondem a cerca de 0,2% a 1,8% de todos os tumores intracranianos, sendo que em apenas 5% dos casos localizam-se no quarto ventrículo. Apesar de sua gênese na vida intrauterina, são geralmente diagnosticados entre a terceira e quinta década de vida em decorrência de seu padrão de crescimento muito lento. A imagem ponderada pela difusão da ressonância magnética é fundamental para a formulação do diagnóstico. O tratamento ideal consiste no esvaziamento do conteúdo cístico com ressecção completa da cápsula. Neste trabalho, é descrito um caso de uma paciente de 31 anos de idade com síndrome cerebelar, evoluindo com síndrome de hipertensão intracraniana. A sintomatologia era decorrente de hidrocefalia obstrutiva por cisto epidermoide localizado no interior do quarto ventrículo, confirmado pela anatomia patológica. Keywords► epidermoid cyst ► fourth ventricle ► hydrocephalus AbstractEpidermoid cysts constitute congenital, benign and rare lesions, corresponding to approximately 0.2 to 1.8% of all intracranial tumors. Only 5% of cases located in the fourth ventricle. Despite its genesis in intrauterine life, are usually diagnosed between the third and fifth decade of life due to its very slow growth pattern. The imagem weighted by the diffusion of the magnetic resonance is essential to formulation of the diagnosis. The ideal treatment of choice is the empyting of the cystic contente with complete capsule ressection. In this work the case of a 31-year-old female with cerebelar syndrome evolving with intracranial hypertension. The symptomatology was due to obstructive hydrocephaly by an epidermoid cyst located inside the fourth ventricle, confirmed by the pathological anatomy.

Introduction Patients undergoing spine surgery by the posterior approach are subjected to excessive and constant pressure on the operative site, because decubitus adopted (dorsal) in most procedures, including lying on his back on the injury held recently. The increased pressure on the wound after surgery may lead to tissue ischemia and this fact may explain why patients operated on by posterior approach have higher rates of pain and infection postoperatively. This prospective, controlled study was designed to demonstrate the excess pressure on the muscle of the wound in patients submitted to surgery in the spine by the posterior approach when they assume supine position. Patients and Methods A total of 22 patients undergoing major surgery in the thoracic and lumbar regions had a fiber optic catheter (Codman ICP Monitoring System, Jonhson and Jonhson) inserted in to the body (right or left) of the paraspinal muscles. The catheter was inserted 3 cm lateral to the incision and 5 cm deep. The pressure was measured and recorded hourly obeying the order of dorsal decubitus, right and left lateral decubitus for 24 hours postoperatively with the patient at bed rest. After this period the catheter was removed. Results Patients had a mean age of 55.9 ± 4.2 years (11 men and 11 women); height of 167.8 ± 2 cm; weight and BMI (body mass index) was 73.0 ± 2 (kg), and 25.3 ± 0.8, respectively. The average abdominal circumference was 93.7 ± 2.7 cm. ANOVA showed a significant difference in mean pressure (24 hours) from the supine position (24.7 ± 2.0 mm Hg) with left or right lateral decubitus (4.92 ± 2.3 mm Hg and 4.77 ± 2.83 mm Hg). There was no significant correlation between weights, sex, BMI, and waist circumference with the pressure of decubitus adopted by the patient, or with the side that the catheter was inserted. Conclusion The supine position adopted in the postoperative period of major spine surgery through the posterior approach can be a factor implicated in postoperative complications. The pressure difference is significant enough to exceed capillary pressure.

Introduction Aneurysmal bone cysts (ABCs) are pseudotumoral bone lesions of unknown etiology that are also hypervascularized, benign, and locally destructive. They are rare in the base of the skull. The present case report describes a case of aneurysmal bone cyst in the sella turcica. Case Report The present study was developed at the department of neurosurgery of the Hospital Universitário Professor Alberto Antunes of the Universidade Federal de Alagoas (HUPAA-AL, in the Portuguese acronym), Maceió, state of Alagoas, Brazil, and is accompanied by a review of the literature from the PubMed database. A 17-year-old female patient with bitemporal hemianopia and intense left hemicranial headache associated with symptoms from the cranial nerves contained in the cavernous sinus. Neuroimaging evidenced a large lesion in the suprasellar region with calcification foci, sellar erosion, and extension to the cavernous sinus. The patient was submitted to a partial lesion resection and the histopathological analysis showed an aneurysmal bone cyst. Conclusion A rare case of intracranial aneurysmal bone cyst, with the important differential diagnosis from pituitary adenoma.