Schwannoma of the greater superficial petrosal nerve

The authors report the clinical features, imaging and surgical findings, and follow-up of 5 rare cases of schwannoma of the middle fossa with possible origin from the greater superficial petrosal nerve (GSPN). All patients presented to a single neurosurgical institution. The study design was a prospective follow-up of 5 cases of schwannomas of the middle fossa that most likely originated from the GSPN. The presenting features were burning pain in the eyes in 2 cases, epilepsy and behavioral changes in 2 cases, and headache in 1 case. Imaging studies showed a subtemporal mass on the anterosuperior aspect of the petrous bone in all cases. An enhancing tail on the MR images was highly suggestive of the origin of the tumor from the GSPN. All tumors were removed through a subtemporal extra- or intradural approach. Partial to complete peripheral facial nerve palsy was encountered after surgery in 3 cases, which recovered completely. Dry eye was the long-term permanent deficit in all cases. Mid- to long-term follow-up of the cases has not revealed any tumor recurrence. The 5 cases of schwannoma of the middle fossa with possible origin from GSPN were managed successfully, and their clinical presentation, differential diagnosis, and management are discussed

Angiographically occult dorsal extramedullary spinal arteriovenous malformations: Report of 4 cases with atypical preoperative findings and postoperative course: Review of classifications

Objectives: Presenting 4 cases of spinal arteriovenous malformations (SAVMs) with typical spinal magnetic resonance imaging (MRI) and myelogram, but negative complete selective spinal angiography (SAG) and a "hard to explain" postoperative course. MATERIALS AND Methods: All were male patients of 40 to 50 year of age presenting with progressive paraparesis and sphincter disturbance. MRI, spinal myelography, multislice spinal computed tomographic angiography, and digital subtraction selective SAG was performed. The surgical treatment is described and the videos of 2 cases are demonstrated. Even though all the patients had slow and acceptable improvement in the short postoperative course but in longer follow-up, the clinical improvement continued slowly in 1 case, plateaued in 1 case, and paraplegia recurred in 2 cases. Results: Low intensity intramedullary ellipsoid shadow in T1-weighted spin echo MRI, turning to a homogenous bright high signal intensity lesion in T2-weighted sequence with flow void serpentine images located in the dorsal aspect of the spinal cord in multiple levels were the typical findings. Ill-defined filling defects visualized in myelography was present in all 4 cases. Digital subtracted selective SAG did not show any abnormal vessels in any of the cases. Conclusions: (a) There are still unusual variants of SAVMs that neurosurgeons should recognize, (b) there should be an acceptable explanation for the lesions being angiographically invisible, and (c) the natural course and outcome of the angiographically occult SAVM is not known and unexpected events can be anticipated in long-term follow-up of similar cases. © 2010 by Lippincott Williams and Wilkins

COMPUTED TOMOGRAPHY IN HYDATID CYST OF THE ORBIT

Two cases of hydatid cysts of the orbit causing unilateral exophthalmos are reported. Diagnosis were suspected by means of computed tomography (CT) and confirmed at Operation. CT changes are described and its value in diagnosis of this lesion particularly in the endemic areas is stressed