Isolated Oculomotor Nerve Palsy as Presenting Symptom of Bilateral Chronic Subdural Hematomas: Two Consecutive Case Report and Review of the Literature

Isolated oculomotor nerve palsy (ONP) is caused most commonly by vascular disease, posterior circulation aneurysms, and inflammatory or traumatic injury. ONP usually occurs in chronic subdural hematoma (CSDH) as a common sign of cerebral herniation that typically is associated with a deterioration of consciousness

Treatment of idiopathic hemifacial spasm with radiosurgery or hypofractionated stereotactic radiotherapy: preliminary results.

Abstract INTRODUCTION: Microvascular decompression in the posterior cranial fossa is the first treatment option for hemifacial spasm. For patients not suitable for surgery because of advanced age, poor general conditions or patients who refuse surgery, radiotherapeutic treatment could be an alternative. Only one case of resolution of hemifacial spasm in a patient undergoing radiosurgery for an intracanalicular vestibular schwannoma has been described in the literature. In this article we present three patients affected by idiopathic hemifacial spasm, refractory to medical therapy and botulinum toxin injections, who were treated by radiosurgery in one case and hypofractionated stereotactic radiotherapy in the other two. METHODS: Radiosurgery, with a single dose of 8 Gy, was used in the first patient affected by idiopathic hemifacial spasm and autoimmune polyneuropathy with severe hypoacusia; hypofractionated stereotactic radiotherapy, with 15 Gy in 5 fractions of 3 Gy each, was preferred in the other 2 cases. In all patients, the target consisted of the vestibulocochlear-facial bundle immediately before its entry into the internal acoustic foramen. RESULTS: A marked improvement of symptoms was observed in 2 patients, and almost complete disappearance in the other case, with no complications, particularly, auditory. CONCLUSION: The mean follow-up time of 24 months reported here could be judged too short, and our series too small, but the good results observed so far lead us to underline that, as in trigeminal neuralgia, radiosurgery or hypofractionated stereotactic radiotherapy could represent a therapeutic alternative to microvascular decompression for idiopathic hemifacial spasm for patients not suitable for surgery

Cystic craniopharyngioma: trans-sphenoidal surgery and intra-cystic apposition of "bleomycin wax".

Abstract BACKGROUND: The current therapeutic approach to craniopharyngioma is multidisciplinary. Sub-total removal, followed by adjuvant treatments, especially in large cystic tumours, is an accepted regime reported by many authors. CASE REPORT: A young patient with an intra- and suprasellar cystic craniopharyngioma was operated on via a microsurgical trans-sphenoidal approach, achieving sub-total removal and bleomycin mixed with bone wax ("bleomycin wax") applied to the capsular remnant. RESULTS: Pre-operative neurological and endocrinological deficit improved after surgery. There was no evidence of tumour recurrence after a follow-up period of 5.4 years. CONCLUSIONS: The intra-operative use of "bleomycin-wax" should be limited to those patients in whom intra-operative CSF fistula does not occu

Extended transsphenoidal microsurgical approach for diaphragma sellae and tuberculum meningiomas.

Diaphragma sellae meningiomas represent a difficult challenge for neurosurgeons; they are generally operated on by a transcranial approach. Some authors reported transsphenoidal surgery in selected cases, but without accurately focusing the surgical technique that should be necessary for removing the typical hard fibrous tissue of the meningioma, that is not aspirable, by this approach. We present the surgical technique and the useful instrumentarium for removing a diaphragma sellae meningioma through an extended microsurgical transsphenoidal approach

Isolated intracranial myeloid sarcoma: report of a case and review of the literature

Myeloid sarcoma is a rare malignant tumor of primitive myeloid cell origin often associated with hematologic disorders. The central nervous system is rarely involved and differentiating between myeloid sarcoma and other tumors is not possible on imaging. Here we present the rare case of an isolated intracranial myeloid sarcoma, initially misdiagnosed radiologically as a meningioma, treated with surgical total resection and subsequent chemotherapy, with no signs of any hematological disorder at follow up. Differential diagnosis and management strategies, as well as follow-up implications are discussed along with literature review, which pointed out that only five cases with no further signs of hematological disorders at follow up have been described in the literature so far and this case has the longest follow up of them at 9 years

Validity of percutaneous controlled radiofrequency thermocoagulation in the treatment of isolated third division trigeminal neuralgia

BACKGROUND: Of 756 percutaneous controlled radiofrequency thermocoagulations of gasserian ganglion and/or retrogasserian rootlets for idiopathic trigeminal neuralgia or for trigeminal neuralgia in multiple sclerosis, the results in 158 patients who had isolated third division trigeminal neuralgia were reviewed. METHODS: In 129 patients, percutaneous thermocoagulation was fluoroscopic guided, whereas in the last 29 the procedure was performed under CT control. In all cases, the goal was to achieve selective anesthesia limited to the third trigeminal division. RESULTS: Complete pain relief was obtained immediately after the procedure in all patients and selective anesthesia in the third division was achieved in all of them, except for 2 patients in whom unwanted first and second division anesthesia/hypoesthesia also occurred. Other significant complications were transient sixth cranial nerve palsy in 1 patient and masseter muscle dysfunction, which improved during follow-up, in another one. The selected sensory impairment was well tolerated in all patients. During an average follow-up period of 8.8 years, recurrences occurred in 12 patients, together with a partial regression of the anesthesia: in 10 patients the procedure was repeated successfully. In 2 patients with multiple sclerosis, the procedure was repeated twice and 3 times, respectively. CONCLUSIONS: Percutaneous controlled radiofrequency thermocoagulation is quite easy to perform under fluoroscopic or CT control, and it involves no mortality and very low morbidity; it is an immediately effective procedure and the rate of recurrence is low. Last, but not least, if the anesthesia is limited to the third division, no anesthesia dolorosa occurs and patients are very grateful

Multidisciplinary treatment of giant invasive prolactinomas in paediatric age: long-term follow-up in two children.

Abstract BACKGROUND: Invasive giant prolactinomas are rare tumours, still representing a therapeutic challenge due to their characteristics of invasiveness and variable clinical course. Giant prolactinomas in childhood are extremely rare. Only single case reports have been described in the literature. CASE PRESENTATION: We report on two children who presented a progressive visual deterioration. Magnetic resonance imaging showed extensive intra-suprasellar tumour invading the anterior skull base. The laboratory investigations detected markedly elevated prolactin levels. The patients were firstly started on dopamine agonist therapy with partial reduction in size of the tumours. The debulking of the residual lesions through a transsphenoidal approach was then performed in both patients, one of whom requiring a second surgical procedure for tumour regrowth. The complete shrinkage of the residual adenomas was achieved after the treatment with conventional radiotherapy, with a follow-up of 13 and 14 years, respectively. DISCUSSION: Multidisciplinary therapeutic approach for giant prolactinomas in paediatric patients can be an effective treatment; despite the invasiveness of these tumours, the efficacy of this combined treatment can reach a satisfactory control of the disease at long term, assuring a good quality of life as well