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The purposes of this study were to describe changes in perinatal nurse (n = 70) and physician (n = 88) perceptions of teamwork and safety climate after implementing a 6-month Crew Resource Management training program and compare responses between nurses and physicians. The Teamwork and Safety Climate Survey was administered prior to and 1 year after the intervention. There were significant improvements in nurse and physician perceptions of teamwork and safety climate; however, physicians perceived teamwork more positive than nurses.

Communication and teamwork improved on this labor and delivery unit.

This article outlines the surgical technique and the indications for the lateral transmaxillosphenoidal approach, which is illustrated by an index case. A 27-year-old woman presented with a trigeminal sensory deficit caused by a dermoid tumor occupying the lateral compartment of her right cavernous sinus. A lateral transmaxillosphenoidal approach was performed, and the tumor was removed lateral to the intracavernous carotid artery (ICA) and medial to intracavernous cranial nerves. The lateral transmaxillosphenoidal approach is similar to the transmaxillosphenoidal approach used for the removal of pituitary adenomas invading the medial compartment of the cavernous sinus. By opening the lateral wall of the sphenoid sinus just above and laterally to the carotid artery, tumor can be removed medial to the intracavernous cranial nerves and lateral to the ICA.

The schwannomas are benign tumors originating from Schwann cells which constitute the nerve sheath. The dorsal pigmented type of schwannomas is relatively rare (Goldstein in Am J Med Genet 86:62-65, 2004; Kurtkaya-Yapicier in Histol Histopathol 18(3):925-934, 2003). There are two distinct types of melanotic schwannoma: the sporadic melanotic schwannomas and the psammomatous melanotic schwannomas of Carney complex. We report a case of a patient harboring a right dorsal dumb-bell melanotic schwannoma and left adrenal mass. The patient underwent a surgical procedure for en bloc total removal of the mass by a posterior and anterior approach. Histopathological examination revealed the diagnosis of melanotic schwannoma. At present, we have no reliable marker of histopathological malignancy of melanotic schwannoma so the follow-up period ought to continue for a period of more than 5 years. As the total removal of the melanotic neurinomas is mandatory to prevent possible malignant transformation of the tumor recurrence or regrowth, we believe that the posterior and trans-thoracic approach are the most suitable one for the dorsal dumb-bell schwannoma.

Background: We present a rare case of a probably poliostotic fibrous dysplasia of the clivus in a young woman with a clival and vertebral involvement. We also compare our case with data reported in tables that include all cases of clival fibrous dysplasia present in literature., Case Description: Thirty-year-old women presented with headache. We reviewed radiological and clinical literature before surgery. It was possible to perform a preoperative diagnosis of fibrous dysplasia of the clivus so it was possible to adopt a minimally invasive surgical approach on the clivus. The diagnosis of fibrous dysplasia of the clivus was confirmed after the operation. As the patient was asymptomatic, we did not operate on the vertebral lesion which was stable after 1 year., Conclusion: We draw the conclusion that it is possible to obtain a correct preoperative diagnosis of fibrous dysplasia based on magnetic resonance imaging and computed tomographic scans; this makes it possible to avoid major surgical operations. The reported case is particularly interesting because apart from the clival fibrous dysplasia, a vertebral involvement of the same type can be assumed; this association has never been reported in literature.

Objective: The treatment of huge craniopharyngiomas represents a therapeutic challenge for neurosurgeons. Some authors prefer to run the high risks of total removal at primary surgery, while others do not despise subtotal removal in accordance with a multidisciplinary treatment., Methods: We report the case of a 17-year-old girl who underwent subtotal removal (tumour remnant with maximum diameter of 2.5 cm) of a huge cystic craniopharyngioma by frontotemporal approach, followed by early external fractionated radiotherapy by linear accelerator. Serial magnetic resonance imaging during a follow-up period of 5 years showed a progressive marked reduction of the tumour remnant, accompanied by a complete recovery of visual deficits and an almost complete regression of diencephalic disturbances., Conclusions: Subtotal removal followed by early fractionated radiotherapy can be an effective treatment for huge craniopharyngiomas. Such a multidisciplinary treatment may favour tumour control and assure a satisfactory quality of life as well.

Background: The occurrence of cerebrospinal fluid fistulas of the frontal sinus after anterior skull base surgery is not rare. The extracerebral techniques to repair cerebrospinal fluid fistulas are often used, especially because they avoid open-air surgical operations., Methods: A percutaneous CT-guided technique to close postsurgical cerebrospinal fluid fistulas of the frontal sinus in three patients after anterior skull base surgery is presented in this report. Ten millimeters of human fibrin glue was injected into the frontal sinus through one of the burr holes of the bone flap by an 18-gauge spinal needle., Results: After an average follow-up period of 2.8 years, all three patients are in excellent general and neurological conditions and have not shown any further signs of rhinoliquorrhea., Conclusions: The presented percutaneous CT-guided technique can be considered a valid and harmless solution to closer small or moderate cerebrospinal fluid fistula that occurred after anterior skull base surgery.

Taking as starging point three patients who unsuccessfully underwent both medical treatment and different neurosurgical interventions, the Authors discuss the problem of the dystonia musculorum deformans nosographic arrangement and its present therapeutical possibilities. They believe that the dystonia musculorum deformans must be considered, rather than as a syndrome, as a real disease, to be distinguished in particular from the various infantile dystonic syndromes and from spasmodic torticollis. In fact in these last morbid forms, at least from a neurosurgical standpoint, the therapeutical possiblities are not so uncertain as those of the dystonia musculorum deformans.

The Authors report the experience about 100 cases of patients affected by chronical pain syndromes where the medical treatment has been uneffective. After a follow-up of 2 years about, only in 14% of the patients treated by S.E.N.T., the benefit has been clear and prolonged.

A case of radical excision of an intramedullary abscess is described. Microsurgical techniques permit a bolder operation than the aspiration and/or drainage intervention currently performed.

The involvement of the Central Nervous System (CNS) in the Schönlein-Henoch Syndrome is quite rare. It seems to be connected with a systemic vasculitis (deriving from Circulating Immuno-Complex), clinically manifested by generic symptoms of meningeal irritation or convulsions, hemiparesis and choreas, due to hemorrhagic lesions. The Authors report a Schönlein-Henoch's syndrome in a 7-year-old boy characterized by diffuse vascular involvement with petechial purpura on his legs, arms and face, intestinal hemorrhages, gross hematuria and serious cerebral involvement. CT-scan showed a right occipital hematoma. A pathogenetic as well as a symptomatic therapy was carried out. The Authors discuss the diagnostic validity of CT.