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Clear-cell meningioma (CCM) is a rare subtype of meningioma which occurs at a younger age and has a higher recurrence rate than other subtypes (WHO grade II). CCM usually occur in younger patients and is located in the posterior fossa and spine. The authors report the first case of olfactory groove mixed clear-cell meningioma. A 66-year-old woman was admitted to the SS. Annunziata Hospital (Taranto, Italy) in January 2007 with a two-year history of subtle changes in personality and mental function. On neurologic examination she presented a loss of sense of smell. The magnetic resonance imaging (MRI) showed an olfactory groove meningioma. The computed tomography (CT) and MRI features of CCM are not different from those of common meningiomas. The tumor was totally removed by frontolateral approach on January 24, 2007). Histological examination showed that the tumor was composed of sheet-like uniform and polygonal cells, with abundant clear cytoplasm, and small and bland nuclei. The cytoplasm was heavily laden with granular periodic acid Schiff-positive and diastase-sensitive material representing glycogen. There were no rich vascular networks but scattered collagen bundles within the tumour, little foci areas of necrosis and whorls of meningothelial cells. The neoplastic cells were positive for epithelial membrane antigen (EMA) and vimentin, and negative for glial fibrillary acidic protein (GFAP)? S-100?chromogranin A; Ki-67 labelling showed an index of 1%. The final diagnosis was mixed clear-cell meningioma. Until now only 38 intracranial CCM cases had been reported in English language literature. Different diagnoses for CCM include lesions with clear cell appearance such metastases of renal cell carcinoma and sarcoma, hemangioblastoma, ependymoma, oligodendroglioma, germinoma, chordoma, pleomorphic xanthoastrocytoma, lipid-rich glioblastoma, microcystic and lipomatous meningioma.

Cranioplasty is a surgical repair of a structural or morphological deformity of the skull, involving the resection, remolding and displacement of the bones of the head. As it pertains to abnormal head shape, cranioplasty is an operative procedure aimed to fill a gap in the cranial theca or to replace bone removed either as a result of trauma or infection, by means of a biocompatible artificial bony substitute. In the present paper authors report a case of custom-made cranioplasty for the reconstruction of a large bilateral skull defect, based on advanced computerized tomography data processing and rapid prototyping (stereolithography) techniques.

A case of meningioma recurring twice in pericranial tissues after complete removal of intracranial mass and overhanging bone is reported. The second recurrence developed outside an acrylic cranioplasty. Previous reports of recurrent meningiomas outside the skull are reviewed.

A short review of polyamines and their possible clinical interest and applications in the field of brain neoplasms is presented. Dosage of CSF polyamines was proved to be useful in monitoring patients with medulloblastomas and others malignancies with meningeal involvement. Polyamines and their enzymes in neoplastic tissue may correlate to tumor growth. Inhibition of polyamines synthesis by drugs may be a possible way of slowing down tumor growth.

The association in the same patient between two meningiomas and an astrocytoma of the third ventricle is presented. All tumors were removed in two surgical sessions. The unusual occurrence of such associations, except for the so-called phakomatoses, is emphasized. Other similar cases drawn from the literature are tabled.