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Objective: Idiopathic myelofibrosis is a clonal stem cell disorder that leads to ineffective erythropoiesis accompanied by reactive myelofibrosis (bone marrow fibrosis). As a consequence, extramedullary hematopoiesis characteristically develops. The central nervous system is rarely affected; the spinal canal and the cranial meninges are generally the preferred locations. Extramedullary hematopoiesis within central nervous system primary tumors have already been reported but, to our knowledge, never before in a patient with evidence of idiopathic myelofibrosis., Clinical Presentation: A patient experiencing generalized idiopathic myelofibrosis developed a hemorrhagic intracranial meningioma containing islets of extramedullary myeloid metaplasia., Intervention: The tumor was radically removed through a right frontal craniotomy. After surgery, the patient recovered completely and was discharged with a normal neurological status. After 6 years, the patient is in excellent condition with no sign of recurrence on magnetic resonance imaging scans., Conclusion: The reasons for this uncommon association are uncertain, but we hypothesize that myeloid islets may be involved in the origin of the tumor as well as in its acute hemorrhagic onset. Moreover, we suggest that in the presence of proven idiopathic myelofibrosis intracranial myeloid metaplasia should be ruled out by appropriate neuroimaging and considered as a potential diagnosis in the presence of brain lesions.

Objective and Importance: Several methods have been proposed to achieve transsphenoidal arachnoid mobilization and chiasmapexy in symptomatic empty sella (primary or secondary empty sella syndrome). These procedures are often difficult to perform and have not always had satisfactory long-term outcomes because of the difficulty of achieving adequate and long-lasting sellar filling over time. The volume of fat or muscle packing decreases over time as a result of scar retraction. The same problem may occur with intrasellar balloon placement because of deflation of the balloon., Technique: We propose extradural packing accomplished through a transsphenoidal approach, using a Silastic (Dow Corning, Auburn, MI) coil, fashioned by means of a ventricular catheter arranged as a spiral., Results: This technique was used in four patients with satisfactory and long-lasting clinical results. It presents several advantages over previous methods: it can be tailored to each patient; Silastic is an inert substance, and therefore scarring, with consequent shrinkage, does not occur; and because the coil is very elastic, it presents few risks of inflammatory complications or of excessive compression of sellar, parasellar, and suprasellar structures. Furthermore, this technique does not require a supplementary skin incision to harvest autologous tissues (fat, muscle, or fascia lata). A skilled neurosurgeon can perform the procedure in a few minutes with more ease and less expense than other techniques., Conclusion: The reported technique is a valid alternative to classic transsphenoidal extradural packing.