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Background: Anterior or anterolateral lesions of the lower third clivus and/or foramen magnum require a surgical exposure that provides a clear visualization of both pathological and normal anatomy without retraction of neural or vascular structures. The posterolateral approach permits access to the anterolateral intradural aspect of the brainstem. The aim of this study was to stress that there is no need for vertebral artery transposition, occipital condyle drilling, occipitocervical fixation or trans-oro-pharyngeal access to remove these lesions., Methods: All five consecutive patients treated surgically for an intradural foramen magnum lesion in the Department of Neurosurgery at Angers University Hospital, between May 2012 and January 2015, were included in this retrospective study. In 4 cases, patients were referred to us for a second opinion after an initial surgical proposal at another institution. For all patients, the data collected were age at diagnosis, clinical signs, and quality of rostral and caudal exposure of the lesion, quality of resection, complications and postoperative neurological deficits., Results: All patients were operated on with a control of the rostrocaudal part of the lesion, without touching the vertebral artery, or the use of occipital condyle drilling. There was no need for occipitocervical fixation. Total resection was achieved in 4 cases, subtotal resection in one. All had watertight dural closure with no dural patch, or postoperative neurological deficits. No recurrence occurred between 6 and 30 months after surgery., Conclusion: Based on these results, the posterolateral approach was a simple, effective and safe procedure for anterior and anterolateral intradural lesion of the foramen magnum., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

An isolated schwannoma of the oculomotor nerve is rare in children without an associated neurofibromatosis. A 13-year-old girl, with a previous medical history of migraine, was admitted for disabling ophthalmic migraine with oblique diplopia. The clinical examination showed a right incomplete ophthalmoplegia with reduced ipsilateral visual acuity (8/10). There was no particular skin reaction. The MRI revealed a right (isosignal-T1 and isosignal-T2) nodular schwannoma located within the cisternal segment of the oculomotor nerve. The angio-CT performed later confirmed the absence of any vascular malformation. The treatment consisted of analgesics and corticotherapy, with complete regression of symptoms three weeks later and a normal MRI follow-up. Therefore, radiosurgery was not performed., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Primary solitary amyloidoma of Meckel's cave is rare, and a bilateral location is even more rare. To the best of our knowledge, only 12 cases in the literature have described such a primary lesion, including one case of bilateral involvement of Meckel's cave. We report here on the case of a 57-year-old woman presenting with pseudotumor masses involving both Meckel's caves and responsible for trigeminal neuropathy. The final diagnosis of amyloidoma was made on the basis of histological examination of surgical biopsy specimens., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Introduction: Neurotropic melanoma is a particular anatomopathological form corresponding to dermal proliferation of desmoplastic cells of neuroid differentiation. We report a new case of neurotropic melanoma revealed by facial neuralgia., Case Report: A 64 year-old man presented in 1996 with a lentigo maligna on the right cheek treated by complete excision. After 2 years of medical supervision, a pigmented lesion recurred leading to new surgical treatment. The histological examination of the total lesion showed intra-epidermal atypical melanocyte proliferation without dermal invasion. In 1999, right trigeminal neuralgia occurred without associated cutaneous change. Cranial MRI revealed an infiltration of the right trigeminal nerve. Endo-buccal surgery disclosed a black swelling of the trigeminal nerve. Histological examination and immunohistochemistry revealed a desmoplastic melanoma., Discussion: Neurotropic melanoma with nerve invasion by malignant cells presenting as a trigeminal neuralgia is rare. Our case report underlined the depth of the neurotropic melanoma and the initial existence of a lentigo maligna without associated "neurotropic" melanoma.

The authors report two cases of neurinomas of the oculomotor nerves: one neurinoma of the oculomotor nerve and one of the abducens nerve. The study of 30 cases in the previous literature points out the major striking features of these tumors. Both headaches and oculo-motor palsies are the most regular clinical features. They are not typically suggestive. Therefore the diagnosis is difficult among all the tumors of cavernous sinus and surrounding structures. C.T. scan and M.R.I. with the clinical history should readily allow pre-operative diagnosis. These data are insufficient to distinguish the affected nerve. The surgical treatment is not always complete due to the tumor infiltration into the cavernous sinus.

A 72 year-old-man presented with right hemiparesis and global aphasia related to a large infarct in the left middle cerebral artery territory. A left carotid angiography revealed internal carotid artery occlusion and vascular blush just below the base of the skull. The blush was supplied by branches from the external carotid artery. Cervical CT-scan showed a large tumor centered by the left internal carotid artery. At cervical surgery, the internal carotid artery was compressed and infiltrated by the tumoral process: a benign paraganglioma. The site below the base of the skull and the connection between tumor and vagal nerve suggested a vagal paraganglioma. To our knowledge, this is the first case of cerebral infarction and internal carotid artery occlusion revealing a vagal paraganglioma.

A 27-year-old woman presented with right spinal accessory juxtabulbar schwannoma, associated with hydrocephalus. The only specific clinical symptom was long-standing weakness of the right trapezius. C.T. scan evoked a cerebellar tumor, whilst the jugular foramen appeared normal. Vertebral angiography was not decisive. M.R.I. suggested an extra-axial tumor. Post-operative evolution was entirely favourable. Schwannomas of the 9th, 10th and 11th cranial nerves are generally located at the level of the jugular foramen but can also be observed along the extracranial path of these nerves. An intracranial paramedial, or so-called "intracisternal" localization is rare and is best diagnosed by magnetic resonance imaging.

A case of a 33 year-old woman presenting an intrapetrous facial nerve neurinoma is reported. The neurological finding was a quickly progressive facial nerve palsy without hearing loss which the initial diagnosis was a Bell's palsy. The radiological findings showing an petrous bone erosion located at the third portion of the facial nerve gave the diagnosis. It was confirmed by CT scan and arteriography that allows a pre-operative embolisation. A one stage operation performed by a triple retromastoid, transpetrous and retroparotid approach, allowed a complete removal. The post-operative course was uneventful and a reconstructive facial surgery was performed to restore a facial symmetry six months later. The authors review the literature about this tumor which remains rare and point out two facts: --A non regressive or recurrent or atypical facial nerve palsy had to be checked up by neuroradiology and even by surgical exploration. --The triple retromastoid, transpetrous and retroparotid approach is very interesting, allowing a one stage complete removal of the tumor and a check up of the facial nerve repair possibilities.

A hemifacial spasm was symptomatic of a neurinoma of the hypoglossal nerve in a 50 year-old woman. It disappeared after the surgical cure of the tumor. Hemifacial spasm is not mentioned among the 19 cases of neurinoma of the hypoglossal nerve which have been reported up to now. The spasm could have been due to the compression of the 7th nerve by the anterior inferior cerebellar artery, displaced by the tumor.

Posterior fossa tumours give rise, sometimes, to psychiatric disturbances, which are difficult to diagnose, when they are isolated without any neurological signs. This was the case in our report of a 32-year-old man who had a pathological laugh, unique symptom, during 4 months, of a trigeminal neurinoma. Spasmodic laughs related to posterior fossa tumours are infrequently reported in the literature. They always are the sign of a pseudo-bulbar syndrome, due to a bilateral lesion of the cortico-bulbar tracts. Other involuntary laughs are encountered in third ventricle's lesions, in frontal lobe lesions and in epilepsy.

A right facial paralysis led to the discovery of a tumor on the left side of the medulla oblongata. A neurinoma was suspected on MRI and confirmed by surgery and pathological examination. Ultrasonic aspiration was on interest in this case. The mechanism of the facial paralysis is uncertain: ischemia, compression and pure coincidence may be considered.

A 39 year-old women presented for the third time in 9 years, with an acute chiasmal syndrome caused by hemorrhage within a ruptured intra-chiasmatic cryptic angioma. We have reviewed this entity described as "chiasmal apoplexy" and defined its clinicopathological characteristics. Sub-frontal microsurgical approach to the optic chiasm is recommended to confirm the diagnosis and to decompress the optic chiasm. However, surgery does not prevent the possibility of recurrences. We have precised the concept of cryptic vascular malformation.

A case of an hemorrhagic cavernous hemangioma of the optic chiasma and the adjacent optic nerve in a 23-year-old woman is reported. The visual disturbance has subacute onset following a sudden lateralized headache. Through a fronto-pterional approach, an intrachiasmal hematoma was evacuated. A small cavernous hemangioma was found in the hematoma cavity, and it was totally removed. Visual symptoms improved slightly postoperatively. Cavernous hemangioma involving the optic nerve and chiasma is extremely rare. Only five similar cases have been reported previously.

The diagnosis of glioma of the chiasm is based on the following factors: occurrence in infancy, association with Von Recklinghausen's disease, progressive and slow loss of vision in both eyes, bilateral optic atrophy, unilateral temporal defect or asymmetrical bitemporal hemianopia, exophthalmos, slow course, omega-deformation of the sella turcica, enlargement of one or both optic foramina, postitive computerized axial tomography. Surgery is contraindicated. Radiotherapy may be applied, but its efficacy is still discussed.