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Purpose The optimal therapy of patients with cerebral cavernoma (CCs) and new onset epilepsy, sporadic seizures, or non well established refractory epilepsy is still not clear. The aim of this study was to compare the incidence of seizures in patients with CCs both operated and non operated, in order to obtain more information on the correct management of these patients. Materials and methods We studied retrospectively 43 patients with non refractory epilepsy secondary to CCs. Twenty-six of them (60.5%) underwent surgery and made up the surgical group, and 17 patients were treated medically and constituted the medical group. Seizure frequency and other clinical variables were compared between both groups. Results At two years, out of the 26 operated patients, 19 (73%) remained seizure free, 4 (15%) had less than a seizure per month, and one patient (4%) had more than one seizure per month. At five years, 15 patients of the surgical group remained for analysis. Of them, 11 (73.3%) were seizure free, and 4 (26.7%) had less than one seizure a month. In the medical group, 12 out of 17 patients were seizure free (70.6%). There were no significant differences between the two groups ( p =0.2 and p =0.3, respectively). Seven patients had postoperative neurological sequelae. Conclusion Surgical treatment of patients with non refractory epilepsy due to CCs did not significantly reduce the likelihood of seizures when compared to medical treatment. It must also be considered that surgery carries serious risks. A prospective and randomized study must be carried out to further clarify our findings.

Tumors of the central nervous system (CNS) demonstrating papillary features, and particularly in the pineal region, are rare. Papillary tumor of the pineal region (PTPR) is a recently described rare neuroepithelial tumour included in the fourth edition of the World Health Organization (WHO) classification of tumours of the CNS, published in 2007. This new histopathological entity manifests in children and adults, with magnetic resonance (MR) imaging showing variable degree of T1 hyperintensity signal as well as contrast enhancement. In addition to the initial report of six cases by Jouvet et al. (Am J Surg Pathol 27:505–512, 2003) several case reports have been published in the literature to date. PTPR is characterized by presenting an epithelial-like cytology and a papillary architecture with immunoreactivity for broad-spectrum cytokeratins. Ultrastructurally observed features suggest ependymal differentiation and a possible origin from specialized ependymal cells of the subcommissural organ (SCO) has been postulated. The differential diagnosis of PTPR include pineal parenchymal tumors, choroid plexus tumors, papillary ependymoma, papillary meningioma, and metastasis. As a result of the rarity of these tumors, the biological behaviour of PTPR is not yet clear. It may correspond to WHO grades II or III. The high risk of local recurrence makes accurate surgery followed by radiotherapy necessary to achieve optimal treatment.

Ischaemic brain lesions still have a high prevalence in fatally head injured patients and are the single most important cause of secondary brain damage. The present study was undertaken to explore the acute phase of severely head injured patients in order to detect early ischaemia using Robertson's approach of estimating cerebral blood flow (CBF) from calculated arterio-jugular differences of oxygen (AVDO2), lactates (AVDL), and the lactate-oxygen index (LOI). Twenty-eight cases with severe head injury were included (Glasgow Coma Scale Score below or equal to 8). All patients but one had a non-missile head injury. All the patients had a diffuse brain injury according to the admission CT scan. ICP measured at the time of admission was below 20 mmHg in 17 cases (61%). All patients were evaluated with the ischaemia score (IS) devised in our center to evaluate risk factors for developing ischaemia. Mean time from injury to the first AVDO2/AVDL study was 23.9 +/- 9.9 hours. According to Robertson's criteria, 13 patients (46%) had a calculated LOI (-AVDL/AVDO2) value above or equal to 0.08 and therefore an ischaemia/infarction pattern in the first 24 hours after the accident. Of the 15 patients without the ischaemia/infarction pattern, in three cases the CBF was below the metabolic demands and therefore in a situation of compensated hypoperfusion. No patient in our series had hyperaemia. Comparing different variables in ischaemic and non-ischaemic patients, only arterial haemoglobin and ischaemia score (IS) was significantly different in both groups. The ischaemia score had mean of 4.3 +/- 1.7 in the ischaemic group and 2.7 +/- 1.4 in non-ischaemic patients (p = 0.01). It is concluded that ischaemia is highly prevalent in the early period after severe head injury. Factors potentially responsible of early ischaemia are discussed.

Fifty patients with subarachnoid hemorrhage (SAH) were evaluated, with attention to past history, age, sex, time from the onset of symptoms to hospital admission, etiology of SAH, diagnostic procedures, therapy and outcome. Of these, 16 who showed ventricular dilatation in the CT during their evolution were analyzed. We emphasize the importance of the neurologic evolution of the patient for the consideration of the need of surgical therapy with external drainage of cerebrospinal fluid or definitive shunt. Ten patients required definitive shunt; in 7 of them, SAH had been caused by arterial aneurysm. All had a grade higher than 3 in Hunt and Hess' scale and only one half received fibrinolytic drugs during their treatment.