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Glioblastoma, a malignant tumor of neuroepithelial origin, is relatively uncommon in childhood, during which it accounts for 7%-9% of brain tumors. A few patients (about 3%) live more than 5 years. We report a 13-year-old girl who was admitted because one month earlier she had begun to present headache and diplopia. Brain computed tomography (CT) showed a right frontal tumor. At operation, complete excision of the visible tumor was performed. Histologic examination showed that the tumor was a glioblastoma multiforme. The patient underwent 52 Gy of external beam radiotherapy to the enhancing tumor mass plus 3-cm border, and chemotherapy with nitrosourea (BCNU). Fourteen years, 9 months later, the patient presents neither neurological deficits nor radiological relapse. We confirm that younger age, the one immutable prognostic factor, supports a particularly aggressive approach to the treatment of glioblastomas.

The authors report 8 cases of central neurocytoma with a minimum follow-up of 3 years. Five patients were males and 3 females with average age of 21 years. All patients underwent surgical removal of tumor, and radiotherapy was delivered to 2 of the 3 patients in whom removal had been partial. At an average follow-up of 5 years, all patients are alive and none of them has presented signs of recurrence or progression of the disease. Some typical clinical and histological features of this tumor are pointed out.

We report the case of a 62-year-old woman, who had a 4-year history of progressive visual acuity deficit. On neurological examination, visual acuity was 5/20 in the right and 4/20 in the left eye. A hormonal study revealed hypophyseal hypofunction. CT and MRI scans showed an intra-suprasellar cystic lesion, hyperintense in T1 and hyperintense in T2-weighted sequences. At surgery, the cyst wall was opened and the cavity placed in communication with the subarachnoid space. Histological examination showed a Rathke's cleft cyst. After four years of follow-up the patient's visual deficit remained unchanged, whereas the results of the hormonal assays were normal. An MRI scan confirmed the absence of the cyst. We review 216 reported cases of Rathke's cyst and discuss its pathogenesis, clinical features and treatment.

The authors report their results in a retrospective study of 6 cases of gliosarcoma. In 3 cases gliosarcoma presented features similar to those of glioblastoma, both at CT scan and macroscopically; in the other 3 cases they resembled meningioma. Average survival varied considerably and was correlatable to the CT features of the lesion (14 months for glioblastoma, 7 for meningioma). It seems likely that patients who have gliosarcoma with CT features suggestive of meningioma may have prolonged survival.

The authors describe 3 cases of cerebral pleomorphic xanthoastrocytoma, one of which has an unusual neuroradiological appearance, and review the clinical and prognostic features of the 96 cases reported in the literature. Pleomorphic xanthoastrocytoma is a neuroectodermal tumor that affects young patients, in a superficial or supratentorial site, most frequently at the temporal level. It is difficult to formulate a differential diagnosis with other neuroectodermal tumors or with meningioma on the basis et neuroradiological appearance, as demonstrated by one of the cases reported here. The prognosis of this tumor is very good, regardless of the type of treatment performed, although both relapse and, more rarely, malignant tumor evolution are possible.

Three cases of pediatric cystic meningioma are reported. In a review of the literature the authors stress the importance and difficulty of accurate preoperative diagnosis. Cystic meningioma in pediatric patients differs from that in adults in the following respects: higher incidence, predilection for males, shorter clinical history, less specific neuroradiological diagnosis, frequent absence of a dural attachment, prevalence of Nauta type II cystic meningioma, and high incidence of the fibroblastic histotype.

The authors report 46 cases of primary supratentorial arachnoid cysts. Thirty-two patients presented with symptomatic arachnoid cysts, which act as space-occupying lesions and were surgically treated by fenestration. 14 patients presented with a scarcity of symptoms; for this reason they were kept under control by periodical neuroradiological examination. After a long follow-up period (median 11 years), 97% of the operated patients presented neurological improvement and a decrease in the size of the cyst; none of the patients who were not operated on showed any variation in either neurological status or size of the cyst. The authors discuss their findings in the light of the published papers.

We report a retrospective study of 35 cases of medulloblastoma in pediatric patients treated at our institution during an 18-year period. Ten of the patients were infants (age2 years) and 25 were children (age2 years). The main factors affecting prognosis were total removal of the tumor (P0.01) and tumor stage (P0.01). There were no differences between the survival rate of infants and children, infants had a worse prognosis in regard to quality of life than children.

We report a retrospective study conducted on 40 patients with neurinoma of the cauda equina, assessing the clinical features and treatment. Neurinomas are clinically indistinguishable from other tumours localized in the same region. It is possible, but not simple, to differentiate neurinoma of the cauda equina from more common lumbar disc herniations. In the early stage, neurinomas provoke sciatic pain that is unilateral and monoradicular, worsened in decubitus and hard to define, whereas in the later stage pain becomes bilateral, polyradicular and is mostly accompanied by motor and sensory disturbances. Moreover, Lasegue's sign was often absent. Therapeutically, total removal of the tumour seems to be the most appropriate form of treatment given that even the sacrifice of a root does not worsen any pre-existing neurological deficit.

A case of metastasis from breast carcinoma found within a cerebral meningioma is reported. Histological diagnosis of the cerebral tumor prompted radiological investigation that visualized the asymptomatic malignant systemic tumor and excluded other metastases elsewhere. The pathogenetic aspects of this exceptional occurrence are discussed in the light of the relevant literature.

Eighteen cases of isolated spinal haemangioblastoma are presented. 13 patients were male and 5 female; average age was 34 years. The site of the tumour was bulbo-cervical in 1 case, cervical in 6, cervico-thoracic in 2, thoracic in 7, thoraco-lumbar in 2. Surgical excision of the tumor was total in all cases and peri-operative mortality was 5%. At average follow-up of 11 years, 8 patients had died (4 from neurological causes and 4 from non-neurological disease), and 9 survived; symptoms and signs improved in 11 cases, and were not improved in 6. The biological and pathological characteristics of this tumour are reported in the light of the present 18 cases and those reported in the literature.

A series of 28 ependymomas arising in the filum terminale was divided into two groups based on the presence/absence of connections with the conus medullaris and/or roots of the cauda equina. Group A comprised ependymomas having no connections with the contiguous structures and group B those either infiltrating or adhering to such structures. Factors having a positive influence on the prognosis (risk of recurrence) were: 1) clinical history under one year (p

We report a series of 41 patients with multiple intracranial aneurysms, analyzing them by type of surgical treatment and prognosis. We compare our findings with those of the largest published series and draw conclusions regarding the most appropriate treatment. The upshot would seem to be that morbidity and mortality depend chiefly on whether the aneurysms are bilateral or unilateral and on the patient's pre-operative status.

This retrospective study focuses on 14 patients with ganglioglioma of the cerebral hemispheres who received surgical treatment in the Neurosciences Department/Neurosurgery of "La Sapienza" University of Rome between 1953 and 1990. The data are analyzed together with those on 98 published cases of ganglioglioma confined to the cerebral hemispheres. These tumours have no sex preference but a decided preference for the young (mean age 18 years). They are characterized by a history of epilepsy often of long standing and sometimes refractory to drugs. The most frequent site is the temporal lobe (61%). At operation the tumour proved to be solid in 52% of cases and the satellite cyst at the tumour wall in 48%. Removal was total in 65% of cases. Even after subtotal removal, the prognosis is good in terms both of survival and of seizure control. Radiotherapy seems to have no role in the treatment of these tumours.

We report on the clinical and pathological characters and factors influencing prognosis in a consecutive series of 20 cases of medulloblastoma presenting in childhood and of 20 cases of the tumour presenting in adulthood. The significant differences which emerged were compared with the findings of the largest published series. Medulloblastoma is more often lateral in site and desmoplastic in histology in adults than in children. On our evidence the age at tumour onset not affect survival.

The authors describe two cases of solitary cerebral metastasis from non-seminatous germ cell tumors of the testis: in the first case, the histology was teratocarcinoma; in the second, it was embryonal carcinoma. Both patients underwent surgery, whole-brain radiotherapy and chemotherapy, and are still alive and disease-free after respectively 42 and 72 months. Although systemic metastasis from tumors of the testis are relatively common, they rarely involve the nervous system. A review of our cases and those reported in the literature shows that the outcome in these patients can be improved by the combined surgical, radiological and chemotherapeutic treatment of the metastasis.

The authors report 2 cases of cerebral meningiomas following high-dose radiotherapy in elderly patients treated for skull basaloma. These two are the first cases over 65 years old cases reported in the literature. The pathological and clinical characteristics of high-dose radio-induced meningiomas are the following: 1) children appear particularly sensitive to the development of this tumor; 2) there is a female patient predominance, in contrast to the male dominance observed in low-dose meningioma, 3) these tumors present a peak frequency in third decade of life; 4) frequently, these tumors are atypical and recur.

Primary craniocerebral plasmacytomas are uncommon they represent only 0.7% of all plasmacytomas. We report one case of solitary plasmacytoma of the skull and discuss the clinical features and prognosis of this tumor. There seems to be no difference in prognosis between plasmacytomas originating from the bone (osseous form) and those originating from the dura mater (non-osseous form). In these lesions, the risk of secondary multiple myeloma appears to be low.

Forty patients with multifocal and multicentric cerebral tumours were retrospectively studied. The patients were divided into two groups: ten patients with multicentric tumours (group A), and 30 patients with multifocal tumours. As far as their preoperative clinical history and the incidence of the various symptoms and signs are concerned, there were no significant differences between the two groups. CT permitted a correct diagnosis in 90% of the cases. All of the patients underwent the removal of the tumour(s) and received radiotherapy; 30 patients also received chemotherapy. In group A, nine patients died and one was lost to follow-up one year after treatment; the average survival was ten months from the appearance of the multicentric tumour. In group B, 29 patients died and one is still alive two years after treatment; the average survival was six months. We consider the problems of diagnosis and the long-term follow-up of patients.

The authors describe two cases of sarcomas of the skull following cranial irradiation in patients treated for other neoplasms, acute lymphatic leukemia, and astrocytoma, respectively. The patients (one man and one woman: mean age 24.5 years) developed sarcomas within the irradiated field after a mean latency period of 11.5 years. Histologically, the tumor proved to be a fibrosarcoma. Despite aggressive surgery and other therapy, the survival of the patients was short (10 and 8 months, respectively). The pathological and clinical aspects of this unusual complication are analyzed with reference to 41 cases taken from the world literature.

Lumbar and intraneural synovial cysts are uncommon lesions, although their incidence has increased since the introduction of MRI. The authors describe the results of a study comprising 23 patients with synovial cyst (5 lumbar, 19 intraneural). Neuroradiological investigations included CT scan and MRI; however, it was not always possible to diagnose the nature of the lesion. In 18 cases the lesion was removed totally including its capsule; in the other 5 cases it was removed subtotally. Seven of the 23 patients presented a total remission of symptoms/signs, 11 improved and 5 remained unchanged. The importance of treating synovial cysts as radically as possible is discussed together with their most significant clinical and neuroradiological aspects.

The authors describe their findings in a study aimed at identifying clinical-prognostic factors in treatment of idiopathic normal-pressure hydrocephalus. The study comprised 18 adult patients submitted to surgery for ventriculo-peritoneal shunting. The findings that emerged from this series of patients were compared with those reported for the 381 published cases. In our group of 18 patients, average age was 65 years and the average duration of clinical history was 47 months (median 18 months). Follow-up ranged from 3 to 5 years (median 4.2 years): 12 patients improved (9 completely) and 6 presented stable neurological deficits. The factors that had a statistically significant influence on outcome were a short clinical history (less than 6 months) (p = 0.05) and a clinical onset without dementia (p = 0.03). Patients with medium-grade preoperative ventricular enlargement always made a complete functional recovery after surgery (p = 0.2).

Peripheral benign nerve sheath tumours are infrequent tumours and affect major nerve trunks. Some authors have indicated a high and prohibitive incidence of neurological injury in resection of these lesions. The authors describe their findings in a retrospective study comprising 119 patients with spontaneous benign nerve sheath tumours of the peripheral nervous system. Seventy-three patients had a schwannoma, 41 had neurofibroma and 5 had plexiform neurofibroma; 25 of the 119 patients suffered from neurofibromatosis. All schwannomas were excised completely and the outcome of patients was 41.0% improved, 6.8% worsened, 52.0% unchanged. Twenty-eight neurofibromas were excised completely and 13 subtotally; the outcome for patients was 19.5% improved, 19.5% worsened and 61% unchanged. All plexiform neurofibromas were removed subtotally and the outcome for patients was 20% improved and 80% unchanged. The best surgical results at average follow-up of 6 years were observed in the patients with schwannoma, the worst in those with plexiform neurofibroma. Our results demonstrated that it is often possible to remove schwannomas as well as neurofibromas with an acceptable risk of injury to the nerve.

The authors describe 2 cases of osteoblastoma of the calvaria and review the clinical features of the 28 cases reported in the world literature. Benign osteoblastoma is a rare tumor that effects young patients, most frequently at temporal level. On the basis of its neuroradiological appearance, it is difficult to formulate a differential diagnosis against other osteoblastic tumors or against osteoid osteoma. In only a few cases MRI findings are reported. In our cases, MRI was more effective than CT scans and radiographs for evaluating the intracranial and intraosseous extension of the tumor. The definitive diagnosis was obtained by combining the histopathological features of the tumor with the clinical and radiological data. The prognosis of this tumor is very good regardless of the type of treatment performed, although both relapse and, more rarely, malignant tumor evolution are possible.

SURGERY OF THE peripheral nerves has only recently achieved brilliant results thanks to technological advances in the development of neurosurgical instrumentation. In past centuries, few surgeons made relevant contributions to this topic and improvement was slow and difficult. Avicenna, Guglielmo da Saliceto, and Guido Lanfranchi reported some attempts to suture nerves directly, but Gabriele Ferrara was the first to give a lucid and succinct description of suturing of the stumps of a transected nerve. He described applying gentle traction on the retracted stumps, suturing using a special needle with an eye, after immersion in a decoction of red wine, rosemary, and roses (alcoholic disinfection ?), and, finally, insulating the sutured segment with a mixture of oils. We are celebrating the 400th anniversary of the first edition of his fundamental work (1596-1996), and we truly esteem this surgeon, a pioneer of peripheral nerve surgery who primarily contributed to its progress.

The authors review three personal cases of patients who developed cerebral meningiomas following high-dose radiotherapy for acute lymphoblastic leukemia. Two patients were female and one male. Their ages when the leukemia appeared were between 11 and 15 years. All patients were treated with a course of prophylactic irradiation to the neuraxis for a total dose of 24 Gy. After an average interval of 10.4 years, all three patients presented a meningioma; histologically, one was meningothelial and two were fibrous. All three meningiomas presented atypical features. At follow-up 1, 4, and 4 years respectively after surgery, none of these patients presents neurological deficits or neuroradiological signs of recurrence. Forty-nine cases of high-dose radiation-induced meningioma are also reviewed.

The authors describe a case of large intrathoracic meningocele (16 cm) associated with neurofibromatosis. Computed tomography with metrizamide myelography proved valuable in locating the lesion and in reformation after surgery. The authors make some comments about surgical excision of large meningocele.

Cerebral vasospasm is a clinical/angiographical condition frequently observed after a subarachnoid hemorrhage due to the rupture of an intracranial aneurysm. Twenty cases of vasospasm observed after the removal of cerebral tumors have been reported in the literature; we here report on a further five. The time of onset of symptomatic vasospasm was 3–7 days after surgery; three of the patients died of an ischemic event induced by the vasospasm and two survive. Although no angiographic confirmation was obtained in our cases, serial transcranial Doppler (TCD) flow velocities were always high. It is suggested that the TCD-revealed accumulation of blood in the basal cisterns observed in all cases may have been responsible for this unusual condition, and it is therefore important to consider vasospasm as a probable etiological cause of clinical deterioration in patients undergoing the surgical removal of a cerebral tumor. For this reason, whenever any neurological deterioration occurs in such patients, it is advisable to perform TCD in order to verify the presence of any vasospasm and promptly commence suitable treatment.

Ependymoblastoma is a malignant rarely reported neuroectodermal tumor. The authors describe a further case of cerebral ependymoblastoma and examine the clinical-prognostic aspects of this tumor in the light of the published data.

Two cases of intradural cavernous angioma of the cauda equina are reported, one of which presented with symptoms of subarachnoid hemorrhage. The clinical and therapeutic aspects of intradural angiomas, in particular those of the cauda equina, are discussed.

The authors present a retrospective study of 15 patients with post-traumatic intracranial meningioma. The 15 cases were selected according to the criteria specified in the relevant literature. Assessment of clinical characteristics in these patients seems to confirm that in some cases head trauma may be a factor contributing to the development of meningioma.

The authors report 5 cases of spinal tumor associated with subarachnoid hemorrhage. Histologically, the tumor was an ependymoma in 2 cases, a neurinoma in 2 cases and a hemangioblastoma in 1 case. The pathogenetic and diagnostic characteristics of these 5 cases are analyzed in the light of other published reports.

Malignant peripheral nerve sheath spinal tumours are relatively rare. A primary spinal location at onset from the nerve roots is rarely reported in the literature, thus the clinical features and therapeutic results of these spinal malignant tumours are not defined. Six cases of malignant primary spinal schwannomas, 2% of 293 spinal schwannomas operated on in a 38 year period, are reported. Based on an analysis of a limited number of cases, ours and those collected from the literature (21 patients), some suggestions are possible: a) pre-operative clinical presentation and imaging studies are not predictive of malignancy; b) postoperative outcome is poor, especially in patients with von Recklinghausen's disease and after partial removal of the tumour; c) local recurrence and metastases are possible, even after radical surgery and radiotherapy.

Intraosseous cavernous hemangioma is a vascular tumor that only rarely affects the cranial bones. We describe three patients with this unusual tumor and discuss the clinical and radiological features of this lesion in the light of published data.

We report the case of a patient with two distinct brain tumors. A meningioma was resected surgically. Nine months later a glioblastoma appeared in the same region, but at a different site. This was not treated, because the patient died. The clinical significance and etiology of these tumors are considered.

Fifty-five cases of epileptic seizures associated with spontaneous intracerebral hemorrhage are reported. Seizures appeared as the first symptom in 23 patients, early (within two weeks after HI) in 18 and late (later than 2 weeks after HI) in 14. From the analysis of the observed cases we noticed that: 1) partial seizures were most frequent type (63%). These appeared mainly in cases with lobar hemorrhage above all; 2) development chronic epilepsy occurred frequently in the case of patients affected by late seizures. We compare our data with those reported in literature in order to highlight main factors which affect the onset and development of seizures associated with spontaneous intracerebral haemorrhage.

Sixteen cases of symptomatic arachnoid cyst in elderly patients (>65 years of age) including of our own case are considered and their clinical and therapeutic features compared with those of the larger series comprising younger patients. From this study, no clinical differences emerged between arachnoid cysts in elderly patients and those of their younger counterparts. Surgical treatment was confirmed as being necessary for a good outcome in this age group when the cysts became symptomatic.

Reporting a series of 27 supratentorial glioblastomas in pediatric patients treated surgically in the Department of Neurosurgical Sciences-Neurosurgery Section—of “La Sapienza” University of Rome, we discuss the principal clinical features, treatment and prognosis of the tumour with reference to the salient published series.

Four cases of ependymoma of the filum terminale occurring in childhood are reported. The clinical, therapeutic and prognostic features seen at this age and in adults were compared.

Intraosseous schwannoma is a rare benign tumor of the bone with characteristic radiological and histological features. The most common sites of this tumor are mandible, sacrum, und vertebral bodies. Two cases, one of which is the first diagnosed with MRI, of this tumor in the vault of the skull are presented.

The authors present a case of post-traumatic intracranial meningioma, selected according to the criteria specified in the relevant literature. Assessment of the clinical characteristics of our patient and those reported in the literature seems to confirm that, in some cases, head trauma may be a factor contributing to the development of meningioma.