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A case of trigeminal cystic neurinoma located solely in the cavernous sinus is reported. The patient's presentation is discussed. Certain diagnostic and surgical aspects of the tumor are highlighted.

To investigate the feasibility and the results of percutaneous hot saline injection therapy (PSIT) of liver tumors.Eight patients with hepatocellular carcinoma (11 nodules), 1 with cholangiocarcinoma and 1 with a metastasis from colon cancer underwent PSIT. The patients were selected according to variable criteria; thus, each patient was considered apart. A boiling saline solution was injected into the hepatic lesions through a needle like those commonly used for percutaneous ethanol injection (PEI). The results were assessed with US, CT, angiography, the measurement of tumor marker levels, the histopathologic examination of needle biopsy material, resected specimens, explanted liver material and follow-up.PSIT was more easily performed and altogether better accepted than PEI; in particular, pain immediately regressed upon infusion interruption. For this reason and for the atoxicity of the injected liquid, relatively large lesions could be treated with a greater volume per session and fewer sessions than with PEI. Treatment outcome was positive in all patients, except for the cholangiocarcinoma patient who required surgery. The only major complication was moderate peritoneal bleeding in a patient with severe coagulopathy.PSIT can be considered a useful tool for the local treatment of hepatic tumors. Its systematic use to treat hepatocellular carcinoma must be proceeded by further comparative studies with PEI.

A 73-year-old man presented a progressive neurologic syndrome with impairment of multiple cranial nerves, ataxia and limb weakness. Neuroradiological evaluation showed multiple supra and infratentorial lesions, which completely disappeared after steroid treatment on two occasions. These neuroradiological modifications were closely correlated with clinical picture and CSF findings. Post-mortem examination showed multifocal primary CNS immunoblastic large cell lymphoma. Immunohistochemistry showed that the tumor was of B-cell origin.

The authors report the results of a study, using CT scan, on 15 patients with scoliosis treated by the Harrington-Luque method. The patients were monitored periodically from the 3rd to the 30th month after operation. Each patient was monitored only once in order to limit the risk of ionizing radiation. In all the follow-ups it was observed that the metallic loops were in close contact with the laminae, which did not show any signs of disturbances. The medullary canal appeared to be of normal dimensions. Vertebral fusion was evident at the first 3 months follow-up and at this time partial corticalization also commenced. In successive follow-ups, fusion progressed steadily, and after 8 months it was completely corticalized. This progression continued even after 18 months so that at 30 months the fusion was such that the distractor was completely surrounded.

Fourteen cases of intracranial lipomas are reported and 200 cases from the literature are reviewed. Intracranial lipomas are rare lesions of developmental origin, which mainly occur in the region of the corpus callosum, more rarely in the ambient, interpeduncular, cerebellopontine angle and sylvian cisterns. Although they are usually asymptomatic, they can sometimes show neurological symptoms, mainly epileptic seizures. Computerized tomography and magnetic resonance imaging usually lead to the diagnosis, because of the very low-density attenuation values of lipomas on CT scan and the short T1 and T2 on magnetic resonance. A direct surgical approach is only rarely indicated, whereas cases associated to hydrocephalus require a CSF shunt. The anticonvulsivant therapy usually results in remission of the seizures.

The Authors report analyses on 83 cases of brain haemorrhage which were conducted over a period of 6 years. On the basis of previous studies made by the same authors, a selection was made from patients whose survival index rating did not exceed 8.1. These patients were treated only with medical and reviving therapies. In this work we attempt to formulate some considerations regarding the prognosis of brain haemorrhage on the basis of clinical and tomodensitometric data.

The Authors review their recent experience in investigating 185 cases of sellar and parasellar lesions, using as preliminary procedure stratigraphy and CT; further examinations were performed only in cases with unclear diagnosis. Their data confirm the reliability of this non-invasive protocol that allowed the detection of pathological changes in nearly 95% of cases and was able to define with certainty the nature of the lesions in over 72% of cases. However, other investigations were performed in 116 cases (63%): in 57 (31%) for diagnostic purpose, in 59 (32%) as complementary pre-operative studies.

Purpose Evaluation of clinical and radiological effects of the therapeutic outcome of CT-guided pulsed radiofrequency (PRF) treatment adjacent to the lumbar dorsal root ganglion (DRG) for patients with chronic intractable lumbosacral radicular pain in a single-center prospective longitudinal study in order to evaluate predictive factors of safety and therapeutic success. Materials and methods Thirty patients, from 2016 to 2018, were enrolled (age: 42–80 aa, 66.7% men and 33.3% females) with low back pain, lumbosciatalgia and/or lumbocruralgia, resistant to previous medical and physical treatments for a period not < 3 months, failure of surgical and chemiodiscolysis with ozone oxygen therapy. Each patient was subjected to a clinical evaluation (antalgic walking, sensitive deficit, interviews with specific questionnaires: ODI, RDQ,VAS) and to a radiological evaluation with MRI examination, before and 30 days after the CT-guided PRF treatment. Measurements of the thickness of the involved and not involved DRG were taken using common postprocessing software of MRI examinations in order to have measurement parameters for comparison. We analyzed the clinical course using the paired samples T test in order to evaluate modification for each clinical and radiological parameter (statistical significance p < 0.05). Results Significant improvements of the clinical outcomes with a good resolution of the pain symptoms (VAS evaluation: The score fell from 68.47 to 39.17 with a difference of 29.3 and a reduction of the 42.79% in the perceived pain, p = 0.00000152). The thickness of DRG falls from an average media of 0.586–0.448 cm (p = 0.000085), with a difference of 0.138 cm and a percentage reduction of 22.30%. Conclusions PRF treatment of the DRG may be considered for patients with chronic severe lumbosacral radicular pain refractory to conventional medical management when other noninvasive or surgical procedures fail. It is minimally invasive, inexpensive and simple to perform with no complications.

Trans-bronchial needle aspiration allows lymph node sampling in several thoracic conditions; the ability of Rapid On-Site Evaluation (ROSE) to predict the final diagnosis in this setting has not been well characterized. We performed a retrospective study to establish the utility of ROSE in the diagnosis of thoracic diseases with mediastinal lymph node involvement. We retrospectively reviewed 297 patients with hilar-mediastinal lymph node enlargement detected at CT scan from January 2013 to April 2016. 201 patients underwent conventional TBNA; in 96 patients, TBNA procedure was performed by on-site presence of a team of pathologists and research morphologists. Lung neoplasms, sarcoidosis, infections and lymphoma were the most common diseases diagnosed with TBNA samples. TBNA simultaneously performed in combination with ROSE produced an increase in percentage of appropriate samples compared to single cTBNA (adequate samples cTBNA vs ROSE-TBNA: 73% vs 81%; p

Objective This paper reports four cases of schwannomas of the brachial plexus operated upon with good outcome and discusses the CT and MRI findings and the best surgical treatment of these lesions. Design All patients had large schwannomas (more than 4 cm in diameter) presenting as painless masses in the supraclavear region, explored by CT and MRI. A homogeneous mass, hypo-isointense in T1- and hyperintense in T2-weighted images, with well-defined margins, is in favor of a schwannoma. The nerve of origin, external to the tumor mass, may be defined on MRI. Intervention All patients have been operated upon using microsurgical technique: enucleation of the tumor content, piecemal removal of the capsule, identification and preservation of the neural elements were the main goals of the operation in all cases. Outcome Postoperatively, one patient experienced transient deficit of the deltoid muscle (two weeks). Actually, all four patients are symptom-free with no tumor recurrence, 6 months to 7 years after the operation. Conclusions A correct preoperative diagnosis of schwannoma of the brachial plexus may be obtained by MRI, which shows a rather typical aspect; on the other hand, needle aspiration histology and open biopsies should be avoided. The microsurgical treatment with preservation of the neural structures, as for schwannomas of the cranial and spinal nerves, results in good outcome without recurrences.

We report 2 cases of 'de novo' aneurysm formation in a vessel which appeared to be normal at a previous angiography. The first patient developed an anterior communicating artery aneurysm nine years after occlusion of the right internal carotid artery by Gianturco coils for the treatment of a giant intracavernous carotid aneurysm. In the second case a 'de novo' aneurysm of the internal angle A1-A2 segment of the left anterior cerebral artery developed 6 years after successful clipping of another aneurysm of the same location. De novo formation of an aneurysm in a vessel which was found to be normal in a previous angiographic study, may occur as result of hemodynamic changes, such as after internal carotid occlusion or in presence of an arteriovenous malformation or variations of the circle of Willis. However, definite hemodynamic changes may also be absent. We conclude that patients operated on for aneurysm clipping must be periodically explored by magnetic resonance angiography to evaluate the possibility of de novo appearance of another aneurysm.

This study retrospectively analyzes the CT findings of 50 patients with spontaneous intracerebral haematomas and correlates them with the clinical condition at admission and the outcome. The volume of the haematoma was well correlated with the outcome and was a very useful indicator for surgery. In patients with haematoma volume lower than 25 ml and above 80 ml there was no indication for surgery; in patients with haematoma volume between 25 and 50 ml the operation does not significantly modify the survival rate, but favours a more rapid and complete recovery of the neurological deficits, whereas a haematoma volume between 50 and 80 ml favours the rate of survival.

A case is reported of successful occlusion of a dural carotid-cavernous fistula (type D) by means of a transvenous anterior approach. Through the left angular vein, the distal superior ophthalmic vein (SOV) and the cavernous sinus were cannulated and three Gianturco coils were delivered close to the fistulous communications. Obliteration of the carotid-cavernous communication was achieved sparing the internal carotid artery and its branches. The major advantage of entering the sinus from the venous route is to preclude any damage to the artery, distal migration of the detachable balloon or of thrombi, intracavernous pseudoaneurysm formation. The trans-orbital approach may be considered chiefly when the openings are in the antero inferior compartment and the SOV is enlarged. Its applications, quite sporadic until now, probably will become more popular, mainly in treating D type fistulas, thanks to the good results achieved and to its safety.

Fifty patients with intracranial meningiomas have been retrospectively examined, and the cerebral edema on computed tomography scan has been correlated with the clinical evolution, size, location, and histological features of the tumor. The degree of brain edema was found to be related to the clinical evolution and the size of the tumor, whereas the histological features were less significant. These results are discussed after reviewing the data of five other series in the literature of this subject. A correlation between the tumor steroid receptors and edema is suggested.

An exceptional case of lipoma of the sylvian region is described and the other seven reported cases are reviewed. The sylvian fissure is the most rare site of intracranial lipomas. Sylvian lipomas may be asymptomatic or present with epileptic seizures due to irritation of the cortex of the sylvian fissure. Only two previous cases have been diagnosed during life by computerized tomography and operated on; the deep location of these lipomas and their adherences to the sylvian cortex and the branches of the middle cerebral artery make radical removal impossible and dangerous.

Three cases of meningiomas associated with large cysts are reported, and 58 other cases from the literature are reviewed. The etiology of these cysts is analyzed on the basis of surgical and pathological findings. The preoperative diagnosis of large computed tomographic hypodensities associated with meningiomas and the differential features from other cystic tumors are discussed. The surgical aspect of the solid tumor and particularly the absence of a capsule separating the tumor from the cyst are usually decisive in confirming the intratumoral nature of the cyst. In questionable cases a histologic evaluation of the cyst walls may be necessary.

A rare case of craniopharyngioma extending to the cranial base and nasopharynx is reported and eight other cases in the literature are reviewed. The embryology and the clinical features of these tumors are discussed. Tomograms of the skull and computed tomography are the most useful radiological tools of investigation. A nasoseptal or transpalatal approach to surgery, which has been performed in reported cases of cystic nasopharyngeal craniopharyngiomas, was not performed on our patient because of the hard consistency and the diffusely infiltrating aspect of the tumor.