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29 out of 34 consecutive patients of pediatric age, operated upon for posterior fossa medulloblastoma, were divided into 2 groups according to the chemotherapeutic treatment (mtrathecal methotrexate or intravenous cyclophosphamide) received at random after surgery and radiation treatment. The modalities of irradiation and chemotherapy are described. 9 patients have not yet shown a local recurrence and are alive at various intervals after surgery. Only 1 patient with local recurrence is still alive 31 months after the primary operation. The mean actuarial survival of the whole series of patients is about 38 months. Differences between the two groups, concerning either the survival rate till local recurrence, or the general and neurologic conditions of survival, are not statistically significant. Hematologic toxicity was more pronounced in the group treated with cyclophosphamide, whereas late neurologic sequelae were a more prominent feature of the in-trathecal methotrexate trial.

✓ A tuberculoma, encasing the anterior optic pathways in a neoplastiform growth, was found in a 25-year-old man complaining of severe visual loss, diabetes insipidus, and sexual impotence following tuberculous meningitis. Following biopsy and anti-tuberculosis treatment, a satisfactory restoration of sight in one eye allowed the patient to resume an almost normal life.

A survey of 56 patients aged less than or equal to 16 years, admitted (1954-1979) for cerebral arteriovenous malformations, is presented. The clinical manifestation was mostly related to hemorrhage, less frequently to epilepsy or to a cerebral 'steal' syndrome. The most frequent site was the parietal lobe, with supply from the middle cerebral artery. Deep malformations were not uncommon and most lesions were of medium or large size. 38 patients were operated upon, and 18 were given treatment other than surgical (including radiotherapy). 23 malformations were completely excised, in 4 patients only a partial excision could be carried out, and in 10 patients surgery consisted of occlusion (clipping or coagulation) of feeding vessels. In 1 patient, surgery had to be limited to removal of an intracerebral hematoma. The immediate and long-term results of treatment are much better in the surgical than in the nonsurgical group.

The case is presented of a child with early manifestations of Hand-Schüller-Christian disease limited to exophthalmos, and rapid final progression towards a clinical picture dominated by intracranial hypertension and cerebeliar involvement, caused by massive histiocytic infiltration of the cerebellum, combined with discrete subdural deposits of xanthomatous tissue and minor deposits in other parts of the central nervous system and other organs.

A series of 24 children with anterior optic gliomas, observed and for the most part operated upon in a neurostirgical service, is reviewed. A low incidence of unilateral nerve tumors and of associated neurofibromatosis, and a rather high frequency of precocious or pseudoprecocious puberty were noted in comparison with other series. Most tumors were low-grade growths. The results of surgical treatment reflect a good prognosis for unilateral tumors and an increasing prognostic ominousness for the posterior neoplastic development. Cerebrospinal fluid shunts and radiation treatment do have a role as adjuncts to surgical exploration and biopsy, which are generally indicated since no preoperative test seems to grant an absolute diagnosis. The opinion that chiasmal tumors should not be treated at all is not shared.

An aneurysmal bone cyst of the orbital roof, causing a monolateral exophthalmos in a 15-month-old child with no previous history of head injury, was operated upon and histologically misdiagnosed as a giant cell tumor. Radiation treatment in a dosage (3,740 rad) appropriate for the latter diagnosis apparently caused a massive calcification of the residual mass with persisting exophthalmos. At a second operation the lesion was removed completely and a radical change in the histopathological features was found. 12 years after surgery, there is no evidence of residuals upon roentgenographic and CT scan examinations and the exophthalmos has practically disappeared, while there is a normal visual function in the affected eye. Some points of histopathological and gross pathological differential diagnosis between aneurysmal bone cysts and giant cell (‘myeloplaxis’) tumors are discussed.

A series of 84 patients with exophthalmos caused by vascular lesions, or neoplastic lesions with a predominant vascular component, is discussed. All patients, observed in the period before CT scan, were investigated by traditional neuroradio-logical techniques, notably angiographic ones (carotid arteriogram and orbital phlebogram). In several cases, cerebral vascular lesions such as saccular aneurysms and arterio-venous malformations, cerebral angiomas and uncommon arterio-venous shunts, were the cause of the exophthalmos. The case is argued for the continuing importance of both types of angiographic examination, especially cerebral angiography, in the investigation of exophthalmos after ‘non-invasive’ techniques (CT scan, ultrasonography) have allowed a preliminary screening and established a firmer indication for ‘invasive’ examinations.

An intraorbital hydatid cyst, removed in 1965 via a transfrontal craniotomy ruptured during its initial operative isolation and gave clinical signs of recurrence. Exophthalmos and amblyopia progressed to amaurosis, about 13 years after surgery. The recurrence was documented with an unenhanced CT scan, showing a large retrobulbar mass extending posteriorly into the left middle cranial fossa.

✓ Fibromuscular hyperplasia is an alteration of the arterial wall, affecting mostly middle-aged women. When localized to the internal carotid arteries, it can give symptoms of intermittent or permanent cerebral ischemia, but is usually asymptomatic. Three cases, all of them accidental angiographic findings, are used as a basis for discussion of the angiographic features, differential diagnosis, and surgical treatment.

Experience with the venous phase of vertebral angiography is reported.The importance of the angiographic appearance of some of the veins of the posterior cranial fossa for diagnosis is discussed.A few demonstrative cases are described and illustrated.

Certain aspects of the deep cerebral phlebogram in hydrocephalus produced by supra- or subtentorial tumors are discussed. It is suggested that no single sign, but rather the over-all clinical and roentgenologic[See figure in the pdf file]logic features in each individual case, should be relied upon to obtain sufficient diagnostic evidence concerning the site and nature of the neoplasm.Representative examples observed in the authors' direct experience are reported and illustrated.

Four cases of a peculiar cerebral vascular abnormality, consisting of hypoplasia and stenosis of the internal carotid artery, often bilateral, and of an unusual pseudoangiomatous cerebral circulation, are reported.Such a condition, originally found in Japanese patients only, has an undetermined cause.The information obtained through clinical and angiographic studies in these 4 cases seems to favor the hypothesis of a congenital and malformative origin of this vascular abnormality.

Two further cases of hypoplasia of the intracranial internal carotid artery, associated with various types of cerebral vascular disorders, are reported.

Recent reports suggest a possible link between ABO blood groups and morbidity for astrocytomas. Eight hundred and forty-four consecutive brain tumors, operated for the first time and histologically verified at the Institute of Neurosurgery of the University of Padua, have been collected for statistical analysis of the variations in the distribution of ABO blood groups among patients affected by tumors of different histological type but with a common histo-embriological derivation from the neuroectoderma. These neoplasms include therefore 565 astrocytomas, 56 tumors of the ependymal series, 63 tumors of the oligodendroglial series, 114 acoustic nerve neurinomas and 46 medulloblastomas. The results of this study are the following: a) the frequency of tumors of neuroectodermal origin does increase among individuals belonging to group A, and the overall variation appears to be of high statistical significance; b) variations observed for astrocytomas are of low value, and however not significant; c) the main differences involve acoustic nerve neurinomas and medulloblastomas: again, this variation affects mainly patients belonging to group A.

Statistical analysis of the variations in blood group distribution among 470 consecutive cases of meningioma, operated at the Institute of Neurosurgery of the University of Padua, shows a statistically significant increase in the frequency of group B.

The angiographic patterns of the normal course and variations of the superficial sylvian vein (s.s.v.) are reviewed.The pathologic alterations of these patterns are considered for extracerebral and intracerebral space-occupying lesions and some exceptions to commonly accepted diagnostic criteria are made and illustrated.

The statistical significance of variations in Wood group distribution among patients affected by chromophobe pituitary adenoma has been debated in recent reports. One hundred and fifty hypophyseal tumors (117 chromophobe adenomas and 33 adenomas of other histological type), operated for the first time at the Institute of Neurosurgery of the University of Padua, have been collected for such an analysis. No difference of statistical significance was detected by the present survey, although this fact is probably due to the small numbers of patients in each subgroup.

5 patients with gliomas of the anterior optic pathways, histologically assessed or with strong diagnostic evidence, who developed precocious or pseudoprecocious puberty (2 cases) before the operation or after radiation treatment, are presented. Only 2 patients presented familial and/or personal evidence of neurofibromatosis. The production mechanism of these sexual changes is discussed.

The case of a woman with slight diencephalic disturbances, a right exophthalmos caused by an intra-orbital inflammatory mass lesion, and a surgically proven opto-chiasmatic arachnoiditis is reported. Surgery (removal of the intra-orbital mass and of the arachnoiditic adhesions) failed to produce any beneficial effect on the vision of the right eye, which eventually became blind.

Sixteen patients (one with tuberculoma of the anterior optic pathways, the other 15 with opto-chiasmatic arachnoiditis) are presented. They are divided into three categories (definite, likely, possible) from the point of view of the pathogenetic link of their optic pathology with a primary tuberculous infection. Neurosurgical treatment had a positive effect upon the visual symptoms in five patients (31.25%), no effect in three cases (18.75%); in the other eight patients (50%) it could not prevent progression of visual impairment.

In this study, 118 consecutive adult patients with supratentorial gliomas underwent preoperative immunological monitoring, with particular regard to B-lymphocyte and T-lymphocyte markers. Most patients were treated surgically and with radiotherapy. Three months later, they were readmitted for postoperative immunological investigation and follow-up control. A total of 76 cases could thus be completely investigated and were statistically eligible for evaluation. A pronounced failure of T-cell-mediated immunity was observed: "E-active" rosette-forming cells and mitogen-induced blastogenesis tests turned out to be markedly depressed, with a slight postoperative recovery. Spontaneous cell-mediated cytotoxicity was significantly (p less than 0.01) increased both in preoperative and postoperative findings. The main immunodiagnostic patterns (immunoglobulins assay, surface immunoglobulins, "mouse" rosettes) concerning the B-cell-dependent "pool" were found to be within normal limits.

A retrospective appraisal of traditional neuroradiological techniques (such as direct rontgenograms, cerebral angiography RISA-cisternography, and pneumo-cisterno-encephalography, as opposed to the “new” technique of computer-assisted tomography) was carried out in a series of 82 cases of opto-chiasmatic arachnoiditis, all surgically verified. It is concluded that none of these examinations can provide a reliable diagnosis of opto-chiasmatic arachnoiditis, which preoperatively can only be a tentative diagnosis that becomes final only when confirmed by surgical findings. In the presence of certain progressive neuro-ophthalmological symptoms and signs, a negative neuro-radiological investigation should not deter the neurosurgeon from exploring the chiasmatic region. Computer-assisted tomography, of which the authors have no personal experience in these cases, may hold the future answer to the diagnostic problem.

14 young patients, operated upon for opto-chiasmatic arachnoiditis by craniotomy are presented. 2 main etiopathogenetic forms (and their respective clinical equivalents) of the disease could be recognized. Only 1 postoperative death occurred, in a patient with a dominant clinical picture of intracranial hypertension. Results of surgery (craniotomy and lysis of adhesions) could be distinguished as positive (functional improvement) in 5 cases, indifferent or negative in the others, with a follow-up duration of up to 23 years. The role of the diagnostic value of the pneumoencephalogram as a basis for surgical indication is discussed: it is felt that this examination, when reported as negative, is not of sufficient value to rule out the diagnosis, which must essentially rely upon clinical data.

✓ A case of multiple neurinomas, firmly embedded within the nervous substance of the spinal cord and presumably extending over the entire length of its surface, is reported. The complete lack of relationship of the multiple lesions with the spinal roots and the absence of signs of neurofibromatosis are the most salient features of this uncommon case. In a discussion on the origin of the condition, it is concluded that this case might be an example of neurocristopathy.

15 cases of cerebral aneurysms in children between 8 and 15 years of age, all operated upon in a 20-year span (1956–1976), are reported. 7 of them were the carriers of large aneurysms (3 ‘giant’). Surgical mortality was limited to 2 patients with aneurysms of the middle cerebral artery and large intracerebral hematomas. All other patients are in satisfactory conditions, with a follow-up ranging from 2 to 22 years. A direct approach to the aneurysm was used in all but 3 cases. Certain features of cerebral aneurysms in children are discussed pertinently to this series.

Four additional cases of pterional meningiomas, fed by a meningeal branch of the lacrimal artery, are reported.The morphology, course, characters and pathologic significance of this vessel are discussed.

Two cases of subdural hematoma, in which carotid angiography has demonstrated an extravasation of contrast medium, as usually seen in epidural hematomas, are reported.The significance of such an angiographic sign is discussed.

The entrance of iodized oil into the venous system represents a possible, although rare, complication of myelography, which usually does not result in any permanent clinical consequences.A case of intravasation with the roentgenographic demonstration of contrast material in the sacroiliac veins and in the lungs is reported.