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To determine the epidemiological profile of patients diagnosed with primary malignant brain tumors in the state of Rio Grande do Sul/RS, Brazil, from 2013 to 2019. This is a descriptive, retrospective study with a quantitative approach, carried out through analysis of secondary data collected at the Information Technology Department of the Unified Health System (DATASUS). One thousand five hundred and fifty-eight cases of malignant primary brain tumor were diagnosed. The highest prevalence of cases occurred among men (55.78%) and among individuals aged 40 to 59 years (28.34%). The macro-region with the highest incidence was the Metropolitan (45.64%). An expansion of the database is necessary, mainly in some pathological characteristics such as location of the neoplasm, histological type and morbidity and mortality and patient characteristics such as race to better predict risk factors, prevention and diagnosis.

Schwannomas are the fourth most common primary neoplasms affecting the brain and cranial nerves. Central lesions commonly arise from sensory nerve roots, and a common intracranial site is the vestibular branch of the 8th nerve (>85%). We present the case report of a patient who has a schwannoma extending from the pterygopalatine fossa to the orbit, complaining about facial pain in the trajectory of the trigeminal ophthalmic branch. Schwannomas represent 1 to 2% of all neoplasms of the orbit, and trigeminal schwannomas are extremely rare, accounting for less than 0.5% of all intracranial tumors.

Tuberculosis (TB) of the central nervous system (CNS) is considered one of the most severe forms of presentation of the disease. Although only 1% of TB cases involve the CNS, these cases represent around between 5 and 15% of extrapulmonary forms.1 2 Tuberculous meningitis (TBM) is the most frequent form of CNS TB. The granulomas formed in the cerebral tuberculoma may cause hydrocephalus and other symptoms indicative of a CNS mass lesion. In the absence of active TB or TBM, the symptoms may be interpreted as indicative of tumors.3 4 The prognosis is directly related to the early diagnosis and proper treatment installation.5 We report the case of a patient with intracranial hypertension syndrome, expansive mass in the parieto-occipital region, accompanied by a lesion in the rib, initially thought to be a metastatic lesion, although posteriorly diagnosed as a cerebral tuberculoma.

Introduction Osteomyelitis is an inflammatory-infectious state that may involve trabecular bone, cortical bone, bone marrow and periosteum. The source of the infection may be hematogenic, acquired from an adjoining infectious focus or by direct inoculation into the bone. Its treatment involves antibiotic administration and surgery, but its management remains challenging. Presentation of case A 76-year-old male patient with a history of car accident 3 months earlier sought hospital care with nasal fracture and loss of substance in the right frontotemporal region, where a pectoral muscle free graft was performed to reconstruct the facial defect. The grafted region had hyperemic edges, necrotic appearance, purulent discharge and bone exposure in the nasal dorsum. The initial diagnostic hypothesis was an infectious process due to graft rejection, with likely evolution to osteomyelitis. The surgical procedure was performed by a multidisciplinary team and the patient received the antibiotic regimen according to the antibiogram, with hospital discharge after 39 days of hospitalization. Discussion Treatment of osteomyelitis requires the combination of antimicrobial therapy and surgery. Despite surgical and chemotherapeutic advances, it is a difficult condition to treat and there is no universally accepted protocol for treatment. Conclusion Surgical treatment was essential for stabilization of the condition. Due to the complexity of this type of infection in the craniofacial region, planning and execution must be carried out through a multidisciplinary team.

Lhermitte-Duclos disease (LDD), or cerebellar dysplastic gangliocytoma, is a rare type of cerebellar tumor, from unknown origin. Patients can be asymptomatic for several years, but there are usually imprecise neurological signs for long periods.

Idiopathic intracranial hypertension (IIH) is a disease characterized by an increase in intracranial pressure, without presence of parenchymal lesions or hydrocephalus that justify it. Over 90% of cases there is association with stenosis of the dural venous sinuses. It is characterized by headache, tinidus, nausea, vomiting and visual disturbances. Initial treatment is clinical and when it fails there is indication of invasive procedures, among them shunts and fenestration of the optic nerve sheath. Angioplasty of dural venous sinuses, when indicated, has shown an alternative with better results and less complications. We report a case of a female patient, with 27 years old, diagnosed with IIH and bilateral transverse sinus stenosis, which was treated by bilateral stenting and total resolution of symptoms. Besides describing the case we review the literature about the subject.

Context: Dural arteriovenous fistulas (DAVFs) of the cavernous sinus are arteriovenous connections located in the dura mater leaflets of this region. DAVFs usually present with ocular symptoms such as diplopia, conjunctival hyperemia, involvement of cranial nerves III/IV/VI, etc. Trigeminal neuralgia caused by a cavernous DAVF is rare, being reported only three times in the literature. Case report: A 46-year-old female smoker sought care with a complaint of multiple daily episodes of shock-like right temporal headache and facial pain in the V1/V2 dermatomes, of 2 years’ duration. A clinical diagnosis of trigeminal neuralgia was established. Magnetic resonance (MR) imaging of the brain and MR angiography of the cerebral and cervical vessels were both normal. Conservative treatment and balloon compression of the trigeminal ganglion were ineffective. Therefore, we chose to perform an angiography for diagnostic clarification, which demonstrated a DAVF of the right cavernous sinus, fed by branches of the external carotid artery. We decided to catheterize the fistula and complete obliteration was achieved. Soon after the procedure the patient reported pain relief. At 3-month follow-up the patient remained pain free and required no analgesia. Conclusion: Trigeminal neuralgia caused by a cavernous DAVF is rare. The fistula in this case was only diagnosed after an angiography was performed, so clinicians must be aware that not all vascular conditions can be identified non invasively, and that cavernous DAVFs may be an underdiagnosed cause of trigeminal neuralgia.

Olfactory groove schwannomas (OGSs) are rare benign tumors of the anterior skull base region. Considering the lack of Schwann cells in the optic and olfactory nerves, their origin remains enigmatic. Despite the precursor cell, total resection of the lesion is curative, as long as the histopathological features of the tumor are compatible with schwannoma. We report the case of a 32-year-old woman, addicted to crack, who was brought to the hospital presenting with cognitive dysfunction after being physically assaulted, whose neuroimaging revealed a large extra-axial mass in the subfrontal sagittal region. The presentation, immunohistochemical markers and histogenesis are discussed in the present study, along with a literature review.

Ventriculo-peritoneal shunt (VPS) is one of the most commonly used procedures in the treatment of hydrocephalus. Nevertheless, even being technically simple and well-known, there are several serious complications that can happen, and among them is bowel perforation. This complication is rare, especially in adults, and it usually happens within the first year after the surgical procedure. It can also be aggravated by both infections, in the central nervous system or systemic, and also by increase in the intracranial pressure, due to shunt system dysfunction. The symptoms are usually mild, what can make the diagnosis challenging, and demanding several complementary tests. Also, there are many questions about the pathophysiology and predisposing factors for this complication. Due to its low incidence, and because it is usually described through case reports and small series, there is no consensus regarding its ideal management. The treatment varies from less invasive approaches, preserving the shuntcomponents in place, until the full withdrawn of the whole system and use of wide spectrum antibiotics. We report a delayed case of bowel perforation and catheter extrusion through the anus in an adult patient, discussing the data available about this pathology.

Atypical rhabdoid teratoid tumors (ARTTs) are rare embryonic tumors, usually localized in the posterior fossa and diagnosed in children under 3 years-old. The treatment includes surgical resection, radio and chemotherapy, and the prognostic is unfavorable, with an average median survival of 1 year. We present the case of a 3-year-old patient, with history of headache and vomiting, followed by absence seizures, temporal automatism, syncope accompanied by sialorrhea and sphincteric loss succeeded by a postictal period. Surgical excision was performed and the anatomopathological study confirmed ARTT. The ARTTs are embryonic tumors, a category in which medulloblastoma and primitive neuroectodermal tumors (PNETs) represent the most common central nervous system (CNS) malignancies in childhood.

Paracoccidioidomycosis is a systemic mycosis caused by the Paracoccidioides brasiliensis fungus, which is endemic in Latin America. Brazil is the country with the highest number of cases. The affection of the central nervous system (CNS), a potentially fatal condition, occurs in ∼ 12% of the cases. The following forms of presentation are identified: meningeal, which is unusual; meningoencephalitic; and pseudotumoral, the latter two being more frequent. Imaging tests are essential for the diagnosis, but the histological identification of the fungus is required for confirmation of the pathology. The clinical picture depends on the neuraxial location. We present a case of a male rural worker, with expansive lesions in the CNS compatible with paracoccidioidomycosis.

Introduction The city of Passo Fundo, in the north of the Rio Grande do Sul state, has been standing out in the health care field for many years. The state has become a reference in endovascular interventional neuroradiology. We will cover 10 years of experience in this area and divide our observations in 3 parts: cerebral angiograms (part I), carotid angioplasties (part II) and intracranial aneurysms (part III). The goal of part I is to statistically assess the cerebral angiograms, their indications, risks and complications, as well as to do a technical review. Materials and Methods A retrospective study from 2005 to 2015 with a total of 5,567 interventional neuroradiology procedures performed. A total of 4,114 angiograms, 639 embolizations of intracranial aneurysms, 414 carotid angioplasties, 143 embolizations of cerebral arteriovenous malformations, 32 embolizations of dural arteriovenous fistulas, 102 cerebral vasospasm treatments, 21 treatments of epistaxis, 36 embolizations of craniocervical tumor, 25 thrombolysis of ischemic stroke, 18 vertebroplasties and 13 embolizations of arteriovenous malformations of the face. Results A total of 4,084 procedures performed, 21,811 vessels studied, average vase 7.62/2.82 vessel and patient/procedure. Of these, 2,536 were diagnostic procedures and 1,548 angiographic controls. Of the total, 1,188 patients received only an angiogram, 27.14% of which were therapeutic procedures. We obtained a total of 3.89% complications: 2.33% reflection vasovagal, 0.56% allergic skin reaction, anaphylactic shock 0.07%, 0.27% femoral hematoma, 0.26% transient neurological deficit, 0.12% permanent neurological deficit and no case of death. Conclusion Cerebral angiography in adults, children and infants is a safe procedure with low risk of permanent neurological complications.

Infantile hemangiomas (IH) are the most common vascular tumor of infancy. Occurrences during the neonatal period are divided in multiple congenital, limited to skin involvement, or diffuse neonatal hemangiomatosis (DNH). DNH is considered to be a benign and rare disease, determined by the presence of multiple cutaneous and extracutaneous hemangiomas. The encephalic and medullary involvement of IHs is unusual and rarely reported. The authors report a case of infantile hemangioma (IH) as diffuse neonatal hemangiomatosis with predominant central nervous system involvement on a neonate, treated with propranolol. We discuss the use propranolol as main therapy and review the available data regarding IHs with neuroaxial involvement and its treatment.

Teratomas are the most common type of Germ Cell Tumors (GCTs). GCTs are classified as extragonadal, if there is no evidence of a primary tumor in neither the testicles, nor in the ovaries. Intracranial Mature Teratomas are tumors with a very low incidence, and clear male predominance. We present the case of a 21 year-old female patient, with a history of two seizures 15 days prior to admission, without any abnormalities upon physical examination. The Magnetic Resonance Imaging (MRI) performed at the admission evidenced an expansive, heterogeneous lesion in the frontal lobe, hypointense on T1-weighted images, hyperintense on T2-weighted images, and restriction on the diffusion imaging and ADC-mapping. The patient underwent microsurgical resection, and it was possible to achieve a near-total resection. During surgery, a well-defined capsule was identified, which was removed after adequate debulking. Tissues resembling hair were taken from inside the lesion. The patient recovered well, without any neurological deficits, and no further intervention was necessary. The authors aim to describe this rare pathology and their option for a surgical approach.

Neurocysticercosis is the most common parasitic infection affecting the central nervous system, usually involving the brain parenchyma, intracranial subarachnoid space, or ventricular system. In rare cases, there is involvement of the spine (vertebral, epidural, subdural, arachnoid, or intramedullary). Even in endemic regions, this variant is rare, with an incidence below 5% of all patients. The diagnosis is made based on the symptoms, which can be very unspecific, imaging and CSF analysis, with biopsy as a possibility. Treatment is usually curative, but important deficits can develop, due to compression of the spinal cord or nerve roots, arachnoiditis, or meningitis. We present the case of a patient who developed this entity, with poor clinical scenario, and review the literature on the topic.

Vestibular schwannomas (VSs) account for ∼ 70% of all tumors of the cerebellopontine angle (CPA). Their clinical presentation is often insidious, with progressive hearing loss and involvement of other cranial nerves. Spontaneous hemorrhage in those tumors is very unusual, and generally presents with acute clinical features such as nausea, vomiting, headache and altered consciousness, usually with marked dysfunction of the cranial nerve involved, and with new deficits of neighboring cranial nerves. Asymptomatic patients are extremely rare. We present a case report of an incidental VS with asymptomatic bleeding, which evolved to death after surgery.

Schwannoma is a benign tumor originating from Schwann cells that make up the peripheral nerve sheath. An 11-year-old male referred by ophthalmologist reporting volume increase in right side orbit at a previous trauma site, with no pain complaints. Physical examination showed preserved visual acuity and motility and swelling in the lateral region of the right supraorbital margin. Computed tomography with contrast showed an expansive formation with contrast enhancement. The diagnostic hypotheses were lipoma and Schwannoma. Excisional biopsy was performed by supraorbital superciliary access and the lesion obtained was encapsulated, with elastic consistency, brown and medium staining 3.5 x 2.8 x 1.2 cm, with the largest laterolateral, anteroposterior, and craniocaudal diameters, respectively. Histopathological examination confirmed the Schwannoma diagnosis hypothesis. Patient is currently 6 months postoperatively, has well healed operative wound without sensory or motor deficits and new contrast-enhanced tomography does not show any signs of recurrence of the lesion.

Background Germinomas are rare malignant central nervous system tumors, a type of germ cell tumor, according to the 2016 World Health Organization Classification of Brain Tumors. Most of these tumors develop along the midline, most often from the pineal gland, followed by tumors arising in the suprasellar cisterns. Suprasellar germinomas commonly manifest with diabetes insipidus, visual impairment, and hypothalamic-pituitary failure. We present a literature review from the PubMed database and report 2 cases of suprasellar germinomas. Case Description Both pediatric patients presented with progressive visual loss; one did not show endocrinologic impairment, and the other presented with hypothyroidism, diabetes insipidus, and generalized edema. Magnetic resonance imaging showed expansive suprasellar masses in both cases, confirmed as germinomas at histopathologic examination. The patients were treated with the same surgical approach, although their outcomes were different because of endocrinologic and post surgical complications. Conclusions Suprasellar germinomas are highly curable lesions when diagnosed early. The treatment remains controversial and should be individualized, but the association of chemotherapy and radiotherapy allows reduce adverse effects and shows great results.

Meningiomas are among the most common intracranial primary tumors, and generally have a benign behavior. The incidence of extracranial metastasis of this pathology is low. There are different variants of them, with a wide variety of aggressiveness and potential to metastatic spread. Among the malignant meningiomas (1–3% of total), the rhabdoid variant is known for its aggressive biological and clinical behavior. It is also known that some histological subtypes are inherently prone to recur or spread, as the latter. In the latest World Health Organization classification, extracranial metastases are not currently considered a pathological criterion for malignancy, and, when present, they are most commonly found in the lung, liver, lymph nodes, and bone. Treatment is usually surgical resection of the metastases, but there is still no consensus about it. Owing to its poor prognosis, the rhabdoid subtype is commonly treated aggressively. Patients are submitted to local radiotherapy to prevent recurrence. Extracranial metastases of meningiomas are rare, but should always be remembered, especially in cases of local recurrence and malignant histology, as the rhabdoid variant. We report one case of extracranial metastases in a patient diagnosed with rhabdoid subtype of meningioma, and discuss the literature on this pathology.

Objectives/Hypothesis This cadaveric study analyzes the endoscopic endonasal anatomy of the ophthalmic division of the trigeminal nerve (V1), from the middle fossa to its orbital entry via the superior orbital fissure. Anatomical relationships with the surrounding cranial nerves and blood vessels are described, with emphasis on their clinical correlation during surgery in this region. Our objective was to describe the anatomical relationships of the ophthalmic division of the trigeminal nerve. Study Design Cadaveric study. Methods Thirty middle cranial fossae, in adult human cadaveric specimens, were dissected endonasally under direct endoscopic visualization. During the dissection, we noted the relationships of the V1 nerve with the other trigeminal branches, as well as with the oculomotor and trochlear nerves, the paraclival and cavernous portions of the internal carotid artery, and the superior orbital fissure (SOF). Results The V1 nerve is the most superior trigeminal branch and runs upward and obliquely, along the middle portion of the lateral wall of the cavernous sinus. The V1 nerve joins the oculomotor and trochlear nerves to exit the cavernous sinus and enter the orbit through the SOF. Ten percent of the specimens displayed the trochlear nerve running along as a mate of the V1 nerve. The V1 nerve borders two key triangles in the lateral wall of the cavernous sinus, and the Parkinson's and anteromedial triangles. Conclusions In this study, the V1 nerve was a constant and reliable landmark, thus allowing the identification of the anteromedial triangle. This potential space can serve as an adequate window to access the temporal lobe. Knowledge of this anatomy is essential when planning and executing endonasal surgery in this region. Level of Evidence NA Laryngoscope, 125:1284–1290, 2015

Introduction: The endoscopic endonasal approach (EEA) has become an increasingly utilized means of addressing pathology at the craniovertebral junction (CVJ) as an alternative to the transoral-transpharyngeal approach (TOA). Although the EEA may offer decreased morbidity compared with the TOA, it is physically limited in its caudal working exposure by the nasal bone anteriorly and the hard palate posteriorly and thus offers restricted caudal access compared with the TOA. Objective: We hypothesized that performing an endoscopic endonasal partial posterior palatectomy would extend the inferior limit of the EEA caudally, thereby, increasing the working corridor to the upper cervical spine. Methods: A total of 10 formalin-fixed cadaveric specimens underwent high-resolution computed tomography (CT) scanning for registration to a stereotactic navigation device. These were assigned to one of two groups: one utilizing an angled drill and one utilizing a straight drill to perform bony resection. Using the navigation probe, the caudal-most limit of access with the assigned drill system to the anterior aspect of the vertebral bodies (AVB) and posterior aspect of the vertebral bodies (PVB) in the upper cervical spine were recorded. Then, the posterior hard palate was resected with the assigned drill from the midline maxillary crest to approximately halfway between midline and the medial maxillary sinus wall unilaterally on the side of the drill. This was done in 0.5 mm incremental resections with basion-to-AVB (b-AVB) and basion-to-PVB (b-PVB) measurements taken immediately afterward until no further caudal exposure was gained. The maximal gain in the b-AVB and b-PVB line was recorded for each specimen and averaged within each group of five specimens. Results: The average prepalatectomy b-AVB and b-PVB distances accessible to the straight drill were 18.74 and 20.96 mm respectively, and the postpalatectomy b-AVB and b-PVB distances were 29.88 and 36.24 mm. For the straight drill, the average caudal exposure gained with palatectomy was 11.14 mm to the AVB and 15.28 mm to the PVB. The average prepalatectomy b-AVB and b-PVB distances accessible to the angled drill were 28.84 and 38.04 mm, respectively, and the postpalatectomy b-AVB and b-PVB distances were 44.64 and 51.14 mm. For the angled drill, the average caudal exposure gained with palatectomy was 15.8 mm to the AVB and 13.1 mm to the PVB. Conclusion: Posterior palatectomy improved caudal access substantially when using both the straight and angled drills. Angled drills provided substantially improved caudal access via EEA compared with straight drills both with and without palatectomy. On the basis of our measurements, the additional caudal access gained for the straight drill was approximately equal to the b-AVB and b-PVB available to the angled drill without palatectomy.

Hemangiopericytoma is a very rare and aggressive tumor that originates from pericytes of Zimmermann. Spinal hemangiopericytoma is a rare neoplasm that behaves similar to intracranial hemangiopericytoma, with approximately 140 cases being reported in the literature. We report a case of recurrent hemangiopericytoma of dorsal spine in a 55-year-old women treated with surgery for 3 times, with liver metastasis. Gross total resection, if possible, is the first choice of treatment. Radiation therapy or chemotherapy may be indicated, especially in cases with high-grade lesions or tumors with unresectable.