Departamento de Especialidades Cirúrgicas

Small cerebellopontine angle cisterns in patients with trigeminal neuralgia To The ediTor: We read with great interest the recent article by Park et al. (Park SH, Hwang SK, Lee SH, et al: Nerve atrophy and a small cerebellopontine angle cistern in patients with trigeminal neuralgia. Clinical article. J Neurosurg 110:633-637, April, 2009), in which patients with trigeminal neuralgia (TN) were reported to have smaller cerebellopontine angle (CPA) cisterns and shorter cisternal segments of the trigeminal nerve on the affected side. This manuscript was in line with another MR imaging study of CPA cistern volume performed by Rasche et al., 6 in which it was suggested that a smaller cistern on the affected side, with descending cerebellar tentorium, may lead to a closer nerve-vessel relationship. For years, we have observed that patients with TN often have small CPA cisterns and/or a small posterior fossa during neurovascular decompression. However, in the literature, the association of skull base abnormalities and TN is sporadic, and these conditions are mainly related to other concurrent pathological entities, such as achondroplasty, Chiari malformation, or Paget disease. 2,3,5,7 To date, it is unknown whether the presence of small CPA cisterns influences satisfactory neurovascular decompression. To contribute to this topic, we describe here a 49year-old woman with left-sided TN in the maxillary and mandibular division who experienced no pain control despite receiving high doses (1800 mg/day) of car

Trigeminal neuralgia is classically associated with neurovascular compression of the trigeminal nerve, at the root entry zone (REZ). However, patients are occasionally affected by intra-axial involvement of trigeminal sensory fibers caused by demyelinating diseases, strokes and, rarely, pontine cavernous malformations. We discuss the management strategies and decision-making process in a 55-year-old patient, affected by trigeminal neuralgia with 2 potential causative mechanisms: a neurovascular conflict at the trigeminal REZ and an ipsilateral cavernous malformation at the pontine nucleus of the trigeminal nerve.

Background: Temporal bone squamous cell carcinoma (TBSCC) is a very rare condition. e prognosis is dismal for advanced tumors. Due to its rarity, information in the literature is scarce. Here, we report a unique case of TBSCC with cerebellar invasion and hydrocephalus. Case Description: A 46-year-old reported right-sided hearing loss and a painful right retroauricular mass for 4 months. Magnetic resonance imaging revealed a 8.7 × 7.6 × 6.4 cm mass invading the right temporal and occipital bones. After a biopsy and 3 surgical procedures over 6 months, the diagnosis of TBSCC was obtained. Due to invasion of the cerebellar tissue and obstructive hydrocephalus, a ventriculoperitoneal shunt was performed. e patient was referred for adjuvant radiotherapy. However, palliative care was initiated due to tumor progression. We report a case of advanced TBSCC with poor prognosis despite surgical treatment and radiotherapy. More data are necessary to provide new and better treatment to these patients.

RESUMO -Os autores rebatam dois casos de meningioma da goteira olfativa em pacientes com câncer da mama. Referem três eventualidades que ocorrem em ambas as neoplasias: período etário predominante entre quinta e sexta décadas; presença em ambas de receptores de hormônios esteróides; e predominância do sexo feminino entre os meningiomas. Recomendam exame das mamas em mulheres com meningiomas e especulam sobre a possibilidade futura de tratamento hormonal coadjuvante para estes tumores. As imagens tomográficas feitas para controle pós-operatório ou quando aparecem sintomas neurológicos nem sempre diferenciam metástases de meningiomas, daí, às vezes, necessidade de verificação cirúrgica. PALAVRAS-CHAVE: goteira olfativa, mama, meningioma, câncer, associação de tumores. SUMMARY -Two cases of olfactory groove meningiomas are presented in patients with breast cancer. Predominance of breast cancer and meningiomas in the age decades of the forties and the fifties, presence of steroid hormones receptors in both and prevalence of meningiomas in women are referred as significant correlations. Examination of the breast of women with meningiomas is recommended. Tomographic images are sometimes atypical, and a surgical intervention may be necessary.