Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin's lymphoma that accounts for 4% of newly diagnosed central nervous system (CNS) tumors. Most primary lymphomas of the central nervous system are of the subtype of diffuse large B-cell lymphomas, which have highly aggressive behavior and may involve the brain, leptomeninges, eyes or spinal cord without evidence of systemic disease. Primary CNS lymphomas are very rare in immunocompetent patients, but their rates are increasing. So far, only 11 primary Gasser ganglion lymphomas have been reported, with an incidence of 2.5 cases per 30,000,000 inhabitants. However, B cell lymphomas of the marginal zone of the Gasserian ganglion have been very rarely reported. We report here a clinical presentation characteristic of B cell lymphoma of the marginal zone of the Gasser ganglion in an immunocompetent patient who was treated with surgery and radiotherapy, evolving with improvement of symptoms and without recurrence in 3 months of follow-up.

Skin flap necrosis is one of the known complications of neurosurgical operations in general and in low flow bypass surgery in particular. We report a technique for using the frontal branch of the superficial temporal artery (STA), while basing the flap on the parietal branch along with the posterior auricular and occipital arteries. TECHNICAL NOTE:The main trunk of STA is palpated in front of the tragus. The skin is then incised directly over the vessel. The main trunk is then dissected and followed distally to the bifurcation. The incision then continues distally, within the hairline and over the frontal branch, till adequate length of usable vessel is dissected (preferably not more than 10 cm.). When this point is reached, the incision is curved backwards 90 degrees and continues parallel to midline. The incision then stops at a line coinciding with the posterior margin of the tragus similar to the Arabic question mark ‫.)؟(‬ The technique is simply based on an inverted question mark incision rather than a linear skin incision or conventional question mark. CONCLUSION:The technique described allows using the frontal division of the STA while performing a skin flap based on the parietal branch, posterior auricular and occipital arteries, in order to allow performing a larger craniotomy, without the fear of cutaneous necrosis, while still remaining within the hair line for good cosmetic results.