HighlightsA very rare case of paraganglioma of filum terminale is described.Clinical and radiological features of spinal paraganglioma are listed.Surgical management of paraganglioma of filum terminale is discussed.

IntroductionCavernous hemangiomas are rare benign bone tumors and those at the level of the cranial bones are even rarer.Case presentationA 50-year-old woman of Italian ethnicity presented with a frontal mass. A computed tomography scan showed an osteolytic lesion and a magnetic resonance imaging scan revealed a hypointense lesion on the T1-weighted image and a hyperintense lesion on the T2-weighted image. We performed a tailored craniectomy and cranioplasty. Histological examination revealed a cavernous hemangioma.ConclusionsThese benign tumors do not have classic radiographic features and so can be misinterpreted as lesions like multiple myeloma or osteosarcoma. Consequently, the diagnosis is most often made during surgical resection.

Background:Middle cerebral artery (MCA) aneurysms constitute from 18–40% of all intracranial aneurysms. They are mainly found in the proximal and bifurcation tracts and only in the 1.1-1.7% of cases they are located in the distal segment. The authors report a case of a ruptured saccular cortical MCA aneurysm with unknown etiology.Case Description:A 53-year-old female was admitted with a sudden severe headache, nausea, vomiting, and a slight left hemiparesis. The computed tomography (CT) scan showed subarachnoid hemorrhage (SAH) in the left sylvian fissure and intracerebral hemorrhage (ICH) in the left posterior parietal area. The CT angiography (CTA) reconstructed with 3D imaging showed a small saccular aneurysm in the M4 segment in proximity of the angular area. A left parieto-temporal craniotomy was performed, the aneurysm was clipped and the ICH evacuated. The motor deficit was progressively recovered. At 3-month follow-up examination, the patient was asymptomatic and feeling well.Conclusions:In our opinion, surgery is the best choice for the treatment of ruptured M4 aneurysms with ICH, because it allows to evacuate the hematoma and to exclude the aneurysm from the intracranial circulation. In addition, we suggest both the use of the neuronavigation technique and of the indocyanine green videoangiography (ICGV) for the aneurismal surgery.

During craniotomy, hemostatic materials such as oxidized cellulose and cotton pads, commonly used to control bleeding, may cause a granulomatous reaction that may produce spaceoccupying mass lesions termed textiloma (or gossypiboma). We present a 46-year-old female who underwent a right frontotemporal craniotomy and surgical removal of intraparenchymal cerebral hemorrhage, and who developed a textiloma during the postoperative period causing seizures. Granulomatous reactions due to hemostatic agents have been reported experimentally, as well as after cranial and spinal operations. We emphasize that although it is rare, an adverse reaction such as a postoperative textiloma due to hemostatic material and subsequent granuloma formation can result in a false image of rebleeding, tumor recurrence, radiation necrosis, or postoperative abscess, depending on the particular clinical history of each patient.

Cerebral cavernous angioma or cavernoma is a benign vascular malformation, usually asymptomatic. It is infrequent and often its discovery is incidental, a so-called incidentaloma. However, these lesions can be symptomatic, causing headaches, epilepsy, cerebral hemorrhage and other neurological signs depending on the brain area involved. Frontal localization is responsible for psychiatric disorders, particularly the prefrontal region, leading to prefrontal syndrome, a condition common in all frontal lobe tumors. Psychopathological syndrome can be depression-type, pseudodepression syndrome or maniac-type, pseudomaniac syndrome. Surgical treatment of lesions like this may not always be possible due to their location in eloquent areas. In this study, we describe an unusual association of migraine-like headache, epilepsy and frontal lobe pseudodepression late-onset syndrome in the same patient. We have considered this case interesting mainly for the rarity of both a headache with migraine features and for the late onset of pseudodepression syndrome. Pathophysiology underlying migraine-like headache and that concerning the late-onset pseudodepression frontal lobe syndrome seems to be unclear. This case leads to further hypotheses about the mechanisms responsible for headache syndromes and psychopathological disorders, in the specific case when caused by a cerebral frontal lobe lesion.