The schwannomas are benign tumors originating from Schwann cells which constitute the nerve sheath. The dorsal pigmented type of schwannomas is relatively rare (Goldstein in Am J Med Genet 86:62–65, 2004; Kurtkaya-Yapicier in Histol Histopathol 18(3):925–934, 2003). There are two distinct types of melanotic schwannoma: the sporadic melanotic schwannomas and the psammomatous melanotic schwannomas of Carney complex. We report a case of a patient harboring a right dorsal dumb-bell melanotic schwannoma and left adrenal mass. The patient underwent a surgical procedure for en bloc total removal of the mass by a posterior and anterior approach. Histopathological examination revealed the diagnosis of melanotic schwannoma. At present, we have no reliable marker of histopathological malignancy of melanotic schwannoma so the follow-up period ought to continue for a period of more than 5 years. As the total removal of the melanotic neurinomas is mandatory to prevent possible malignant transformation of the tumor recurrence or regrowth, we believe that the posterior and trans-thoracic approach are the most suitable one for the dorsal dumb-bell schwannoma.

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Subtotal removal followed by early fractionated radiotherapy can be an effective treatment for huge craniopharyngiomas. Such a multidisciplinary treatment may favour tumour control and assure a satisfactory quality of life as well.

L e t t e r s t o t h e e d i t o r 285 Subarachnoid hemorrhageTo The ediTor: We read with great interest the re cent article by Kuo et al. 1 (Kuo CP, Wen LL, Chen CM, et al: Attenuation of neurological injury with early baica lein treatment following subarachnoid hemorrhage in rats. Laboratory investigation. J Neurosurg 119:1028-1037, Oc tober 2013).Ruptured aneurysm-related subarachnoid hemor rhage (SAH) is an emergent neurosurgical condition re quiring clipping or embolization of the aneurysm. More over, SAHinduced vasospasm often leads to cerebral infarction and morbidity, or death. Kuo et al. conducted a laboratory investigation to evaluate the effect of baicalein reduction of neurological injury in the early stage after SAH. They found that baicalein significantly decreased mortality and neuronal injury. Moreover, treatment with baicalein was associated with a decrease in reactive oxy gen species (ROS) and better neurological scores.Their study provided an important potential appli cation of baicalein in the improvement of SAHinduced neuronal injury and cerebral vasospasm, and aroused the curiosity of readers to ask whether the effect of baicalein is through direct passage through the bloodbrain barrier to regulate the cerebral inflammation and ROS, or indi rectly regulates the peripheral blood inflammation to im prove the outcome of SAHinduced vasospasm. DisclosureThe authors report no conflict of interest. previously demonstrated that baicalein has both antiin flammatory and antioxidative activities in rats. In our cur rent study, we investigated only the antioxidative stress effect of baicalein by examining superoxide dismutase, catalase, and malondialdehyde levels in the brain tissues (hippocampi and cortices). We found that cerebral vaso spasm and brain injury were decreased and neurological outcomes were improved. According to the study of Tsai et al., 4 baicalein is able to penetrate the bloodbrain barrier. Therefore, we believe that baicalein can both directly and indirectly regulate inflammation and the oxidative stress effect after SAH. However, our results only provided evidence of the an tioxidative stress effect of baicalein, which might occur through both direct and indirect regulation.

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