Out of a series of 1850 cases operated upon for lumbar disc herniation 130 underwent re-operation because of persistent or recurrent symptoms. Re-operation was successful in 62%. The prognosis of re-operation was not related to special clinical symptoms and signs but only to the operative findings. Herniations at other levels and recurrences of lumbar disc herniations had the best results (excellent in 98% respectively 54%), but scar formations alone came out much less satisfactory (only 38% excellent results). Computed tomography (CT) findings were less reliable in distinguishing between disc prolapse and fibrosis than magnet resonance imaging (MR). Therefore MR is the diagnostic method of choice in these conditions, and scar formations alone should be considered a contra-indication for re-operation.

Sphenoidal aspergillosis is an unusual cause of sella turcica enlargement. Pituitary abscess secondary to Aspergillus had been reported. In the present case, a woman with sphenoid sinus aspergillosis mimicked a pituitary tumor. This patient survived her infection with intact pituitary function following a transsphenoidal approach. No postoperative amphotericine-B and 5-fluorocytosine were necessary. CT scan revealed a mass occupying the sphenoid sinus extending to the sella turcica. Factors that should alert the clinican to the presence of a sphenoidal and pituitary abscess in a patient with sella turcica enlargement are prior episodes of sinusitis, meningitis and immunosuppression and, as in the present case, hyperglycemia.

A case of fourth ventricle cysticercosis treated with praziquantel is presented. The disappearance of the lesion six months after the treatment was demonstrated by CT scan. A review of the literature indicates that this is a very exceptional result, because with recently intraventricular cysticercosis was considered to be non-responsive to praziquantel treatment, making surgery necessary.

✓ The authors report a case in which the cause of a “spontaneous” carotid-cavernous fistula could not be demonstrated by selective angiography of external and internal carotid arteries. However, postmortem study of the cavernous sinuses revealed an unsuspected ruptured aneurysm of the internal carotid artery at the origin of the meningohypophyseal branch.

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