Background: Calcifying pseudoneoplasm of the neuroaxis (CAPNON) is a very rare benign lesion that can be located anywhere in the nervous system, with only 59 intracranial cases described. The general lack of knowledge about this lesion hinders its preoperative diagnosis. Despite the consistent image findings, the final diagnosis is only established based on anatomopathological and immunohistochemical studies. The lesion is more commonly positive for epithelial membrane antigen (EMA) and vimentin, and negative for glial fibrillary acidic protein (GFAP) and S-100, suggesting a leptomeningeal origin. The opposite, however, may also occur, although very rarely (just two cases positive for GFAP and negative for EMA and vimentin reported this far). The treatment consists of total resection of the lesion, which yields a good prognosis. Case Presentation: We report the case of a 23-year-old female who presented with disperceptive focal seizures, sometimes evolving to bilateral tonic-clonic seizures, starting at age 9. She had a nodular calcified lesion in the left precuneus and inferior parietal lobe. The lesion was completely resected, and the immunohistochemical study revealed positivity for EMA, vimentin, GFAP, and S-100. No case hitherto published was positive for all four markers. This atypical immunohistochemical profile of the CAPNON may suggest a dual origin of this lesion, both parenchymal and leptomeningeal. Conclusion: The general lack of knowledge of CAPNON makes this lesion underdiagnosed. Therefore, in the face of a calcified lesion in the nervous system, one should consider the possibility of a CAPNON among the differential diagnoses. The immunohistochemistry is undoubtedly an important tool, but the anatomopathological study, associated with image findings, remain the gold standard for the diagnosis of CAPNON.

BACKGROUND Resection of the seizure onset zone (SOZ) is considered the gold standard for treating refractory focal aware seizures (FASs). When resective surgery is unadvisable, deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT; ANT-DBS) has been the procedure of choice. However, less than half of patients with FASs respond to ANT-DBS. The need for alternative targets to effectively treat FAS is thus evident. OBSERVATIONS The authors report the case of a 39-year-old woman presenting with pharmaco-resistant focal aware motor seizures, with the SOZ located in the primary motor cortical area. She had previously undergone unsuccessful resection of the left temporoparietal operculum elsewhere. Considering the risk of new resective surgery, she was offered combined ventral intermediate nucleus (Vim)/ANT-DBS. Vim-DBS proved to be superior to ANT-DBS for seizure control (88% vs 32%), although the association of both provided the best results (97%). LESSONS This is the first report on the use of the Vim as a target of DBS for the treatment of FAS. The excellent results were presumably obtained by modulation of the SOZ through Vim projections to the motor cortex. This opens a completely new avenue for treating FAS: chronic stimulation of specific thalamic nuclei.

Background: Delusions and hallucinations, hallmarks of the psychotic disorders, usually do not respond to surgical intervention. For many years, the surgical technique of choice for the treatment of refractory aggressiveness in psychotic patients in our Service was amygdalotomy in isolation or associated with anterior cingulotomy. No improvement of hallucinations and delusions was noticed in any of these patients. To improve the control of aggression, subcaudate tractotomy was added to the previous surgical protocol. The main goal of the present study was to investigate the impact of this modified surgical approach on delusions and hallucinations. Methods: Retrospective analysis of the medical records of psychotic patients presenting with treatment-resistant aggressiveness, delusions, and hallucinations submitted to bilateral subcaudate tractotomy + bilateral anterior cingulotomy + bilateral amygdalotomy in our institution. Results: Five patients, all males, with ages ranging from 25 to 65 years, followed up by a mean of 45.6 months (17–72 months), fulfilled the inclusion criteria. Delusions and hallucinations were abolished in four of them. Conclusion: These results suggest that the key element for relieving these symptoms was the subcaudate tractotomy and that the orbitofrontal and ventromedial prefrontal cortices play an important role in the genesis of hallucinatory and delusional symptoms of schizophrenia and other psychoses.

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