Many endovascular techniques have been described in recent years for the management of wide necked aneurysms. The Y stent assisted technique has been generally used for coil embolization of wide necked bifurcation aneurysms. This technique was first described for the treatment of basilar tip aneurysms in combination with several different devices, demonstrating encouraging results. We report the results of the first two cases of wide necked basilar tip aneurysms treated with Y stent assisted coil embolization using a new low profile visible intraluminal stent (LVIS Jr; MicroVention, Tustin, California, USA) delivered through a 0.017 inch microcatheter. We also reviewed the literature comparing other endovascular techniques (coiling alone, stent assisted coiling, and Y stent assisted coiling) for wide necked aneurysms. The LVIS Jr device offers a new option for the treatment of these challenging lesions, with clear advantages over currently available intracranial stents. Larger series and long term results are needed to confirm the applicability and durability of this technique/technology.

We report a case of a 31 year-old woman who in 1991 presented a clinical history of headaches, nausea and vomiting. CT scan showed a right frontotemporal meningioma. The first operation achieved a macroscopically complete resection. The tumour was histologically classified as a transitional meningioma. There were recurrences of the intracranial meningioma in 1994, 1996, 1997 and 1998. These recurrences were accompanied by differentiation to atypical and anaplastic meningioma. In all of these operations, a macroscopically complete resection of the tumour was performed. In 1996 adjuvant radiation therapy was given. In 1998 therapy with bromocriptine was adopted. In April 1999, the patient presented with lumbosacral pain associated with L5 bilateral sciatica. MRI showed a gadolinium enhancing mass lesion at L5-S1 level. Complete tumour resection was performed. The histological findings were the same as in 1998. In December 1999 the patient presented with perineal pain and MRI showed a L4 and S3 recurrence and the tumour was resected. The histological findings were those of a malignant meningioma. In February 2000 an intracranial recurrence was detected and operated on. The histological diagnosis was malignant meningioma. A review of the literature was undertake and is discussed.

The difficulty of the treatment of an residual aneurysm after coiling is discussed as well as those surgical techniques alternative to clipping (wrapping or coagulation of the residual sac).

RESUMO -Os neurocitomas do sistema nervoso central são tumores raros, na maioria intracranianos e caracterizados pela sua benignidade. Por muito tempo permaneceram insuficientemente conhecidos, em razão da sua distinção clínica e radiológica difícil entre os tumores intraventriculares (ependimomas, papilomas do plexo coróide, oligodendrogliomas, astrocitomas sub-ependimários) e da semelhança histológica com os oligodendrogliomas. O diagnóstico passou a ser possível através da análise imuno-histoquínica específica e da microscopia eletrônica. Nós apresentamos três casos clínicos de neurocitomas intraventriculares confirmados pelo estudo imuno-histoquínico. A apresentação clínica, os dados radiológicos, cirúrgicos, anatomopatológicos e o prognóstico serão discutidos em comparação aos dados recentes da literatura.PALAVRAS-CHAVES: neurocitoma, sistema nervoso central, tumores intraventriculares, imuno-histoquímica. Central nervous system neurocytomas: clinicopathological analysis of tree casesABSTRACT -Central nervous system neurocytoma is a rare benign tumor of neuronal origin. Because of some clinical and radiological findings CNS neurocytomas were confused with other intraventricular lesions (ependymomas, choroid plexus papilloma, oligodendrogliomas, subependymal astrocytomas). Pathological diagnosis improved with immunohistochemical and electron microscopic studies. We present three cases of intraventricular neurocytomas confirmed by immunohistochemical studies. According to the literature clinical signs, radiological features, surgical and pathological findings are discussed.KEY WORDS: neurocytoma, central nervous system, intraventricular tumor, immunohistochemistry.Os neurocitomas do sistema nervoso central são tumores benignos, raros, geralmente de bom prognóstico, cuja incidência varia entre 0,1 e 0,5% dos tumores cerebrais. Primeiramente descritos por Hassoun et al. em 1982 1 , estes tumores são frequentemente localizados no sistema ventricular e acometem em geral os adultos jovens. A apresentação clínica e a radiológica não são específicas e são frequentemente confundidos com outros tumores (oligodendrogliomas, ependimomas). O diagnóstico histológico tornou-se possível graças ao estudo imuno-histoquímico específico e pelo exame em microscopia eletrônica.Apresentamos três casos de neurocitomas intraventriculares e fazemos uma comparação, a partir da revisão da literatura, entre os traços clínicos, paraclínicos e terapêuticos destes tumores excepcionais.

The image-guided technique offers a better help than the previously used methods (preoperative localization with CT scan or stereotactic implantation of guiding catheters) to resect intracranial lesions, especially if the lesion is deeply situated in the brain or in an eloquent area. Preoperative MRI-based 3D models, performed using special skin markers, and surgical computer-assisted neuronavigation allow us to find and to resect small and deep lesions with minimal mortality and low morbidity rate.