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Case report: A 43-year-old woman with a thoracic lesion extending into the extradural space along four levels, T 1 -T 4 , presented with sudden spastic incomplete paraplegia and paresthesia at the lower limbs. Results: The neoplasm was surgically resected 'en bloc' and histological findings corresponded to paraganglioma. One year after surgery, the patient was walking without assistance, a T 3 -T 4 hypoesthesia was still present and an magnetic resonance imaging (MRI) study showed no signs of focal recurrence. Conclusions: The imaging features of thoracic paragangliomas may be misleading and an advanced malignant lesion could be primarily suspected; thus, a histological study is always needed. Total resection is the gold standard therapy. Owing to the risk of recurrence or multicentric growth, follow-up must be prolonged and accurate.

Complex abdominal wall defects (CAWDs) can be difficult to repair and using a conventional synthetic mesh is often unsuitable. A biological mesh might offer a solution for CAWD repair, but the clinical outcomes are unclear. Here, we evaluated the efficacy of a cross-linked, acellular porcine dermal collagen matrix implant (Permacol) for CAWD repair in a cohort of 60 patients. Here, 58.3% patients presented with a grade 3 hernia (according to the Ventral Hernia Working Group grading system) and a contaminated surgical field. Permacol was implanted as a bridge in 46.7%, as an underlay (intraperitoneal position) in 38.3% and as a sublay (retromuscolar position) in 15% of patients. Fascia closure was achieved in 53.3% of patients. The surgical site occurrence rate was 35% and the defect size significantly influenced the probability of post-operative complications. The long-term (2 year) hernia recurrence rate was 36.2%. This study represents the first large multi-centre Italian case series on permacol implants in patients with a cAWD. our data suggest that permacol is a feasible strategy to repair a CAWD, with acceptable early complications and long-term (2 year) recurrence rates.

Study design: A case of a very rare type of schwannoma is reported. It is the sixth reported case of intramedullary melanotic schwannoma and the only one localized in the conus. Methods: A 56-year-old woman was treated in this department for a C5-C6 spondylodiscitis. After 6 months her arms showed a rapid recovery, but her incomplete flaccid paraplegia remained stable. Magnetic resonance imaging (MRI) with gadolinium enhancement of the lumbar tract revealed an intramedullary lesion at the level of Th12-L1. During surgery, an intramedullary, poorly vascularized, dark gray lesion was detected and was totally removed. One year after surgery, no recurrence was encountered and the patient showed significant improvement. Conclusion: It had previously been hypothesized that intramedullary melanotic schwannomas originate from the rostral components of the neural tube. This case presented a different localization with respect to the previously described cases, all localized in the cervical or high thoracic tracts, and thus uncertainties are raised about the previous hypotheses. Nevertheless, it is agreed that total surgical removal is the best treatment.

We here report the major permanent neurological complications that developed in three patients after epidural anesthesia. MR clearly showed that paraplegia, which arose one and nine days after anesthesia, was due to epi-subdural haematoma in the first case and epidural abscess in the second. The sudden left lower limb palsy in the third patient was caused by a paracentral ischemic lesion all along the conus-epiconus following a probable trauma of the cord during the insertion of the needle. Despite the fact that this was reported to have been performed at L1-L2, an erroneous introduction into the upper interspace must be postulated since the spinal cord of this patient terminated at mid-L1. Our report is useful insofar as it may remind anesthesiologists and neurologists to pay attention to the unusual complications of spinal anesthesia that may require urgent intervention.