Papillomas of the choroid plexuses are rare tumou rs, accounting fo r 0.4% ( 0 0.6 % o f all cerebral tum o ur s (Guidetti and Spattone. 1980; N orlen , 1949; Stanley, 1968; Z ülch, 1949). In ch ild ren, ho wever , th ese t um ours have a high er Incid encefro m 3% ro 5% of cerebral tumo urs (Rovit er al., 1970) and they are locared in the lateral ventricles and in the rhird ven tricle (Fortuna er al., 1979) wh erea s in adults the princip al sires are the fourth ven t ricle a nd lat era l vent ricles, more ra rely the third ven tr icle and cerebellopont ine angle. Th e c1i nical signs an d symp to ms ar e us ua lly no nsp ecific: generic signs o f increased in tracr an ia l p ressur e, acco rnpan ied inconst ant ly by cha nges in cerebrosp ina l fluid che mistry an d/o r lo calising signs (ara xia, n yst agmu s, p yra mid al signs a nd so o n). H ence th e d iagnosis is radio lo gical. Since th ese lesion s are, as a ru le, histo logically benign and radic a l o peration o ffers ex cellen t eha nee s of lo ng rer m eure with aeeepta ble mo rta lity, th e im po rt a nce o f timel y d iagno sis is o bvio us.Mate ria l and met ho d We p resenr here rhe ra diologieal data fo r rbe 2 8 cases o f papilloma of rbe cho roid plexus obse rved ar the Insti tute of Neu rosurgery, Rome M edical Sehool, in the period 195 2-1978. Sixteen of th e pat ient s were male, fo ur unde r tbe age o f 12 years, and 12 female , five under rhe age of 12. In 12 cases the rurno ur was located in the late ral ventri cles, in 14 in rhe fou rrh vent ricle, in one in tbe cere belloponti ne angle. T he neuro radiological investigarions ineluded: plain x-rays, air stu d ies, ven rriculog raphy, ang iograph y, scinrigr aph y and co mputer romcgra p hy (CI') . T he plain x -ra ys o f the skull wer e negative in rwo patients (7 . 1% ). In alt the ot her 26 cases the re were signs o f increased mrracranial pressu re (lCP) and/o r hyd rocephalus. In rhree cases (1O%) rhere wa s calcific ation in rhe rurnou r ( Figure 1).Fifteen patients had air srud ies: ventriculogra ph)' in 12 and Pt\ E in th ree (Figu re 2), the da ra fo r which are given in Tabl e 1. Six pa tients were subjected ro posi tive eont rast vent riculography (Figures 3 ) (fo ur eases with Myodil, o ne with Conray and o ne, reoperated afte r ten years for reeurrenee, with both me thods). The results are summarized in Tahle 2. In one of the se parient s rhe simulraneous prese nee o f a eo lloid cyst of the th ird ventfi ele, diag nosed p re-op eratively, preelu ded th e p re-ope rative identi fieation of the pa pilloma o f the right lat eral ventriele. Angiography was done in 15 pa tients , via th e caro tid in ten (Figur e 4 ), by the righ t brac hial in th ree an d by the verteb ral in tw o cases (Figu re 5 ). Oireet signs o f (he tumou r, i. e. hypertroph)' o f the choroid afferents and/or a tu mour b lush, were pre sent in eight cases. In fou r o f them th e t um our Jay in t he lat eral vent rieles, in fou r in the fo urth ventriele. Neurocbirurgia 25 (1982) 165 Summa ry T he ra...

A case is reported of a 53-year-old woman who was hit by a bullet which penetrated the skull base and caused a left carotid-cavernous fistula of the direct type and a pseudoaneurysmal dilation of the high cervical portion of the left internal carotid artery. The fistula was successfully embolized by positioning a balloon into the fistula itself by means of the Debrun technique: unexpectedly the size of the pseudoaneurysm decreased after the embolization; the possible explanations for this event are discussed.

Gli autori riferiscono la loro esperienza nella diagnostica delle affezioni del canale spinale mediante introduzione endorachidea di contrasto idrosolubile a bassa concentrazione: 1500 casi. La casistica comprende 1117 spondiloartrosi, 92 ernie lombari, 15 ernie cervicali, 12 ernie dorsali, 30 tumori intramidollari, 12 malformazioni vascolari, 46 malformazioni della cerniera, 35 aracnoiditi, 18 siringomielie ed infine 3 diastematomielie. I progressi tecnologici (TC e RMN) tendono a sostituire in molti casi gli esami con mdc; è augurabile che ciò possa avvenire, in un prossimo futuro, per tutte le patologie. Allo stato attuale occorre ricordare che la mielografia, con la tecnica descritta, non presenta gravi complicazioni e consente in tutti i casi una corretta diagnosi.

Parole chiave: ecotomografia, nervo sciatica, neurofibromi RIASSUNTO -L'ecotomografia e una metodica diagnostica che si e dimostrata utile nello studio di patologie di molti organi ed apparati tra cui quelle che interessano il sistema nervosa periferico e in particolare quelle del nervo sciatica. 11 nostro studio e stato condotto su 17 pazienti portatori di patologie traumatiche e neoplastiche del nervo sciatica nonche su individui sani. 11 nostro strumento ha fornito immagini rivelatesi poi fondamentali per il conseguimento della diagnosi senza richiedere il supporto di esami molto piu complessi e costosi come TC e RM.Dallo studio neurofisiologico e neuroradiologico delle patologie occorse nel nostro reparto e emerso che chiarezza d'immagine, assoluta non-invasivita, visualizzazione del tronco nervosa in tutto il suo decorso eccetto quello perisacrale-intrapelvico 3 • 5 si associano nella ecotomografia ad un basso costo operativo, una veloce esecuzione, al minimo ingombro dello strumento e alla possibilita di usarlo intraoperativamente. SUMMARY -Echotomography is a useful imaging technique in the study of disease in many organsincluding the peripheral nervous system, particularly the sciatic nerve. We investigated healthy controls and 17 patients with nerve injuries and neoplastic disease. Echotomographic images proved diagnostic and did not require confirmation by more complex costly examinations such as CT and MR. Neurophysiological (EMG) and neuroradiological (CT, MR, ETG) investigations in our institution showed that echotomography is non invasive and offer clear images displaying the whole length of the nerve except the perisacral-intrapelvic portion. ETG is fast and inexpensive, the instrumentation takes up a minimum amount of room and can be used intraoperatively.

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