Background: Dermal sinus is usually located at either end of neural tube but most commonly lumbosacral. When occipital, it extends caudally and is mostly localized in the midline position or in the cavity of the fourth ventricle. It could communicate with the skin through a fistula with potential risk of deeper abscesses. Posterior fossa abscess secondary to dermal sinus associated with intracranial dermal cyst is an uncommon pathology. Case Description: A 24-month-old girl was admitted to our institution with a cutaneous fistula in the midline of the occipital region. Brain imaging showed an infratentorial intradiploic cyst with peripheral enhancement to contrast medium. The mass showed hyperintensity on T1-weighted sequences, with the lower signal on T2-weighted images. A suboccipital craniotomy was performed with evacuation of the abscess and excision of the capsule. Contextually a 3 cm whitish and encapsulated cystic mass with hair component was extracted. Histology confirmed the diagnosis of abscess associated with dermal cyst and dermal sinus. The patient condition improved and 15 days after excision, was discharged. The postoperative MRI showed total removal of the lesion. A 36-month follow-up highlighted no evidence of recurrence. Conclusion: Posterior fossa dermoid cyst should be considered in all children with a cutaneous fistula. Early neurosurgical treatment of these benign tumors should be performed to prevent the development of severe intracranial infection. Best results are associated with early diagnosis and complete removal of the abscess. The present work further reviews the few similar cases that have been reported in the literature confirming the need for future research.

Introduction Spinal ependymomas are from 3 to 6% of all tumors of the central nervous system and 15% of all spinal cord tumors. The WHO classifies ependymomas in the following four distinct subtypes: subependymoma, ependymoma myxopapillare, classic ependymoma, and anaplastic ependymoma. Spinal ependymomas are typically present in adults and include the following two subtypes: myxopapillary and classic. This review reports the data obtained on 23 patients treated for spinal ependymoma at our department of Neurosurgery from 2000 to 2012, describing the type of surgical treatment and clinical outcome with a mean follow-up of 4 years. Materials and Methods Among 53 cases of intramedullary tumors, 23 (43%) were ependymomas. The average age of patients with spinal ependymoma was 42.65 years with a range between 18 and 71 years. The main locations were cauda equina (70%), medullary cone (13%), and cervical region (13%). Neurological examination of each patient at the entrance, in the postoperative and last –follow-up was determined using the McCormick grading scales. All patients underwent surgical removal of the tumor and the McCormick grading was evaluated with multiple follow-up. The extent of resection and surgical results were evaluated with postoperative MRI. Results As evidenced in some tables, we performed gross-total removal (GTR) in 21 patients (91%) and subtotal removal (STR) in only 2 patients (9%). None of patient was treated with adjuvant radiotherapy and/or chemotherapy. There were no recurrences. No patient's follow-up showed signs of postoperative instability of the spine. Some particular surgical techniques in removal of this tumor are reported. Conclusion This study underlines some aspects of the surgical treatment of spinal ependymomas. Patients who underwent total removal had a clear neurological improvement. As evidenced in tables, patients who had McCormick II–III at the entrance improved significantly. To achieve good functional results, an early diagnosis and a prompt surgery are important. In case of a good surgical removal, postoperative radiotherapy is not indicated.

Introduction The importance of a correct preoperative radiological diagnosis in patients with cervical myelopathy has been widely demonstrated. Indeed, few studies still exist about the correlation between postoperative radiographic and clinical modifications. Materials and Methods The authors present a prospective study of 54 patients with cervical spondilogenetic myelopathy, who underwent surgery for corpectomy and anterior fusion with mesh in a period between January 2005 and August 2013. Images of cervical RMN were studied pre-and postoperatively and attention has been focused on alterations of intramedullary signal on T1- and T2-weighted sequences. Pre-and postoperative changes were correlated with clinical data (obtained by means of a Nurick scales and JOA classification—modified by Benzel). In relation to cervical RM-based studies, patients were divided into 3 groups: (A) no intramedullary signal alteration; (B) alterations in T2-weighted sequences; (C) alterations of the signal in both T1- and T2-weighted sequences. Results In all patients, decompression of the cervical spinal cord has been demonstrated by extension of the anteroposterior diameter of the spinal canal and by increase in the thickness of the subarachnoid space. In group A patients, no intramedullary signal changes were highlighted postoperatively. Patients in group B showed improvement on the base of hyperintensity disappearance on T2-weighted MRI, correlating with an improvement in the clinical quadro. Patients of group C have not been showing changes in the intramedullary MRI signal despite spinal cord decompression. Conclusions Signal alterations in T1 are an unfavorable prognostic index and proved to be irreversible. They correlate with a lack of clinical improvement of the patient. Patients in group B are those with the greatest clinical benefit after surgery and in whom clinical improvement correlates clearly with the radiological outcome.