We describe three cases of incidentally found lesions in the dural venous sinuses on magnetic resonance imaging, that other had erroneously considered pathological entities. We made the diagnosis of giant arachnoid granulations. The differential diagnosis with thrombosis or intrasinusal tumoral lesions was easily made on the basis of three typical radiological features of the granulations: the hyperintensity of the lesions on FLAIR, a blood vessel within the lesion and bone erosion.

Background:Hemangioblastomas are associated with Von Hippel-Lindau disease (VHLD) in 10-40% of cases. Based upon a literature review we state the core features the neurosurgeon should be aware of.Methods:We performed a selective literature (Cochrane and Medline) search for hemangioblastoma, both sporadic and VHL associated. We reviewed general characteristics (epidemiology, symptomatology, diagnosis, and management) and focused on follow-up as well as screening modalities for sporadic and VHL associated lesions.Results:Based upon our literature search, we established guidelines for screening and follow-up in both sporadic and VHL associated hemangioblastoma patients.Conclusions:Screening for retinal angiomas, abdominal masses, and pheochromocytomas as well as genetic analysis is recommended for every patient with a newly diagnosed hemangioblastoma. Follow-up is by magnetic resonance imaging (MRI) of the clinical neuronal region at 6 and at 12-24 months postoperatively. For VHL-associated hemangioblastomas yearly investigation for craniospinal hemangioblastoma by MRI and yearly screening and follow-up for retinal angiomas is recommended. Annual abdominal ultrasound with triennial computed tomography (CT) imaging for abdominal masses is postulated. Annual audiometry is to be performed for possible endolymphatic sac tumor, detailed radiographic imaging of the skull base should be performed upon abnormality in auditory testing. Investigations for cystadenomas of the epidydimis and broad ligament only are mandatory on indication. Annual investigation for pheochromocytoma is recommended.

Background: Schwannomatosis is a relatively rare disorder and is related to neurofibromatosis type 2. Although there is clinical overlap between schwannomatosis and neurofibromatosis type 2, these diseases have to be regarded as separate entities due to the genetic origin and course of the disease. Methods: A comprehensive review of the literature was conducted for relevant studies using Pubmed and Cochrane databases to discuss the epidemiology, clinical presentation, diagnostic criteria, pathological and imaging features, treatment and genetics of schwannomatosis. Results: Germline mutations SMARCB1 and LZTRI together with the NF2 gene play a role in the pathophysiology of schwannomatosis. The most common symptom is pain with affection of the spine and peripheral nerves in the majority of patients. High quality contrast enhanced MRI scan is the imaging modality of choice. Treatment is conservative if asymptomatic and surgical if symptomatic. The goal is symptom control with preservation of neurological function. Conclusion: Schwannomatosis is a relatively rare disorder in which the main goal is to preserve neurological function.

Introduction:Arthroscopy has become a major diagnostic tool and treatment option for shoulder pathology. However rare, respiratory complications such as a pneumothorax have been reported in patients undergoing shoulder arthroscopy. Surgery - as well as anesthesiology-related factors and respiratory comorbidity have been hypothesized to intervene in the onset of respiratory complications.Case Report:We report the case of a 42-year-old male patient who underwent an arthroscopy of the left shoulder. The anesthesia, the surgical procedure as well as the post-operative course went uncomplicated. The patients were discharged 6 h after the end of the surgical procedure. 4 h after discharge, however, the patient developed severe respiratory distress and signs of hemodynamic shock due to an ipsilateral (tension) post-operative pneumothorax. The available literature is reviewed focusing on the possible pathogenic mechanisms implying the development of this complication.Conclusion:The presence of a pneumothorax after shoulder arthroscopy is a rare but dangerous complication. It can primarily be attributed to rupture of parietal pleura, rupture of visceral pleura, and alveolar rupture or trauma during anesthesia. In our patient, we speculate that a rupture of parietal pleura was the underlying cause. This can be related to the surgical methodology (portal placement and continuous pump infusion with intermittent suction) and subacromial distention used during the procedure. Awareness, prompt recognition, and treatment are necessary.