Glioblastoma (also called glioblastoma multiforme-GBM) is a primary brain neoplasm, representing about 55% of all gliomas. It is a very aggressive and infiltrative tumor. Glioblastoma is usually highly malignant, with more than 90% 5-year mortality and a median survival of about 14.6 months. Compared to other cancers, the survival rate has not greatly changed over time and no current treatment is curative for this disease. Because the tumor has a heterogeneous cell population containing several types of cells, the treatment for GBM is one of the most challenging in clinical oncology. This chapter will discuss the current approaches in glioblastoma treatment, including resection techniques, chemotherapy and radiation therapy.

Olfactory groove meningiomas are benign tumors, which arise in the midline of the anterior cranial fossa, over the cribriform plate and frontosphenoid suture. They represent approximately 10 percent of all intracranial meningiomas, more likely to occur in women in the fifth and sixth decades of life. They often involve the area from the grista galli to the posterior planum sphenoidale, and can be either simetric, bilateral or unilateral based on their midline origin. We report the case of a 45-year-old man who presented with an episode of loss of consciousness, progressive mental disturbances, impairment of visual acuity, anosmia and headache. Gadolinium-enhanced T1-weighted MR images showed a well-defined, hyperintense mass, located in the anterior cranial fossa, measuring 45/50/61 mm, with homogenous enhancement and a broad dural attachment to the cribriform plate, from crista galli to the planum sphenoidale. Preoperative Angiography revealed tumor vascularization from anterior and posterior ethmoidal arteries, branches of ophthalmic artery and branches of external carotid artery. The olfactory groove meningioma was successfully resected using a bifrontal approach with frontal sinuses opened in order to avoid brain retraction. Cranialization with pericranium of frontal sinuses was performed at the end of surgical procedure. Improvement of visual acuity was noted, mental disturbances and seizures remitted, but cerebrospinal leakage occurred, resolved via recranialization of frontal sinuses and lumbar punctions. The last postoperative computer-tomography investigation showed total surgical removal with no recurrence or residual tumor. Total tumor removal must be performed with coagulation of its arachnoid attachments and resection of hyperostotic bone in order to avoid recurrence, but with least brain retraction.

Meningiomas represent almost 15 percent of primary brain tumors and are the most common non-glial primary brain tumor. Parasellar meningiomas represent 5–10 percent of all intracranial meningiomas. They may arise from the diaphragma sella, tuberculum sellae, planum sphenoidale, medial lesser wing of sphenoid, anterior clinoid, clivus, and cavernous sinus (Smith 2005). Planum sphenoidale meningiomas are located anterior to and in proximity to the olfactory groove. For an optimal postoperative outcome planum, sphenoidale meningiomas must be diagnosed early, and the operative procedures performed promptly and with utmost care. Ideally, management is intended to preserve and improve vision and consists of total resection with no injury to the neighboring vital structures. We report the case of a 64-year-old woman who presented with progressive visual disturbance, impairment of visual acuity, visual field defects and diffuse headache. Gadolinium-enhanced T1-weighted MR images showed a well-defined, suprasellar solid mass, measuring 30/35/40 mm. The lesion was hyperintense on T1-weighted imaging with homogenous enhancement and a broad dural attachment to the planum sphenoidale. The planum sphenoidale meningioma was successfully resected using a left pterional approach. The intraoperative and postoperative courses were uneventful with a total recovery. Improvement of visual acuity was noted and the postoperative computer-tomography investigation showed total surgical removal with no residual tumor.

The expansive processes of the sellar region include tumors of mesenchymal, neural or epithelial origin, along with cystic and inflammatory processes. From the epithelial sellar tumors, almost 90 % are represented by pituitary adenomata – benign tumors which develop from the adenohypophyseal cells, accounting for approximately 10–15% of all intracranial expansive processes. According to the clinical criteria, the pituitary adenomata can be classified as endocrine-inactive or non-producing adenomata, and endocrine-active or producing adenomata. The non-producing adenomata represent approximately 39–50% of all pituitary tumors; the prolactinomata represent approximately 6.1%; the growth hormone producing adenomata approximately 27.9%; the adenocorticotropic hormone producing adenomata 6%; the thyrotropic producing hormone adenomata 0.4%; and the follicle-stimulating or luteinizing producing hormone adenomata are extremely rare. The surgical approach used on a large scale today in pituitary and suprasellar tumors is the transnasal transsphenoidal approach, which is less invasive compared to the standard transcranial approach and has got excellent results so far. The purpose of this article is to illustrate the main data about pituitary tumors, based on a case report presentation. At the same time, we aim to keep track of the latest information in the specialty literature, and focus on the neurosurgical aspects. The therapeutic strategy in the case of a 24-year-old female patient diagnosed with a growth hormone-secreting pituitary macroadenoma, with a suprasellar extension and an infrasellar one in the sphenoidal sinus and with invasion in the right cavernous sinus.

Neuroenteric cysts, are rare benign endodermal lesions which mostly occur in the central nervous system. We report a case of a neuroenteric cyst in a 30-year-old man who presented with rhinoliquorrhea at the ENT department. After clinical examination, a semisolid mass was revealed in the left nostril. The Computer Tomography Scan revealed a frontal ethmoidal nasal meningoencephalocele with inferior extension into the left nostril. Gadolinium-enhanced T1-weighted MR images showed a well-defined frontal mass with ring-like enhancement and extension into the cribriform plate of the ethmoid bone and into the left nostril. The lesion measured 10/10/20 mm. The tumor was totally resected using a unilateral subfrontal approach. At five months’ follow-up, the patient showed significant amelioration of symptoms and remission of cerebrospinal fluid leakage. Native and Contrast-enhanced Cerebral Computer Tomography, as well as Magnetic Resonance Imaging showed total surgical resection of the cyst. Supratentorial neurenteric cysts involving the anterior fossa are rare. Intracranial neurenteric cysts should be differentiated by any well-demarcated cystic tumors. The gold standard treatment remains complete surgical resection with favorable outcome.