We report a 37 year-old man with tension pneumoencephalus secondary to frontal sinus osteoma. He had history of headache and left hemiparesia. CT scan revealed a large volume of air entrapped in the right frontal lobe related to an osteoma in the frontal sinus. The osteoma eroded the posterior wall of the sinus and extended into the cranial fossa. We resected the osteoma throw supraorbital craniotomy, close the dura with temporal fascia, close the bone defect with diploe and put periostium above the bone.

Cerebellar mutism is a non infrequent alteration of the language in patients who underwent to a surgery of different injuries, generally tumors, affecting vermis or cerebellar hemispheres. The anatomical base of this syndrome is not well understood yet, nevertheless the injury of the dominant superior cerebellar hemisphere or the deep medial cerebellar nuclei would play an important role in the physiopathology. In this paper we make a brief revision of this problem at the time we report a case of a 18 years-old patient who had a mass in the cerebellar vermis that was operated trough a suboccipital craniotomy and telovelar approach. At the second day of postoperative period the patient developed mutism. After 16 days, the patient began to speak and improved his communication slowly.

Astroblastoma is a tumor of the glial lineage of unknown origin and uncertain prognosis. Represents 0,4 - 2,8% of brain gliomas, which generally presents in youth people as an hemispheric well defined tumor, often associated with a cystic component, being extremely rare intraventricular location. The author reports the case of a patient of 4 years old girl with intraventricular astroblastoma and a review of the literature. Complete resection was demonstrated in early postoperative CT. The patient began disease since three month before the surgery with persistent headache, nausea and vomiting. She suffer cranial trauma and the indicated brain scan showed well-defined giant intraventricular tumor, at the right temporal horn with heterogeneously contrast enhancement. The patient was not treated favorably adjuvant after surgery without evidence of tumor recurrence 06 months after surgery. The histological features including nuclear pleomorphism, presence of perivascular pseudorosettes astroblastic typical and perivascular hyalinization. Have distinguished two types of astroblastoma according to histological grade; however, the prognosis in cases is not directly related to the histological type. Surgical resection remains an important prognostic factor.
 

Objective: Intra-operative cytological diagnosis of the CNS lesions helps the neurosurgeon to decide about the extent of resection particularly in eloquent areas. The squash or crush preparation of the available tiny tumor tissue at the start of the resection is a time saving and lead to better decision on further plan of surgery.
Material and methods - We have prospectively studied the accuracy of this technique at our institute. During the period of last two years we have operated 118 CNS mass lesions including cranial and spinal. All cases were subjected to squash diagnosis and later compared with paraffin sections.
Results - Out of total 118, cranial lesions were 105 and spinal were 13. Males outnumbered in frequency (77 cases, 65.2%) while the females comprised 41 cases (34.7%). Most (59.2%) of the patients were from 20 to 50 years of age. The cerebral hemisphere including all lobes had the largest number of cases (49 cases, 41.5%). Among them glial tumors form the major group (34 cases, 28.8%). Meningiomas were the next main group (18 cases, 15.3%) followed by Schwanommas and metastatic tumors having nine cases (7.7%) each. The cytological or squash diagnosis was possible in all except 11 cases (9.3%), in which a definite diagnosis could not be provided due to fibrous tissue, necrosis, and hemorrhage or poor preservation of cytological features.
Conclusion - Thus, our early experience concluded that Intra-operative SQUASH smear cytology is a fairly rapid and reliable method of intra operative diagnosis for a wide spectrum of central nervous system lesions.

The autors review the most common hypervascular craniofacial tumors usually managed with endovascular embolization techniques. Even though controversial issues remain, there are reasonable data supporting the use of transcatheter devascularization techniques prior to the surgical resection of these lesions in order to reduce the intraoperative blood loss, the operative time and to facilitate their complete removal. Nevertheless, its use is not recommended as a broad treatment strategy for all craniofacial tumors. Eventually, embolization may induce and accelerate the natural involution of some hemangiomas. Randomized clinical studies must be done in order to define the efficacy and indications of these techniques.