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Background: Recent studies suggest gliomas location may be correlated with specific biological signatures. Our purpose was to focus on the possible correlation between MGMT metilation status and Ki67 positivity with patient age, glioma location and lateralization., Methods: We performed a retrospective evaluation to assess the correlation between MGMT metilation status and Ki67 index positivity with patient age, glioma location and lateralization., Results: The study included 174 supratentorial gliomas. Of these, 144 tumors were high grade gliomas (HGGs), and 30 tumors were low grade gliomas (LGGs). In HGG group we detected an association between tumor location and MGMT status. Those GBMs located in the frontal lobe were significantly associated with MGMT methylated status (MGMT+) and Ki67<30% than those GBMs located in other sites; while those GBMs located in the temporal lobe were associated with MGMT unmethylated (MGMT-) status. In anaplastic gliomas, we found an association between the involvement of the frontal lobe with MGMT+ status and Ki67<30%. In LGG group, our results showed that both frontal and temporal lobe were associated with a Ki67<30% and there was a predictive value for MGMT methylation status when patient age increased., Conclusions: Our findings suggest there is a high variability in anatomical distribution of biological glioma markers and this high heterogeneity may have a clinical role. Moreover, our study supports the idea that frontal lobe HGGs may be biologically favorable. Considering that as all glioma with lobar location are more amenable to radical surgical resection, it may be assumed that frontal tumor can have a better prognosis, and we have shown, to our knowledge for the first time, this is true both for HGG and for LGG.

Aim: Studies in the literature with specific information concerning the neuropsychological alterations in patients with high and low grade gliomas are poor. The aim of the present study was to investigate and compare the cognitive functioning in patients with high and low-grade glioma pre- and postoperatively., Methods: Between January 2009 and January 2011 27 patients with high-grade glioma (HG group) and 15 patients with low-grade glioma (LG group) were neuropsychologically assessed in the preoperative time, as well as 6 months and 1 year after surgery. During the examination, memory, visuo-constructive abilities, language and executive functions were tested. In addition in the preoperative time, the effect on cognition of lateralization, size and edema was analyzed for each group., Results: Both in the HG and LG group statistical comparisons of the pre- and postoperative assessments of cognitive abilities showed a postoperative improvement in memory functions and in processing speed (P<0.05). In particular the analysis of the significance of clinical factors in the postoperative outcome of patients with glioma showed that lesion size, edema and lateralization affect cognitive functioning in varying degree., Conclusion: These findings demonstrated different levels of impairments in executive and memory domains and in processing speed in patients with low and high grade gliomas. These deficits may have a strong impact on quality of life. Psychiatric interventions may be useful for patients and their families; in particular for helping the patient to become aware of the illness, in bolstering coping strategies, and for facilitating their support at home.

Aim: Approximate survival for glioblastoma is less than 1 year. Age, histological features and performance status at presentation represent the three statistically independent factors affecting longevity. The purpose of the study was to assess the role of surgery and to analyze prognostic factors in our patients operated for glioblastoma., Methods: We evaluated in 56 patients operated for glioblastoma their depressive and performance status in the preoperative and postoperative time. Moreover we analyzed the extent of surgery, the site and the size of lesions., Results: Median overall survival was 17 months. An age of ≥60 years (P<0.03), a preoperative Karnofsky Performance Status KPS≤70 (P=0.04), a subtotal tumor resection (P<0.001), a tumor size >5 cm (P=0.01), and no postoperative adjuvant treatment (P=0.01) were associated with the worst prognosis. Before surgery we found the presence of depression in 10 patients with a significative reduction of mean Back Depression Inventory scores after tumor resection (P=0.03). Finally, a KPS≤70 was significantly associated with an increased incidence of depression in the postoperative time., Conclusion: Tumor size, total resection and affective disorders were identified as predictors of survival in our series of patients with glioblastoma in addition to age and KPS score. In our opinion an early diagnosis and the use of specific safeguards in the operating room contribute to have an extension of the tumor progression time and median survival.

Aim: The aim of this study is to present the application of endovascular intraoperative occlusion of the parent artery during the microsurgical treatment of giant paraclinoidal internal carotid artery aneurysms (ICA) and of complex vertebrobasilar junction aneurysms ., Methods: Five cases of giant paraclinoidal ICA aneury-sms were treated by direct surgical approach. In the operatory room any patient underwent angiography and balloon occlusion test using a mobile digital subtraction angiograph. Thereafter the catheter was left in the aortic arch. Through an extended pterional craniotomy, it was possible to evidentiate the aneurismal sac. The proximal control of the vessel was achieved inflating a double-lumen balloon; clipping of the aneurysm was achieved, because of pressure lowering inside the aneurysm. Also a giant vertebrobasilar junction aneurysm was treated by this combined technique: using a posterolateral approach the control of the omolateral vertebral artery was obtained by temporary clipping above PICA's origin; the control of controlateral artery was obtained inflating a balloon introduced through the femoral artery. These combined manoeuvres determined sac deflation, allowing an easier clipping., Results: Aneurysm obliteration was achieved with preservation of the circulation without complications in all cases., Conclusions: The endovascular procedure allows safer and reliable proximal control of paraclinoidal ICA and vertebral artery during the microsurgical treatment of paraclinoid and vertebrobasilar junction aneurysms.

Aim: Cavernomas located in eloquent areas of cerebral hemispheres represent a challenge for the neurosurgeon. An accurate surgical approach is essential to completely remove the lesion with function preservation. Aim of this study was to evaluate the usefulness of integration between standard magnetic resonance imaging (MRI) for neuronavigation and functional MRI (fMRI) in preoperative planning and intraoperative removal of cavernomas., Methods: Between June 2000 and December 2002, 21 patients underwent surgery for supratentorial subcortical cavernomas. Eleven lesions were located adjacent to eloquent brain areas. All the patients in the series underwent MRI for neuronavigation and, since January 2002, in 6 cases of lesions located in eloquent areas, fMRI was also performed, with subsequent images fusion. The surgical approach was performed via the transgyral route under conventional and ultrasound-guided neuronavigation., Results: All the lesions were totally removed. No morbidity was seen in patients harbouring lesions in non eloquent areas. Four patients with lesions in critical areas suffered transient focal deficits, but only one patient of this series was operated on by the auxilium of image fusion. In 7 patients operated on by conventional image-guided surgery and affected by preoperative seizures, no further seizures were observed after surgery. In 3 patients more hosting lesions neighbouring critical areas, the perilesional ring was not removed, observing persistence of seizures pharmacologically treated. In 4 of the 6 patients (all affected by seizures), operated on by fMRI auxilium, lesion removal was associated to the removal of the perilesional ring. No further epilepsy was seen in these patients., Conclusions: In all the cases the use of neuronavigation allowed minimally invasive approaches and radical excision of the lesions. Moreover, fMRI seemed to provide important additional information in patients with lesions in eloquent brain areas, allowing a more aggressive approach on the perilesional tissue to the aim of resolving seizures, in absence of an increase in the morbidity rate.

The Authors, after a brief discussion of current therapies used in the treatment of cerebral abscesses, present a series of 10 cases treated topically with antibiotics (through drill-hole and puncturing of the abscess). The determining role of CT scan in this technique is emphasised.

A rare case of intracerebral abscess caused by aspergillus fumigatus located in the right occipital region is described; pathogenesis, prognosis and treatment of this particular infection are discussed.

A case of symptomatic parailiac ectopic bone neoformation, following the removal of a bone plug for cervical disc surgery, is reported. The pathogenesis of this rare complication is discussed and some technical hints to avoid it are given.

The authors present three cases of orbital angioma (two with serious spontaneous hemorrhage) and discuss the symptomatology, the diagnostic procedures and operability. The pertinent literature is reviewed.

The possibility of lumbosacral root involvement caused by lateral recess stenosis is discussed. The anatomy of the lateral recess, its pathology and the correct surgical approach are considered.

A rare case of spinal cord compression caused by a solitary plasmocytoma situated at the level of the 9th and 10th thoracic vertebrae, is described. The solitary plasmocytoma should be included in the differential diagnosis of various types of spinal cord compression and considered as something completely separate from multiple myeloma (Willis, 1941). If operated on adequately, the solitary plasmocytoma can be considered a lesion with benign characteristics.

A case of migration into a lateral ventricle of a Raimondi ventriculoperitoneal uni-shunt system is reported.