Percutaneous microcompression of the trigeminal ganglion (PMTG) was performed in nine elderly patients ( > 70 years) with trigeminal neuralgia and six patients with atypical neuralgia under short-acting anesthesia using propofol. Two patients had postherpetic neuralgia and two had postoperative neuralgia following removal of a posterior fossa neurinoma. Four patients had recurrent neuralgia following microvascular decompression (MVD). PMTG provided complete relief in 10 patients and the other five patients reported at least 50% improvement. No major complications occurred. PMTG is effective for typical trigeminal neuralgia in elderly patients, patients with atypical trigeminal neuralgia, and patients with recurrence after MVD.

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Cervical spinal cord stimulation (SCS) was used to increase cerebral blood flow (CBF) in 10 patients with secured cerebral aneurysms in Hunt and Hess grade 3 or 4 and with Fisher group 3 subarachnoid hemorrhage (SAH). The patients underwent preemptive electrical stimulation through a percutaneous lead following aneurysm surgery. All patients also received hypervolemic therapy and nicardipine. Efficacy of the treatment was evaluated using xenon computed tomography and cerebral angiography. The CBF in the distribution of the middle cerebral artery significantly increased following SCS (p < 0.05). Four of 10 patients showed angiographic vasospasm, but none developed severe sequelae of cerebral vasospasm. The overall outcome was good or excellent in seven of the 10 patients. No serious adverse effects due to SCS were observed. Fluid management and calcium antagonist have a beneficial effect on cerebral vasospasm following SAH, but is not tolerated or is ineffective in some patients. SCS as an adjunctive therapy for cerebral vasospasm following SAH may have a favorable effect on outcome.

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Four patients presented with transient trochlear nerve palsy following occipital impact. The impact was slight in all patients, and neuroimaging found no lesions of the nerve. Three patients had delayed onset. Two patients did not complain of diplopia, but were only aware of blurred vision. In such patients, the head tilting test was useful for diagnosis. Minor occipital impact can cause trochlear nerve palsy, which requires careful neurological examinations to identify.

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Intracranial sinus thrombosis following a mild closed head injury without a skull fracture or intracranial hematoma is extremely rare. A 23-month-old girl presented with vomiting and gait ataxia 1 day after occipital trauma. Computed tomography revealed a slightly increased density area in the region of the left sigmoid sinus. T₁-weighted magnetic resonance (MR) imaging demonstrated an isointense area in the left sigmoid sinus and T₂-weighted imaging showed a hyperintense area reflecting the characteristics of oxyhemoglobin. MR angiography and cerebral angiography indicated occlusion of the left sigmoid sinus. After 4 days of conservative treatment, her symptoms subsided completely. Follow-up MR angiography and cerebral angiography showed recanalization of the sigmoid sinus. The MR images and MR angiograms were useful for both early diagnosis and follow-up. Treatment should reflect the severity of individual cases, and early diagnosis will help achieve a good outcome.

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A 62-year-old male presented with a variant dural arteriovenous fistula (DAVF) within the wall of the convexity-superior sagittal sinus, fed by branches of the bilateral external carotid arteries and only cortical venous drainage despite the presence of a patent sinus. Transarterial embolization with poly-(2-hydroxyethyl methacrylate-co-methyl methacrylate) (HEMA-MMA) was performed, resulting in complete obliteration of the DAVF. Embolization with HEMA-MMA is an effective and safe procedure for the treatment of DAVF.

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A 54-year-old male presented with bilateral simultaneous thalamic hemorrhages manifesting as semicoma, tetraplegia, and skew deviation. Magnetic resonance imaging and angiography demonstrated no lesions responsible for the bleeding. Coagulant factors were within normal ranges. The cause of these hemorrhages was considered to be hypertension. Conservative treatment was performed. He was discharged with serious neurological deficits.

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A 45-year-old male presented with a rare pineal region cavernoma. Magnetic resonance (MR) imaging confirmed the preoperative diagnosis. The tumor was totally excised. The patient was subsequently cured. Analysis of 15 reported cases found a slight female preponderance. The second and third decades were the most common age group. The course of pineal cavernomas can be complicated by hemorrhage, occlusion of cerebrospinal fluid pathways, and focal neurological and neuroendocrine symptoms but no specific clinical features. However, MR imaging has high sensitivity and the specificity for the diagnosis of pineal cavernoma. Total microneurosurgical excision is the treatment of choice, and patients had an excellent outcome. Stereotactic biopsy can be potentially dangerous because of the risk of hemorrhage. The use of radiosurgery requires evaluation of long-term risks and safe dose levels. Total excision of the pineal cavernoma using microsurgical techniques is the choice of treatment in young and healthy patients since there is an increased risk of recurrent hemorrhage and progressive neurological decline. A conservative approach is preferred in older patients.

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A 72-year-old male presented with a superficially-located oligodendroglioma associated with intratumoral and peritumoral cysts. Neuroimaging showed the outer cyst wall as enhanced but not the inner cyst wall. The outer cyst was removed and a biopsy taken of the solid component. The inner cyst wall appeared to consist of non-neoplastic tissue. Histological examination showed the tumor was an oligodendroglioma with tumor cells in the outer wall. The outer cyst was probably the result of blood-brain barrier disruption and intratumoral hemorrhage. The inner cyst probably resulted from reactive gliosis or peritumoral edema. Cyst formation in intraaxial tumors occurs through similar mechanisms to those of extraaxial tumors.

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A 50-year-old male with acromegalic features presented with a pituitary stone in a growth hormone-secreting adenoma. Endocrinological examination showed “low growth hormone acromegaly.” The serum growth hormone level responded to the thyrotropin-releasing hormone test and was not suppressed by oral glucose loading. Neuroimaging revealed an adenoma including a large calcification (pituitary stone) located in the right lateral wing. The adenoma with stone was totally removed by transsphenoidal surgery. The patient regained almost normal response of serum growth hormone. Histological examination showed the stone was composed of thick calcification surrounded by necrotic adenoma tissue and chronic hemorrhage. Large intratumoral pituitary stone is very rare, although calcification is sometimes observed in the adenoma capsule. The long history of this disease and previous apoplexy within the tumor may have caused the pituitary stone in this patient.

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An 86-year-old male presented with progressive myelopathy due to retro-odontoid massive deposits of calcium pyrophosphate dihydrate (CPPD) crystals. Magnetic resonance imaging revealed a non-enhanced isointense extradural mass on the T₁-weighted image and heterogeneously intense mass on the T₂-weighted image. Computed tomography showed typical punctate and linear calcifications within the mass. The mass was resected via a lateral approach resulting in marked improvement of the symptoms. Histological examination revealed birefringent rhomboid crystals consistent with CPPD. CPPD deposition should be considered in the differential diagnosis of retro-odontoid extradural mass because surgical therapy is beneficial even for elderly patients.

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