Neurosurgery 31; 804-806, 1992 Neurological Features of Cranial Vault Lymphomas: Report of Two Cases I read the article by Herkes et al. (2) with interest and felt obliged to make a contribution. We recently had experience with a case of lymphoma of the cranial base, and during our literature review, we found a case of a Burkitt's lymphoma of the frontal bone reported by Gawish (1) in 1976. Because Burkitt's lymphoma is a morphologically, immunopheno-typically, and cytogenetically distinct rare subtype of non-Hodgkin's lymphoma, this case must be added to the authors' list to complete the information they have gathered. Ismail H. Tekkok Ankara, Turkey
bleeding was seen in at least 60% of cases, which seems to be somewhat higher than what is seen in subdural extramedullary cavernomas. Spinal cavernomas (both subdural extramedullary and intramedullary) remain a little known entity, and case reports of the kind in question are a welcome addition to the scant body of knowledge. Carlo A. Pagni Sergio Canavero Turin, Italy REFERENCES: (1-3) 1.
2. 3.
REFERENCES: (1,2) 1. 2.
Gawish HHA: Primary Burkitt's lymphoma of the frontal bone. Case report. J Neurosurg 45:712-714, 1976. Herkes GK, Partington MD, O'Neill BP: Neurological features of cranial vault lymphomas: Report of two cases. Neurosurgery 29:898-901, 1991.
Intradural Extramedullary Cavernous Angioma: Case Report To the editor: We read with interest the article by Mastronardi et al. (1) who reported a case of subdural extramedullary cavernoma in a 49-year-old woman. The authors could find only two other detailed cases in their literature review, excluding three cases that lacked details. In 1990, we reviewed subdural extramedullary cavernomas and found 10 detailed reports in the literature (2), including those cited by Mastronardi et al. In the meantime, another report was published (3). We would like to emphasize a few points: 1) 4 of the original 10 cases had an onset marked by bleeding (40%), generally a subarachnoid hemorrhage; however, a sciatica-like picture was seen in 2 cases of caudal lesions; 2) subdural extramedullary cavernomas generally affect men in their third to fifth decades, including the patients of Mastronardi et al. and Ramos et al (3). Sixty-four percent of subdural extramedullary cavernomas are found in the male sex; 3) although the surgical outcome is generally good, in a few cases, it was not optimal; and 4) magnetic resonance imaging, particularly high field (1.5 tesla), has emerged as the diagnostic modality of choice. Preoperative status was highly significant in predicting outcome, as we found for intramedullary cavernomas (Pagni CA, Canavero S: unpublished observations); in the latter,
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Mastronardi L, Ferrante L, Scrapinati M, Gagliardi FM, Celli P, Fortuna A: Intradural extramedullary cavernous angioma: Case report. Neurosurgery 29:924-926, 1991. Pagni CA, Canavero S, Forni M: Report of a cavernoma of the cauda equina and review of the literature. Surg Neurol 33:124-131, 1990. Ramos F Jr, De Toffol B, Aesch B, Jan M: Hydrocephalus and cavernoma of the cauda equina: Neurosurgery 27:139-142, 1990.
Preoperative Diagnosis of an Extradural Cyst Arising from a Spinal Facet Joint: Case Report To the editor: Heary et al. (1) did a fine job of describing the synovial cyst, its clinical presentation, and radiological diagnosis. In their article, the authors indicate that spinal extradural cysts are relatively rare lesions and state that theirs is the first case report of an extradural synovial cyst diagnosed prospectively by magnetic resonance imaging. In my own practice, I have treated four patients who had surgically verified synovial cyst causing extradural compression of a lumbar nerve root during the period of September 6, 1990, through March 11, 1992. The correct diagnosis was made in all four of these cases preoperatively; three with magnetic resonance imaging and one with computed tomography. There are many reports in the literature regarding synovial cysts of the lumbosacral spine and their definition by magnetic resonance imaging, computed tomography and postmyelography computed tomography and are not cited by Heary et al. (2,3,4,5,6,7, 8,9) . Based on my own experience as well as the copious citations in the literature, I think synovial cysts causing extradural nerve root compression are not as rare as has been previously thought. Stephen L. Fedder Wynnewood, Pennsylvania REFERENCES: (1-9) 1.
2.
Heary RF, Stellar S, Fobben ES: Preoperative Diagnosis of an Extradural Cyst Arising from a Spinal Facet Joint: Case Report. Neurosurgery 30:415-418, 1992. Liu SS, Williams KD, Drayer BP, Spetzler RF,
Redistribution of this article permitted only in accordance with the publisher’s copyright provisions.
Neurosurgery 1992-98 October 1992, Volume 31, Number 4 804 Correspondence Departments: Correspondence
bleeding was seen in at least 60% of cases, which seems to be somewhat higher than what is seen in subdural extramedullary cavernomas. Spinal cavernomas (both subdural extramedullary and intramedullary) remain a little known entity, and case reports of the kind in question are a welcome addition to the scant body of knowledge. Carlo A. Pagni Sergio Canavero Turin, Italy REFERENCES: (1-3) 1.
2. 3.
REFERENCES: (1,2) 1. 2.
Gawish HHA: Primary Burkitt's lymphoma of the frontal bone. Case report. J Neurosurg 45:712-714, 1976. Herkes GK, Partington MD, O'Neill BP: Neurological features of cranial vault lymphomas: Report of two cases. Neurosurgery 29:898-901, 1991.
Intradural Extramedullary Cavernous Angioma: Case Report To the editor: We read with interest the article by Mastronardi et al. (1) who reported a case of subdural extramedullary cavernoma in a 49-year-old woman. The authors could find only two other detailed cases in their literature review, excluding three cases that lacked details. In 1990, we reviewed subdural extramedullary cavernomas and found 10 detailed reports in the literature (2), including those cited by Mastronardi et al. In the meantime, another report was published (3). We would like to emphasize a few points: 1) 4 of the original 10 cases had an onset marked by bleeding (40%), generally a subarachnoid hemorrhage; however, a sciatica-like picture was seen in 2 cases of caudal lesions; 2) subdural extramedullary cavernomas generally affect men in their third to fifth decades, including the patients of Mastronardi et al. and Ramos et al (3). Sixty-four percent of subdural extramedullary cavernomas are found in the male sex; 3) although the surgical outcome is generally good, in a few cases, it was not optimal; and 4) magnetic resonance imaging, particularly high field (1.5 tesla), has emerged as the diagnostic modality of choice. Preoperative status was highly significant in predicting outcome, as we found for intramedullary cavernomas (Pagni CA, Canavero S: unpublished observations); in the latter,
Downloaded from https://academic.oup.com/neurosurgery/article-abstract/31/4/804/2752123 by guest on 10 August 2018
Mastronardi L, Ferrante L, Scrapinati M, Gagliardi FM, Celli P, Fortuna A: Intradural extramedullary cavernous angioma: Case report. Neurosurgery 29:924-926, 1991. Pagni CA, Canavero S, Forni M: Report of a cavernoma of the cauda equina and review of the literature. Surg Neurol 33:124-131, 1990. Ramos F Jr, De Toffol B, Aesch B, Jan M: Hydrocephalus and cavernoma of the cauda equina: Neurosurgery 27:139-142, 1990.
Preoperative Diagnosis of an Extradural Cyst Arising from a Spinal Facet Joint: Case Report To the editor: Heary et al. (1) did a fine job of describing the synovial cyst, its clinical presentation, and radiological diagnosis. In their article, the authors indicate that spinal extradural cysts are relatively rare lesions and state that theirs is the first case report of an extradural synovial cyst diagnosed prospectively by magnetic resonance imaging. In my own practice, I have treated four patients who had surgically verified synovial cyst causing extradural compression of a lumbar nerve root during the period of September 6, 1990, through March 11, 1992. The correct diagnosis was made in all four of these cases preoperatively; three with magnetic resonance imaging and one with computed tomography. There are many reports in the literature regarding synovial cysts of the lumbosacral spine and their definition by magnetic resonance imaging, computed tomography and postmyelography computed tomography and are not cited by Heary et al. (2,3,4,5,6,7, 8,9) . Based on my own experience as well as the copious citations in the literature, I think synovial cysts causing extradural nerve root compression are not as rare as has been previously thought. Stephen L. Fedder Wynnewood, Pennsylvania REFERENCES: (1-9) 1.
2.
Heary RF, Stellar S, Fobben ES: Preoperative Diagnosis of an Extradural Cyst Arising from a Spinal Facet Joint: Case Report. Neurosurgery 30:415-418, 1992. Liu SS, Williams KD, Drayer BP, Spetzler RF,
Redistribution of this article permitted only in accordance with the publisher’s copyright provisions.
Neurosurgery 1992-98 October 1992, Volume 31, Number 4 804 Correspondence Departments: Correspondence
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