Introduction: Schwannomas account for approximately 8% of primary intracranial tumors and constitute almost 90% of tumors in the cerebellopontine angle, which is always associated with the eighth cranial nerve. Intraparenchymal schwannomas are sporadic, and only 64 cases have been reported to date in the literature, among which the first case was described by Gibson et al. in 1966.

Case presentation: A 30-year-old female had been subject to headaches and intermittent seizures for two years. On clinical examination, no neurological deficit was found. A brain CT scan revealed an isodense lesion in the right frontal lobe with homogenous enhancement after contrast injection. During surgery, a well defined mildly vascular, grayish with measuring 7 x 5 cm was found. The tumor was completely intraaxial with a well-demarcated margin. The total removal of the tumor was done. Histopathological study indicates a tumor encapsulated in thin connective tissue, composed entirely of neoplastic Schwann cells and forming two basic patterns. The hypocellular parts (Antoni B pattern) and hypercellular parts composed of an elongated cell with occasional nuclear palisading (Antoni A pattern) with slight nuclear polymorphism.

Conclusion: The clinical manifestation of intracerebral parenchymal schwannoma depends mainly on the locations and the sizes of the tumors. The histogenesis of intracranial schwannomas not arising from cranial nerves is still unclear as Schwann cells are generally not present in the cerebral parenchyma. Microscopically, analysis of the tissue has shown areas of nuclear palisading, characteristic of schwannoma, and dense, cellular tumor, alternating with the loosely textured myxoid tumor is present in equal portions, consistent with Antoni type A and Antoni type B tissue.

Keyword: extra parenchymal, histogenesis, meningioma, mimicking, schwannoma

Introduction: Management of blood pressure (BP) in patients with spontaneous intracerebral hemorrhage (ICH) concern that significantly elevated BP may precipitate ongoing bleeding, and lowering BP might decrease cerebral perfusion and create secondary ischemia. The target range of BP in patients with ICH should take into account the cause of the hemorrhage, the intracranial pressure (ICP), and whether the patient has a history of hypertension. This case report aims to show the importance of intraventricular ICP monitoring for cerebral perfusion pressure (CPP) management in spontaneous ICH.

Case presentation: A 58-year-old woman presented to the emergency room with ICH on the left lentiform nucleus. She has conducted an emergency decompressive craniectomy (DC) for trans-Sylvian ICH evacuation with the insertion of an intraventricular ICP monitor. The manual ICP monitor was set up from the external ventricular drainage (EVD) apparatus connected to the infusion line set for measuring ICP. CPP management was done by observing her GCS score, BP, ICP, MAP, and CSF production. On a postoperative day (POD) 4, the ICP monitor was removed due to minimal production of CSF and low ICP measurement in three consecutive days.

Conclusion: Strict ICP and CPP management is paramount in the prevention of secondary injury in spontaneous ICH.

Keywords: cerebral perfusion pressure, hemorrhagic stroke, intracerebral hemorrhage, intracranial pressure

Introduction: Chiari type 1 malformation associate with some abnormalities of the spinal cord and spine. Suboccipital decompression to prevent progression or deterioration scoliosis are still differences concern.

Case presentation: A 39 years old Madurese woman comes with an occipital headache for 5 years and getting worse. The patient is a housewife from rural and agricultural one of the Jember area. There are also sensory deficits like extreme pain in neck, shoulder, arms, and legs, numbness in hands and feet, unable to feel hot and cold. Motoric deficit like weakness, stiffness, loss of fine motor control, balance problem, and other symptoms like loss of vision oculi dextra and otalgia dextra. Patients have no history of previous illnesses such as spinal injury, diabetes mellitus, heart disease, asthma, high blood pressure, and no family history has a similar complaint. Thorax photo showed dextroscoliosis, no spinal deformity, no kyphosis. Cervical MRI showed cerebellar herniation. Neurosurgeon considers performing suboccipital decompression. Two months post-operative all symptoms slowly decreased.

Conclusion: Chiari type 1 could be associate with scoliosis and suboccipital decompression could relieve the symptoms.

Keywords: Chiari malformation type I, scoliosis, suboccipital decompression

Background: Medial sphenoid wing meningiomas involved to the anterior clinoid process (APC) and located medial on the lesser and greater wing of the sphenoid. Surgical planning of medial sphenoid wing meningiomas must be carefully considered, which in skull base surgery has emphasized the essential of venous preserving and the morbidity when accidentally sacrificed.

Objective: This study aimed to understand the characteristic venous drainage pattern of medial sphenoid wing meningiomas and correlate with surgical planning

Methods: A retrospective analysis evaluation was performed on 7 patients with medial sphenoid wing meningiomas using digital subtraction angiography (DSA) to determine the venous drainage system characteristics before surgery. Classification of the venous drainage pattern from sylvian veins was divided into cortical type, sphenobasal type and cavernous type. Clinical information and postoperative complication were retrospectively reviewed using the patient’s medical and surgical records.

Results: Based on the 7 surgical cases, 5 cases found as cortical type, sphenobasal type was found in 2 cases and did not find the cavernous type. The average tumor volume of cortical and sphenobasal type was 47,7 cm³, 36 cm³ respectively. In this study, one surgical complication was identified, frontal intracerebral hemorrhage (ICH) from postoperative computed tomography (CT) scan evaluation in patients who diagnosed with sphenobasal type.

Conclusion: Complication because venous damage in cases of Medial sphenoid wing meningiomas was rare. However, surgical strategies that aimed to avoid venous complications influenced by venous preservation and a good understanding of venous characteristics.

Keywords: Meningioma, Medial sphenoid wing meningioma, Skull base surgery, Venous drainage