We present a case of a young male patient with a fatal pulmonary air embolism following a penetrating gunshot head injury. He suffered from severe head trauma including a laceration of the superior sagittal sinus. Operative neurosurgical intervention did not establish a watertight closure of the wounds. Eight days after the trauma, the patient suddenly collapsed and died after an attempt to mobilise him to the vertical. Forensic autopsy indicated pulmonary air embolism as the cause of death. Retrospectively, we postulate an entry of air to the venous system via the incompletely occluded wounds and the lacerated superior sagittal sinus while mobilisation to the vertical created a negative pressure in the dural sinus.

Abstract Background Primary pineal malignant melanoma is a rare type of primary central nervous system melanoma with only 19 cases reported in the literature. Case Report We present a case of a 53-year-old man with primary melanoma of the pineal region. He presented to the emergency department with gait unsteadiness and ataxia. Magnetic resonance imaging (MRI) revealed a 22 × 17 × 22-mm mass in the pineal region. On MRI the tumor was hyperintense in T1, isointense in T2, and on T1-weighted images with gadolinium enhancement it appeared homogeneously hyperintense with hypointense spots. Our patient underwent subtotal tumor resection as well as radiotherapy. The 52-week MRI control showed no recurrence of the lesion. After 62 weeks he developed gait ataxia and headaches and was admitted to the emergency department. Computed tomography revealed tumor bleeding and obstructive hydrocephalus. An external ventricular drain was placed, but the bleeding progressed, and 7 days after admission, MRI showed bleeding in the thalamus and mesencephalon. With a dismal prognosis, therapy was discontinued. He died 65 weeks after diagnosis. Methods We reviewed the available literature (PubMed) with 19 published cases of primary pineal malignant melanoma and evaluated the common symptoms at presentation, histopathologic features, radiologic findings, therapeutic regimens, and time of survival to provide the most up-to-date treatment. Results The median age of patients with primary pineal malignant melanoma is 52 years (female-to-male ratio: 10:10 years); a common first sign is chronic hydrocephalus. On MRI the lesion presents hyperintense in T1 and hypo- to isointense in T2. Biopsy or resection and histopathologic analysis are the key to diagnosis. Common histopathologic features are melanic pigment (n = 19/20), positive Human Melanoma Black (HMB-45) marker (n = 13/20), positive S100 protein reactivity (n = 11/20), as well as positive Melan-A (n = 9/20). The median survival was > 56.5 weeks in patients treated with resection and radiation. Conclusion Reconsidering the reported cases surgical treatment followed by radiation increases the length of survival.

Background Anterior cervical diskectomy (ACD) is an established therapy for degenerative cervical radiculopathy and myelopathy. Controversy remains regarding the dynamic or rigid stabilization of the segment.Methods We studied our first 31 patients treated with ACD plus the Dynamic Cervical Implant (DCI) as an alternative to fusion or to arthroplasty, treated between February 2009 and 2011. Radiologic data were collected before and 12 months after surgery. Clinical results were documented 12 months after surgery. The radiologic analysis focused on the mobility of the segment, position of the implant, amount of preoperative osteochondrosis, and the development of heterotopic ossifications (HOs) after 1 year.Results At the 1-year follow-up after DCI implantation, there was quite a high fusion rate (23%); however, the formation of HOs was comparable with that of arthroplasty. Fusion could not be predicted by viewing the degree of disk degeneration on preoperative magnetic resonance imaging studies and had no negative impact on the clinical outcome.Conclusion As an alternative to arthroplasty, DCI does maintain some flexion-extension mobility after 1 year in 77% of our cases.

This review summarizes the basic knowledge about intradural tumours such as spinal meningiomas, neurinomas and ependymomas. Some own illustrative cases are presented to recall the MRI features and to show some intra-operative microsurgical aspects. With a targeted approach extended over 1–2 segments, no additional stabilization was needed. Resection of the medial 3/4 of the pedicle enabled to remove ventro-laterally located meningiomas through a posterior approach without damaging the cord.