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Eduardo Rossi, Jesús Vaquero, and Roberto Martínez

✓ A rare case of parailiac ectopic bone formation 10 years after a Cloward procedure is presented. Dystrophic calcification of a previous hematoma or deposit of bone dust were considered to be the origin of this unusual complication.

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Jesús Vaquero, Carlos Jiménez, and Roberto Martínez

✓ A case of presumed cerebral hydatid embolism in the course of cardiac surgery for echinococciasis is reported. Follow-up computerized tomography immediately after embolization, and 1 and 5 years later suggested an average growth pattern of 1 cm/year for intracranial hydatid cysts in the adult.

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Gonzalo Bravo, Jesús Vaquero, Roberto Martínez, and José Cabezudo

✓ A case of clinically unsuspected mesencephalic tuberculoma that was diagnosed at operation is presented. After intraoperative diagnosis, the surgical procedure was interrupted and specific treatment with tuberculostatic agents was started. The symptoms remitted totally in a few months. This conservative management is preferable to surgical removal when the diagnosis of brain-stem tuberculoma has been established.

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Jesús Vaquero, Rafael G. de Sola, and Roberto Martínez

✓ A case of lateral sinus pericranii in a 49-year-old woman is presented. These extraordinarily rare lesions should be considered in the differential diagnosis of epicranial tumors. The lack of filling on external carotid artery angiograms may lead to the error of dismissing the possibility of a vascularized lesion.

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Jesús Vaquero, Roberto Martínez, Eduardo Rossi, and Rafael López

✓ A case of primary cerebral lymphoma is presented. The particular biological features of these tumors may pose a special problem. In this case, the lesion was diagnosed on computerized tomography (CT) but was not found at surgery. The disappearance of the lesion was associated with a long period of corticosteroid therapy between CT diagnosis and the operation.

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Roberto Martínez-Álvarez, Nuria Martínez-Moreno, M. Elena Kusak, and Germán Rey-Portolés

Object

Glossopharyngeal neuralgia is difficult to treat. On the basis of results obtained by using Gamma Knife surgery (GKS) to treat trigeminal neuralgia, the authors have used GKS to treat glossopharyngeal neuralgia in a series of patients since 2007. Their objectives with this study were to demonstrate the usefulness and safety of GKS for treating glossopharyngeal neuralgia and to describe a simple treatment method.

Methods

From 2007 through 2013, the authors treated glossopharyngeal neuralgia in 5 patients (4 women and 1 man), who ranged in age from 36 to 74 years. One patient had previously undergone treatment for trigeminal neuralgia at the Ruber International Hospital, Department of Functional Neurosurgery and Gamma Knife Radiosurgery. For all patients, before GKS, medical management did not control the pain. Three patients had previously undergone surgery (2 microvascular decompression and 1 rhizotomy) without improvement. For the GKS procedure, the nerve was localized by MRI and CT under stereotactic conditions and the target was located at the level of the glossopharyngeal meatus of the jugular foramen. For 1 patient, a maximum dose of 80 Gy was administrated with a 4-mm collimator, and for the others, the maximum dose was 90 Gy. The nerves located near the glossopharyngeal nerve received between 63 and 10 Gy, and the brainstem received less than 10 Gy. The mean follow-up time was 43 months (range 14–83 months).

Results

All patients improved within 3–6 months after undergoing GKS. All 5 are without pain; 3 patients take no medication, but the other 2 patients continue to take medication. No neurological deficits after GKS were observed.

Conclusions

GKS is useful and safe for treating glossopharyngeal neuralgia, even for patients who have previously undergone surgery. GKS should be considered as the initial therapy for glossopharyngeal neuralgia.

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Roberto Martínez, Jesús Vaquero, José Cabezudo, Eduardo Areitio, and Gonzalo Bravo

✓ Two cases of neurinomas of the jugular foramen in patients under 16 years of age are presented. Neurinomas of this location have not been previously reported in children.