A ocorrência de meningiomas císticos é incomum. As imagens destas lesões obtidas pela tomografia computadorizada de crânio (TC) podem lembrar lesão cística de origem glial ou metastática, sendo necessário realizarmos, além da TC, angiografia cerebral e ressonância magnética do crânio para firmarmos diagnóstico correto pré-operatório. O diagnóstico incorreto de glioma pode resultar em tratamento paliativo, ao invés da remoção radical desta neoplasia potencialmente curável. Três casos são relatados, ilustrando o problema.

Cystic meningiomas are uncommon lesions. CT image may simulate a glial or a metastatic tumor with cystic or necrotic changes. The correct radiological evaluation and the recognition of this kind of tumor are important for surgical treatment since they are potentially curable neoplasms. In this paper the authors report their experience with the treatment of three cases of cystic meningiomas, and discuss some characteristics of these lesions.

Revisão dos conceitos vigentes sobre a clínica, patogenia, diagnóstico diferencial e tratamento da neuralgia vagoglossofaríngea, e relato de três casos operados por neurotomia intracraniana do n. IX e n. X (parcial). A anatomia da inervação sensitiva das regiões profundas da face e transição cervicofacial, com suas implicações clínicas, e a teoria da compressão neurovascular na patogenia das disfunções ditas «hiperativas» dos nervos cranianos, são comentadas criticamente.

Review of current opinions concerning clinical presentation, etiology, differential diagnosis and management of vagoglossopharyngeal neuralgia. Three cases are reported, treated by intracranial section of n. IX (alone in one case) and upper rootlets of n. X. In two patients no vascular compression of the nerves was observed. In one case an atheromatous elongated basilar artery was observed compressing and deforming the medulla oblonga at the entry zone of nerves IX-X. In this case, pain paroxysms recurred, some weeks after surgery, and the patient underwent re-operation (microvascular decompression of the medulla) with good outcome. Clinical implications of the complex sensitive innervation of profound regions of the face and cervicofacial region are emphasized. Certain circumstances, such as gustatory pain due to sympathetic denervation of parotid gland, the neck-tongue syndrome and oropharyngeal pain by irritation of the first cervical spinal nerve (during lateral suboccipital puncture), point to the fact that in this region similar symptoms may be provoked by mechanisms involving different peripheric pain pathways. The theory of microvascular compression in the pathogeny of cranial nerve «hyperactive» dysfunctions is critically commented.

Relata de um caso com verificação cirúrgica de cisticercose espinhal, forma leptomeníngea restrita à cauda eqüina, em paciente adulto. É discutido o papel do sistema venoso vertebral na infestação dos espaços subaracnóideos na neurocisticercose, originando formas clínicas primariamente espinhais.

An adult female patient presented with an exclusively spinal leptomeningeal infestation by cysticercosis (restricted to the cauda equina), verified in surgery. The rôle of the vertebral vein system in the spread of cysticercotic larvae is discussed. A commentary on the possibility that cysticercosis of the batal cisterns may be due to ascending migration of primarily spinal cysticerci, as originally proposed by Isamat de la Riva, is stated.

A hipótese de que embriões cisticercóticos possam alcançar os espaços suba-racnóideos espinhais por migração descendente a partir de espaços intracranianos previamente infestados não é compatível ao acometimento leptomeníngeo espinhal primário, que observamos em duas pacientes. É sugerido que nesses casos os embriões invadem o sistema nervoso central através do fluxo sangüíneo retrógrado pelo plexo venoso vertebral interno e veias intervertebrais, e que o compartimento intracraniano do liqüido cefalorraqueano possa ser secundariamente invadido pelos cisticercos.

The spinal forms of neurocysticercosis are rather rare. The more common presentation is the leptomeningeal form. We have reported two patients with an exclusively spinal involvement verified through surgery. The current theory of downward migration of the parasites from the cerebral to the spinal subarachnoid space cannot explain primary spinal forms, and it is suggested that retrograde flow through the epidural vertebral veins provides an alternative route.