The authors present four patients with trigeminal neuralgia treated by percutaneous rhizotomy of the Gasserian ganglion with balloon. The procedure was performed with fluoroscopic assistance with sedo analgesia without intubation. All patients were females. The sector most affected was V2 (50%). We obtained the three forms of balloon described (pear, hourglass, oval). In the four patients had immediate pain relief in the immediate postoperative.

 Intra-operative cytological diagnosis of the CNS lesions helps the neurosurgeon to decide about the extent of resection particularly in eloquent areas. The squash or crush preparation of the available tiny tumor tissue at the start of the resection is a time saving and lead to better decision on further plan of surgery.The authors conclude that Intra-operative SQUASH smear cytology is a fairly rapid and reliable method of intra operative diagnosis for a wide spectrum of central nervous system lesions.

Patients affected with chronic pain due to lesions by avulsion of the brachial plexus are treated with many different surgical procedures of brachial plexus and long term schemes of pain therapy remaining with high scores in VAS. Drezotomy is an important alternative to relief persistent pain related to the topography of the deafferentation. The author reports the results of the first cases operated in our institution by this therapy mode.

The autors review the most common hypervascular craniofacial tumors usually managed with endovascular embolization techniques. Even though controversial issues remain, there are reasonable data supporting the use of transcatheter devascularization techniques prior to the surgical resection of these lesions in order to reduce the intraoperative blood loss, the operative time and to facilitate their complete removal.

The surgical approaches to reach the base of the skull represents a challenge for the neurosurgeon. The knowledge of anatomy and neurosurgical technique to use is essential before tackling the diseases that are located there. The present is a brief review of the main skull base approaches, describing the surgical technique of each of them, taking as reference the experience acquired by the author in a course led by Antonio Bernardo.

The hypertrophic pachymeningitis is a rare granulomatous disease of the dura, characterized by thickening of chronic granulomatous, which may affect, both intracranial and cervical or thoracic spine. Its etiology is unknown although it is associated with various concomitant disease. We present a patient with hypertrophic pachymeningitis of granulomatous tuberculous etiology likely that ongoing with symptoms of multineuritis cranial and spinal cord compression, who underwent surgery in our hospital.

Surgical management has been the only one method of treatment for broken Extracranial Interna Carotid Artery (EICA) in the last 100 years, but was limited in those aneurysms with distal extension to the skull base. Nowadays, new technologies such as endovascular technique through the placement of stents, coils and carotid trapping are shown as alternatives for this difficult disease. We report a 44 years old man with left giant carotid cervical aneurysm, who was undertaken to carotid trapping in our hospital.

On November 25, 1884, at the Hospital for Epilepsy and Paralysis and other Diseases of the Nervous System (now Maida Vale Hospital) in London, surgeon Rickman Godlee, led by neurologists A.H. Bennet and David Ferrier, who traced in the skull the major convolutions of the Brain and the exact point where he was to trepanarse, operated from a brain tumor to the young Henderson, native of the county of Dumfries.