Objective: 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.
Material and methods - We have prospectively studied the accuracy of this technique at our institute. During the period of last two years we have operated 118 CNS mass lesions including cranial and spinal. All cases were subjected to squash diagnosis and later compared with paraffin sections.
Results - Out of total 118, cranial lesions were 105 and spinal were 13. Males outnumbered in frequency (77 cases, 65.2%) while the females comprised 41 cases (34.7%). Most (59.2%) of the patients were from 20 to 50 years of age. The cerebral hemisphere including all lobes had the largest number of cases (49 cases, 41.5%). Among them glial tumors form the major group (34 cases, 28.8%). Meningiomas were the next main group (18 cases, 15.3%) followed by Schwanommas and metastatic tumors having nine cases (7.7%) each. The cytological or squash diagnosis was possible in all except 11 cases (9.3%), in which a definite diagnosis could not be provided due to fibrous tissue, necrosis, and hemorrhage or poor preservation of cytological features.
Conclusion - Thus, our early experience concluded 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.

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. Nevertheless, its use is not recommended as a broad treatment strategy for all craniofacial tumors. Eventually, embolization may induce and accelerate the natural involution of some hemangiomas. Randomized clinical studies must be done in order to define the efficacy and indications of these techniques.

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.
One hundred and twenty-five years later this seems to us of no importance and for many it will be a surprise that it wants to give the transcendence of being the birth of a new specialty: Neurosurgery.
The story is not that of an operation more to the brain, which as we know they were done from many centuries before. The transcendence is that it was the first operation of a brain tumor located only by clinical methods.

Objective:To investigate Gamma Knife and LINAC radiosurgery technologies regarding technical aspects and clinical results.
Patients and methods: A comparison was made with respect to stereotactic frame, mechanical accuracy, dosimetry, radiobiology, treatment planning and clinical results regarding both systems.
Results: The different stereotactic frames available in the market are not different in terms of proper fixation as well as for geometric localization reference. Similar excellent clinical results are obtained for small lesions with photon beams of the gamma knife and the linac. Similar beam dose distributions with sharp fall-off for small spherical shaped targets are obtained for both devices. The superior mechanical precision for the gamma knife as compared with the linac is of limited clinical relevance because inaccuracy of cranial target localization based on contemporary available radiological imaging is greater than the typical linac imprecision (of around 1mm). Treatment planning systems for the linac are not standardized but are based on well-known algorithms. The linac has no field size limitations, achieving more homogeneous dose distributions compared with that obtained with the gamma unit.
Conclusion: Linac based radiosurgery is a practical treatment method with equivalent physical, radiobiological and clinical results compared to the gamma knife technology although its routine methodology requires multidisciplinary effort
 

Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin lymphoma (NHL) which affects brain, spinal cord, leptomeninges and eyes. Its clinical course and radiological features are different in inmunocompetent patients comparated with inmunocomprised patients, especially in patients with acquired inmunodeficiency syndrome (AIDS). The diagnosis should be followed for a detailed evaluation, including a carefully physical examination, ophthalmologic evaluation, a chest/abdomen/pelvis computed tomography (CT) scan, cerebrospinal fluid (CSF) analysis, human immuno deficiency virus (HIV) testing and a contrast enhanced brain magnetic resonance image (MRI). MRI usually shows one or more enhanced paraventricular lesions, deep in the white matter, spanning the corpus callosum. Stereotactic brain biopsy sampling is the gold standard for the diagnosis. The use of Metotrexate in high doses followed by radiotherapy has demonstrated the best results in the treatment of PCNSL. A 44 years old woman, with apparently spontaneous remission of multiple brain lesions demonstrated in MRI plus initial negative biopsy sampling for PCNSL, showed tumoral enlarging after a follow up of 2 years.