Background: The differentiation by means of magnetic resonance between high-grade gliomas and intracranial solitary single metastasis is of the utmost importance since they condition both surgical and complementary treatment. Results: Retrospective study that analyzes the parameters of advanced magnetic resonance imaging: spectroscopy, diffusion and perfusion, specifically focused on the differences in the coefficients of the metabolites Cho/Cr, Cho/NAA and NAA/Cr in peritumoral edema between high-grade gliomas and metastases. The data have been statistically analyzed using ROC (receiver operating characteristic) curves, and cutoff values were obtained. A total of 79 patients with histologically analyzed tumors were analyzed: 49 high-grade gliomas (40 multiform glioblastomas and 9 anaplastic astrocytomas) and 30 metastases. A statistically significant mean difference was obtained in the three metabolite ratios. The area under the curve for the Cho/NAA ratio was 0.958 (CI: 0.903–1), for Cho/Cr 0.922 (CI: 0.859–0.985) and for NAA/Cr 0.163 (CI: 0.068–0.258; p < 0.001). The cutoff values were 1.115 for Cho/NAA (sensitivity 93.87%, specificity 93.33%, global precision 93.67%); 1.18 for the Cho/Cr ratio (sensitivity 89.79%, specificity 93.33% and precision 91.13%) and 1.155 for the NAA/Cr ratio (sensitivity 67.34%, specificity 93.33%, global precision 44.30%). Conclusion: The results of the study support the premise that spectroscopy at the level of peritumoral edema is able to differentiate between high-grade gliomas and metastases by showing tumor infiltration in peritumoral edema.

Cavernous hemangiomas are benign tumors that exceptionally affect the cranial bones. The first description of this type of tumor was in 1845 by Toynbee. A review of the literature reveals less than 100 published cases and a growing trend every year. Total surgical excision is the treatment of choice, and the prognosis after complete excision is excellent, with a recurrence usually rare. We present the case of a 57-year-old patient with a painless tumor of the left frontal bone, of slow growth and osteolytic characteristics from the neuro-radiological point of view. The lesion was excised en bloc by craniectomy, followed by cranioplasty. The anatomopathological diagnosis was intraosseous cavernous hemangioma. Despite its low frequency, the diagnosis of intraosseous cavernous hemangioma should be considered in the presence of a slow-growing cranial tumor, with solid and painless characteristics, and its osteolytic nature confirmed by radiology. The treatment of choice consists in the complete resection of the lesion.

Introduction: Intramedullary hemangioblastomas are usually accompanied by syringomyelia. However, a holocord syringomyelia is rare. The most common cause of syringomyelia continues to be Chiari disease, and only 10 cases of hemangioblastomas with holocord syringomyelia reported so far. Case report: We present a case of a 35-year-old patient with a two-month history of cervicobrachialgia at the C7-C8 root level, previously preceded by pain at the D1-D2 level. Cervico-dorso-lumbar MRI revealed a medullar tumor with hyper-uptake mural nodule at the conus medullaris level accompanied by an extensive syringomyelic cavity from C5 to L1 compatible with medullary hemangioblastoma. The patient underwent surgery for tumor resection with subsequent resolution of her painful symptoms. Conclusion: It is important to note that the surgery is aimed at treating the origin of this syringomyelia and not the syringomyelia itself. Although the majority of patients with holocord syringomyelia have Chiari as its cause, the possibility of focal spinal intramedullary tumors as being responsible for syringomyelia should not be forgotten.

Introduction:Choroidal fissure cysts are usually incidental findings on imaging studies. They are typically benign lesions, although in some cases they may cause morbidity due to intracranial hypertension. The formation of cysts in this location is related to abnormal development of the choroid tela and the choroidal fissure. Fewer than ten cases have been reported in the literature. Case description: A 3-month-old patient with a small choroidal fissure cyst at birth presented with acute symptoms of intracranial hypertension, nausea, and vomiting. Imaging revealed a rapid and severe enlargement of the arachnoid cyst within just two weeks, reaching a preoperative size of 50 × 35 × 30 mm. The patient underwent endoscopic fenestration of the cyst, resulting in complete resolution of clinical symptoms in the early postoperative period and marked reduction in cyst size on imaging (36 × 21 × 24 mm) one day after surgery.At two-month follow-up, the cyst measured 28 × 21 × 19 mm. Symptomatic choroidal fissure cysts are exceptionally rare, with only eight clinical cases reported to date in the literature. Traditionally, treatment has consisted of cystoperitoneal shunting. We currently believe that endoscopic treatment can be offered as a first-line option, achieving complete clinical resolution without evidence of complications. Conclusion:Symptomatic choroidal fissure cysts are an exceptionally rare pathology. Treatment by endoscopic fenestration provides excellent clinical and radiological resolution without additional short-term complications.