Lipomas are common, well-circumscribed neoplasms of mesodermal origin, characterized by being slow, painless growths that are mostly subcutaneous, not invasive, and not recurring after surgery. Lipomas are the most prevalent kind of mesenchymal tumor, yet giant lipomas are rare in the cervical region and the occipital area. We report a 46-year-old female with diabetes insipidus was referred with a giant occipital cervical tumor, which she had noticed for 17 years and which had rarely given her any complaints of compressive symptoms. The clinical assessment indicated a firm, painless, and mobile swelling, which demonstrated features of venous ectasia, and there was no external ulceration. Ultrasonography and MRI of the neck revealed a large, subcutaneous fatty tumor with distinctive echographic features on both modalities, including hyperintense signals on T1 and T2 and no ring enhancement after Gadolinium injection. Due to the mass being smooth, round, and not attached to any structure, the patient underwent surgical enucleation under general anesthesia, resulting in full recovery without complications. Pathology revealed a benign adipose tissue tumor without liposarcoma, and there were no difficulties observed during follow-up for two years.

BACKGROUND: Gigantic epidermal cysts (GECs) are rare benign skin appendicular tumours also known as keratinocysts. GECs have a high incidence and their wall is made up of epidermis. Epidermal cysts can occur in any part of the skin; clinical manifestations include skin colour hemispherical swelling; cystic; mobile; 0.5 cm to several centimetres in diameter; and slow growth.
METHODS: Herein, we report a case involving a 56-year-old female with a GEC in the occipitalia. On July 25, 2023, a patient with a GEC was admitted to the neurosurgery Department of the Second Affiliated Hospital of Xi\'an Medical University. The phyma was shown to be a solid mass during the operation and was confirmed to be a GEC based on pathological examination.
CONCLUSIONS: Epidermal cysts are common cystic nodules on the surface of the body, the aetiology is unclear, the clinical manifestations can vary, and the misdiagnosis rate is high. However, giant epidermal cysts are rare. In most cases, however, the prognosis is satisfactory. This paper analyses and summarizes the population, location, clinical and pathological characteristics and pathogenesis of the disease to strengthen the understanding of this disease and improve the accuracy of clinical diagnosis.

UNASSIGNED: Protrusion of cerebrospinal fluid and meninges is called meningocele. Meningoencephalocele is a protrusion of neural tissue and meninges. The incidence of an Encephalocele is 1 in every 5000 live births. Anterior encephalocele is more common in men, while occipital encephalocele is seen in 70% of women. In a large encephalocele, the head size is small. Encephaloceles can occasionally be very large and are called giant encephaloceles. Occipital encephaloceles accounted for 80% to 90% of encephalocele cases in the western hemisphere. Encephaloceles vary in size and content. Various factors affecting the prognosis of patients with occipital encephalocele. Among them: extent, amount of brain tissue in the sac with or without Dural venous sinuses in the sac, with the brain or occipital lobe with hydrocephalus or presence of ventricles. Rarely, the sagittal and transverse sinuses are adjacent to the sac.
UNASSIGNED: This is a case of an 8-month old male infant born to a mother who had no regular antenatal care. After the baby presented with progressively increasing posterior head mass which is cystic, transilluminating, tender and size is 40cmX35cm imaging demonstrated small brain tissue mainly part of right occipital lobe with most of the sac being occupied by cerebrospinal fluid. Repair done and dysplastic brain tissue resected then healthy-looking brain tissue and Dural sinuses reduced to the skull, then patient stayed in the hospital and closely followed for hydrocephalus for seven days and discharged with no hydrocephalus and no neurologic deficit.

OBJECTIVE: We report a unique case of a suspected recurrent intracranial epidermoid cyst (EDC) that was found on pathology to have undergone malignant transformation to squamous cell carcinoma (SCC) approximately 25 years after initial resection. Additionally, we performed a systematic review including 94 studies reporting intracranial EDC to SCC transformation.
METHODS: Ninety-four studies were included in our systematic review. PubMed, Scopus, Cochrane Central, and EMBASE were searched in April 2020 for studies regarding histologically confirmed SCC arising within an EDC. Kaplan-Meier estimations were used to estimate time to event including survival, and log rank tests were used to test for significance. All analyses were conducted using STATA 14.1 (StataCorp, College Station, Texas, USA); tests were two-sided, and statistical significance was defined using the alpha threshold of 0.05.
RESULTS: The overall median time to transformation was 60 months (95% confidence interval {CI}, 12-96). Transformation time was significantly shorter in the no surgery group (10 months, 95% CI undefined) versus the other 2 groups (60 months, 95% CI, 12-72 in surgery only and 70 months, 95% CI, 9-180 in surgery + adjuvant therapy group, both P < 0.01). Overall survival was significantly longer in the surgery + adjuvant therapy group (13 months, 95% CI, 9-24) versus the other 2 groups (3 months, 95% CI, 1-7 in surgery only and 6 months, 95% CI, 1-12 in the no surgery group, both P < 0.01).
CONCLUSIONS: We report a rare case of delayed malignant transformation of an intracranial EDC to SCC, occurring nearly 25 years after initial resection. Transformation time in the no-surgery group was statistically significantly shorter as compared to the surgery only and surgery + adjuvant therapy groups. Overall survival was statistically significantly higher in the surgery + adjuvant therapy group as compared to the surgery only and no surgery groups.

BACKGROUND: Intradiploic pseudomeningoceles, also called intradiploic cerebrospinal fluid (CSF) fistulas, are abnormal CSF collections between the two bony tables of the calvaria resulting from postsurgical CSF leakage. To date, only six cases of intradiploic pseudomeningocele have been reported, all occurring in the occipital area. In this paper, we report the seventh case of late-onset occipital intradiploic pseudomeningocele (OIP) occurring in a young female patient who underwent surgery for the removal of a cerebellar pilocytic astrocytoma. In this regard, we also review the literature on the few recognized cases of OIP.
METHODS: The case of an 18-year-old female patient known to our institute for an operation 12 years earlier to remove a pilocytic astrocytoma is illustrated. At admission, the patient complained only of occasional orthostatic headache. Brain imaging demonstrated a pseudomeningocele extended intradiploically from the occipital squama to the condylar and clivus regions, thinning both occipital bone tables and dilating the CSF-filled diploe. Watertight duroplasty and cranioplasty were effectively performed.
CONCLUSIONS: Pediatric patients undergoing posterior cranial fossa craniotomy/craniectomy may postoperatively develop OIP. In this setting, treatment of any dural CSF fistula should be considered because of the risk of progressive extension and bone erosion.

UNASSIGNED: Aneurysms of the occipital artery (OA) are rare, with few cases published in the literature. The pathophysiology is unknown, and the presentation is variable. We present a case of a ruptured intracranial aneurysm arising from a branch of the OA.
UNASSIGNED: A 36-year-old male with a history of ankylosing spondylitis presented with altered mental status after an assaulted. On examination, he was intubated, with a Glasgow coma scale of 9, and imaging of the head and neck revealed a subdural hematoma of the posterior fossa and the cervical spine. The patient underwent suboccipital craniectomy and C1-5 laminectomy with the evacuation of the subdural hematoma. Postoperative cerebral angiography showed an intracranial aneurysm arising from the retromastoid branch of the OA on the left side. Furthermore, the parent vessel of the aneurysm supplied the left lower half of the cerebellar hemisphere. The aneurysm and the parent vessel were embolized using platinum coils. The patient tolerated the procedure well, and magnetic resonance imaging of the brain showed a minor left-sided cerebellar infarct, which was asymptomatic. The patient was discharged home with a modified Rankin scale of 2. There were no outpatient follow-up data available because the patient lost to follow-up.
UNASSIGNED: Intracranial OA aneurysms are extremely rare with no clear consensus concerning the management of these aneurysms. They can be treated using endovascular and or open surgical techniques depending on the aneurysm characteristics, patient condition, rupture status, and others.

Kleine-Levin syndrome (KLS) is characterized by recurrent episodes of hypersomnia, compulsive hyperphagia, disinhibition, hypersexuality and self modifications. To investigate the Self, we used afunctional magnetic resonance imaging paradigm evaluating Self-reference processing (SRP) and Self-reference effect (SRE) in a17-year-old male adolescent at the end of an episode. We observed enhanced activations in right hemisphere and posterior areas- associated with physical Self representations- during the SRP condition, while during the SRE condition, enhanced activations in bilateral but prevailing left frontal areas- associated with the conceptual Self. These results suggest amodified Self during aKLS episode being more physically grounded.

Patients with atlanto-occipital dislocation (AOD) are increasingly being transported to emergency rooms, alive, by the improved pre-hospital emergency rescue system. The author reports a fatal case of AOD with severe neurovascular injuries following a high-speed pedestrian collision. Therefore, nowadays, neurosurgeons can expect an increase in the occurrence of such cases; an early diagnosis and prompt occipitocervical fusion can save lives. This report reviews the current concepts of AOD in mild to fatal conditions.

We report a case of a 1-month-old boy with a cystic swelling in the occipital region without intracranial communication, called atretic cephalocoele. We discuss clues to the diagnosis of atretic cephalocoeles. We also discuss common clinical findings and a possible mechanism by which these lesions develop.

BACKGROUND: Congenital cranial bone defects predispose to herniation of meninges, sometimes with brain tissue involvement, to form a cerebrospinal fluid (CSF)-filled cyst in the head. Such defects mainly results from focal failure of neural tube closure during fetal development and has been reported in various species of domestic mammals.
METHODS: A one week old Ayrshire calf with a fluctuant swelling on parieto-occipital region of the head was referred to the faculty. The calf was always lying on lateral recumbency and exhibited resistance to deep palpation around the swelling and neck flexion. Embedded to the midline of the dorso-caudal surface of the cyst\'s wall was a hard longitudinally oriented structure. The case was diagnosed as meningocele by means of radiographic examination. As the likelihood to full recovery was greatly reduced due to the negative impact already meted on brain tissue by intracranial pressure, the calf was euthanized on grounds of animal welfare and the diagnosis confirmed by anatomopathological findings which also revealed a circular bone defect in parieto-occipital region of the skull vault and a flattened bony structure embedded to the cyst\'s wall.
CONCLUSIONS: Anatomopathological findings confirmed the diagnosis as cranial bifidum with meningocele at the parieto-occipital region of the skull vault. The presence of a bony structure embedded to the wall of meningeal sac was rather unusual and could not be sufficiently explained. It was however thought to, most likely, represent a part of interparietal bone that failed to get incorporated into squamous part of occipital bone as a result of the defect. The report also highlights challenges that work against timely delivery of urgent veterinary interventions in rural set ups of Africa and rest of the developing world, often leaving veterinarians with animal welfare consideration as main determinant of intervention measures.