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INTRODUCCIÓN: El tumor glioneuronal formador de rosetas (TGFR) del cuarto ventrículo es un tumor infrecuente que ha sido recientemente caracterizado. Fue incluido como una nueva neoplasia glioneural en el ańo 2007 por la Organización Mundial de la Salud (OMS) en la clasificación de tumores del sistema nervioso central. Dentro de este grupo hemos encontrado 34 casos documentados. En este artículo presentamos un nuevo caso de TGFR del cuarto ventrículo con hemorragia intratumoral postraumática y revisamos la literatura existente de esta nueva entidad. CASO CLÍNICO: Paciente de 30 ańos que tras sufrir traumatismo craneoencefálico leve presentó cefalea, diplopía y ataxia. Los estudios de tomografía computarizada y resonancia magnética cerebral revelaron una tumoración a nivel del cuarto ventrículo con sangrado intralesional y áreas de calcificación. La paciente fue intervenida realizándose extirpación tumoral macroscópicamente completa. El estudio anatomopatológico mostró un tumor glioneuronal formador de rosetas del cuarto ventrículo. CONCLUSIONES: Los TGFR del cuarto ventrículo son raros y afectan a adultos jóvenes. La evidencia demuestra que el pronóstico suele ser favorable, pero existe la posibilidad de progresión y recidiva. La hemorragia intratumoral es una forma de presentación muy poco habitual que implica riesgo para la vida del paciente. La resección quirúrgica debe ser cuidadosa debido a la localización de estas lesiones y su extensión hacia zonas críticas. Todos los pacientes, independientemente del grado de resección logrado, precisan un seguimiento a largo plazo por el riesgo de recidiva tardía

INTRODUCTION: Rosette-forming glioneuronal tumor (RGNT) of the fourth ventricle is a rare tumor that has been recently characterized. RGNT was included as a new glioneuronal tumor in 2007 by the World Health Organization (WHO) in classification of tumors of the central nervous system. Within this group we found 34 documented cases. We present a new case of RGNT of the fourth ventricle with intratumoral posttraumatic bleeding and review the existing literature of this new entity. CASE REPORT: A 30-year-old patient was admitted after suffering mild traumatic brain injury (TBI) had headache, diplopia and ataxia. Studies of computed tomography and magnetic resonance imaging revealed a tumor at the fourth ventricle with intralesional bleeding and areas of calcification. She was operated performing macroscopically complete tumor resection. Pathologic examination showed a rosette-forming glioneuronal tumor of the fourth ventricle. CONCLUSIONS: The RGNT of the fourth ventricle are rare and affect young adults. The evidence shows that the prognosis is usually favorable but there is the possibility of progression and recurrence. Intratumoral hemorrhage is a very unusual presentation that involves risk to the patient's life. Surgical resection should be careful due to the location of these lesions and their extension into critical areas, all patients regardless of extent of resection achieved require a long-term monitoring of the risk of late relapse

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INTRODUCTION: Rosette-forming glioneuronal tumor (RGNT) of the fourth ventricle is a rare tumor that has been recently characterized. RGNT was included as a new glioneuronal tumor in 2007 by the World Health Organization (WHO) in classification of tumors of the central nervous system. Within this group we found 34 documented cases. We present a new case of RGNT of the fourth ventricle with intratumoral posttraumatic bleeding and review the existing literature of this new entity. CASE REPORT: A 30-year-old patient was admitted after suffering mild traumatic brain injury (TBI) had headache, diplopia and ataxia. Studies of computed tomography and magnetic resonance imaging revealed a tumor at the fourth ventricle with intralesional bleeding and areas of calcification. She was operated performing macroscopically complete tumor resection. Pathologic examination showed a rosette-forming glioneuronal tumor of the fourth ventricle. CONCLUSIONS: The RGNT of the fourth ventricle are rare and affect young adults. The evidence shows that the prognosis is usually favorable but there is the possibility of progression and recurrence. Intratumoral hemorrhage is a very unusual presentation that involves risk to the patient's life. Surgical resection should be careful due to the location of these lesions and their extension into critical areas, all patients regardless of extent of resection achieved require a long-term monitoring of the risk of late relapse.

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BACKGROUND: Acute venous air embolism (AE) is a well-known intraoperative complication of neurosurgical procedures, especially during surgical procedures performed in the sitting position, but it is a rare complication in the supine position. A case of a patient who developed an AE during a supratentorial craniotomy in the supine position is presented and the literature is reviewed. CASE DESCRIPTION: A 45-year-old man had a large left frontal convexity meningioma. He was operated upon and, during craniotomy in the supine position, suffered a massive episode of air embolism with severe respiratory and hemodynamic changes. The AE episode occurred while we were cutting the bone for the craniotomy before turning the bone flap. Because the patient was bleeding profusely, the bone flap was quickly removed to achieve hemostasis. Aspiration of irrigant into the cut bone surfaces through several venous diploic channels in the bone edges was observed. The procedure was terminated when hemostasis was achieved. The meningioma was successfully removed in a second operation. CONCLUSION: We think that our case should serve to warn the neurosurgical community about the risk of AE in supratentorial procedures in the supine or semisitting positions when preoperative radiological imaging studies show the presence of important venous channels in relation to the site of the tumor.

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