Giant mucocele of paranasal sinuses.

A large mucocele of the frontal and ethmoidal sinuses with extracranial, intracranial, and intraorbital extension accompanied by total destruction of the left frontal sinus was treated successfully. We chose a two-stage surgical procedure for radical removal of the lesion. It is important to ascertain the degree of dural involvement, not only because extensive involvement of the dura mater presents technical surgical difficulties, but also because this knowledge provides clues regarding the pathology of the lesion. Even after surgical treatment, the mucocele may recur if the patent sinus ostium is exposed to the dura mater, or if the ostium subsequently becomes blocked.

Tumoral calcinosis in the upper cervical spine causing progressive radiculomyelopathy--case report.

A 54-year-old woman with chronic renal failure presented with tumoral calcinosis manifesting as progressive radiculomyelopathy. Magnetic resonance imaging revealed a spinal epidural mass in the C-2 to C-4 levels. The clinical and radiological findings suggested malignant tumor. Resection of the lesion was performed with total C-2 laminectomy and C-3 and C-4 laminoplasty. The symptoms totally disappeared after surgery. The histological diagnosis was tumoral calcinosis. Tumoral calcinosis is a rare tumoral calcium pyrophosphate dihydrate crystal deposition disease which presents as periarticular soft tissue calcification. Tumoral calcinosis should be considered in patients with a mass lesion involving the upper cervical spine and associated with metabolic abnormalities. Surgical excision is the treatment of choice, because this is completely curative without known recurrence.

[A retrospective analysis of the outcomes of patients with aneurysmal subarachnoid hemorrhages: a focus on the prognostic factors].

The authors report a clinical analysis of the outcomes of aneurysmal subarachnoid hemorrhages in 112 patients. Cerebral angiography was conducted on 85 patients. Clipping or wrapping of the aneurysm was performed on 81 patients. The overall good outcome (GR and MD in the Glasgow Outcome Scale) ratio and mortality rate were 43% and 34%, respectively. The good outcome ratio and mortality rate in operative cases were 59% and 12%, respectively. With regard to the timing of the operation, 77 cases (95%) underwent early operation and 4 cases (5%) underwent delayed operation. The good outcome ratio of patients with grade I to III at surgery using the Hunt and Kosnik grading system was 74%. There was no difference in outcome between the patients with a ruptured aneurysm in the anterior circulation and those with one in the posterior circulation. The retrospective analysis of the overall outcomes showed the risk factors as being: age over 70 years, cerebral atherosclerosis, poor grade on Hunt and Kosnik grading system and symptomatic vasospasm. Preoperative bleeding of the aneurysm, severe brain swelling at surgery, and postoperative symptomatic vasospasm were factors which worsen the outcome of surgically treated patients. Patients with more than 2 factors showed worse outcomes than those with only one factor. The utilization of these prognostic factors should be important to improve the outcome of patients with aneurysmal subarachnoid hemorrhage.

[A case of clival chordoma without bone destruction].

A case of clival chordoma without bone destruction is reported. A 28-year-old man was admitted to Kagoshima University Hospital on April 8, 1983 with the complaints of headache, displopia and gait disturbance. Neurological examination revealed the right eighth, ninth, tenth nerve palsy and gait disturbance. Plain skull firms showed no abnormality and left vertebral arteriography revealed a displacement of basilar artery to the left side. The CT scanning showed a low density area at the retroclival region, and enhancement was acquired slightly. Metrizamide cisternography, CT cisternography showed retroclival round tumor and no destruction of the bone. The tumor which invaded intradurally was removed totally. Histological examination confilmed the chordoma. In this report, it will be stressed that when clival chordoma invades intradually, subtemporal approach will be most favorable, and metrizamide CT cisternography is one of the useful diagnostic procedures of retroclival mass.