Posterior subscapular approach for specific brachial plexus lesions.

The surgical technique for exposure of the brachial plexus via a posterior subscapular approach is reviewed, with its relevant anatomy. The author has used this approach for four brachial plexus procedures. The indications for this approach will be discussed, and a case history presented to illustrate the benefits of this procedure in recurrent thoracic outlet syndrome.

Intracranial epithelioid hemangioendothelioma arising at site of previously excised atypical meningioma.

Epithelioid hemangioendothelioma is an uncommon vascular tumor which, in most cases, pursues a clinical course intermediate between hemangioma and angiosarcoma. Only four completely documented cases of central nervous system involvement by this tumor appear in the literature. We present an additional case, which is remarkable in its occurrence at the site of a previously excised atypical meningioma and in its unusually aggressive clinical course. To our knowledge this is the first report of intracranial epithelioid hemangioendothelioma with postmortem documentation. The patient initially presented with a 7 cm right post frontal tumor; an atypical meningioma was excised and removal appeared complete on immediate post-operative scans. Seven months later the patient re-presented with tumor recurrence at the previous operative site; a second craniotomy was performed and, on this occasion, the excised tumor had the histological features of an epithelioid hemangioendothelioma without evidence of meningioma: both morphologically and immunohistochemically the two tumors were quite distinctive. Further recurrence prompted radiotherapy but the patient continued to deteriorate and died five months later. Massive recurrence of intracranial tumor was found at postmortem examination.

Direct embolectomy of the basilar artery bifurcation. Case report.

The case is presented of a 27-year-old man who developed a basilar artery bifurcation embolus encompassing Hilal microcoil as a complication following therapeutic embolization. An immediate direct surgical approach to the basilar artery bifurcation enabled the microcoil and associated thrombus to be removed and flow to be restored in the basilar artery and its distal branches. Postoperatively, the patient made a good recovery and on discharge was neurologically normal with the exception of a right third nerve palsy. This case suggests that in selected patients a direct surgical approach to the top of the basilar artery may be possible for treatment of emboli.

Meningioma of the posterior skull base.

Combined intratemporal and cerebellopontine angle meningiomas are rejatively rare. There are unsolved problems with the stability of the skull and spine and the lower cranial nerves and there is a marked tendency for the tumor to involve the spinal cord. This article reports on five cases of combined intratemporal and cerebellopontine angle meningiomas.