Giant serpentine aneurysm of the posterior cerebral artery.

We are reporting an unusual case of a giant serpentine aneurysm of the posterior cerebral artery (PCA). We were unable to find a report in the literature of a similar aneurysm. The microsurgical pterional approach was used for temporary clipping of the P-2 segment of the PCA, and the aneurysm was trapped successfully and excised. The discussion includes the operative approach to the giant serpentine aneurysm.

[Unilateral exophthalmos - diagnostic and therapeutic procedure (author's transl)].

Unilateral exophthalmos related to orbital diseases was analyzed in 37 cases. Thirty-four out of 37 cases were operated on and histologically verified. The cases included five pseudotumors, five intracranial tumors invading the orbit, four carotid-cavernous fistulas, three mucoceles, two lacrimal gland tumors, two cavernous angiomas, two osteomas, two histiocytomas, two fibrous dysplasias, one neurinoma, one meningioma, one embryonal rhabdomyosarcoma, one metastatic tumor, one venous malformation, one orbital meningoencephalocele, one infraclinoid internal carotid giant aneurysm, three mass lesions not verified operatively. The location of mass lesions in the orbit was diagnostically significant and was certified by CT scan. Mucocele and osteoma occurred at the medial site of the orbit. Lacrimal gland tumors were located anterolaterally in the orbit. Pseudotumors, cavernous angiomas, and the neurionoma were situated posterior to the orbital bulb. As for age distribution, meningoencephalocele, venous angioma, fibrous dysplasia, histiocytoma and embryonal rhabdomyosarcoma occurred in infancy and childhood. The onset and course of the orbital mass lesions were characteristic in the disease process: carotid-cavernous fistula and infraclinoid internal carotid giant aneurysm occurred suddenly. Malignant tumors, such as adenoid cystic carcinoma, embryonal rhabdomyosarcoma and metastatic tumor, revealed rapidly progressive exophthalmos. Benign tumors and mucocele were slowly progressive. Orbital meningoencephaloceles were observed at birth and no remarkable change thereafter. Pseudotumors were progressive at the initial disease process and later became stationary or regressive. Venous malformation showed intermittent exophthalmos. The frontozygomatic operative approach for orbital mass lesions was applied when the tumors were large enough and located laterally in the orbit.

Primary leptomeningeal melanoma with epipharyngeal invasion.

A case of primary leptomeningeal malignant melanoma in a 45-year-old woman is reported. The tumour was located at the basal aspect of the brain with a larger aggregation in the left parasellar and cerebello-pontine angle regions. The tumour showed not only spinal meningeal dissemination but also infiltration into the petrous bone and along the trigeminal nerve till it reached the submucosal tissue of epipharynx. There are a few reported cases of primary leptomeningeal melanoma which invaded areas outside the central nervous system.

Psychiatric symptoms in ruptured anterior communicating aneurysms: social prognosis.

Pre- and postoperative psychiatric symptoms were compared in 85 patients with anterior communicating aneurysms and 73 of these cases were followed up to determine the long-term results. Psychiatric symptoms of varying severity were present preoperatively in 61 % of the cases, which decreased to 34 % after surgery. Use of the microsurgery microscope resulted in a no change: aggravation:mortality ratio of 27:5:0, as compared with 33:20:4 when the microscope was not used.