No abstract

SUMMARY One brother and one sister, of seven siblings, had cirsoid aneurysms of the occipital scalp with underlying skull defects and possible intracranial communication. Another sister had no gross scalp abnormality but radiographs of the skull revealed a small occipital bony defect. This is thought to be the first reported example of familial cirsoid aneurysm of the scalp.

Carotid arteriograms on three patients with unilateral pulsatile tinnitus demonstrated an ipsilateral atypical trigeminal artery extending from the cavernous portion of the internal carotid artery to form the posterior inferior cerebellar artery. Illustrations and a dissection of a human fetus with a similar finding show this artery crossing the cochlear nerve near its insertion in the pons. Evidence is presented suggesting that neurovascular compression of the eighth nerve is the source of pulsatile tinnitus in these patients.

Four patients with symptoms and signs of brain stem ischemia due to occlusive disease of the vertebrobasilar system and one patient with similar cerebrovascular disease who was thought to be prone to brain stem stroke underwent a microvascular anastomosis between the occipital artery and the caudal loop of the posterior inferior cerebellar artery. There was no morbidity of mortality and neurologically all patients improved. Post-operative angiograms showed patent anastomosis in all the patients and improved circulation in three. This new operation may prove beneficial in a selected group of stroke patients who suffer from vertebrobasilar insufficiency and cannot be treated with gross surgical techniques.

Radiological and anatomical studies of a persistent trigeminal artery in three human fetuses are reported. In one fetus there was also an anastomotic artery connecting one of the carotid arteries to the contralateral inferior cerebellar artery. In all three cases, the trigeminal arteries gave branches to the pons. In addition to the pontine branches, one trigeminal artery gave an anastomotic branch to the posterior inferior cerebellar artery and the other trigeminal artery gave branches to both the superior cerebellar artery and the internal auditory artery.