Between 1972 and 1996, 450 consecutive patients with intracranial meningiomas were operated on at Cukurova University School of Medicine. By size, intracranial meningiomas were classified as huge (>6 cm minimum diameter when extrapolated to anatomic size) or not huge (<6 cm). The present study involves 93 patients who underwent 109 craniotomies for the removal of huge meningiomas. All patients are adult, with 31 men and 62 women or a 1:2 male to female ratio, with a mean age of 48.7 +/- 2.3 years at the time of diagnosis. The average duration of observed survival in 85 patients followed in the computed tomography (CT) era was 4.8 years and that of 8 patients in the pre-CT era was 8.8 years. Eleven patients died by the last follow-up assessment. Seventy-nine patients were still alive at the last follow-up assessment. The overall postoperative mortality rate was 3.2%. The overall recurrence rate was 19%. In descending order of frequency, the first five anatomic locations of the huge meningiomas were the parasagittal region in 18 patients (19.3%), the cerebral convexity in 15 (16.1%), the olfactory groove in 15 (16.1%), the falx in 12 (12.9%), and the tuberculum sellae in 11 (11.8%). The overall results of surgical treatment in 93 patients were total removal in 59 (63.4%), radical subtotal in 18 (18.3%), and subtotal in 16 (17.2%), with good outcome in 69 (74.1%), fair in 16 (17.2%), and poor in 5 (5.3%). In conclusion, the huge size of meningiomas affects the extent of removal, recurrence rate, postoperative outcome, operative morbidity and mortality rates, and survival time negatively.

Behçet's disease, a rare condition in central Europe but more common in Turkey where it was originally described, is characterized clinically by the presence of a diagnostic triad of oral and genital aphthous ulcers, meningitis, and relapsing iridocyclitis. Vascular lesions including arterial and venous occlusions, arterial aneurysms and varices are one of the common complications of Behçet's disease occur most commonly in the abdominal aorta, femoral arteries and pulmonary arteries. There have been only four reports of aneurysms of cerebral arteries in the literature. The authors describe a patient with Behçet's disease who suffered secondary subarachnoid hemorrhage due to a ruptured aneurysm of the anterior communicating artery 3 years after the initial diagnosis. This case report draws further attention to this rare entity in patients with Behçet's disease.

Endorphins have been implicated in the pathophysiology of spinal cord injury. The effect of naloxone on the sodium- and potassium-activated and magnesium-dependent adenosine-5'-triphosphatase (Na(+)-K+/Mg+2 ATPase, EC.3.6.1.3.) activity, lipid peroxidation, and early ultrastructural findings were studied in rats at the early stage of spinal cord injury, produced with an aneurysm clip on the T2-T7 segments. The rats were divided into four groups. The 10 rats in Group I, which had no injury and received no medication, were used for determining Na(+)-K+/Mg+2 ATPase activity, the extent of lipid peroxidation (by measuring the level of thiobarbituric acid-reactive substances as malondialdehyde), and normal ultrastructural findings. On the 15 rats in Group II, without spinal cord injury, only laminectomy was performed to determine the effect of surgery on the biochemical indices and findings. In the 15 rats in Group III, physiological saline was administered intraperitoneally in an amount equivalent to that of the naloxone administered immediately after spinal cord injury. In the 15 rats in Group IV, 0.5 mg of naloxone was administered intraperitoneally as a single dose immediately after injury and again 60 minutes after injury. The Na(+)-K+/Mg+2 ATPase activity was promptly reduced after spinal cord injury and remained in a lower level than the levels of Groups I and II during 120 minutes after injury. Naloxone treatment, immediately after trauma, attenuated the inactivation of Na(+)-K+/Mg+2 ATPase. On the other hand, there was a significant difference in the malondialdehyde content between animals in Groups I and III. Naloxone treatment reduced the malondialdehyde content in Group IV.(ABSTRACT TRUNCATED AT 250 WORDS)

Intracranial dissecting and giant serpentine aneurysms are rare vascular anomalies. Their precise cause has not yet been completely clarified, and the radiological appearance of such lesions can be different in each case according to the effect of hemodynamic stress on a pathologic vessel wall. For berry aneurysms, available evidence overwhelmingly favors their causation by hemodynamically induced degenerative vascular disease and there is an obvious need to determine the hemodynamic parameters most likely to induce the precursor atrophic lesions. In this study, a case of a giant dissecting aneurysm angiographically mimicking serpentine aneurysm of the right ophthalmic artery is reported and the relevant literature is reviewed to investigate the pathological characteristics and pathogenesis of this lesion. In the present case, radiological investigation of the lesion suggested a serpentine aneurysm, but the diagnosis was corrected to dissecting aneurysm subsequent to the pathological examination of the resected aneurysm. A giant dissecting aneurysm angiographically mimicking serpentine aneurysm and developing as the result of a circumferential dissection located between the internal elastic lamina and media is of particular interest when the etiology of these aneurysms is considered. To our knowledge this is the first report on intracranial dissecting aneurysm mimicking serpentine aneurysm angiographically. Our case illustrates the importance of careful serial section studies for a better understanding of the vascular pathology underlying the processes involved in intracranial serpentine aneurysms. We conclude that serpentine, dissecting and berry aneurysms may all arise by way of similar pathophysiological mechanisms.

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