Objectives We report our institutional experience with calcifying pseudoneoplasms of the skull base that presented with cranial neuropathies. These lesions are also known as fibro-osseous lesions, cerebral calculi, or brain stones.Results One patient presented with facial numbness and retro-orbital pain secondary to compression of the maxillary branch of the trigeminal nerve at the anterior portion of the infratemporal fossa. The other patient presented with occipital headaches and hypoglossal nerve palsy. This patient was found to have a calcified lesion in the posterior fossa, which eroded the left occipital condyle.Conclusion Calcifying pseudoneoplasms are benign, slow-growing masses that are apparently cured by gross total resection. Even with incomplete tumor resection, the prognosis is considered to be favorable. We advocate a minimally invasive surgical resection of such tumors involving the cranial nerves.

We report a case of a closed outer-table parietal "ping-pong" skull fracture occurring in a 4 190-gram female infant born at 39 weeks and 5 days gestation after an uneventful Cesarean section (Apgar scores of 9 and 9 at one and five minutes). There was no maternal history of abdominal trauma during pregnancy and there were no complications or difficulties with Cesarean section delivery. Neurological examination was normal. Computed tomography with three-dimensional reconstruction images showed a 4 x 5 cm depression in the right parietal bone with a medial lucency consistent with a fracture of the superior margin of the skull and leftward deviation of the sagittal suture and sinus. Spontaneous resolution did not occur by one month of age and the skull fracture was repaired with excellent cosmetic results. Rarely has a case of spontaneous intrauterine skull fracture been reported in an atraumatic Cesarean delivery. We believe this fracture resulted from a chronic in utero process without associated trauma as evidenced by deviation of the sagittal suture and sinus.

Optimal surgical exposure during the transcondylar approach may result in injury to the hypoglossal nerve. This study evaluated the utility of three-dimensional computed tomography (3-D CT) as a means of obtaining detailed anatomic information in an individual patient prior to surgery involving the hypoglossal canal. We studied 20 hypoglossal canals in ten patients using 3-D CT reconstructed from 1-mm CT slices. Detailed anatomic measurements were performed to define the relationship of the hypoglossal canal to the occipital condyles and clivus. The relationship of the hypoglossal canal to the occipital condyles and clivus were extremely variable. From the outer table of the clivus in the midline, the extracranial opening of the hypoglossal canal was 20.3 + 2.7 mm (range 15.7-24.7 mm). The intracranial opening was 7.4 + 2.3 mm (range 6.2-11.5 mm) from the inner table of the clivus. From the superior aspect of the condyle, the inner opening was 11.0 + 1.4 mm (range 8.7-12.7 mm) and the outer opening was 19.1 + 2.4 mm (range 14.3-22.8 mm). From the lowest point of the condyle, the outer opening was 12.4 + 2.1 mm (range 9.1-15.6 mm). The posterior condylar emissary vein was 12.2 + 3.0 mm from the intracranial opening of the hypoglossal canal. Three-dimensional CT is a useful tool for assessing critical anatomic relationships and tailoring surgical approaches for individual patients. The amount of bone that can be safely removed without violating the hypoglossal canal can be determined preoperatively for each patient.

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