SummaryA review of 116 cases of coexistent brain tumours and intracranial arterial aneurysms is made. The eases were collected from the literature, personal experience (8 cases) and different ncurosurgical centres all over the world.According to the literature the general incidence of intraeranial arterial aneurysms does not seem to be higher in brain tumours than in the general population. Our own material is not suitable to contribute to this question.Several factors may explain the presence of some intracranial arterial aneurysm accompanying different groups of brain tumours. Localization as well as local circulatory changes may be responsible for the higher incidence of intracranial arterial aneurysms, especially those located in the internM carotid artery group found associated with tumours at the base of the skull (basal meningiomas and pituitary adenomas). A high incidence of aneurysms of the middle cerebral artery group accompanying ipselateral tumours may be due to an increased regional blood flow, because of the vascularity of certain tumours.A dysgenetic factor might explain the high incidence of multiple aneurysms in meningiomas and other various tumours of congenital origin.Clinically the presenting symptomatology was mainly one of a space occupying lesion. From a therapeutic point of view a combined surgical approach to tumour and aneurysm is accompanied by better results in basal meningiomas and pituitary adenomas.

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A classification of aneurysms of the posterior cerebral artery from a series of 8 personal cases and 34 cases collected from the literature is attempted. The classification is based on the topography and sites of origin of the cortical and central branches of the artery. The artery was divided into six sections which permitted the description of the origin and projection of typical aneurysms. Single cases of atypical aneurysms can be explained by the known vascular anomalies. The predilective site is section B (origins of the posteromedial choroidal artery and quadrigeminal artery), then section D with the main division of the posterior cerebral artery and origins of the anterior temporal artery, the anterior posterolateral choroidal artery, the hippocampal artery and the thalamogeniculate artery, and finally section C--the junction with the posterior communicating artery. Clinical syndromes corresponding to these locations are described. The classification, when considered together with improved angiographic technique and microsurgery, allows exact preoperative and peroperative definition of topography which in turn enables the avoidance of injury to functionally important typical and atypical central branches of the posterior cerebral artery.

Report of 251 spontaneous intraeerebral haematomas (aneurysms 48, angiomas and microangiomas 89, hypertension 64, miscellaneous aetiology 22, tumours 28) and among them of 125 intraventrieular bleedings. The relations are checked and discussed between aetiology, age distribution, localization, forms of ventrieular bleeding, development, evolution and severity of symptoms, and the prognosis. As for the indication of operation the result of these findings is to get early diagnosis of lobar haematoma with or without ventrieular bleeding, and of general intracranial hypertension by means of Eeho-Encephalography, early angiography and CSF. Age, aetiology and time of operation are of less importance.Close diagnostic and therapeutic cooperation with internists, and neurologists, and modern intensive care are of greatest importance for the early and late outcome.Out of 144 cases with intracerebraI, including intraventricular haematomas subjected to operation 33 died and ill survived.Surgical treatment of spontaneous intracerebral haematomas is debatable when the haemorrhage is due to hypertension, or localized in the basal ganglia, or when the ventricles are invaded by clot. When deading whether to operate or not, one should consider the aetiology and localization of the haemorrhage, the age of the patient, the evolution of the disease and symptoms, cerebral and general shock and stress reactions, and the mortality rate.In the present article, certain aspects are considered from the clinical point of view. The personal material of 251 spontaneous haematomas (Table 1) shows wellknown aetiological subdivisions. In 35 ~o of the patients an angioma or probable microangioma was the cause of the

An account is given of 93 spinal angiomas found in 74 patients. 55 were solitary malformations and 38 were comp]ex. In 5 patients angioma and ~ngioblastoma were both present, and in I case an angioma was found in association with an aneurysm.The main problems of morphology, diagnostic investigation, improvement of early diagnosis, complications as a result of bleeding and circulatory disturbances with arachnoiditis and myelo-malacia and the microsurgieal treatment with radical removal and the palliative procedures are discussed.Results depend on the situation of the angioma. After total extirpation of intradural angiomas in 34 cases, 14 patients recovered completely, 13 recovered partially, 5 were unchanged, and 2 deteriorated.With. the development of selective methods of angiography and improvements in operative technique, accurate diagnosis and operative treatment of spinal angiomas have become more practicable.In contrast with cerebral angiomas there seems to be no agreement so far on operative methods and indications. The reasons for this seem to be scanty experience, diversity of clinical material, and differing presentations in relation to functional morphology and pathogenesis. In practice one of the most important problems is early diagnosis. I am reporting some of our own experiences in the hopes of answering some of these questions. MorphologyOur observations deal with 74 patients with a total of 93 angiomas (Fig. 1). Of these 55 were solitary and 38 complex. In the latter group the vertebral-extradnral type were more numerous than the extraduralintradural variety.Quite remarkable are those angiomas showing involvement of all the contiguous layers, apart from the skin and the dnrG Acta ]~euroehirurgica, Vol. 28, Fasc. 1--2 1