In 1964, a 51-year-old man experienced a right abducens nerve palsy, which resolved spontaneously. In 1978, he developed painful ophthalmoplegia on the right with paresis of the right oculomotor and trigeminal nerves. Neuroradiographic evaluation was reported unremarkable, and the painful ophthalmoplegia was attributed to the Tolosa-Hunt syndrome. High-dose corticosteroids were administered with transient improvement of signs and symptoms. In 1979, cranial computerized tomography demonstrated a low-density lesion adjacent to the right cavernous sinus, which at operation proved to be an epidermoid tumor.

A 62-year-old woman presenting with intracranial lesion eroding the sella with compression of optic chiasma was found to have plasmacytoma of the pituitary area. At the time of initial surgery, the patient had no biochemical, immunologic or marrow findings of multiple myeloma. The intracranial tumor was interpreted initially as chromophobe adenoma on light microscopy, but the diagnosis of plasmacytoma was established by electron microscopic examination of the tumor. The case illustrates the usefulness of electron microscopy as a diagnostic tool.

Hydrocephalus is caused by an imbalance between the production and absorption of cerebrospinal fluid. Ventriculostomy of the third ventricle now is an acceptable treatment alternative for this problem. This procedure reduces costs over the course of the illness because the patient does not require subsequent shunt revisions throughout his or her life. The specialized care and the fear associated with the dependency on mechanical hardware also are eliminated if shunt placement is avoided. Postoperative complications may include increased intracranial pressure, bleeding, infection, and pain.

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