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HE finding of a vascular structure, aneurysm, arteriosclerotic plaque, or anomalous vascular channel with encroachment on a cranial nerve causing some degree of pain or paresis has been frequently described. 2,4,7-9,13 This paper concerns facial pain or spasm as the clinical manifestation of persistence of the trigeminal, acoustic, or hypoglossal artery. Case Reports Case 1. This patient, a 52-year-old woman, appeared to have the pain of typical trigeminal neuralgia over the second and third divisions of the nerve in the left side of the face. It was noteworthy, however, that the attacks were often precipitated during physical exertion, and were also frequent at night time. Neurological examination revealed that she had an area of hypesthesia over a portion of the second division of the left trigeminal nerve. Because of these atypical features in a patient with an otherwise

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The use of methyl methacrylate for cranioplastic repair in 417 patients over a 13 year period has been presented. Its advantages have been noted as well as the indications and the operative technique. Infection has occurred in less than one percent, and half of these cases (2) were due to surgical errors.Operations for repair of cranial defects have been performed for many years, and a good historical account is given by Reeves 3. Many different materials have been used which have included bone (autogenous, homogenous, and heterogenous), metal (aluminum, gold, silver, lead, vitallium, ticonium, tantalum, and stainless steel), and alloplasties (celluloid and acrylic resins). The use of many of these substances has been discontinued, but acrylic resin, tantalum and bone are ones that have remained popular and are in current use by neurosurgeons and plastic surgeons.Bone and tantalum eranioplasties were being performed by the Neurosurgical Service at Walter Reed General Hospital until 1957 when the acrylic resin, methyl methaerylate, was evaluated. Methyl methaerylate is known by various trade names as lucite, vitaerylic, plexiglass or crystallite.Since our preliminary evaluation with methyl methacrylate, we have continued to use it as the material of choice, to the virtual exclusion of all others. 4t7 patients have had insertion of methyl methacrylate prostheses from 1957 through 1969. 70 W, M. Hammon and L. G. Kempe: Pre-operative Evaluation and Operative ProcedurePrior to surgery, complete x-ray examination of the skull is performed, and where the defect includes an air sinus region, special attempts are made to try and determine the presence of any air in the sinus which would preclude the performance of the eranioplasty, but indicate the need for a further exenterative procedure. Evidence of osteomyelitis is a eontraindieation to eranioplasty.

With the introduction of additional diagnostic methods, computerized axial tomography, interventricular tumors are discovered at a time when these lesions are still small and may have presented very insignificant or no clinical symptoms. If the lesion is a benign tumor as a meningioma and within the lateral ventricle of the dominant hemisphere a very difficult problem persents itself to the patient and surgeon. Shall they wait until the tumor reaches such a size to make more permanent symptoms to justify entering the ventricle by the conventional approach through the middle temporal gyrus and leaving the patient at least with a visual field defect? Or should surgery be postponed until the ventricle especially the temporal horne is enlarged due to blockage by the tumor, making the operative procedure technically easier? The authors present a method used in three atrial trigonal meningiomas of the dominant hemisphere which did not result in any neurological deficit which was not present before surgery and which abolished paroxysmal attacks of hemianopsia and severe headaches in one patient. The latter patient was believed to have suffered from migraine for 2 1/2 years.