An 80-year-old male visited the hospital as an outpatient with a head injury sustained in a traffic accident. Brain computed tomography incidentally revealed a left frontal lobe tumor measuring 5 cm in a diameter. The patient had a history of taking chlormadinone acetate (a progesterone agonist) prescribed several years previously as treatment for benign prostatic hypertrophy. The tumor was seen as an isointense lesion on T 1 -weighted magnetic resonance (MR) images with enhancement by gadolinium, and as a heterogeneously hyperintense mass on T 2 -weighted MR images. The tentative diagnosis was left frontal meningioma attached to the sphenoid ridge or sphenoid plane. The patient was managed conservatively because of his advanced age and no symptoms or progression were observed during a 9-month follow-up period. The medication for benign prostatic hypertrophy was changed from chlormadinone acetate to naftopidil (an alpha-2-blocker) about 9 months after his first presentation. The patient presented again 2 years later complaining of dizziness. Computed tomography and MR imaging performed at this time revealed remarkable regression of the tumor. The signal intensity change with regression of the tumor on T 2 -weighted images was observed as a hypointense lesion. Thus, we wish to emphasize that treatment of meningiomas, especially those diagnosed incidentally, must be based on a thorough consideration of any history of hormonal therapy with prostate disease.

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Fracture of the anterior arch of the atlas is a rare complication of foramen magnum decompression(FMD)for Chiari malformation. We report a case of a fracture of the anterior arch of the atlas after FMD. A 42-year-old woman was referred to our hospital from a nearby clinic where Chiari malformation and syringomyelia were incidentally detected during head magnetic resonance imaging (MRI)examination for headache. We performed FMD and tonsillectomy for the Chiari malformation. The patient had an uneventful postoperative course and was in good condition when discharged. She developed neck pain without any preceding incident approximately 7 months after surgery. Subsequently, she experienced neck pain during flexion, extension, and sneezing. Neck computed tomography(CT)performed at a nearby clinic revealed a fracture of the anterior arch of the atlas, and she was referred to our hospital once again. Although neck radiography did not confirm an instability of the craniocervical junction, the neck pain progressed；thus, posterior atlantoaxial fusion was performed. Due to the thinning of the C2 vertebral pedicles, part of the C2 vertebral arch was removed during FMD, and pars screws were inserted into the C2 vertebra with lateral mass screws inserted into the C1 vertebra. The subsequent postoperative course was uneventful. Three cases have been reported in the literature, and the mechanism of injury(e.g., trauma)was not confirmed in all of them. Posterior fusion was used in 2 cases, external immobilization with a halo vest was used in 1 case, and fracture healing was achieved with a good prognosis in all three cases. When neck pain develops a few months after FMD, fracture of the anterior arch of the atlas should be suspected and preferably confirmed using CT.

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