One-hundred thirty-six patients operated on for extra-axial tumors of the posterior and middle cranial fossae were retrospectively evaluated to define the relevance of trigeminal nerve dysfunction and to correlate clinical and surgical observations. The following data are reported: tumor types, presence of specific trigeminal symptoms and signs, mean duration of symptomatology, anatomical relation between tumor and fifth nerve. Trigeminal symptoms were present in 45 subjects (33.08%) with a mean duration of 23.56 months. Frequency of symptoms was different in various oncotypes. Fifth nerve disturbances were the symptom of onset in 18 subjects (13.23%). A tumoral involvement of the nerve was reported at surgery in 73 patients (53.67%) and was defined as contact, compression or infiltration. Postoperatively, 12 patients showed an improvement of fifth nerve disturbances. A statistically significant difference (p < 0.05) was found in: (1) the incidence of symptoms in patients with and in those without anatomical trigeminal involvement: (2) the incidence of signs in the same groups; (3) the incidence of postoperative relief in patients with fifth nerve compression compared to patients with different surgical findings; (4) the incidence of postoperative relief in patients with typical trigeminal neuralgia compared to those with other symptoms.

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Neoplastic involvement of the trigeminal nerve was observed in 73 patients operated on in our institution for extra-axial tumours of the posterior and middle cranial fossae. It was defined as contact, compression, or infiltration. The nerve root was involved in 58 patients, the ganglion and/or the peripheral divisions in 9, all portions of the Vth nerve system in 6. A clinical trigeminal dysfunction was present in 44 patients (60%). Anatomico-surgical findings are correlated with clinical features and with tumour type. Typical trigeminal neuralgia was the complaint in 7 subjects; all of them presented an involvement of the sensory root. Post-operatively, 11 patients were relieved of their symptoms. The outcome is correlated with the anatomical findings and with the extent of surgical removal of the tumours. The importance of a careful evaluation of patients with trigeminal symptomatology is stressed.

The appearance of cerebral metastases of malignant melanoma (MM) more than 10 years after the primary diagnosis is extremely rare. We report the case of a patient with a solitary brain metastasis of MM who came to our observation 11 years after the treatment of the cutaneous lesion. This patient, who up until then had appeared disease free, presented with two episodes of intracranial haemorrhage in a 5-month period. Neuroradiological findings (CT, MRI, angiogram) did not suggest a brain metastasis. The correct diagnosis was reached only after histopathological examination of the surgically removed lesion. On the basis of this experience, we stress the importance of a long-term clinical and radiological follow-up of all patients with MM.

ZusammenfassungDie Vena giacomini verbindet das Stromgebiet der oberflächlichen Stammvenen Vena saphena magna (VSM) und Vena saphena parva (VSP) im Sinne einer kollateralen Vernetzung. Sie wird häufig sowohl in der präoperativen Diagnostik wie auch während der Operation aufgrund ihrer variablen Anatomie und der schweren Zugänglichkeit übersehen oder vernachlässigt. Die V. giacomini stellt dadurch bei Stammvarikosis von VSM und/ oder VSP eine pathophysiologische Verbindung her, wodurch die Insuffizienz der einen Stammvene auf die andere übertragen werden kann und Rezidiventwicklung begünstigt wird. Anhand von 173 Fällen werden Problematik, Konzepte und Strategien der Chirurgie dieser Vene dargestellt.