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Solitary plasmacytomas rarely develop in the skull, meninges, or brain. Ophthalmic signs as the initial manifestations of solitary intracranial plasmacytoma have rarely been described. We report the neuro-ophthalmologic, imaging, and pathologic findings for two patients. One patient presented with optic neuropathy, the second with bilateral sixth nerve palsies. Plasmacytoma is a treatable intracranial tumor that should be considered in the differential diagnosis of patients who present with optic neuropathy or sixth nerve palsy.

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THIS IS TO REPORT the successful use of a two-rib incision for a resection of the esophagus with an esophagogastrostomy above the aortic arch. With the usual incision through the left chest1-7 the operative exposure either high or low in the chest has been poor, especially for the dissection of the esophagus from under the aortic arch and for the anastomosis high in the chest. This difficulty has been previously avoided by (i) separate abdominal and right thoracic incisions, and (2) various types of left thoracico-abdominal incisions. The first type have the disadvantage of not being able to determine the operability before a major abdominal stage of the procedure has been completed. The second type have the disadvantage of being time-consuming, tedious, and quite traumatic to a patient already in poor condition.DeBakey and Ochsner8 in I948, after using the left thoracico-abdominal incision, suggested the use of a two-rib approach through the beds of the seventh or eighth ribs for the lower thoracic part and through the bed of the fourth rib for the superior thoracic part of the operation. They suggested the incision as being less traumatic, less time-consuming, and as designed to overcome the objections of the other incisions.The incision used in this report was located over the left eighth rib from the costochondral end posteriorly to its angle, then superiorly to the level of the fourth rib. The eighth rib was completely removed to its angle posteriorly and 1 cm. segments posteriorly were removed from the ninth, seventh, sixth, and fifth ribs. After the subaortic esophageal dissection and transdiaphragmatic freeing up of the stomach had been completed, the fifth rib was removed and the superior esophageal dissection and esophagogastrostomy were more easily done. Removing the fifth rib added very little time to complete the incision and greatly shortened the total operating time by enabling a much easier and safer dissection of the esophagus from behind the aortic arch and a more accurate esophagogastrostomy.