The authors present four cases of vascular lesions and 10 cases of tumors involving the cavernous sinus. They were operated on via a combined orbitozygomatic infratemporal epidural and subdural approach. With this approach, multisided exposure of the cavernous sinus can be achieved via the shortest possible distance with minimal retraction of the neural structures in and around the cavernous sinus. In one patient the carotid artery had been occluded previously, but in the other 13 patients it was preserved. There was no mortality, and all patients except one returned to work within 6 months after surgery.

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The authors report eight cases of trigeminal neurinoma managed over the past 13 years with radical resection at a single-stage operation. Three patients were male and five were female, ranging in age from 25 to 56 years (mean 41.5 years). One had von Recklinghausen's disease. The tumors were located mainly within the middle fossa in two cases and within the posterior fossa in two, and extended both supra-and infratentorially in four cases. Facial pain and hearing disturbance were the main symptoms, with various other symptoms such as focal seizures, hemiparesis, gait disturbance, increased intracranial pressure, and visual disturbance also being noted. All patients underwent radical tumor resection with either a transpetrosal transtentorial or orbitozygomatic infratemporal surgical approach; the approach depended on the topography of the tumor. Total removal was performed in all cases. Only one patient, treated early in the series, required a second operation to remove the tumor completely. In another case the tumor recurred 5 years after the operation. There has been no operative mortality, but injury or permanent damage to the trigeminal branches was inevitable in many cases. The surgical results were excellent in three patients and good in five.

SummaryMeningiomas which arise from the clivus are extremely rare. According to Dany8), the incidence of this tumor is 8.4% of the meningiomas of the posterior fossa and 0.125% of all brain tumors. The clinical features of the clivus meningioma consist of asymmentrical bilateral cranial nerve involvements (especially V, VII, VIII, IX, X), cerebellar and long tract signs and increased intracranial pressure. Practically, VAG and CAG are the most useful diagnostic procedures.Results of treatment have been quite disappointing, primarily because of the position of the mass which is anterior to the brain stem and in direct contact with the vertebral and/or basilar artery. Most neurosurgeons would consider it to be inoperable and would simply perform a biopsy or partial removal. However, when the tumor is not too large and hard, total removal of a clivus meningioma should be tried with some precautions. The approach must be chosen to provide the shortest access to the main feeders, and multisided exposure should be obtained according to the location and the extension of the tumor. The results which have been obtained in our own 6 cases are encouraging. Case Reports Case 1. A 45-year-old male presented a 2 year history of difficulty in walking and swal lowing, a one-year history of double vision on looking to his left, leaking of saliva and food from the left corner of the mouth, and a few months history of psychic disturbances such as easy crying and forced laughter.Examination showed left abducens palsy, absent corneal and gag reflex on the left side, left peripheral facial paresis, dysarthria, positive Romberg's sign, horizontal nystagmus on the left lateral gaze, and limb ataxia on the left side. Plain roentgenograms were negative. Bilateral retrograde vertebral angiogram (VAG) dem onstrated that the basilar tip was displaced 2 cm backward (Fig. 1A) and shifted to the right (Fig. 1 B). The left posterior cerebral artery was dis placed upward and arched. The left superior cerebellar artery was shifted backward and medially (Fig. 1 B). Left carotid angiogram (CAG) showed that the carotid siphon was opened. There were several tumor vessels com ing from meningeal branches off the cavernous portion of the left internal carotid artery (Fig. 2). Pneumoencephalograms demonstrated no air in the ventricular system and bilateral ponto cerebellar cisterns. The pericallosal cistern was widened.Operation. On Sep. 25, 1972, left temporo occipital craniotomy and left suboccipital craniectomy as well as left mastoidectomy and removal of the posterior part of the petrosal bone were performed. The left sigmoid sinus was divided. Amputation of the lateral half of the cerebellar hemisphere and tentoriotomy were made. A round granular, hard-elastic, and un suckable mass was located ventral to the brain stem and attached to the left upper lateral part

Five cases of sinus pericranii are presented, four congenital and one traumatic. All five cases were successfully treated with extirpation and reinforcement with Gelfoam and silk thread over the skull openings. The literature on this rare symptom-complex is reviewed and a new definition of sinus pericranii proposed.