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Sodium valproate (VPA) was first marketed in the United States in 1978. In this pilot study of pharmacokinetics and toxicity, VPA was added to the treatment regimens of 20 patients (10 adults and 10 children) with intractable seizures. The drug was absorbed and excreted rapidly; the mean half-life was 9.6 hours. Drowsiness and gastrointestinal symptoms were the most common side effects, but they were usually minor and transient. An increase in some plasma phenobarbital levels and a decrease in some plasma phenytoin levels were attributed to drug interaction. Control of absence attacks was assessed by 12-hour telemetered electroencephalograms. Sodium valproate was most efficacious in generalized seizure disorders, particularly absence seizures.

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The difficulty in the operation for basilar tip aneurysm is the restriction in surgical working space. To resolve this problem, aggressive skull base surgery has been reported, but these techniques are not prevalent. Pterional and subtemporal approaches are commonly used for basilar tip aneurysms. In an attempt to increase the surgical working space during the pterional approach, the anterior clinoid process and the roof of the optic nerve were removed extradurally to increase the mobilization of the intracranial internal carotid artery and optic nerve. The effects of removing the anterior clinoid process and microanatomy in the perioptic area were analyzed by cadaveric procedures in 10 cases (20 sides). With this procedure, the internal carotid artery can be retracted medially with a spatula 6.1 +/- 0.8 mm (mean +/- SD). The length and the area of dural fold in the bone defect region in the optic canal roof are 2.1 mm and 13.6 mm. In 10 clinical cases, this procedure allowed enough space to approach the basilar tip aneurysm without disturbing the internal carotid artery blood flow. The clinical outcome was satisfactory.

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