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Vessel tortuosity as a cause of posterior fossa cranial nerve syndromes.

Neurologic syndromes may be caused by mechanical vascular compression of cranial nerves in the posterior fossa. The clinical expression is variable and can be divided into two main groups. Isolated cranial nerve involvement is most frequently associated with tortuous, elongated vertebral and basilar arteries as well as redundant loops of the anteroinferior cerebellar artery. Pseudotumoral manifestations of cranial nerve involvement at the level of the cerebellopontine angle are more frequently related to aneurysms of the vertebral and basilar arteries.

Adult

[Echotomography of the posterior cranial fossa].

The use of ultrasound tomography for the study of the posterior cranial fossa through intact bones of the skull permits to detect the contour of the cerebellar hemispheres. A scanning of the operational defect of the occipial bone allows one to determine the echotographical structure of the posterior cranial fossa and the adjacent area in a 2 plane picture which is easily correlated with the anatomical sawing of the head in the same plane. It was also possible to eliminate the contours of a recurrent cystous tumour of the cerebellum. The clinical results are correlated with the data of autopsies in experimental studies. The authors are of the opinion that the method of echoencephalotomography during surgical operations of the posterior cranial fossa is quite perspective.

Brain

[Hygroma of the posterior cranial fossa. Case report].

Posterior fossa hygroma is a rare entity. In a series of 553 cases of surgically treated traumatic subdural lesions, reported by Jamieson and Yelland, only 14 were in the posterior fossa; of these 7 were hygromas and 7 haematomas, giving an incidence of only 1,4% of all subdural haematomas. This report describes a case of a posterior fossa hygroma, that occurred in a 16-years-old boy, 4 days after an occipital head injury.

Adolescent

[The blood vessels of the posterior cranial fossa. anatomy, pathophysiology, clinic--a survey (author's transl)].

Pathophysiology and tomography of the blood vessels of the posterior cranial fossa gain clinical interest in treatment of diseases of the inner ear, complications of middle ear inflammations, tumors of the pyramid and cerebello-pontine angle. Numerous variations in the arterial venous system restrict neuroradiological procedures. Techniques to treat a thrombosis of the sinuses were developed 50 years ago. Surgical procedures to remove glomus tumors of the pyramid could be improved by new anatomical and surgical experiences. Unilateral neck dissection occasionally alters the blood flow in the sinuses of the posterior cranial fossa causing serious complications.

Basilar Artery

[Angiographic diagnosis of expanding processes in the posterior cranial fossa using a new topographic line].

The authors proposed a new rentgenometrie method allowing objective determination of the site of expanding lesions in the posterior cranial fossa. On the lateral angiograms of the vertebral arteries they determined the position of the choroid point of the posterior inferior cerebellar artery in relation to the line joining internal occipital protuberance with the upper ridge of acetabulum of the mandibular articulation. On the material of 50 subjects with expanding lesions of the posterior cranial fossa the authors determined interrelationship between the shift of the choroid point and the site of the lesion. They pointed out that the presented method can be of a considerable diagnostic value. In the presented material it allowed for the precise determination of localisation of the tumour in 86% of the cases.

Brain Neoplasms

The potential of vertebral phlebography for the diagnosis of tumours in the posterior cranial fossa.

The diagnostic value of the vertebral phlebogram is emphasized. A practice orientated principle is recommended for the classification of infratentorial veins. A total of 132 phlebograms taken from patients with intratentorial tumours is analyzed for local diagnosis, general diagnosis, venous circulatory disorder, and pathologic veins. An example is given to underline the importance of tomography in vertebral phlebography.

Brain Neoplasms

[Angiographic findings in 86 confirmed tumours of the posterior cranial fossa (author's transl)].

The accuracy of vertebral angiography in the diagnosis of tumours was reviewed on the basis 368 selective angiograms. The greatest accuracy was achieved with space-occupying lesions situated centrally in the cerebellum in the region of the fourth ventricle or in the vermis. However, tumours growing eccentrically, but arising in this region, were occasionally missed. Least reliable is the angiographic diagnosis of tumours is the cerebellar hemispheres. Of these, only about two-thirds could be demonstrated. Only 60% of cerebello-pontine tumours were diagnosed from displacement of various structures, another 10% by the presence of pathological vessels or tumour staining. The classic angiographic picture of pontine tumours is rare. Brain stem tumours are frequently eccentric and may simulate cerebello-pontine angle tumours. The demonstration or exclusion of brain stem involvement can be difficult. In view of the implications for treatment, this should, however, always be attempted.

Adolescent