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Samruay Shuangshoti, Vira Kasantikul, Nitaya Suwanwela and Charas Suwanwela

✓ A case is presented of a solitary primary extracerebral mixed glioma occurring in the right suprasellar and parasellar region of a 49-year-old woman who had bilateral temporal hemianopsia for 3 months. At craniotomy, the well demarcated outline and extracerebral location of the tumor suggested that it was a meningioma. However, its gliomatous nature was confirmed by identification of glial fibrillary acidic protein (GFAP) in the tumor cells. Review of nine reported solitary primary intracranial extracerebral gliomas, including the present case, revealed that they tended to occur in the third to fifth decades of life, in patients with an average age of 42½ years, and without sexual predilection. All were supratentorial with a tendency to be situated in the vicinity of the Sylvian fissure. Only the glioma in the present case was at the cranial base. They were diagnosed as three astrocytomas, two glioblastomas, two oligodendrogliomas, one astroblastoma, and one mixed glioma. A suggestion is made that all these gliomas arose primarily from heterotopic neuroglia in the leptomeninges.

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Charas Suwanwela, Nitaya Suwanwela, Srisakul Charuchinda and Chaturaporn Hongsaprabhas

✓ Six patients with intracranial mycotic aneurysms of extravascular origin are reported. Four had aneurysms of the intracavernous portion of the internal carotid artery associated with thrombophlebitis of the cavernous sinus, and two had aneurysms of the cerebral arteries associated with meningitis. An aneurysm of this type may rupture, producing subarachnoid hemorrhage, or it may become thrombosed and decrease in size or spontaneously disappear. In some patients it may persist and develop calcification in the wall.

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Charas Suwanwela and Nitaya Suwanwela

✓ Arteriography in 350 patients with a moderate to severe head injury, including repeated studies in 40 patients, revealed narrowing of one or more of the intracranial arteries in 65 patients (18.6%). Narrowing of the intracranial portion of the internal carotid artery and the first part of the anterior and middle cerebral arteries was found in 18 patients and was believed to be responsible for the clinical symptoms in some. Narrowing of the branches of the cerebral arteries at the site of the cerebral contusion was seen in 33 patients and diffuse narrowing of the intracranial arteries in 12. In two additional patients with gunshot wounds of the brain, there was narrowing of the cerebral artery adjoining a torn vessel. The evidence suggests that vascular spasm is responsible for the narrowing in some patients, while contusion and hemorrhage in the arterial wall is the cause in others. Whatever the mechanism, the occurrence and significance of cerebral arterial narrowing in association with acute head injury needs to be emphasized.

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Charas Suwanwela and Nitaya Suwanwela

✓ Cranial defects and cerebral abnormalities as revealed by postmortem dissection in 12 patients with sincipital encephalomeningocele are reported. The various methods of classifying this lesion are discussed. A classification based on the location of the defect in the cranium is outlined. The clinical application of such a classification and its usefulness in the surgical management are emphasized.