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Henry T. Wycis

of the roentgenologic findings in this case. “Advanced Paget's disease of the skull and upper cervical spine is here visualized ( Fig. 1 ). This is characterized by thickening of the bone with loss of demarcation of the outer table of the skull. Many small distinct and conglomerate areas of increased bone density are seen. These are characteristic of the disease. Fig. 1. Right lateral projection of skull showing advanced Paget's disease with secondary platybasia (marked flattening of the “basal angle” between floor of anterior fossa and clivus) and

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Dean H. Echols

appeared to exist on the left. The floor of the temporal fossa was completely eroded and the soft palate could be felt. The posterior third of the bony orbit of each eye had been completely eroded, and the sphenoids and ethmoids were gone. About two-thirds of the clivus was completely eroded and the tumor was removed from this area in its entirety. At the end of the procedure the optic chiasm and both optic nerves hung suspended in mid air unsupported from the base of the brain to the globes of each eye. The patient's condition at the end of the operation was excellent

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Antonio Gonzalez Revilla

clivus. The base of the tumor was attached to the dura, where there was a thick layer of newly formed bone. There was softening of the left half of the medulla and pons. The remaining 3 patients had complete relief of symptoms after operation. Comment . Four cases of meningioma at the cerebellopontine angle producing tic douloureux have been summarized. The primary symptom was that of intermittent attacks of lancinating pain in one side of the face. There was impairment of hearing in 1, the other 3 showing no evidence of other cranial nerve involvement. The

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Eldridge Campbell and Robert D. Whitfield

) those that took origin above the clivus or in the cerebellopontine angles. In the first group, symptoms and signs were not unlike those of many neoplasms of cerebellar origin. Save for the rather long history in Case 2 and the tell-tale calcification in Case 3, there was no evidence upon which to predict the type of tumor. On the other hand, meningiomas of the clivus and cerebellopontine angle involved cranial nerves early, grew relatively slowly, eroded underlying bone deeply, involved brain stem structures much less quickly than gliomas that arose within it, and in

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Jerzy Chorobski and Lucjan Stȩpien

to the left, and some adiadokokinesis, especially in the left hand. Roentgenograms of the skull and the cervical spinal column revealed that the basiocciput and the clivus Blumenbachii were pushed into the interior of the posterior cranial fossa, so that the corpus of the 1st cervical vertebra and the dense epistropheus stood higher than normal. The lamina of the atlas was touching the posterior edge of the foramen magnum. There was also a spina bifida atlantis, and osteoporosis of all the cervical vertebrae (Prof. W. Zawadowski). Diagnosis: Malformation of the

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James L. Poppen and Arthur B. King

I t has been nearly a century since slimy, sessile tumors on the clivus blumenbachii were first recognized. For fifty years, it has been established that these neoplasms originated from remnants of the embryonic chorda dorsalis. Since then, tumors of this tissue have been described arising along the entire axis ( Fig. 1 ) of the chorda from the sphenoid region to the coccyx. When fragments became isolated chordomas were found in unusual positions, such as the alveolar process of the mandible, the maxilla, tonsillar region and superior portion of the occipital

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James L. Poppen and Eugene W. Skwarok

vicinity of the foramen magnum. Ecker 1 reported a case of meningioma which arose from the clivus, anterior to the medulla, in which there was involvement of all extremities. Piehl, Reese and Steelman 2 in reporting 3 unusual cases of meningioma, described one case in which the meningioma was located at the level of the foramen magnum and resulted in the motor involvement of all extremities. The following case is presented because of the puzzling and bizarre symptoms and signs which resulted from a single left frontoparietal meningioma that weighed 310 gm., and also

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Persistent Carotid-Basilar Anastomosis

Three Arteriographically Demonstrated cases with one Anatomical Specimen

Clinton R. Harrison and Charles Luttrell

division of the trigeminal nerve, the medial portion of the gasserian ganglion, and the sensory root of the trigeminal nerve. As the artery leaves the cavernous sinus it emerges through an opening formed by a groove in the posterior petrosal process whose roof is the petroclinoid ligament. At this point the abducens nerve lies directly beneath it. The course now becomes almost transverse, joining the midportion of the basilar artery over the clivus. Superior to this junction the size of the basilar artery is over twice that of the portion lying between the anastomosis

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Pierre Namin

second is concave anteriorly; the third is concave posteriorly. The principal trunk remains at a slight distance from the clivus. The preprotuberal cistern is in front of it. We insist on these two signs: the triple curvature and the interclivoarterial space, the importance of which will be shown in the discussion of tumors of the cerebellum. The principal vascular trunk is at a rather variable angle with the plane of Frankfort. The angle has an average of 73 degrees; it varies from 50 to 80 degrees. It never terminates below the clinoidal line (a line parallel to

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A Case of Carotid-Basilar Anastomosis

With Multiple Associated Cerebrovascular Anomalies

J. P. Schaerer

following day, the patient became suddenly comatose; his respirations deepened, and became irregular and stertorous. He expired within 30 minutes, at 2:30 a.m. Autopsy was limited to the head. It disclosed the following cerebrovascular anomalies: 1. Persistent carotid-basilar anastomosis on the right, arising from the internal carotid artery in its intradural portion. It was seen to swing medial to the right posterior clinoid process, passing in the midline down to emerge in the midline from the dura mater covering the clivus, joining the basilar artery in its