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Ryoji Ishii, Susumu Sato, Komei Ueki, and Yo Oyake

ventral and rostral surfaces could not be examined ( Fig. 2 ). The total mass removed weighed 23 gm. After the tumor had been subtotally removed, the dilated aqueduct of Sylvius could be recognized, and cerebrospinal fluid flowed freely into the fourth ventricle. Fig. 2. Schematic drawing of sagittal section of the brain-stem showing the tumor developing in the parenchyma of the pons without attachment to the bone or dura mater. The dotted area also may be occupied by the tumor, although this was not verified during the operation. Pathological

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David G. Kline and Hector J. Leblanc

G unshot wounds of the brain stem are usually fatal. Military series have not included missile injuries to the brain stem because soldiers with such wounds die immediately or before they reach the first echelon of medical care. 5, 7, 8, 11, 12 Civilian instances of survival after gunshot wound to the pons or medulla may have occurred but have not to our knowledge been reported. Case Report A 39-year-old taxi driver was brought unconscious to Charity Hospital on January 2, 1970, soon after an automobile collision. Examination The patient was

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Jeffrey Myers, Michael Scott, and Alexander Silverstein

publication of the case report. A short addendum with the autopsy findings was included but no specific diagnosis was given. The gross and microscopic findings were those of a typical cystic hemangioblastoma. We have been unable to find a reported case of this lesion occurring in the pons. It is interesting that in reporting the clinical case the authors were unable to find a similar case and postulated a posthemorrhagic cyst as the etiologic factor. The reader is referred to the case report for a detailed clinical story. A brief summary is included since the operation

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Stephen J. Haines, A. Julio Martinez, and Peter J. Jannetta

D andy 2 and Jannetta 5 have proposed that trigeminal neuralgia is associated with compression of the trigeminal nerve by branches of the superior cerebellar artery at the root entry zone near the pons. Their observations in large series of patients operated on for trigeminal neuralgia via the posterior fossa seem to support this proposal. 2, 6 Independent confirmation has been reported by Apfelbaum 1 and Petty and Southby, 8 again in operated patients. Another potential source of information for assessing this hypothesis would be postmortem examination of

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Osamu Akiyama, Ken Matsushima, Maximiliano Nunez, Satoshi Matsuo, Akihide Kondo, Hajime Arai, Albert L. Rhoton Jr., and Toshio Matsushima

presented in Table 1 . C: Surgical approaches around the lateral recess. The medial and lateral routes of the transcerebellomedullary fissure approach ( green arrows ) provide wide exposure of the lateral recess and the floccular peduncle. By utilizing both routes of the transcerebellomedullary fissure approach, the posteroinferior circumference ( red line ) of the lateral recess was exposed. The floccular peduncle ( green area ), rostral to the lateral recess, may be a good option for approaching lesions inside the lower pons. The orange oval shows the dorsal

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Chad D. Abernathey, Arturo Camacho, and Patrick J. Kelly

L esions of the pons and brachium pontis have long represented a difficult diagnostic and surgical challenge. A presumptive diagnosis can often be made based upon characteristic computerized tomography (CT) and magnetic resonance (MR) imaging appearances; 2, 5, 9, 26 therefore, patients have been treated purely on the basis of radiographic findings in the absence of a diagnostic tissue specimen. 7, 25, 39 The dangers of such a course are obvious; patients are frequently administered inappropriate therapy because their diagnoses were based upon clinical and

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Madjid Samii, Rama Eghbal, Gustavo Adolpho Carvalho, and Cordula Matthies

months. The following parameters were also analyzed: 1) number of preoperative hemorrhages; 2) location of the cavernous angioma (pontomesencephalic, pons, and medulla oblongata); 3) pre- and postoperative cranial nerve status; 4) pre- and postoperative motor and sensory deficits; 5) size (volume) of the cavernous angiomas; and 6) pre- and postoperative KPS scores. 16 Volume of the lesions was evaluated on MR imaging studies and calculated based the following formula: 0.75π × 0.5 sagittal diameter × 0.5 coronal diameter × 0.5 axial diameter. The postoperative

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Hans-Jakob Steiger, Daniel Hänggi, Walter Stummer, and Peter A. Winkler

, and drilling continued in this direction as needed. F: The bone that lies between the third branch of the trigeminal nerve anteriorly, the CA and cochlea laterally, the IPS medially, and the IAC posteriorly can now be removed. G and H: This exposure provides access to the BA and the ventral pons down to the seventh and eighth cranial nerves. AE = arcuate eminence; CB = cochlear block; VI = sixth cranial nerve. The dura on the petrous apex is then incised in an anterolateral direction ( Fig. 2C ) and stripped from the petrous apex. At this stage, the petrosal

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Maria Koutourousiou, Francisco Vaz Guimaraes Filho, Tina Costacou, Juan C. Fernandez-Miranda, Eric W. Wang, Carl H. Snyderman, William E. Rothfus, and Paul A. Gardner

postoperative month) of T1-weighted sequences and evaluated with the same criteria. Four parameters were studied and compared in the two populations: 1) the pontine location/displacement, 2) the maximum anteroposterior (AP) diameter of the pons, 3) the maximum AP diameter of the fourth ventricle, and 4) the cervicomedullary angle (CMA). Instead of the clival plane (given the postoperative absence of the clivus bone), the location of the pons was evaluated using a line drawn from the anterior commissure to the basion ( Fig. 1 ). This line is not parallel and is slightly

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Daniel D. Cavalcanti and Paulo Niemeyer Filho

Transcript Median suboccipital craniotomy and telovelar approach for posterior pontine cavernous malformations. This is the history of a 19-year-old male with acute episode of headaches 3 weeks prior admission, double vision, progressive imbalance, and numbness in right face and arm. In the physical exam, it was found reduced sensation to light touch and pinprick in the right hemiface and arm, as well as right cranial nerve VI palsy. Located in the central pons, there is a round lesion hypointense to isointense centrally (0:45). Posteriorly, it is possible to