Two cases of chronic subdural hematoma, one organized in an 83-year-old female and the other calcified in a 14-year-old male are reported. The outer membrane and organized hematoma were removed after craniotomy, but a fair number of fresh clots were visible throughout the organized hematoma during the operation in both cases. Therefore, these organized chronic subdural hematomas seemed to consist not only of old homogeneously organized hematoma, but also of long-standing, intermittent hemorrhages from the hematoma capsule. Since it has been reported in the literature that total removal of an organized chronic subdural hematoma, including outer and inner membranes, results in serious complications after the operation, the inner membrane was left intact on the cerebral surface in both cases. The hematoma cavity in both cases disappeared without any complications after the operation. We would like to propose that the inner membrane preservation operation should be the operation of choice for organized or calcified chronic subdural hematomas.

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The authors performed scintigraphy using <99m>^Tc(V)-DMSA (Technetium-99m pentavalent dimercaptosuccinic acid) on patients with pituitary adenomas. Three non-functioning (100%), 2 GH-secreting (67%), 4 PRL-secreting (80%), and zero ACTH-secreting (0%) adenomas concentrated the <99m>^Tc(V)-DMSA, but all 5 of the non-adenomatous lesions and 1 normal pituitary gland did not. There was no significant relationship between tumor-to-background ratios and tumor sizes, or the serum hormone level. The <99m>^Tc(V)-DMSA scintigraphy showed an overall sensitivity of 69% (9/13) in detecting pituitary adenomas, which increased to 82% for non-functioning, GH-secreting and PRL-secreting adenomas. In conclusions, <99m>^Tc(V)-DMSA was found to be a suitable radiotracer for detecting pituitary adenomas. But further studies are necessary to define the processes that concentrate <99m>^Tc(V)-DMSA and their role in pituitary adenomas.

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A 64-year-old woman who had a transphenoidal surgery for large pituitary adenoma expanding to clivus 2 months before presented with impaired consciouness and plain CT revealed massive hemorrhage in front of the pons with subarachnoid hemorrhage. To our knowledge, only 8 cases which presented with intracerebral hemorrhage from pituitary adenoma were reported in the literature. Characteristic clinical feature and the mechanism are discussed.

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A 49-year-old man was admitted to our hospital suffering from right ophthalmic pain and incomplete oculomotor palsy. Neuroradiological examination revealed a partially thrombosed, large aneurysm at the right BA-SCA junction. Surgical neck ligation of the aneurysm, followed by endovascular packing using GDC, was effective in tis case. A combination of operative and endovascular techniques in a complementary was, may result in the best possible outcome for patients with partially thrombosed large aneurysms in the posterior fossa.

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We report a rare case of an acute subdural hematoma (ASDH), which rapidly diminished. The patient was an 88-year-old female who was found unconscious lying prostrate on the street and was then transferred to our hospital. On admission, she had a Glasgow Coma Scale (GCS) score of 5. Her pupils were anisocoric and the left pupil was dilated and without light reflex. Tetraplegia was also recognized. A CT scans revealed an acute subdural hematoma with a remarkable midline shift. A thin low density area, which implied the involvement of cerebrospinal fluid (CSF) in the subdural space, existed at the medial and lateral portions of the hematoma. The next day she had a GCS score of 8 and CT scans revealed a remarkable reduction in the size of the hematoma and the shift of the midline structures. In order to further improve of the neurological state, surgical removal of residual the ASDH was perfomed under local anesthesia and without any complications. A month after admission, she was discharged on foot with a cane. In our case, the mechanism of the spontaneous resolution of the hematoma was considered that the hematoma was diluted and washed out by CSF due to tearing of the arachnoid membrane.

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An intracanalicular acoustic neurinoma was successfully removed, with the patient's hearing preserved by NEURO-SAT guided middle fossa extradural approach. A 54-year-old man had been suffering from recurrent vertigo for 12 years. Magnetic resonance images showed an intracanalicular acoustic neurinoma, 5 mm in diameter. Prior to surgery, the superior semicircular canal, cochlea and internal auditary canal were calculated for target points on a CT scan. During surgery, the internal auditory canal was unroofed safely with NEURO-SAT guidance. The tumor originating from the inferior vestibular nerve was totally resected without any collateral nerve damages. The postoperative course was uneventful and the patient's hearing was preserved. By avoiding any collateral damage, NEURO-SAT was proven to be a useful surgical monitor for the middle fossa extradural approach to the intracanalicular acoustic neurinoma.

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A large calcified chronic subdural hematoma is called "armoured brain" when it covers most all of bilateral cortical surface. This disorder has been reported occasionally. The clinical cource and treatment has been discussed in the literature, but surgical treatment strategy is still remained unresolved. We report a 19-year-old man with an attacks of unconsciousness who displayed a bilateral large calcified chronic subdural hematoma with severe descending herniation signs on CT and MRI. The calcified mass was almost totally removed surgically, and separation of inner membrane of hematoma from the brain surface was performed carefully not to injure the brain under an operative microscope. An MRI taken 3 years after operation showed good reexpansion of the brain. The postoperative course was uneventful, and the patient was free from unconsciousness attack afterwards.

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A 66-year-old man had a slight swelling with mild pain in his right parietal region. Skull X-ray showed an osteolytic lesion in the right parietal area. Bone target CT showed a 4×2.5cm osteolytic lesion surrounded with hyperostotic margin. Magnetic resonance imaging (MRI) revealed a mixed-intensity area on a T1-weighted image and a hyper-intensity area on a T2-weighted image. The tumor is homogeneously enhanced after administration of Gd-DTPA, and there is no dural enhancement. The skull tumor was removed en block together with the surrounding normal skull by osteoplastic craniotomy. The histological findings revealed trasitional meningioma. To the best of our knowledge, there have been only 38 cases of extracranial or ectopic meningioma reported in the literature, comprising only one percent of all menigioma. Among them, primary intraosseous meningioma is extremely rare. We extensively reviewed the clinical features, neuro-imaging characteristics, classifications and proposed etiology of the primary intraosseous meningioma.

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According to the hypothesis of Jannetta, an arterial compression of the left root entry zone of cranial nerve IX and X by looping arteries could play an important role in the pathogenesis of arterial hypertension. We present 2 successful microvascular decompression cases that had essential hypertension and hemifacial spasm. Case 1 is a 53-year-old man who has had a left hemifacial spasm. Case 2 is a 50-year-old woman who has had a right hemifacil spasm. In both cases the neuro-vascular decompression at the ventrolateral medulla on the same side of the hemifacial spasm was done with microvascular decompression surgery for hemifacial spasm. After the microvascular decompression, the systolic and diastolic blood pressure gradually decreased in both cases, and became within normal limits after 3 months. Our results support that essential hypertension may be associated with neurovascular compression not only on the left side but also on the right side. And also the surgical effect may appear gradually in few months.

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A rare case of meningioma arising in the superior sagittal siuns is reported in a 50-year-old woman originally presented with multiple lower cranial nerve palsies. Although the etiology of her disease was not clear, an incidental meningioma was found in the middle third of the superior sagittal sinus. After an improvement of her symptoms, the tumor was rmoved throught craniotomy. At the surgery, the tumor was found growing in the superior sagittal sinus and involving the parietal bone. Related problems in diagnosis and treatment are discussed.

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