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Two patients presented with hypoglossal neurinoma extending both intra- and extracranially. A 63-year-old male presented with right trigeminal neuralgia and hypoglossal nerve paresis. The intracranial part of the tumor was removed totally via a suboccipital craniectomy. Over-coagulation of the venous collaterals, particularly the emissary veins, resulted in dural venous sinus thrombosis and cerebellar infarction. Unfortunately this patient died. A 48-year-old male presented with pareses of the VII, IX, X, XI, and XII cranial nerves and cerebellar sign. The tumor extended both extra- and intracranially, and was completely removed by opening the hypoglossal canal and the jugular foramen without over-coagulation of the venous collaterals. Preservation of the venous collaterals is very important for the prevention of postoperative venous complications.

The patient was involved in a traffic accident at the age of 1 and the left parieto-occipital scalp was contused without skull fracture. At the age of 5, an extracranial scalp mass was first noticed just beneath the multiple scalp scars. Angiography through the mass revealed that the extracranial mass cavity was connected to the superior sagittal sinus through the emissary veins. The mass located in the subgaleal, epiperiosteal space was totally resected and the connection with the intracranial sinus was closed with bone wax. Histologically, there were many capillaries and some large blood cavities with only one layered endothelium and connective tissue. Therefore, the mass was diagnosed as sinus pericranii and considered to be secondary to previous head trauma because: 1) The patient had a history of head trauma with considerably severe scalp injuries. 2) The extracranial blood sinus was located exactly beneath the traumatic scar. 3) There was no neoplastic tissue histologically. 4) No scalp mass was noticed before the traffic accident. 5) There was an elapsed time between the trauma and the growth of the mass. 6) No scalp nevus such as port-wine stain existed.

A 44-year-old man presented with a rare case of idiopathic hypertrophic cranial pachymeningitis manifesting as generalized seizure. Neuroimaging and pathological examinations showed the typical features of hypertrophic cranial pachymeningitis. Tuberculosis was a possible cause based on the positive purified protein-derived skin test, but the origin of the disease was not confirmed by further examinations. Cerebral angiography showed total occlusion of the dural sinuses with development of the emissary veins. Histological examination of the dura showed thickening of the fibrous tissue with rare inflammatory cells, suggestive of the extremely long duration of the disease. The diagnosis was idiopathic hypertrophic cranial pachymeningitis, but was treated only with anticonvulsants. The disease did not progress during follow up of 3 years. Idiopathic hypertrophic cranial pachymeningitis may have various causes related to unusual forms of infectious or autoimmune disorders.

A case of cranial metastasis of hepatocellular carcinoma associated with epidural hematoma in a 58-year-old male is presented. The epidural hematoma demonstrated an unusual chronic clinical course and computed tomographic appearance. Associated bleeding from either the diploic marrow or emissary veins might be a cause of the slowly expanding hematoma, and the outward displacement of the artificial bone-flap implanted previously may also have contributed to the chronic course.

Six cases of sinus pericranii are reported and new classifications are proposed. The age of onset varied from neonate to 22 years. Two patients were male and four were female. In all cases, diagnostic radiography obtained by direct injection of contrast medium at the site of epicranial blood cyst revealed communication between the intracranial dural sinus and sinus pericranii. Total removal of the tumor was performed in four patients, and ventriculo-peritoneal shunt alone was carried out in two cases associated with hydrocephalus. Sinus pericranii is a symptom-complex, and not an independent clinical entity. Therefore, its definition and classification are matters of controversy. The authors describe a new classification from the pathological aspects, based on their own cases and previous reports. The new classification is the following. Type 1: multilocular blood cyst consisting of fibrous connective tissue similar to the architecture of cavernous hemangioma. (This type is defined as the only type of sinus pericranii by some authors.) Type 2: true hemangiomas (such as capillary hemangioma and cavernous hemangioma) as neoplastic entities. Type 3: varicose vein represented by enlarged emissary vein. Type 4: herniated dural sinus through the defect of calvarium. Type 5: miscellaneous.