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A case of the falx tumor of a 60-year-old man is reported. The tumor consisted of a pleomorphic mixture of lymphoid cells, histiocytes, atypical reticulum cells, and bizarre giant cells, including the diagnostic Reed-Sternberg cells. No transitional forms among these cells were observed. This is the first report of primary Hodgkin's disease of the dura matter, as verified by complete necropsy.

The falx cerebri at taches anteriorly at the crista galli in proximity to the cribriform plate and to the frontal and ethmoid sinuses. Two layers of dura mater form the falx during its embryological development, later becoming coherent. In view of the close proximity of the anterior a t tachment of tha t structure to potential sources of bacterial infection, it seems fortunate tha t experience is limited with infection that enters the falx and dissects apart its two layers to form an abscess. No previous case with this complication has been found. I t is possible tha t such a case may have been previously reported as a complication of brain abscess. Reported in tha t manner, it may not be easily revealed through the usual methods of literary research. The case reported here is the only one in the author 's experience. Inqui ry of associates indicated tha t they too had not heard of this entity. Consequently, it is believed worth while to bring it to attention. I t may later become evident tha t the use of antibiotics is the reason tha t such an abscess can develop. Previously the patient would have expired from one or more brain abscesses before sufficient time had elapsed for the development of a dissecting abscess of the falx cerebri. No doubt a considerable period of time must elapse for the separation of these two layers of dura mater. I t also seems probable tha t antibiotics do not reach this region as thoroughly as they do the brain in view of the relative avascularity of the region as compared to the brain.

Utilizing a series of 13 consecutive patients with nasal dermal sinus-cyst (NDSC) as a basis for study, this area of embryopathology was re-examined in light of the known and also the speculative knowledge available. Four of these patients had NDSC that involved the intracranial cavity and these served as a basis for correlating preoperative radiologic findings with what was actually found at the time of surgery. In so doing, we have been able to show that the pathogenesis of these lesions is consistent and the predictability of their intracranial involvement is based on this consistency. The repeated penetration through the prenasal space and into the foramen cecum is accompanied by a characteristic deformity of the base of the skull that is entirely recognizable radiographically. A protocol of findings has been developed, therefore, that allows the surgeon to be forewarned regarding the depths to which NDSC extends, and as such to design the surgical procedure to fit the lesion. The more basic findings for this study relate to the demonstration in human embryos of an anatomic reason why intracranial dermal cysts grow in the manner in which they do, i.e., in the substance of the falx cerebri; and even more basically, with additional human embryo studies we have been able to demonstrate a neuroectodermal pathway through the prenasal space, thus definitively confirming previous speculated embryomorphologic information. By corroborating the placement of the dermal displacement in the prenasal space, we have speculated that the NDSC is often but one disorder in a spectrum of aberrations which involves not only dermal and neural displacement, but also cranial floor deformities.

The bright midline echo observed in fetal cranial sonography has been termed by many authors the "falx cerebri." Anatomic, embryologic, and sonographic evidence presented here suggests that this terminology is incorrect and that use of the term "interhemispheric fissure" is more appropriate.

The authors present the case of a 65-year-old woman with a solitary extracerebral glioma. The tumour originated from the falx in the left fronto-parietal region near the paracentral lobule. Because it was well delineated and was completely outside the brain it was thought at operation to be a meningioma or a metastasis. Histologically the tumour could be classified as an oligodendroglioma (WHO grade II). Intracranial extracerebral gliomas so far described are most frequently located in the vicinity of the sylvian fissure. Involvement of the dura has only been observed in three cases. This case is to the best of our knowledge the only one in which the tumour was situated in the longitudinal fissure having originated from the falx. Extracerebral gliomas are thought to arise from heterotropic nests of glial cells in the leptomeninges.

Interhemispheric subdural hematoma (IHSDH) usually manifests itself in a delayed fashion after trauma as a slow neurological deterioration with signs of the falx syndrome (paresis or seizures of the lower extremity contralateral to the hematoma). Several etiologies of IHSDH have been described, with tearing of bridging veins being especially associated with trauma. We present the second reported case of IHSDH due to traumatic arterial laceration. This lesion demonstrates a benign and delayed initial presentation. Conservative observation has been employed in the past with mixed results. Patients receiving early definitive surgical treatment have a lower mortality rate then those treated similarly having convexity SDHs. This review of 31 cases discusses the salient aspects of this clinical entity, emphasizing the need for prompt diagnosis and treatment, despite the patient's seemingly stable neurological status.

Successful removal of a meningioma arising from the straight sinus is described. The tumor was removed via a combined right occipital craniotomy and suboccipital craniectomy. The occluded straight sinus and an unusual vein draining the Galenic system to the superior sagittal sinus were demonstrated angiographically. Various kinds of visual symptoms appeared after the operation, but these gradually cleared.

The application of intravenous, intrathecal, and inhalation enhancement techniques to the CT evaluation of the nonhuman primate (Papio cynocephalus/anubis) is described. The falx cerebri cortical vasculature, vein of Galen, straight sinus and tentorium cerebelli were defined with intravenous enhancement. Intrathecal CT enhancement with air was limited by distortion in cerebrospinal fluid spaces. Intrathecal CT enhancement using a low dose of metrizamide accurately delineated the subarachnoid spaces and the brain substance they surrounded with minimal morbidity. Symmetrical brain enhancement (perfusion) was prominent following inhalation CT enhancement; the degree of enhancement correlated with the estimated xenon concentration in the bloodstream. In addition, by performing repeated CT scans during the clearance of xenon from the brain, an approximate analysis of regional cerebral blood flow was obtained.

The dura mater of the cranium is composed of an outer fibrous layer and an inner fibrous layer. The outer layer acts as the inner periosteum of the adjacent cranial bones. In the anterior fossa the fibers of the outer layer radiate from the frontal tuber, passing downward and medially. The dura is thinned in the area of the olfactory fossa, and the dura on the planum sphenoidale consists of transverse fibers grouped into thicker bundles. The inner layer of the dura mater is relatively thin. Between the two layers are the larger branches of the dural vessels, which give off small branches to the cranium and to the dura itself. The major vessels of the cerebral dura mater (and of the bones of the anterior fossa) are the ethmoidal arteries and the frontal branch of the middle meningeal. The ethmoidal arteries anastomose with various nasal arteries, while the frontal branch of the middle meningeal anastomoses with branches of the ethmoidal arteries and also with branches of the ophthalmic artery. In our material we occasionally found a branch of the internal carotid artery entering the most posterior portion of the floor of the anterior cranial fossa (Yasargil et al. 1984 identified this branch consistently). In the frontal midline approach to the skull base, attention must be given to the superior sagittal sinus, which extends only part way to the skull base, and to the falx cerebri. The falx carries a relatively large branch of the anterior ethmoidal artery called the anterior falceal artery. All the dural arteries interanastomose with one another and with the contralateral homonymous vessels. Venous drainage from the dura mater generally follows the course of the dural arteries.

Members of three generations of a Negro family with features of the multiple basal-cell nevus syndrome have been investigated. The proband, a 7-year-old boy was originally seen because of multiple odontogenic keratocysts. Further examination disclosed palmar pits and a bifid rib. His 28-year-old mother was found to have multiple jaw cysts, palmar and plantar pits, multiple nevi, and a calcifying ovarian fibroma. Her 30-year-old sister had multiple jaw cysts, palmar and plantar pits, basal-cell carcinoma and fibrosarcoma of the ovaries. The grandfather of the proband also had multiple jaw cysts and palmar pits plus calcification of the falx cerebri and bridging of the sella turcica. These findings support other authors' findings of a high degree of penetrance but a variable expressivity. Interestingly, only one of this kindred has had a malignant disease. The member is also the only one to have had a basal-cell carcinoma. It is because of the associated manifestations and management problems that this syndrome should be considered in any patient having multiple cysts of the jaws.

Arachnoid granulations are not always present in lower mammals and primate newborns. In order to visualize the route for the cerebrospinal fluid (CSF) to drain into the venous system, horseradish peroxidase (HRP) was injected into the lateral ventricle or cisterna cerebellomedullaris of the mouse and rat. From 30 to 60 min after the commencing of a slow infusion for 15-30 min of 0.05-0.1 ml solution containing 10-20 mg HRP, the mouse, whose skull had been exposed, was dropped into cold acetone at dry ice temperature; other animals were fixed by perfusion with aldehyde solution. The frozen head was dissected in a cryostat kept at -18 degrees C to remove the skull, but leave the dura mater and the falx cerebri. The brain with meninges was cut into 30-45 microns sagittal sections in the cryostat, and processed for peroxidase reaction. The perfusion-fixed brains were used for scanning electron microscopy and for electron microscope observation of the tracer. The reaction product was found within fenestrated venous capillaries of the choroid plexus. The route for the HRP in the CSF to drain into the sinus rectus via the vena choroidea and vena cerebri magna was directly visualized in the mouse.

The use of ultrasonic pulse echo techniques to measure the biparietal diameter (BPD) of fetal heads in utero and to monitor fetal growth rate has now become a routine procedure. Various claims as to the accuracy of ultrasonic cephalometry have been made. In an effort to reduce systematically the error in prediction of gestation age, an ultrasonic investigation has been made of aborted fetuses with a view to explaining the existence of a range of midline images. Our work suggests that whilst a midline is a necessary condition for BPD determination it is not, in general, a sufficient one. We have been able to demonstrate a variety of midlines corresponding to differing diameters of the fetal head at various levels of the fetal skull. Variations in acoustic impedance over the plane containing the falx cerebri are postulated to explain the appearance and position of the midlines. Beam divergence is adduced to explain our further observation that even when the sound strikes the fetal skull at angles o...

A 32-year-old patient had marked reduction of visual acuity due to falciform folds of the retina and retinal detachment, and severe neurological abnormality: bilateral pyramidal involvement, fasciculation in all limbs and gait ataxia. Skull radiographs showed internal frontal hyperostosis; CT scan showed calcification of the falx cerebri, and multiple arachnoid cysts were shown by myelography. A naevoid lesion had previously been removed from the left forearm. There was a history of ophthalmological symptoms in the mother and the daughter of the propositus. His son has "cafe au lait" spot on the abdomen and dentigerous cysts. The diagnosis of an adult form of basal cell naevus syndrome with an autosomal dominant mode of inheritance is discussed.

Complete dura maters exclusive of their midline basilar attachments were obtained by autopsy from persons of all age groups. Vinylite casts of the venous channels in the diaphragma sellae, falx cerebelli, falx cerebri, and tentorium cerebelli were made by injecting a mixture of Vinylite and acetone, after which the specimens were fixed in formalin and subsequently corroded with concentrated hydrochloric acid. Studies showed that the size and position of the channels within the diaphragma sellae were quite constant. Large venous lakes were present in the falx cerebelli and contiguous suboccipital dura mater, and venous pools were also seen connecting the caudal end of the inferior sagittal sinus and the superior sagittal sinus. A great variety of channels were observed in the tentorium cerebelli.

Four cases of Gorlin’s syndrome occurring in one family are described. Family memberI 2 marriedI 1; one of their daughters had the syndrome. The man married for the second time, and two of his children inherited the syndrome. The patients showed many of the characteristic features of the syndrome, such as jaw cysts, basal cell carcinoma, calcification of the falx cerebri, palmar or plantar dyskeratotic pits, congenital cataract, polydactyly, benign cysts and tumors. The symptom complex appeared to be inherited in an autosomal dominant pattern. We have not found any numerical and structural abnormalities in cultured lymphocytes of the patients, but the SCE frequency was significantly higher in patients than in normal individuals. Recognition of this syndrome is extremely important, especially in children, because of the malignant potential and the need for seeking genetic consultation.

✓ A case of meningioma of the anterior falx cerebri is described in which herniation of the gyrus rectus into the suprasellar cistern with compression of the optic chiasm is demonstrated radiographically. Resection of the tumor mass led to recovery of vision.

Two cases of nevoid basal cell carcinoma syndrome were reported with a review of pertinent literature. The first case was a 59-year-old man, whose autopsy was warranted. Signs and symptoms manifested in this case were basal cell carcinoma, generalized multiple nevi, multiple cysts in the jaws and long bones, pits in the palm and sole, frontal and occipital bossing, ossification of the falx cerebri, a bifid rib, renal fibroma and a patent foramen ovale. The family history revealed a hereditary predisposition as to the syndrome. The patient in the second case included basal cell carcinoma, multiple nevi, multiple jaw cysts, pits in the palm and sole, frontal bossing, calcification of the falx cerebri, cervical vertebral fusion and high-arched palate.

A 2-year-old girl having a bald nodule on the scalp is reported. The tumor was circular, hemispherically elevated and had a dull reddish color. Roentgenologic studies revealed a defect of the underlying skull bone, and spina bifída occulta on the first and second sacral vertebra were found. Craniotomy was carried out. The tumor extended into the falx cerebri and reached to the tentorium cerebelli, and was not connected with the cerebrum. Histological examination showed insular brain tissue containing glial cells in the lower dermis. Around this tissue, there seemed to be vascular leptomeninges with numerous melanocytes and thickened fibrous elements, probably dura. From these findings, this case was diagnosed as a variant of encephalomeningocele, and as melanocytes physiologically exist on the leptomeninges, melanocytes in an encephalomeningocele may diagnostically identify the leptomeninges.

Two patients with head injury and pulmonary emboli of brain tissue are described. Both patients developed persistent bleeding with elevations of prothrombin time, partial thromboplastin time, and decreased platelet counts. Postmortem examination identified multiple skull fractures, subdural and subarachnoid blood, cortical tears, and intraparenchymal hemorrhages. Lacerations of dural venous sinuses were documented in each case. Multiple pulmonary arteries contained plugs of cerebral tissue, including fragments of cerebral and cerebellar cortex, and white matter. The literature concerning brain tissue emboli is reviewed. In neonates, three patients who survived longer than 1 hour were found to have evidence of persistent hemorrhage. Among both children and adults, our two cases are the only ones reported with associated clotting abnormalities. Brain tissue embolism in neonates occurs after difficult vaginal deliveries, often in conjunction with the use of forceps. Tears of the tentorium cerebelli or falx cerebri have been documented at postmortem examination in the majority of these cases. By contrast, brain tissue embolism in children and adults occurs in association with severe closed or penetrating head injury. In several cases, as in the two reported here, postmortem examination has demonstrated a large cerebral venous defect as the probable site of entry of brain tissue into the systemic circulation. Language: en

Publisher Summary This chapter discusses the structure and function of the meninges. The brain and spinal cord are covered by four membranes called collectively the meninges. The dura mater, the outer covering, is a tough fibrous coat consisting of two layers. The outer layer lines the skull, the inner one loosely covering the brain and spinal cord. These two layers are closely adherent, but they separate to form the venous sinuses. The inner layer dips down between the two cerebral hemispheres forming the falx cerebri. It also forms a fold separating the cerebral hemispheres from the cerebellum forming the tentorium cerebelli. The dura mater is the outer covering of the spinal cord also, but extends beyond the end of the spinal cord to the level of the second sacral vertebra. Between the dura mater and the arachnoid mater is a potential space, the subdural space in which there is a network of blood vessels. The arachnoid mater is an avascular coat also loosely applied to the brain and spinal cord and closely adherent to the dura mater. It penetrates the dura mater at intervals and forms the arachnoid villi or granulations which filter cerebrospinal fluid back into the venous system.

In two unrelated families a new type of chromosomal translocation [t(3;6)(3qter~3p21::6q26~6qter; 6p ter~6q26: :3p21~ 3pter)] has been observed. From a clinical point of view, it is associated with repeated spontaneous abortions in the mothers as well as with severe malformations in the index patients, e.g., arhinencephaly, ethmocephaly, absence of the falx cerebri, and brain malformation presenting as holoprosencephaly in a German case and hydrocephalus internus in a Czechoslovakian affected fetus. We would like to contact other colleagues who have observed similar cases, for more detailed analysis and for eventual joint publication.

Various types of neuropathology can be simulated experimentally by creating surgical lesions in certain areas of the brain. While the motor and sensory deficits that result are related to the specific area of the brain that has been damaged, the ablation of portions of the motor cortex in dogs will not always produce obvious motor deficiencies. In the dog and other vertebrates, other regions of the brain also contribute to motor performance and may compensate for the cortical damage.

Brachyolmia refers to a form of skeletal dysplasia characterized by general platyspondyly without significant epiphyseal, metaphyseal, or diaphyseal changes in the long bones. As a result of a study of 11 patients from 7 different families and a review of the literature we propose that there are 3 and possibly 4 different types of brachyolmia: 1. Hobaek type--an autosomal recessive condition with universal platyspondyly, irregular, and reduced intervertebral spaces and marked extension of the lateral margins of the vertebrae. Rectangular and elongated vertebral bodies are seen on lateral views of the spine, which become more pronounced with age. Toledo type--radiographically similar to Hobaek type but also associated with corneal opacities and precocious ossification of costal cartilage. It is uncertain as to whether this represents variability or heterogeneity. 2. Maroteaux type--an autosomal recessive disorder that is distinguished from Hobaek type by rounding of the anterior and posterior vertebral borders with less elongation on lateral view and less lateral extension on A.P. view. This type may be associated with precocious calcification of the falx cerebri, and minor facial anomalies. 3. Dominant type--a previously underscribed form which we have observed in a mother and her son. This type has the most severe vertebral changes with flattening and irregularities of the cervical spine. These clinical, radiological, and genetic differences suggest genetic heterogeneity in this group of platyspondylic disorders.

This chapter describes the venous drainage of the brain. Venous blood is drained by means of venous sinuses which lie between the two layers of the dura mater. Blood drains from the brain into the adjacent venous sinuses. There are many of these linking with each other. The most notable is the superior sagittal sinus which travels from the anterior part of the brain along the edge of the falx cerebri to the occipital region. The cavernous sinuses lie on either side of the body of the sphenoid bone and the pituitary. The transverse sinus travels from the occipital bone past the mastoid bone and eventually into the internal jugular vein. Sepsis and thrombosis may occur in the cavernous sinus from infection of the face, otitis media may cause infective thrombosis of the sagittal and transverse sinuses, and fractures of the skull may damage the internal carotid artery in the cavernous sinus. The venous sinuses eventually drain into the internal jugular vein.

A 27-year-old woman with β-thalassemia/hemoglobin E disease presented with an intracranial mass of 10 × 9 × 1.2 cm firmly attached to the dura and the falx cerebri extending over the central part of both hemispheres, with pressure atrophy of the underlying brain. Histopathologic examination revealed that the mass consisted entirely of hematopoietic cells. We have seen 1,315 cases with β-thalassemia/hemoglobin E, but this was the first case with intracranial extramedullary hematopoietic mass.

We report a microcystic meningioma of the falx cerebri which had an unusual histological pattern. It contained numerous palisaded structures in loose areas, giving the appearance of the loose and dense areas of a schwannoma. There were minimal meningeal whorls. Ultrastructural study confirmed the totally meningiomatous nature of this tumor.

A chondrosarcoma arising from the falx cerebri in a 15-year-old boy is reported. The patient had been suffering from convulsive seizures and weakness of the limbs on the left side for about 7 months prior to admission. A high-density mass attached to the falx was demonstrated by computed tomographic scan. Clinically it was very similar to a falx meningioma, and the final diagnosis was obtained from histopathological examination. The tumor was completely excised at operation, which is extremely important to prevent both local recurrence and distant metastasis.

In the evaluation of angiograms of parasagittal meningiomas operated on by us, the question was asked as to whether there was sufficient information present to enable a parasagittal meningioma of the dural sinus angle to be differentiated angiographically from a meningioma of the falx cerebri (5).

Thirty-two cases of intracranial subdural abscess were treated between 1947 and 1969 in two neurosurgical centres. Five patients (15.6 per cent) died. When an E.N.T. focus is detected clinically or radiologically the abscess is always related to it. Four of the 5 fatalities harboured pus along the falx cerebri. Angiography is used to aid localization and to detect further collection of pus. Limited experience in the use of gamma scanning for localization is encouraging. Pus in the subdural space is drained through bur-holes and antibiotics are administered locally. Broadspectrum bactericidal antibiotics are used in high dosage as the initial treatment and cerebral oedema is controlled by mannitol and dexamethasone in the drowsy or unconscious patient. Surgical decompression should be considered when comatose patients do not respond to bur-hole drainage of the pus and medical measures.

✓ The straight sinus was examined in 43 human cadavers. In 13.95% of the cadavers the straight sinus was double, being either median in position, that is, one was superior and the other inferior (9.3%), or paramedian, that is, both lay side by side on either side of the midline at the junction of the falx cerebri with the tentorium cerebelli (4.65%).

Das Corpus pineale verkalkt sehr haufig. Die Verkalkung kann in seltenen Fallen schon nach dem 1. Lebensjahr rontgenologisch in Erscheinung treten (Loepp und Lorenz, Roselmann). Mit zunehmendem Alter nimmt auch die Haufigkeit zu, so das im 6. Jahrzehnt etwa 60–70% Verkalkungen angegeben werden. Die Verkalkungen haben im Rontgenbild ein verschiedenes Aussehen, angefangen von der Entstehung feinster Konkrementschatten bis zur Ausbildung eines homogenen, dichten Schattens, gelegentlich mit Unterteilung in zwei Halften (Bronner).

IN 1951 Binkley and Johnson1 reported the case of a thirty-one-year-old woman with basal-cell nevi, agenesis of the corpus callosum and dental cysts. The skin lesions, appearing in childhood, exten...

De 411 casos de tumores cerebrais foram estudados 86 (19,4%) que apresentaram manifestações epilépticas. A epilepsia foi estudada quanto à duração, ao tipo de manifestação e à severidade, em relação à natureza e à localização dos tumores cerebrais. A análise dos resultados permitiu aos autores chegarem às seguintes conclusões: 1) a epilepsia incidiu em 19,4% dos casos; 2) o oligodendroglioma, as metástases carcinomatosas e o glioblastoma multiforme foram, pela ordem, os tumores mais epileptogênicos; 3) as áreas frontal, parietal e temporal foram, nessa ordem, as localizações mais epileptogênicas; 4) os carcinomas metastáticos predominaram nos casos com epilepsia com menos de um ano de evolução, enquanto que os astrocitomas predominaram nos casos com mais de três anos; quanto à topografia, predominou a região frontal no primeiro grupo e a temporal, no segundo; 5) nas formas mais severas de epilepsia predominaram os oligodendrogliomas e os meningeomas, quanto à natureza, e a região frontotemporal e a foice, quanto à localização; 6) os craniofaringeomas e os meduloblastomas foram os tumores que mais freqüentemente determinaram o aparecimento de convulsões puras; nesses casos, a sela túrsica e a fossa posterior foram as sedes mais freqüentes; 7) os carcinomas metastáticos e os meningeomas, quanto à natureza, e as regiões frontoparietal e parietal, quanto à localização, foram os mais freqüentemente encontrados nos casos com crises de tipo bravais-jacksoniano. In 411 cases of cerebral tumors, 86 (19,4%) with epileptic manifestations were studied. The duration, the manifestations and the severity of epilepsy, in regard to the nature and site of the tumor, were investigated. The analysis of the results lead the authors to the following conclusions: 1) 19.4% of the cerebral tumors showed epileptic symptoms; 2) oligodendroglioma, metastatic carcinomas and glioblastoma multiforme were, in this order, the most epileptogenic tumors; 3) the frontal, parietal and temporal areas were, in this order, the most epileptogenic localizations; 4) concerning the duration of epilepsy, the metastatic carcinomas were more frequent when the duration of epilepsy was lower than one year, while the astrocytoma were more frequent in the cases with more than three years; regarding the location, the frontal area was more frequent in the first group and the temporal area in the second one; 5) regarding the frequency of seizures, oligodendroglioma and meningeoma, and the frontotemporal and falx cerebri locations were found more frequently in the more severe cases; 6) concerning the pattern of epileptic manifestations, cranio-pharyngiomas and meduloblastomas were the tumors that induced most seizure without aura; in these cases the pituitary region and the posterior fossa were the more frequent sites; 7) metastatic carcinomas and meningeomas, as well as frontoparietal and parietal areas, were most frequently found in the cases with jacksonian seizures.

Malformations of the central nervous system in trisomy 18 are relatively uncommon as compared with trisomy 13 (D 1 ), but may nevertheless be part of the phenotypic manifestation of trisomy 18. Anomalies of the central nervous system observed in trisomy 18 have included: meningoencephalocele, hydrocephalus, prosencephaly, absent corpus callosum, defective falx cerebri, and abnormal cerebellum. A lumbar meningocele was observed in two infants described here, in one of whom there was also a strikingly abnormal brain with malformed gyri, absent occipital lobe, and defective optic tracts. The malformations of the central nervous system observed in the trisomy 18 syndrome are reviewed and summarized in a table.

✓ Among 449 specimens of dura mater and enclosed sinuses obtained at autopsy, there was one with a venous sac in the midpart of the falx cerebri. The vascular connections of this cavity indicated that it was an aneurysm of the inferior sagittal sinus without arterial components.

THE ANTERIOR portion of the falx cerebri is supplied by a small meningeal branch of the anterior ethmoidal artery. The meningeal branches of the ophthalmic artery were recently described by Kuru (4), and the vessel that extends superiorly to the falx was referred to as the anterior falx artery. This designation is appropriate and should serve to eliminate confusion in respect to this vessel and other anterior meningeal branches from both the ophthalmic and external carotid arteries (1, 8–10). When visualized angiographically, the anterior falx artery occupies a constant anatomic site and should not be confused with other meningeal vessels. In this report, we shall demonstrate the normal angiographic anatomy of the anterior falx artery as well as its enlargement from various pathologic conditions. Anatomy The anterior falx artery arises from the anterior ethmoidal branch of the ophthalmic artery and perforates the cribriform plate. It ascends in the falx cerebri, parallel to the inner table of the skull to...

THE combination of multiple basal-cell carcinomas, cysts of the jaw, and skeletal deformities forms an uncommon disorder often referred to as the basal-cell nevus syndrome . The condition can be recognized in early childhood and is thought to be inherited as a highly penetrant, autosomal dominant gene with multiple and variable effects. 1 Cases have been described with scoliosis, prominent frontal bosses, short metacarpal bones, nasal deformity, agenesis of the corpus callosum, calcification of the falx cerebri, medulloblastoma, mental changes, hypertelorism, gonadal dysplasia, milia, and dyskeratosis of the palms and soles. 2-10 It has recently been suggested that this syndrome may be a variant of pseudohypoparathyroidism because of (1) certain gross similarities, including body habitus, short metacarpal bones, ectopic calcification, and mental abnormalities, and (2) the failure to respond to infusions of parathyroid hormone with a phosphorus diuresis. 8,9 We have studied a boy with multiple basal-cell carcinomas and bone defects.

Knowledge of the exact tumor location and structures at risk in its vicinity are crucial for neurosurgical interventions. Neuronavigation systems support navigation within the patient's brain, based on preoperative MRI (preMRI). However, increasing tissue deformation during the course of tumor resection reduces navigation accuracy based on preMRI. Intraoperative ultrasound (iUS) is therefore used as real-time intraoperative imaging. Registration of preMRI and iUS remains a challenge due to different or varying contrasts in iUS and preMRI. Here, we present an automatic and efficient segmentation of B-mode US images to support the registration process. The falx cerebri and the tentorium cerebelli were identified as examples for central cerebral structures and their segmentations can serve as guiding frame for multi-modal image registration. Segmentations of the falx and tentorium were performed with an average Dice coefficient of 0.74 and an average Hausdorff distance of 12.2 mm. The subsequent registration incorporates these segmentations and increases accuracy, robustness and speed of the overall registration process compared to purely intensity-based registration. For validation an expert manually located corresponding landmarks. Our approach reduces the initial mean T arget R egistration E rror from 16.9 mm to 3.8 mm using our intensity-based registration and to 2.2 mm with our combined segmentation and registration approach. The intensity-based registration reduced the maximum initial TRE from 19.4 mm to 5.6 mm, with the approach incorporating segmentations this is reduced to 3.0 mm. Mean volumetric intensity-based registration of preMRI and iUS took 40.5 s, including segmentations 12.0 s.

✓ The authors describe the radiological and pathological features in a patient with an intracranial chondroma originating in the falx cerebri. Diagnostic procedures and management in treatment are discussed, and a review of the literature is presented.

Intracranial calcification is not rare, and it is associated with a variety of "physiologic" and pathologic conditions. Calcification of the pineal body or of the falx cerebri occurs with such frequency that the alteration is considered physiologic by many observers. The deposition of calcareous concretions in the region of the basal ganglia has recently been reviewed extensively by Eaton, Camp and Love.1Their report that the calcification occurs in and about the finer cerebral blood vessels coincides with our observations in cases of a similar condition. This study, on the other hand, pertains to calcification of the brain parenchyma itself, particularly the cortex. Calcification of the cortex of the brain takes place in a variety of pathologic states, the most common being tuberous sclerosis, in which the alterations may be noted within some of the tuberosclerotic nodules. According to Yakovlev and Corwin,2the calcification in such lesions tends

1. FCPS course, Department of Medicine, Dhaka Medical College. 2. Post-graduate resident, Department of Medicine, Dhaka Medical College. 3. Professor, Department of Medicine, Dhaka Medical College. Correspondence: Dr. Md. Shahriar Mahbub, FCPS course, Department of Medicine, Dhaka Medical College. E-mail: shahriar04@yahoo.com Fig.-1: (a) Left sided proptosis (b) Contrast-enhanced CT scan of brain showing homogenously enhancing mass lesion involving the falx cerebri

As a distant effect of tumor of the brain and other intracranial disorders, there may be herniations of the brain into all possible openings into which cerebral tissue may be molded, as illustrated in the well known cases of bulging of the third ventricle, a pressure cone at the foramen magnum and minor cortical protrusions at the location of the arachnoid villi. Herniations which have received less emphasis in the literature are those of the fornicate gyrus under the free edge of the falx cerebri and of the uncus and subiculum of the cornu ammonis under the free edge of the tentorium. These were described by Meyer1in 1920. Without reference to the work of Meyer, Vincent and his co-workers2described herniation of the uncus as a temporal pressure cone. In this article, the authors said that they first described the lesion in 1930 before the Societe de

Strom 1 in 1919 conveniently divided intracranial calcification as revealed by roentgenograms into two groups: the physiologic and the pathologic. The former group includes structures such as the pineal gland, choroid plexus, falx cerebri and pacchionian bodies which normally may exhibit varying amounts of calcium. The pathologic group includes all tumors and certain non-neoplastic lesions. Many of the latter produce clinical signs which simulate those of a cerebral neoplasm, and in the differential diagnosis roentgenographic evidence can play a most important role. Not infrequently the roentgenologist not only can exclude the presence of a tumor but by virtue of the shape, extent and distribution of shadows of calcification can predict the nature of the disease and often the cause. The table shows a practical classification of these lesions for the roentgenologist. The pathologist may disagree with such a grouping because, microscopically, the method of deposition of calcium is similar in

Cushing divided meningiomas of the tela choroidea superior (velum interpositum) into two groups, lateral and posterior tumors of the velum. Posterior tumors of the velum are indeed rare. In a review of the literature reports of but 4 such tumors were found. Horrax, 1 in 1936, resected the occipital lobe and removed successfully a meningioma, weighing 40 Gm., overlying the quadrigeminal region. The tumor was of fibroblastic type, with no psammoma bodies. Araki 2 had experience with 2 meningiomas in this location. Both tumors were successfully attacked by splitting the splenium of the corpus callosum and removing the growth piecemeal. One of these tumors had psammoma bodies and was visible roentgenographically. The tumor reported by Balado and Tiscornia 3 was a meningioma arising from the free posterior margin of the falx cerebri. Suboccipital exploration in two stages for an associated medulloblastoma in the midline of the vermis terminated fatally. The

A 30-year-old Puerto Rican woman sought dermatologic attention because of painful feet. Diffuse, hyperkeratotic, fissured plaques with well-defined margins were present on the soles. On one foot, the eruption extended medially to the metatarsophalangeal joint of the great toe; on the other, it involved the lateral aspect of the foot and the Achilles tendon. Mild keratoderma of the palms and psoriasiform patches on the arms were also noted. Oral examination disclosed an edentulous maxilla and only eight teeth in the mandible. Radiographs of the skull showed bilateral calcifications in the falx cerebri, documenting the full-blown Papillon-Lefevre syndrome. In patients with palmoplantar keratoderma, careful examination of the mouth is essential; if significant dental changes are discovered, roentgenograms of the skull should be obtained.