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The authors report a case of growing skull fracture in which watertight dural closure was difficult at the first operation because a dural defect extended deep into the middle fossa. Bulging of the cranioplasty site occurred 2 months later. In the second operation, instead of reinforcement of the dura mater, a shunt operation was performed to decompress the cyst and the locally dilated ventricle, which was thought to contribute to the intracranial expansive forces. The bulging did not recur. In the treatment of growing skull fracture, a shunt operation should be considered when watertight closure of the dural defect cannot be achieved and in case of recurrence after failure of the first operation.

Four patients with chiasmal syndromes were found to have intrachiasmal hematomas. Computerized tomography scans showed high-density suprasellar masses in all cases. Cryptic vascular anomalies were presumed to be responsible for spontaneous bleeding into the chiasm in three of the cases. In the remaining case, hemorrhage was due to an occult optic glioma. Surgical evacuation of clotted blood resulted in improved visual function in three of the four cases.

The diagnosis of intrasphenoidal encephalocele may be difficult because of its rarity and its nonspecific signs and symptoms. The authors report a patient with intrasphenoidal encephalocele who was operated on by the transsphenoidal approach with a good result. They also review five reported cases, with discussion of their clinical characteristics and operative indications.