Gordon Thomson

Giant intracranial aneurysms: Diagnosis with special reference to computerised tomography

The clinical presentation, radiological investigations and surgical management of 11 patients with giant intracranial aneurysm (greater than 2.5 cm) have been reviewed. Most patients had signs and symptomd haemorrhage. The most helpful plain film finding was intracranial calcification. This varied from a mere fleck to the classical curvilinear variety. Computerised tomography (CT) scans were available on all 11 patients. All showed a space-occupying lesion of high density. Two types of enhancement were seen following intravenous contrast medium, (a) homogeneous and (b) rim enhancement with or without a patchy increase in density centrally. The CT appearances in some of the cases resembled those shown by other lesions such as neoplasm. Arteriography in almost all cases demonstrated the aneurysm but often under-estimated its size. On two occasions the aneurysm did not fill and the nature of the lesion demonstrated on the plain CT remained unconfirmed. Direct surgical attack rather than carotid ligation was the operation of choice. Most patients responded very well to this treatment.

Atlas of the Human Brain and the Orbit for Computed Tomography, 2nd edn. By J. Hanaway, W. R. Scott and C. M. Strother. Warren H. Green Inc. St Louis, Missouri. 76 pp.

After an introduction of 2 pages a series of photographs follows showing sections of the brain with the corresponding computed tomography (CT) scan. Three planes are studied-the horizontal, 250 from the horizontal plane, and 350 from the horizontal plane. The anatomical slices are well labelled and the orbital sections adequate. Unfortunately, technological advances have meant that the CT scan pictures are now outdated, and the additional