A 26-year-old man presented with an epidermoid tumor of the fourth ventricle manifesting as headache with nausea and vertigo. Neurological examination revealed no cerebellar signs, except nystagmus. Bilateral vestibular impairment was identified by the caloric test. The tumor was removed via the midline suboccipital approach. The bilateral peripheral vestibular function recovered remarkably postoperatively. This marked improvement suggests that the bilateral vestibular impairment was caused by compression of the vestibular nuclei by the tumor.

The early experience is reported here of the use of Intra‐operative frozen‐section service by telepathology using the Integrated Service Digital Network (ISDN), a commercially available system that is being connected between the Department of Pathology of Tottori University and Matsue City Hospital, a distance of 30 km. The transfer rate is currently 64kbit/s. The frozen‐section service was conducted for a total of 117 tissue specimens (organs) from 100 patients between August 1993 and May 1995. The average time taken for examination of each specimen of frozen section was 13min, ranging between 2 and 42min. The average number of transmitted Images was 6.2. Six cases necessitated more than 11 transmitted Images to make a diagnosis, while 13 cases could be diagnosed from two images only. Correct and permissible diagnoses were obtained in 109 (93.2%) out of 117 specimens when comparing the telepathology diagnosis with that of direct microscopy. Improper or misdiag‐nosis was made for eight cases (specimens), which were misinterpreted as papillary carcinoma in Basedow's disease, adenoma and hyperplasia in two pheochromocytomas, solid‐tubular carcinoma in phyilodes tumor, mastopathy in invasive carcinoma, metastatic carcinoma in astrocytoma, follicular lymphoma in reactive hyperplasia, and lymphadenitis in follicular lymphoma. in retrospect, diagnosis of these cases should have been deferred. From the results, it was concluded that the Intraoperatlve frozen‐section service by telepathology may be a worthwhile substitute for hospitals with limited accessibility to local pathology service, in spite of pitfalls in some cases. Well prepared, high‐quality frozen sections, sufficient verbal communication with surgeons, and a rather conservative attitude on the part of a well‐trained pathologist seem to be the essential Ingredients for reaching an accurate decision when using telepathology.

We report a case of rebleeding after proximal clipping of ruptured vertebral arterydissecting aneurysm.A 61-year-old-man suffered from severe SAH with coma and dyspnea. VAG showed “pearl & string sign” at the non-dominant right VA distal to the PICA. The left predominant VA demonstrated retrograde filling of the right VA-DA. Through the right suboccipital craniectomy, a Sugita clip was placed across the VA just proximal to the dissection and distal to the PICA.Just after extubation, 4 hours after surgery, the patient was afflicted with coma and respiratory arrest. Therefore through the left suboccipital approach, the dissecting aneurysm with a small rebleeding point was trapped just distal to the dissection. The patient was discharged under severe disability 1 year after trapping.We studied 7 cases of rebleeding after proximal clipping of the ruptured VA-DA with our case in a review of the literature.The following can be concluded:1) In each case, the evaluation of the preoperative hemodynamics is necessary by balloon occlusion test at cerebral angiography.2) If a case shows retrograde filling to the VA-DA in the preoperative vertebral angiography, trapping of the VA-DA should be tried.3) Because rebleeding after proximal clipping of the VA-DA may be encountered not only proximal but also distal to the PICA, the vertebral angiography should be performed within 1 week after surgery.4) If the angiograms through the contralateral VA demonstrate retrograde filling of the dissecting aneurysm, the patient should be carefully followed up for postoperative rebleeding.