Introduction: Large primary middle cranial fossa tumors that extend into the spheno-ethmoido-clival regions and infratemporal fossa often require combined approaches that may be performed at the same sitting or in staged procedures. We applied a low pterional approach with zygomatic arch osteotomy combined with a midfacial degloving to a large, predominantly right-sided skull base meningioma that threatened contralateral vision. This unique surgical approach was used to successfully debulk a massive meningioma originating from the right sphenoid wing and expanding medially toward the cavernous sinus and pituitary fossa, anteriorly into the sphenoid and ethmoid sinuses and right orbital apex, and inferiorly into the right infratemporal fossa and maxillary antrum.

Nouraei, Reza MA, MBBChir; Chatrath, Paul MA, FRCS; Saleh, Hesham A. FRCS; Eccles, Simon FRCS Author Information

Mycosis fungoides is a rare malignant T-cell lymphoma, involving mainly the skin. It can, in 50%-75% of cases, involve visceral organs and, in 11%-14% of cases, metastasize to the central nervous system. The prognosis is poor. A case with cerebral involvement is presented and the relevant literature reviewed.

Group 1. The Implementation of the Mental Capacity Act 2005 Chaired by Harry Cayton and feedback was provided by Penny Hill. The group received a presentation from Paul Gantley, Implementation Manager (Mental Capacity Act) at the Department of Health. Also taking part in the discussion were Mary Teasdale from Rethink and John Eatock from the British Association of Counselling and Psychotherapy. The group heard about the two stages of the implementation of the Mental Capacity Act 2005, taking place in April and October 2007. The Act provides a statutory framework (for those aged 16+) to empower and protect people who may lack capacity to make some decisions for themselves, including people with dementia, learning disabilities, mental health problems, stroke or head injuries. The key principles which underpin the act were outlined (a presumption of capacity, individuals being supported to make their own decisions, best interests and least restrictive option). The new act introduces Lasting Powers of Attorney (LPAs) and Court appointed deputies. LPAs allow anyone (over 16) to appoint someone else to act and make decisions on their behalf should they lose capacity in the future. The act also introduces Independent Mental Capacity Advocates (IMCAs), who are appointed to support a person lacking capacity who does not have family or friends to speak for them. Advanced decisions to refuse treatment in the future will also be introduced.