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gradually and the patient was confused or stuporous. Six days after admission, the right frontal ventricular tap with closed system drainage was performed. Seven days after admission, the pneumoventriculographic study showed a defect in the rhomboid fossa with displacement of the fourth ventricle to the left. A suboccipital craniectomy was carried out. We found a bluish-colored elevation in the right and middle lower portion of the floor of the fourth ventricle, and a hematoma, semifluid collection of 18 cc black blood, was evacuated. No tumor tissue was found, and the biopsies from the hematoma cavity were also negative. Recovery was very satisfactory with slightly right-sided cerebellar disturbance and he was discharged two months after the operation. At the time of this report, improvement has been maintained for approximately one year and eleven months. The pathogenesis of these primary hemorrhages of the pontien-medeullary part is, as shown by others, possibly related to a microaneurysm of a branch of the basilar artery.

54. The New Operative Procedure for the Carotid-Cavernous Fistula without any Interference to Blood Circulation of Internal Carotid Artery