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Objectives: A serious catastrophic complication of endoscopic third ventriculostomy (ETV) is basilar artery (BA) damage. Although the BA has been discussed as the cause of haemorrhage and even pseudoaneurysm, variations of the posterior cerebral artery proximal segment (P1) and its protrusion into the third ventricle floor have not been emphasised. A series of cases are reported in which the P1 segment was located at the stoma during an ETV and was at risk of perforation. Precautionary techniques for complication avoidance are described.Methods: A retrospective review was performed of all ETVs performed in adults at our institution between 2004 and 2008. Cases were identified in which the P1 segment was noted to herniate into the stoma at the time of third ventricular floor fenestration.Results: Among 65 cases reviewed, six were identified in which the P1 segment significantly herniated into an area of the stoma at the time of third ventricular floor fenestration. In no case was the P1 segment injured by the ETV procedure. Each of the six patients had opaque third ventricle floors. A 'cookie cut' technique was used in which the opaque third ventricle floor was abraded to reveal the underlying translucent membrane, offering an improved view of arteries in the basilar cisterns. In four of six patients, ETV resulted in clinical improvement.Conclusions: The posterior cerebral artery P1 segment is potentially at risk during ETV in adults as well as in children. Awareness and proper precautions may help reduce injuries to either the P1 or the basilar apex during an ETV. [ABSTRACT FROM AUTHOR]

The objective of this study was to ascertain if stereotactic neurosurgical biopsy (SNB) optimizes the therapy of undefined CNS masses. The design was of retrospective treatment and outcome analysis and the setting was a large general hospital. We studied a total of 141 patients with undefined, space-occupying CNS lesions detected between 1991–1997, with whom we used SNB to define the lesions. We sought to correlate empiric and histological diagnostics and their impact on medical management. The stereotactic biopsy produced a diagnostic yield for each patient. Management was altered in 57 cases (40%) due to histology and, of these, malignancy was found in 39. Morbidity was ten asymptomatic hemorrhages on post-biopsy CT scans and two cases of clinical deterioraton. Our conclusions were that SNB produces high yield with low morbidity. In the community setting, a wide variety of diagnoses can be made with improvements in medical management. SNB should be employed to guide therapy of CNS lesions where complete excision is not possible or when diagnostic questions arise. [ABSTRACT FROM AUTHOR]

Four cases are presented of marked periventricular oedema associated with hydrocephalus on CT scan. In one of the patients oedema, as well as the hydrocephalus, subsided after successful re-establishment of CSF absorption. The most likely explanation of the periventricular oedema is increased absorption of CSF by periventricular brain tissue. [ABSTRACT FROM AUTHOR]

Five patients surgically treated for unusual intracranial foreign bodies are presented. They include representative cases of the three most commonly encountered types of these injuries: industrial accidents, suicidal attempts and the result of criminal assault. Immediate radiological examination is mandatory because the deceptively small entrance wound is usually in no way commensurate with the large size of the foreign body the presence of which is frequently not suspected. The surgical removal of these foreign bodies requires careful pre-operative assessment to avoid hemorrhages and undue injury to the surrounding normal brain tissue. [ABSTRACT FROM AUTHOR]

The clinical symptoms of thirty patients with surgically treated posterior fossa meningiomas were reviewed. These included 16 cerebellopontine (CPA), 7 cerebellar, 4 carrefour-falco-tentorial (CFT), 2 foramen magnum, and 1 clivus meningiomas. Careful attention to clinical findings is necessary in diagnosing these tumors. With rare exception they have an insidious onset and even after having reached considerable size, the ensuing neurological abnormalities might not be revealing. On occasion there are false localizing neurological findings. Neuroradiological localization is essential to obtain accurate diagnosis and to plan the best operative approach. Radioactive brain scanning offers the best screening method. Although air studies remain useful, angiography of vessels of the posterior fossa is assuming a dominant role in diagnosis and surgical planning. [ABSTRACT FROM AUTHOR]

Five cases of early post-traumatic status epilepticus in childhood are reported. In all cases the trauma was apparently of a minor nature and the seizures appeared within two hours after injury. In none of the cases was a significant intracranial clot detected, nor was lasting cerebral damage evident. This is in contrast with adults, where status epilepticus after head injury is thought to be an ominous sign. Rapid improvement in level of consciousness after prompt treatment is certainly the most important criterion in assessing the role of the seizures. In the same period of time, post-traumatic status epilepticus was not seen in children with more severe head injury. [ABSTRACT FROM AUTHOR]