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We performed a retrospective review of 78 consecutive neurosurgical procedures using Vicryl Collagen®, a resorbable mesh of polyglactin 910 coated with bovine collagen, for dural substitution. The complications we encountered were infrequent and mostly minor (5 cases of subcutaneous CSF collections, 2 cases of aseptic meningitis, 1 superficial wound infection), and not unusual for the surgical procedures studied. One patient, however, had a major infection, starting in the superficial tissues, and extending toward the brain. In this patient, the resorption of the dural substitute appeared to be the cause for the intracranial extension of the infection. Three patients were reoperated on for recurrent tumour after a longer interval. We found minimal adhesions and good fibrous incorporation of the Vicryl Collagen® into the surrounding normal dura. We conclude that Vicryl Collagen® is a valuable alternative to the patient’s own fibrous tissues when dural substitution is necessary. [ABSTRACT FROM AUTHOR]

We performed a retrospective follow-up study of 33 patients, with 34 ruptured aneurysms, treated by coating using bio-adhesive polymers. The rebleeding rate after a mean follow-up of 10 years was 18% (6 patients), with 4 cases of early haemorrhage and 2 late rebleedings (late rebleeding rate of 0.7% per year). All rebleedings proved fatal. Coating of the aneurysmal wall provides some protection in patients with 'unclippable' aneurysms, but is obviously inferior to clipping, and should be used only in very selected cases. [ABSTRACT FROM AUTHOR]

We have reviewed our experience with a series of 49 consecutive patients with spontaneous cerebellar haematoma, treated according to a standardized management protocol. Seventeen patients were managed conservatively, 30 underwent ventricular drainage, and in six patients the haematoma was evacuated. The indications for the different modes of treatment are discussed. The most significant prognostic factors determining the outcome at one month were the grade of quadrigeminal cistern obliteration on the initial CT scan and the Glasgow Coma Scale on admission. Patients with normal cisterns had a good outcome, and only needed (temporary) ventricular drainage in case of hydrocephalus. Patients with totally obliterated cisterns had a bad outcome irrespective of treatment. In the patients with compressed cisterns, it is suggested that evacuation of the haematoma might improve outcome; treatment of hydrocephalus alone is insufficient in many cases in this group. [ABSTRACT FROM AUTHOR]

The authors report a case of tension pneumocephalus in association with a ventriculoperitoneal shunt for obstructive hydrocephalus, due to the presence of a pineal tumour. In this unique form of tension pneumocephalus, air from the middle ear must have penetrated into the brain parenchyma and later on into the ventricular system through pre-existing congenital defects in the bony tegmen tympani and the covering dura mater. The possible pathogenetic mechanisms of this kind of tension pneumocephalus are discussed. [ABSTRACT FROM AUTHOR]

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This study presents a series of 10 patients with anterior skull base tumours, treated by a team of neurosurgeons and head- and neck surgeons. The series included 7 malignant tumours of the nose and paranasal sinuses and 1 retinoblastoma, all with intracranial extension through the lamina cribrosa. There were also 2 patients with an anterior base meningioma, growing into the ethmoid sinus and the nasal cavity. 8 tumours were resected by a combined bifrontal craniotomy and uni- or bilateral rhinotomy. In 2 cases a bifrontal craniotomy alone without facial incision sufficed. The skull base was closed with a pediculated pericranial flap and a split-thickness free skin graft underneath. There were no postoperative problems of wound infection, CSF-leakage or meningitis. Recurrent tumour growth or systemic metastasis occurred in 5 out of 7 patients with malignant tumours, 6 months to 2 years postoperatively. The related literature and especially questions of operative indications and technique, including different possibilities of closure and reconstruction of the skull base, are discussed.