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Background and Methods: Brain metastases are far more common than primary central nervous system tumours. Based on our own clinical experiences and relevant literature published over the last decade (Medline), we present an overview of diagnosis and treatment., Results: Brain metastases are caused by haematogenous spread from extracranial tumours, most frequently from cancers in the lung, breast, melanoma, renal carcinomas and colorectal carcinomas. Three out of four patients present with multiple brain metastases. Cerebral MR is the most sensitive investigation. The most important prognostic factors for survival are Karnofsky score, age < 65, well controlled primary cancer and absence of systemic cancer disease., Interpretation: Some patients are offered neurosurgical treatment (surgery or gamma knife), depending on their clinical status, the number and location of brain metastases, and the histology and degree of systemic involvement of the primary tumour. The gamma knife is the treatment of choice with multiple and solitary tumours smaller than 3 cm that lie deep within the brain or within eloquent areas, whereas surgery is the treatment of choice with solitary metastases larger than 3-3.5 cm that are surgically accessible and cause significant mass effects. Solitary lesions without significant mass effect can be treated with either technique, as their documented efficacies are similar. However, the gamma knife is often preferred since this method is rapid, less invasive, has low morbidity and shortens the hospital stay.

Background: Complex craniofacial synostosis is a group of rare genetic disorders characterized by premature closure of the sutures in the craniofacial skeleton and which to varying degrees affects the extremities., Material and Methods: On the basis of relevant literature, we present a review of syndromal craniofacial synostosis., Results: Phenotypically, the complex craniofacial syndromes have many similarities. Synostosis of the sutures of the cranial vault can result in a variety of skull deformations, depending on the sutures involved, the sequence of premature closure, and the time of closure. Synostosis of the sutures in the skull base and facial skeleton leads to shallow orbits, exophthalmus, hypertelorism, midface retrusion, and prognathia., Interpretation: Precise diagnosis of complex craniofacial syndromes may be difficult solely on the basis of a clinical examination. However, several of the most common syndromes are caused by mutations in genes that code for fibroblast growth-factor receptors. Children with a suspected complex craniofacial syndrome should be referred to genetic testing.

Background: Spinal dysraphism is a group of congenital anomalies of the spine characterized by a midline defect affecting the nervous tissue and its bony and soft tissue coverings. Closed spinal dysraphism, spina bifida occulta, refers to skin-covered lesions. However, there are a number of cutaneous stigmata or other physical signs that serve as indicators of an underlying dysraphic malformation of the lower spinal canal., Material and Methods: Based upon relevant literature, we present a review of occult spina bifida., Results and Interpretation: The cutaneous stigmata that may indicate an underlying dysraphism are particularly hairy patches, subcutaneous lipomas, capillary hemangiomas, dorsal dermal sinuses and sacral cutaneous pits. The clinical examination of a child with lumbosacral cutaneous stigmata should focus on neurological signs and symptoms, urological disturbances and orthopaedic deformities in the lower limbs. Spinal MRI is the imaging modality of choice in children presenting with features consistent with occult spinal dysraphism. Children with occult spinal dysraphism should be referred to a neurosurgical unit.