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We describe the case of a 39-year-old man who was accidentally shot in the back by a rivet gun. This resulted in paraplegia and partial sensory loss. Magnetic resonance imaging (MRI) was helpful in the accurate localization of the foreign body and in the assessment of the spinal cord damage. MRI enabled accurate pre-operative localization of the rivet and provided information on the degree of damage to the spinal cord. The artefact produced on computed tomography plus the limited anatomical detail of the spinal cord in the absence of intrathecal contrast makes this technique unhelpful.

Three patients are described who were selected for stereotactic thalamotomy to alleviate the tremor and rigidity of Parkinson's disease but in whom these symptoms were abolished whilst attempting ventriculography. Discrete deep brain lesions were seen on post-operative CT scan and the basis for their relieving the patients' symptoms is discussed. Although the tremor and rigidity was abolished in these cases and a favourable result ensued, ventriculography is an invasive and potentially dangerous procedure and it is therefore recommended that CT-derived thalamic targets should be employed for functional stereotaxy.

The recent expansion in CT guided stereotactic biopsy has revealed deficiencies in biopsy instrumentation. In view of this, the authors have developed a versatile side-cutting cannula which has been used successfully in over eighty stereotactic biopsies as well as for the drainage of deep seated abscesses.

Two hundred consecutive stereotactic procedures were performed. These were 153 biopsies and 43 therapeutic procedures. The latter included aspiration of craniopharyngiomata, arachnoid cysts, deep-seated abscesses, and the destruction of colloid cysts. Cryogenesis was used to treat an arteriovenious malformation (AVM) in one case. In four cases, the system was used to locate lesions during open surgery. Leksell stereotactic systems were used throughout. The ages of the patients ranged between 12 months and 83 years. Overall, in 35% of biopsies the preoperative diagnosis was not confirmed. When the provisional diagnosis was glioma 70% were confirmed; 21% of them were benign, with 9% some other form of malignancy. Biopsy provided tissue on which a histological diagnosis could be made in 140 procedures. In eight cases the biopsy was repeated and in seven cases a positive diagnosis was subsequently made. Mortality was 1%; there was transient deterioration postoperatively in 5% and prolonged deterioration in 1%. These observations suggest that stereotactic surgery is far superior to freehand burr hole biopsy in the management of these lesions. No radiation treatment should be considered without histological confirmation.

A 31-year-old male presented with a 1 year history of left leg weakness and right leg sensory changes. Myelography revealed a probable intramedullary lesion at T4 and CT confirmed its intramedullary nature. At operation an almost black, firm mass was found projecting from the dorsal aspect of the cord and was totally excised. Histological examination revealed it to be a cavernous angioma.