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Background: Traumatic intracranial aerocele, also known as pneumocephalus, is an uncommon condition that may be asymptomatic or may present with progressive neurological deficits and life threatening conditions that demand urgent decompressive craniotomy to reduce the acute rise in intracranial pressure and the sequelae., Aims & Objectives: A high degree of suspicion and continuous neurological monitoring are essential for the early detection and the prompt neurosurgical intervention demanded for the achievement of a good outcome in patients following traumatic acute severe head injury with life threatening neurological complications., Method: Presentation of a young motorcyclist who was not wearing a crash helmet and was involved in a road traffic accident in which he sustained a compound cranio-facial injury with loss of consciousness and symptomatic intracranial aerocele., Results: The case of a 28-year old motorcyclist without a helmet, following a road traffic accident, sustained compound skull fracture with CSF rhinorrhea, ventricular aerocele and progressive blindness who recovered his vision fully following bitemporal decompressive craniotomy., Conclusion: A high index of suspicion enabled early detection and prompt decompressive craniotomy that stemmed the progressive loss of vision in this patient with an uncommon but symptomatic intracranial aerocele and cranio-facial compound head injury.

Study Design: Surgical technique article with retrospective case series., Summary of Background Data: Sacral insufficiency fractures are commonly encountered in oncologic patients and constitute a cause for persistent lower back and pelvic pain., Objective: The aim of this study is to describe the modified technique of navigated percutaneous sacroiliac (SI) fixation using multiple long screws per level that cross both SI joints and engage bilateral iliac bones; furthermore to evaluate its safety and efficacy in oncologic patients with sacral insufficiency fractures., Methods: Six oncologic patients (3 male, 3 female, mean age: 58.8 y) with sacral insufficiency fractures who had undergone additional radiation therapy were operated with navigated percutaneous fixation. Two patients had failed preoperative sacroplasty and 1 had failed SI pinning. Eighteen SI screws were placed (15 at S1 level and 3 at S2). In the majority of cases the screws were long enough to engage bilateral ilium and sacrum. Additionally, 1 patient underwent percutaneous iliolumbar instrumentation and in 4 patients we performed concomitant sacroplasty or polymethylmethacrylate screw augmentation. The patients were followed for 18.8 months in average (range: 12-30 mo). Outcome was assessed using the Karnofsky Performance Status score (KPS), pain scale (0-10) and detailed neurologic examination., Results: In 1 case, a revision of a screw was required due to radiculopathy. There was no perioperative morbidity or mortality. No hardware failure was encountered. There was significant improvement in KPS (P=0.04) and pain levels (P=0.02)., Conclusions: These preliminary data suggest that navigated percutaneous SI screw fixation is a safe and effective intervention in terms of pain control and performance status improvement in oncologic patients with sacral insufficiency fractures. For optimal fixation, multiple long screws that engage both iliac bones may be inserted through the S1 level in a safe manner. The technique may be combined with sacroplasty or closed posterior instrumentation to augment the screw fixation. Further investigation is needed to compare this technique with other treatment modalities.

Adeloye-Odeku disease, also known as congenital inclusion dermoid cyst (CIDC) of the anterior fontanelle was first described in a publication in 1971 by Adeloye A and Odeku EL, as a solitary congenital subgaleal inclusion dermoid cyst of the anterior fontanelle in Nigerians. This rare lesion, (0.1-0.5% of all cranial tumors and 0.2% of all inclusion cysts), was initially thought to be an African cyst. The universal distribution of this cyst has subsequently been shown in accumulated literature of other ethnic distribution, Caucasians, Indians, Chinese, Japanese, Turkish and others. This is the first published report that we know of Adeloye-Odeku disease in Saudi Arab children in Abha, Saudi Arabia. Four patients with Adeloye-Odeku disease, two boys and two girls, Saudi patients with ages ranging from 3months to 9years are presented. All had CT and MRI brain scans. Successful surgical excision of the cyst was achieved in each of the three patients who consented for surgery and there was no recurrence. The parents of the oldest patient declined surgical intervention but agreed to outpatient follow up.

With wide application of antireflux surgery, reoperations for failed fundoplications are increasingly seen. This study was undertaken to document outcomes after reoperative fundoplications. Sixty-four patients, 26 men and 38 women, of average age 55 years+/-15.6 (SD), underwent reoperative antireflux surgery between 1992 and 2003. Fundoplication prior to reoperation had been undertaken via celiotomy in 27 and laparoscopically in 37. Both before and after reoperative antireflux surgery, patients scored their reflux and dysphagia on a Likert Scale (0 = none, 10 = continuous). Reoperation was undertaken because of dysphagia in 16 per cent, recurrent reflux in 52 per cent (median DeMeester Score 52), or both in 27 per cent. Failure leading to reoperation was due to hiatal failure in 28 per cent, wrap failure in 19 per cent, both in 33 per cent, and slipped Nissen fundoplication in 20 per cent. Laparoscopic reoperations were completed in 49 of 54 patients (91%); 15 had reoperations undertaken via celiotomy. Eighty-eight per cent of reoperations were Nissen fundoplications. With reoperation, Dysphagia Scores improved from 9.5+/-0.7 to 2.6+/-2.8, and Reflux Scores improved from 9.1+/-1.4 to 1.8+/-2.7. Seventy-nine per cent of patients with reflux prior to reoperation, 100 per cent with dysphagia, and 74 per cent with both noted excellent or good outcomes after reoperation. We conclude that failure after fundoplication occurs. Reoperations reduce the severity of dysphagia and reflux, thus salvaging excellent and good outcomes in most. Laparoscopic reoperations are generally possible. Reoperative fundoplications are effective treatment for dysphagia and recurrent gastroesophageal reflux, and their application is encouraged.

Transcatheter arterial chemoembolization (TACE) is efficacious against hepatic malignancies by rendering tumors ischemic while delivering high-dose chemotherapy. The added benefit of radiofrequency ablation (RFA) has not been determined. We sought to review our experience with TACE with or without RFA in the treatment of hepatocellular carcinoma and colorectal liver metastases in patients not amenable to resection. TACE and RFA were undertaken in 13 patients with hepatocellular carcinoma (n = 7) or colorectal liver metastases (n = 6). Concurrently 24 patients underwent TACE alone for hepatocellular carcinoma (n = 15) or colorectal liver metastases (n = 9). Patients undergoing TACE with or without RFA were similar in age, gender, and diagnosis. Overall follow-up was 9.1 months +/- 7.1. One-year survival was greater in patients undergoing TACE with RFA than with TACE alone (100% vs 67%, P = 0.04). Mean survival was longer after TACE with RFA compared with TACE alone (25.3 months +/- 15.9 vs 11.4 months +/- 7.3, P < 0.05). No patients suffered significant complications. The addition of RFA to TACE improves survival in patients with unresectable primary or metastatic hepatic malignancies. RFA with TACE should be in the armamentarium of surgeons caring for patients with malignant liver lesions.

A small number of patients with congenital hydrocephalus, who have been treated effectively with ventriculoperitoneal shunts, develop progressive increase in abdominal girth, due to cerebrospinal fluid ascites. This abdominal distension can produce respiratory difficulties that require endotracheal intubation and ventilator support. The respiratory difficulties and the abdominal distension were eliminated when the ventriculoperitoneal shunt was converted to a ventriculoatrial shunt in each of the three cases presented in this paper for discussion.

The pattern of congenital malformation of the central nervous system (CNS) as seen in Jos University Teaching Hospital (JUTH) is slightly different from that seen in Europe, Japan and Southern Nigeria. Not all the various types of CNS malformations reported from these centres have been seen in JUTH. Myelomeningocele was the commonest anomaly of the CNS seen and it accounted for more than 60% of all cases. Bilateral talipes equinovarus deformity was the commonest associated anomaly found. No case of anencephaly was seen in this study.

Pituitary apoplexy, an uncommon syndrome, presented in a 40-year-old Nigerian with severe impairment of vision and persistent headaches over a 4-month period. Surgical decompression successfully restored his vision. This case is presented with a review of the literature and discussed as the first case seen in this unit since it started 5 years ago.

A 13-year old Nigerian boy presented with a painless swelling which had grown, over ten years, into a pulsatile monstrous deformity of the left side of the face. Histology of the excised tissue showed a plexiform neurofibroma. It manifested with cutaneous, ocular and bony features. There was also a left eye optic nerve glioma. The case is presented and used to highlight the clinicopathological manifestations of orbital plexiform neurofibroma.