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Summary Description of a two-stage surgical treatment of a case of chordoma of the fifth cervical vertebra mainly affecting the vertebral body. In the first stage the cervical column was immobilized employing a posterior approach and a small portion of the tumour in the right lamina was removed. In the second stage the whole of the body of C5 was removed by an anterior route and replaced with an acrylic prosthesis. The advantages of acrylic resin and the literature on vertebral prostheses are discussed.

The case is described of a 52 year old patient admitted for acauda equina compression syndrome (flaccid paraplegia of the lower limbs, bilateral lumbar and sciatic pains, urinary incontinence) of rapid onset and due to narrowing of the lumbar canal from tabetic arthropathy. These vertebral manifestations occur in a low percentage of tabetic arthropathies, which are relatively rare, and are not often accompanied by severe neurological disturbances. Decompressive laminectomy afforded rapid and lasting relief.

The operative results in 37 consecutive patients suffering from developmental stenosis of the lumbar spinal canal, compared with those in spondylosis and disc herniations, are discussed. The diagnostic certainty of stenosis, suspected on the bases of clinical and radiographic data, is reached only at the operating table. To judge the usefulness of the operation we have considered not only the patients' verdicts, but also the improvements in neurological signs and the appearance of new deficits. Satisfactory results are around 80%, slightly less good with stenosis than with the other causes of lumbar syndrome. Radiographic study with contrast medium is mandatory. Dimer-X has been used with very clear radiographic findings and very few complications. Operating technique is also described: a wide laminectomy with facetectomy is advised. The great importance of early physiotherapy is emphasized.

4 cases of thoracic disk protrusion were studied with spinal CT and with either plain X rays of myelography, until now the only tools for a precise diagnosis. In patients with a thoracic compression syndrome and a calcification within the canal CT alone clinches the diagnosis, as it does in cases in which the calcified material is not detectable but the clinical symptoms point to a precise lesion level. In such cases myelography is unnecessary. It should however be done first when neither the clinical symptoms nor the plain X rays indicate the level of the lesion.

The Authors report a case of intranasal cerebral ectopia; the problems concerning the nosographic and diagnostic definition of this condition as well as the differences from other similar pathologies with the same location (such as meningoencephalocele and nasal glioma) are discussed. Particular attention is payed to the various surgical techniques that can be used in these cases.

The authors have reported on the prognostic value of continuous monitoring of somatosensory evoked potentials (SEP) in a survey of 25 patients who underwent carotid surgery. SEP recordings were correlated with the EEG, stump pressure (SP) values and clinical outcome. A non-cephalic reference was used for SEP recordings to allow the analysis of both subcortical and cortical components. During surgery the conduction time between SEP peaks relating to the subcortical components remained stable or showed minimum variations in all patients. During carotid clamping, SEP variations were observed in 9 out of 25 cases (36%). The application of an intraluminal shunt was accompanied by the return to normal values in 7 out of 9 patients. In the remaining two cases SEP abnormalities continued post-operatively and were accompanied by new neurological deficits. EEG changes during carotid clamping were associated with SEP modifications in 6 out of 7 cases, although they were not always correlated. Results confirm that SEP recordings provide useful data concerning the function of the CNS in anaesthetized patients and that, being sensitive to CBF changes, SEP monitoring acts as an indicator of cerebral ischaemia.

The aim of this paper is to assess the results of surgical treatment in spondylosis and cervical disc protrusion, and to indicate some operative parameters which have an influence on the outcome. Particular attention is devoted to the operative techniques used — that is the posterior laminectomy and the anterior approach according to CLOWARD — and to the indication for their choice.

Intramedullary cavernous angiomas are rare vascular malformations; all published cases have been surgically approached posteriorly by standard laminectomy. We describe the case of a 63-year-old man with an intramedullary cavernous angioma, anteriorly located in the thoracic spinal cord. The angioma was operated on by transthoracic approach and totally removed.