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Introduction: Iatrogenic dural tear with cerebrospinal fluid leakage is a known complication of lumbar surgery of the columna. In the literature, the incidence is 3-16%., Material and Methods: The study was a retrospective, consecutive review of electronic patient records after spinal surgery at the Private Hospital Hamlet. The study covers cases from the 10-month period from September 1, 2007 to June 30, 2008. Data was collected after this period and consists of surgeon-documented dural tears. At the time of surgery, the surgeon was unaware that there would be a subsequent registration. A total of 634 patients had lumbar neural decompressive surgery - 479 patients were treated for spinal stenosis and 155 for prolapsed disc., Results: The incidence of dural tear was 3.9% (25 dural tears in 634 operations). The risk of a dural tear after secondary surgery was 7.9% versus 3.3% for primary (p = 0.02) and the mean age was 65.9 years for patients with dural tear compared with 58.1 years for patients without (p = 0.00). The difference in the mean duration of surgery was significant being 72 minutes in the group suffering a dural tear compared with 56 minutes (p = 0.03) among the remaining patients, and in the former group length of stay was increased by 1.1 day (p = 0.00)., Conclusion: The incidence of iatrogenic dural tear was 3.9%. The incidence of dural tear was doubled in secondary surgery. The duration of surgery increased by 16 minutes and the patients with dural tear were also hospitalized one day longer.

Metastatic spinal cord compression (MSCC) is a disabling complication to cancer for which the optimal treatment of choice is not settled. An analysis was performed in patients with MSCC secondary to lung cancer in order to elucidate clinical symptoms and treatment results according to regression of neurological deficits and survival. The total series consisted of 102 retrospectively evaluated patients referred for treatment, in the Eastern part of Denmark in the period 1979-1988. Patients included 40% cases with Small Cell Carcinoma (SCLC), Adeno-carcinoma (ACL) (26%), Squamous Cell Carcinoma (SQLC) (18%) and Large Cell Carcinoma (LCC) (9%). Symptoms, clinical presentations and therapeutic results are described. The outcome of treatment depended fundamentally on the patient's neurological condition at the time of the diagnosis. All patients with SCLC who were able to walk at the time of MSCC remained ambulatory while 15% of the non-ambulatory SCLC patients regained walking ability; in non-SCLC, 95% of patients retained walking ability while 22% regained the ability to walk. No major differences in the immediate outcome of treatment between the various histological types of lung cancer as to the different treatment modalities were observed, however, 82% of the patients with non-SCLC had benefit from treatment with laminectomy followed by radiotherapy compared with either laminectomy (47%) or radiotherapy (39%) alone (p = .03, Chi-square test). The group of patients treated with laminectomy followed by radiotherapy had a better survival (median value 3.5 months, range 0-132 months) than patients treated with either laminectomy (median value 1.5 months, range 0-32 months) or radiotherapy (median value 1 month, range 0-59 months) alone (p = .03, Log-Rank test). No significant difference was observed in survival between the various histological types of lung cancer (p = .18, Log-Rank test). Despite a short survival, early diagnosis and immediate treatment is crucial, since it may preserve the gait function in 97% of lung cancer patients developing malignant spinal cord compression.

Background: The 21-aminosteroids are a series of compounds designed to inhibit lipid peroxidation in the cell, and, as such, may have cerebral protective effects. The current study was performed to evaluate the effect of a 21-aminosteroid, tirilazad mesylate (U74006F), on cerebral blood flow, metabolism, and carbon dioxide reactivity., Methods: Using a double-blind study design, eight volunteers received tirilazad mesylate, and eight others received only vehicle. The cerebral blood flow was measured by single photon emission computerized tomography using 133Xe inhalation in the resting condition at the beginning of the study and after infusion of tirilazad mesylate (1.5 mg/kg) or vehicle. Cerebral oxygen metabolism was calculated from the cerebral blood flow and the measured cerebral arteriovenous oxygen content difference. After both of the above cerebral blood flow measurements, arterial carbon dioxide tension was decreased by voluntary hyperventilation, and, later, increased by breathing an air/carbon dioxide mixture. The relative changes in cerebral blood flow induced by the PaCO2 variations were estimated from the changes in the arteriovenous oxygen content difference., Results: Blood pressure, pulse rate, and PaCO2 were similar before and after the infusion of tirilazad mesylate in both groups, and there was no difference between the groups. The cerebral blood flow and oxygen metabolism did not change after the tirilazad mesylate infusion. The slope of the regression line of relative change of estimated cerebral blood flow and PaCO2 (regression coefficients in both groups, > 0.90) was unchanged after infusion., Conclusions: Tirilazad mesylate has no effect on cerebral blood flow, cerebral oxygen metabolism, or reactivity of cerebral blood flow to carbon dioxide in healthy volunteers.

A retrospective study of 398 patients suffering from metastatic compression of the spinal cord or cauda equina is presented. The study comprised almost all relevant medical records of patients admitted to hospital in the eastern part of Denmark in the period 1979 through 1985. Carcinoma of the lung, prostate, breast and kidney were the most frequent primary malignancies causing spinal compression. Most patients were treated with laminectomy, or radiotherapy or with laminectomy and radiotherapy combined. The effect of the treatment was estimated by evaluation of motor function and sphincter control. Treatment with laminectomy followed by radiotherapy was significantly superior to treatment with laminectomy or radiotherapy alone. But if the patients' motor function and primary tumour were taken into account, no significant difference between the treatments was observed. The efficacy of treatment depended upon the symptoms when the diagnosis was established, and accordingly early diagnosis is of the utmost importance. The incidence of metastatic compression increased during the period covered by the study, and since this condition must not go untreated, awareness of the symptoms, primarily pain, is essential.

Damage to the olfactory nerve during frontotemporal approach to the basal cisternal region has not previously been investigated in a quantified manner. In this retrospective study of 25 patients operated on for ruptured intracranial aneurysms via the frontotemporal route, 22 patients suffered postoperatively from anosmia ipsilateral to the side of surgery. This complication most often goes unrecognized by the patient as well as the physician, and attention should be drawn to it because of its widespread occurrence. This investigation demonstrates a high incidence of anosmia (24 (88.9%) of 27 surgical sides) occurring ipsilateral to the frontotemporal approach in aneurysm surgery. Recovery after traumatic anosmia has been recorded up to 5 years after injury. Nevertheless, the authors believe that the damage is permanent when lasting 35 months or longer.