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A seven year old girl, known to have hereditary multiple exostoses, developed moderate gait disorders at the age of six years. Deterioration of myelopathy initiated the clinical investigation including spinal computed tomography (CT) and magnetic resonance imaging (MRI). These examinations demonstrated a coneshaped exostosis originating from the posterior arch of C2. The spinal canal was markedly narrowed with significant compression of the spinal cord at the C2 level. The girl underwent laminectomy of C2 with total removal of the exostosis. Postoperative deterioration of neurological symptoms correlated with a hypointense lesion on T1 weighted imaging in the cord at the same level, but no further cord compression on follow-up MRI. The spastic tetraparesis has improved considerably within 12 months thereafter.

The data on arachnoid cysts in children (0-15 years) operated upon between 1980 and 1988 were analysed in a retrospective, co-operative study. The results from 285 patients indicate a predominance of these lesions in boys (64%) more than girls (36%) and a mean age of 6 years at onset of symptoms. Focal EEG patterns corresponding to the cyst's location were encountered in 32%. About 40% of all cysts were located along the midline, the sylvian fissure representing the predominant location. Open surgery, i.e. total excision or marsurpialization (together 43.3%), emerged as the first-choice surgical procedure. The type of surgery switched somewhat to shunting procedures in cases of lesions in deeper locations (22.8%). Morphological results on follow-up revealed a reduction of the size of the cyst in a significant majority (61%); in 18% the cyst had disappeared completely on CT scans. There was an obvious correlation between postoperative morphological findings and clinical outcome.

A case of traumatic foreign body embolism into the right intracranial carotid artery with stenosis of the right middle cerebral artery in a 9-year-old boy is presented. Initial hemiparesis and a consecutive asymptomatic interval of 12 months were followed by a period of frequent transient ischemic attacks. After an extracranial-intracranial arterial bypass had been performed 18 months later, symptoms ceased without relapse. A thorough review of the literature demonstrates the rare incidence of this entity.

The clinical and pathological report presents a seven-week old girl suffering from signs of raised ICP. A ventriculo-atrial shunt was inserted and replaced by a ventriculo-abdominal shunt due to occlusion at 15 months of age. At 16 months, craniotomy and resection of an oligodendroglioma was performed and the shunt was preserved. The child died at 18 months due to extensive local recurrence. Autopsy revealed massive peritoneal metastases of the tumor. This is the eleventh published case of canalicular metastases of glioma.

Prior to invention of computerized tomography, the coincidence of hydrocephalus and brain tumors in early infancy resulted in diagnostic problems, frequently. Two cases with primarily insufficient diagnosis are reported. In spite of the necessity of deep sedation or general anesthesia at the present, computerized tomography has turned out to be highly perferable to other common methods.

Infectious complications of hydrocephalus shunts are serious problems. A possible method of treating such infections is by external ventricular drainage (EVD). 20 patients - 17 with infected shunts, 3 with neonatal meningitis, ventriculitis and subsequent hydrocephalus - were treated by EVD and the results are presented in this report. The advantages of the procedure are control of the intraventricular pressure to bring it within normal limits and the possibility of intraventricular antibiotic instillation to supplement systemic therapy. Furthermore, the optimal operation time for the definitive shunt can be assessed by EVD once the infection has been overcome.

Sixty-four infants were selected for evaluation of hydrocephalus and associated cerebral anomalies on CT scan; initial findings are compared with follow-up results after shunt therapy and correlated with psychomotor development. Analysis indicates that initial high-grade cortical thinning, the capability of the brain to recover after CSF diversion, and size and number of associated cerebral anomalies can all be considered decisive factors in estimating prognosis in infantile hydrocephalus.

Permanent (CSF-drainages for treatment of hydrocephalus in posterior fossa tumors have been used in the last few years, increasingly. The rare incidence of extracranial metastases and it's higher frequency in the same period of time has been remarkable. An additional case of metastasis via ventriculoperitoneal shunt is presented. Such deleterious complications of malignant CNS-tumors should be avoided, as progressively improving results with combined radio-chemotherapy have established a more encouraging prognosis.

A case of Dandy-Walker-syndrome is presented, comparing the value of sonography and CT in intrauterine diagnosis. Together with a review of the literature of the subject, pathogenesis, morphology and prognosis in regard to the psychomotoric development are discussed.

The introduction of lasers in neurosurgery in 1976 can be considered as a major contribution to gaining access to "untouchable" areas of the brain. This immaterial instrument provides for precise cutting at low penetration depth in surrounding tissues and may carbonize, and thus remove, layers not to be touched because of their highly sensitive vicinity. From a total of 794 patients experiencing the advantages of laser surgery (1976-1984), a series of 12 children with lower brainstem tumors is presented. Intraoperative instability of vital functions was absent throughout, leaving the patients without deterioration of their initial neurological condition. Given appropriate handling and adequate experience, the laser is a singularly helpful surgical tool for gaining access to areas hitherto barred to surgery.