Early minimally invasive intracerebral hemorrhage evacuation: a phase 2a feasibility, safety, and promise of surgical efficacy study.

Background: Surgical treatment of intracerebral hemorrhage (ICH) is unproven, although meta-analyses suggest that both early conventional surgery with craniotomy and minimally invasive surgery (MIS) may be beneficial. We aimed to demonstrate the safety, feasibility, and promise of efficacy of early MIS for ICH using the Aurora Surgiscope and Evacuator.

Methods: We performed a prospective, single arm, phase IIa Simon's two stage design study at two stroke centers (10 patients with supratentorial ICH volumes ≥20 mL and National Institutes of Health Stroke Scale (NIHSS) score of ≥6, and surgery commencing <12 hours after onset).

Locally invasive giant spinal paraganglioma.

Cauda equina paragangliomas are neuroendocrine tumours rarely encountered in neurosurgical practice. Large cauda equina paragangliomas with an intradural and extradural component, dense adhesion to nerve roots and high vascularity are surgically challenging and mandate meticulous operative dissection. The presence of extensive bony erosion can lead to spinal instability requiring solid instrumentation and fixation.

Rare case of malignant transformation of a solitary spinal osteochondroma into recurrent metastatic chondrosarcoma.

Osteochondroma or osteocartilaginous exostosis is a commonly occurring primary tumor of the bone. Solitary spinal osteochondromas are, however, very rare, seen in only in 1-4% of all known cases and only few symptomatic cases have been reported in the literature so far. Further, while recurrence and malignant transformation are known to occur in osteochondroma, this is rare in the spine.

Outcomes of decompressive craniectomy in patients after traumatic brain injury.

Objective: Traumatic brain injury (TBI) can result in cerebral oedema and vascular changes resulting in an increase in intracranial pressure (ICP), which can lead to further secondary damage. Decompressive craniectomy (DC) is a surgical option in the management of ICP. We aimed to investigate outcomes of DC after TBI.

Central nervous system lymphoma associated with natalizumab.

Patients with primary central nervous system lymphoma (PCNSL) after treatment with natalizumab have been considered co-incidental. We report another case of PCNSL in a patient where the explosive onset suggests a causal link.

Clinical presentation and outcome of patients with intradural spinal cord tumours.

We aimed to retrospectively investigate the clinical presentation and outcome of surgical intervention of patients with intradural spinal cord tumours (IDSCT), and to assess the predictors of surgical outcome. A total of 109 patients with IDSCT (57 males and 52 females) (130 admissions; mean age, 45.9 years; range, 14-89 years) underwent surgery between 1 January 1994 and 30 June 2009 at The Royal Melbourne Hospital.

Extensive spinal epidural abscess as a complication of Crohn's disease.

A spinal epidural abscess is a neurosurgical emergency. Successful treatment frequently requires decompression of the spinal canal in combination with intravenous antibiotics. We report a patient with Crohn's disease who developed an extensive spinal epidural abscess communicating with an intra-abdominal collection.

Early detection of spinal sepsis.

Spinal sepsis (spinal epidural or subdural abscess) is a rare condition, which, if not diagnosed rapidly, can lead to paralysis or death. It is difficult to diagnose in its early stages as the symptoms are as yet non-specific. We aimed to identify predisposing factors and presenting symptoms that might aid in the early diagnosis of spinal sepsis.

Management and hospital outcome of the severely head injured elderly patient.

Introduction: Severe traumatic head injury in the elderly has been associated with poor outcomes. However, there is currently no consensus to direct management in these patients. This study outlines the demographics, injury characteristics, management and outcome of the elderly trauma patients with severe head injury across a defined population.

Splenic angiosarcoma metastasis to the brain.

Angiosarcoma is a rare primary non-haematolymphoid malignant neoplasm of the spleen. This neoplastic process has a poor prognosis, with disease usually widespread by the time of presentation. In the literature there has been only six case reports of cerebral metastasis from splenic angiosarcomas.

Intradural extramedullary spinal spread of oligoastrocytoma.

Spinal involvement from supratentorial oligoastrocytoma is rare, with only five previous case reports. We report a patient with a past history of a frontal oligoastrocytoma who presented 26 months post-primary resection with posterior fossa disease and spinal extension, in the absence of local recurrence or malignant transformation. The case and relevant literature review are instructive to those following patients with previously treated central nervous system tumours possessing seeding potential.

Acute atlanto-axial post-operative subluxation following posterior C1/2 fusion.

Two cases referred with acute post-operative C1/2 subluxation following posterior fusion are reported. Both cases had initial treatment for atlanto-axial instability with posterior cable (Brooks and interspinous) and graft techniques, and placed immediately in a Philadelphia collar. One case was found to have subluxed immediately post-operatively when failing to breathe following reversal of anaesthetic agents, and despite immediate realignment and reoperation was left with a significant quadriparesis.

Spinal cord ischaemic stroke associated with vertebral body infarction.

Only eight cases of spinal cord ischaemic stroke causing paraplegia with associated vertebral body infarction have been previously described. We describe a ninth case with histopathology confirming the Magnetic Resonance Imaging (MRI) appearance of vertebral body infarction. We have reviewed the literature concerning this condition and discuss its diagnosis and aetiology.