The ASPECT Hydrocephalus System: a non-hierarchical descriptive system for clinical use.

In patients with hydrocephalus, prognosis and intervention are based on multiple factors. This includes, but is not limited to, time of onset, patient age, treatment history, and obstruction of cerebrospinal fluid flow. Consequently, several distinct hydrocephalus classification systems exist.

Assessment of patients with a Chiari malformation type I.

Introduction: The prevalence of Chiari malformation type I (CM-I) has been estimated as up to 1% of the general population. The majority of patients are asymptomatic and usually do not need treatment. Symptomatic patients, and some asymptomatic patients with associated conditions, may benefit from further assessment and treatment.

Safety analysis and complications of condylar screws in a single-surgeon series of 250 occipitocervical fusions.

Objective: Condylar screw fixation is a rescue technique and an alternative to the conventional configuration of occipitocervical fusion. Condylar screws are utilized when previous surgical bone removal along the supraocciput has occurred which makes anchoring of a traditional barplate technically difficult or impossible. However, the challenging dissection of C0-1 necessary for condylar screw fixation and the concerns about possible complications have, thus far, prevented the acquisition of large surgical series utilizing occipital condylar screws.

Bilateral mirror image lumbar spinal dural arterial venous fistula: a rare case and systematic review of the literature.

Background: Spinal dural arteriovenous fistulas (SDAVF) are rare with an incidence of 5-10/million annually. They can be difficult to diagnose causing a delay in treatment with significant morbidity. We describe the first case in the literature of a symptomatic mirror lumbar SDAVF which may go unnoticed due to its unique vascular anatomy.

Posterior fossa decompression with duraplasty in Chiari malformation type 1: a systematic review and meta-analysis.

Background: Surgery for symptomatic Chiari type I malformation (CM-I) patients include posterior fossa decompression (PFD) involving craniectomy with or without dural opening, and posterior fossa decompression with duraplasty (PFDD). This review aims to examine the evidence to aid surgical decision-making.

Methods: A medical database search was expanded to include article references to identify all relevant published case series.

Subarachnoid haemorrhage secondary to traumatic intracranial aneurysm of the posterior cerebral circulation: case series and literature review.

Background: To identify the clinical features, rebleed risk, timing and method of diagnosis, complications and outcome for subarachnoid haemorrhage (SAH) from traumatic intracranial aneurysm (TICA) of the posterior circulation. Subjects included 26 patients aged 3-54 (mean 24.8).

Third ventricular shape: a predictor of endoscopic third ventriculostomy success in pediatric patients.

Object: The criteria for identifying patients in whom endoscopic third ventriculostomy (ETV) provides control of hydrocephalus remain in evolution. In particular, it is not clear when ETV would be effective if intraventricular obstruction is not found preoperatively. The authors postulated that 1) displacement of the third ventricle floor inferiorly into the interpeduncular cistern and displacement of the lamina terminalis anteriorly into the lamina terminalis cistern could predict clinical success of ETV, and 2) improvement in these displacements would correlate with the success of ETV.

Spontaneous regression of septum pellucidum/forniceal pilocytic astrocytomas--possible role of Cannabis inhalation.

Introduction: Spontaneous regression of pilocytic astrocytoma after incomplete resection is well recognized, especially for cerebellar and optic pathway tumors, and tumors associated with Neurofibromatosis type-1 (NF1). The purpose of this report is to document spontaneous regression of pilocytic astrocytomas of the septum pellucidum and to discuss the possible role of cannabis in promoting regression.

Case Report: We report two children with septum pellucidum/forniceal pilocytic astrocytoma (PA) tumors in the absence of NF-1, who underwent craniotomy and subtotal excision, leaving behind a small residual in each case.

Microneurosurgical management of anterior choroid artery aneurysms.

Objective: Anterior choroid artery aneurysms (AChAAs) constitute 2%-5% of all intracranial aneurysms. They are usually small, thin walled with one or several arteries originating at their base, and often associated with multiple aneurysms. In this article, we review the practical microsurgical anatomy, the preoperative imaging, surgical planning, and the microneurosurgical steps in the dissection and the clipping of AChAAs.

Excision of vestibular schwannomas--is there a learning curve and how best to demonstrate it?

Objective: To demonstrate the existence of a learning curve in a consultant neurosurgeon's performance in excising vestibular schwannomas by plotting the cumulative sum (CUSUM) chart. Also, to evaluate the influence of new technology in the form of the facial nerve monitor (FNM) and the KTP-532 Laser on surgical performance.

Method: Analysis was carried out on a prospectively collected data series of 102 consecutive cases of vestibular schwannomas excisions between 1986 and 2000 by a single neurosurgeon using the retrosigmoid approach.

Influence of light and time on bilirubin degradation in CSF spectrophotometry for subarachnoid haemorrhage.

Aim: Investigation of the influence of light on bilirubin degradation over time in cerebrospinal fluid (CSF) specimens from patients with computed tomography (CT) positive subarachnoid haemorrhage (SAH).

Methods: Twenty-nine CSF samples were analysed from 23 patients with CT-positive SAH. Samples were divided into two cohorts - one half being stored in the dark, the other in normal room light conditions.

Operative intervention for delayed symptomatic radionecrotic masses developing following stereotactic radiosurgery for cerebral arteriovenous malformations--case analysis and literature review.

Case Report: We report two cases of operative intervention that was beneficial in the treatment of delayed symptomatic radionecrotic masses that had developed following stereotactic radiosurgery (SRS) using the gamma knife (GK) for the treatment of cerebral arteriovenous malformations (AVM).

Discussion: Case 1 involved a small craniotomy for decompression of a large cerebral multiloculated cyst, which had become symptomatic 84 months following gamma knife treatment for a left frontal lobe AVM. Case 2 involved surgical excision of an occipital radionecrotic mass 72 months following GK treatment for an occipital AVM.

Is the routine placement of a CSF reservoir following endoscopic third ventriculostomy justified?

Endoscopic third ventriculostomy (ETV) is a well established treatment for selected cases of obstructive hydrocephalus. However, it does carry a significant rate of failure, which can be abrupt and life threatening. The present study analyses the benefits versus the risks of routine CSF reservoir insertion during ETV.