Posterior cervical foraminotomy versus anterior cervical discectomy for Cervical Brachialgia: the FORVAD RCT.

Background: Posterior cervical foraminotomy and anterior cervical discectomy are routinely used operations to treat cervical brachialgia, although definitive evidence supporting superiority of either is lacking.

Objective: The primary objective was to investigate whether or not posterior cervical foraminotomy is superior to anterior cervical discectomy in improving clinical outcome.

Design: This was a Phase III, unblinded, prospective, United Kingdom multicentre, parallel-group, individually randomised controlled superiority trial comparing posterior cervical foraminotomy with anterior cervical discectomy.

Chronic CSF leak from lumbar-peritoneal shunt tract: A case report.

Background: We describe a case of long-standing intracranial hypotension caused by an iatrogenic arachnoid diverticulum. This case illustrates two learning points. First, excessive CSF absorption may occur through an acquired arachnoid-epidural venous plexus at a dural defect.

The influence of concomitant syringomyelia on patient reported outcome following hind brain decompression.

To evaluate the impact of concomitant syringomyelia and self-reported complications on patient reported outcome measures in patients undergoing hindbrain decompression for a Chiari 1 malformation. Prospective data collection of 95 patients who underwent Foramen magnum decompression between March 2011 and March 2015. Outcome evaluation was performed using the Core Outcome Measure Index questionnaire for neck (COMI-neck) and Gestalt impression (to assess improvement of headaches).

A rare case of ventriculoperitoneal shunt malfunction due to scrotal migration of the peritoneal catheter.

The authors describe an unusual cause of ventriculoperitoneal shunt malfunction presenting as acute hydrocephalus.

Carcinoid transformation of presacral dermoid cyst in patient with currarino syndrome: a case report.

Currarino syndrome (CS) is a congenital disorder characterized by partial sacral agenesis, anorectal malformation and a presacral mass. Only three cases of carcinoid transformation of the presacral mass have been described in the literature. We present a case of carcinoid transformation of presacral dermoid cyst in patient with Currarino syndrome.

Posterior spinal cord herniation: a novel occurrence following surgery for an intramedullary cyst at the thoracolumbar junction.

Background: Dorsal herniation of the spinal cord through the dura is an uncommon phenomenon and this is only the fifth reported case in the thoracolumbar spine, the first following surgery at the thoracolumbar junction.

Case: A 57-year-old male underwent marsupialisation of a benign intramedullary cyst at the T12-L1 level and subsequently returned with symptoms of dorsal column compromise. He was found to have a posterior herniation of the cord into a pseudomeningocele at the level of the previous surgery.

Long term neuropsychological outcome and management of 'decompensated' longstanding overt ventriculomegaly in adults.

Objective: We aimed to study a group of patients presenting with symptomatic longstanding overt ventriculomegaly in adults (LOVA) requiring treatment (endoscopic third ventriculostomy), and to study their long term neuropsychological status and functionality.

Methods: Twenty patients were treated with endoscopic third ventriculostomy on presentation and were studied with neuropsychological assessments including the repeatable battery for the assessment of neuropsychological status and the hospital anxiety and depression scores. Pre- and post-operative MRI studies were used to assess the patency of the endoscopic third ventriculostomy (ETV) along with clinical outcome scores.

Diffuse central nervous system protoplasmic astrocytoma.

Protoplasmic astrocytoma is an extremely rare form of grade II low grade glioma which usually presents as a discrete mass lesion. We describe a 3-year-old female with diffuse protoplasmic astrocytoma with parenchymal involvement and leptomeningeal spread. This tumour proved extremely difficult to diagnose and followed a progressive course.

The role of visually evoked potentials in the management of hemispheric arachnoid cyst compressing the posterior visual pathways.

We report a case of an occipital arachnoid cyst in an infant, managed on the basis of changes in visually evoked potentials (VEPs). A significant asymmetry of VEP responses prompted neurosurgical intervention, which improved visual behavior and electrical response to both pattern and flash stimuli.

Spina bifida occulta and monozygotic twins.

Central nervous system maldevelopment can have different presentations in twins. We report on a case of different presentations of spina bifida occulta in monozygotic twins. The first twin presented at birth with a lipomyelomeningocele; a tethered cord was diagnosed in the second twin at 2 years of age.

Subdural empyema secondary to sinus infection in children.

Objective: To evaluate the impact, on morbidity and mortality, of aggressive surgical management of subdural empyema of sinus origin in children.

Method: The authors conducted a retrospective review of 20 children admitted between 2000-2007 to Alder Hay Children Hospital and The Walton centre for Neurology and Neurosurgery for subdural empyema secondary to sinus infection. Clinical presentation, duration of symptoms, radiological investigations, surgical treatment and post-operative outcome were evaluated.

Combination of myxopapillary ependymoma and fatty filum in a child with tethered cord syndrome. Case report.

The authors present a case of a child with a tethered spinal cord associated with a myxopapillary ependymoma. This 16-month-old boy presented to the authors' institution with developmental delays in standing and walking. Magnetic resonance (MR) imaging demonstrated a fatty terminal filum and tethered cord.

Endoscopic management of arachnoid cysts: an advancing technique.

Object: Neuroendoscopy is increasingly used in neurosurgery. The authors report their evolving experience in the management of arachnoid cysts using endoscopic techniques and, more recently, the use of these techniques in combination with neuronavigation systems. The aim of this study was to assess the efficacy of this approach and the factors influencing the final outcome of treatment.

Injuries caused by parachute risers during foreign military parachuting.

Objective: The objective was to study the injuries from the deployment of military parachutes when parachuting with foreign armies.

Methods: The number and nature of injuries sustained while military parachuting with domestic and foreign parachute systems and techniques was compared.

Results: Of a total of 370 parachutists, 41 (11.

Outcome predictors in the management of spinal cord ependymoma.

The aim of this study was to determine predictors of functional outcome and survival in a retrospective cohort of spinal cord ependymomas treated at a single institution. Twenty-six patients who underwent treatment of spinal cord ependymoma at a single institution were retrospectively analysed. The clinicopathological features were reviewed and correlated with functional outcome (measured using the Frankel grade), recurrence (clinical or radiological), progression-free survival (PFS) and overall survival (OS).

Cervical osteophytes: a cause of potentially life-threatening laryngeal spasms. Case report.

This 80-year-old woman presented with acute breathing difficulty during neck flexion when cyanosis also developed. The only potential causes were detected on cervical magnetic resonance imaging: two large anterior cervical osteophytes compressing the retropharyngeal space. Excision of these osteophytes resulted in resolution of the symptoms.

Traumatic cerebral aneurysm formation following ventriculoperitoneal shunt insertion.

Introduction: Iatrogenic intracranial aneurysms are rare in children.

Case Report: A 15-year-old girl presented in coma with a fixed dilated left pupil six weeks following removal of a long-standing left-sided ventriculoperitoneal shunt. Computed tomography (CT) and cerebral angiography revealed a left temporoparietal intracerebral haemorrhage with a fusiform distal middle cerebral artery aneurysm.

External ventricular drains: is there a time limit in children?

Background/purpose: The time limit for the use of external ventricular drains (EVDs) has always been controversial. The purpose of this study is to find out if there is a time limit with regard to infection of EVDs and their duration of use in children.

Methods: The records of 28 patients who had a total of 46 EVDs over a 4-year period at the Regional Paediatric Neurosurgical Centre at the Royal Liverpool Children's Hospital, Alder Hey, Liverpool, UK, were retrieved.

Neuroendoscopic third ventriculostomy for failed shunts.

Background: Neuroendoscopic third ventriculostomy has increased in frequency for the management of hydrocephalus. The objective of this paper is to study the outcome in patients with hydrocephalus whose shunt subsequently failed and who were treated with neuroendoscopic third ventriculostomy (NTV).

Method: The departmental prospectively acquired database, kept since 1994, was researched to identify those patients who underwent NTV, having presented with a failed shunt.