Iatrogenic cerebrospinal fluid leak and intracranial hypotension after gynecological surgery.

Perineural cysts are common lesions of the sacral spine. They have rarely been reported in a presacral location, leading to their misdiagnosis as a gynecological lesion. The authors report the second such case, in a patient undergoing fenestration of what was presumed to be a benign pelvic cyst, and the resultant high-flow CSF leak that occurred.

What would I want for my surgery?

If you were to have an operation tomorrow, would you want your surgical team members to feel comfortable speaking up, to defy hierarchy, to interact with each other just as well as they perform technical aspects of the procedure? Would you want to feel like part of the team? Your answers to these admittedly leading questions are based on the culture of the surgical team and the interdependence of team members and are at the heart of a current debate around the surgical checklist's effectiveness. In British Columbia (BC), many individuals responded to the paper by Urbach et al. (2014) that described the minimal impact on patient mortality after implementation of the surgical safety checklist in Ontario.

Esophageal perforation from anterior cervical screw migration.

Background: Esophageal perforation from anterior cervical instrumentation migration is an uncommon but potentially highly morbid or even fatal complication. Early recognition and aggressive investigation and treatment are essential to ensure good outcome.

Case Description: A 58-year-old man underwent C6 vertebrectomy and C5-7 interbody fusion with a cage and anterior cervical plate.

Usefulness of intracranial EEG in the decision process for epilepsy surgery.

Background And Purpose: In patients with discordant results, non-localizing EEG, or bitemporal seizure onset, intracranial monitoring is done to confirm the seizure onset. Our aim was to assess the yield of intracranial recordings in patients with different clinical scenarios.

Methods: The records of all patients who underwent prolonged intracranial EEG monitoring (IEM) at the London Health Sciences Centre, University of Western Ontario, Canada, between 1993 and 1999, identified using our EEG patient database in continuous use since December 1972, were reviewed.

Pseudogout of the transverse atlantal ligament: an unusual cause of cervical myelopathy.

Background: Calcium pyrophosphate dihydrate deposition in the cervical spine is infrequently symptomatic. This is especially true at the craniocervical junction and upper cervical spine.

Case Report: A 70-year-old previously healthy woman presented with a progressive cervical myelopathy of four months duration.

Dexamethasone for morbidity after subdural electrode insertion--a randomized controlled trial.

Background: Invasive monitoring with subdural electrodes (SDE) for investigation of medically intractable epilepsy may be associated with undesirable immediate postoperative morbidity such as headache, nausea, vomiting, fever, and meningism. We undertook to evaluate the potential beneficial role of perioperative dexamethasone in reducing these symptoms.

Methods: In a double-blind placebo controlled clinical trial 30 patients undergoing SDE insertion were randomized to receive either placebo or a course of dexamethasone beginning one hour prior to surgery and tapering to discontinue over 72 hours postoperatively.

Idiopathic free-floating thrombus of the common carotid artery.

Background: The observation of an intraluminal common carotid artery thrombus overlying a wall defect at ultrasonography or angiography is unusual. To our knowledge, there are no previous reports of a free-floating thrombus in the common carotid artery.

Case Report: A 45-year-old woman who was previously healthy and on no medications presented with acute hemiparesis and aphasia.

Intracranial pressure monitoring in severe traumatic brain injury--results of a Canadian survey.

Objective: The purpose of this study was to obtain information from Canadian neurosurgeons regarding their opinions on, and utilization of, intracranial pressure (ICP) monitoring for severe traumatic brain injury (TBI).

Methods: A brief survey was sent to practicing Canadian neurosurgeons questioning them about their utilization of, and confidence in, intracranial pressure monitoring in the management of patients with severe TBI.

Results: One hundred and ninety-six surveys were mailed.

Awake craniotomy: controversies, indications and techniques in the surgical treatment of temporal lobe epilepsy.

In 1886, Victor Horsley excised an epileptogenic posttraumatic cortical scar in a 23-year-old man under general anaesthesia and discussed his choice of anaesthesia: "I have not employed ether in operations on man, fearing that it would tend to cause cerebral excitement; chloroform, of course, producing on the contrary, well-marked depression." His concerns regarding anaesthesia are reiterated 100 years later as evidenced by the ongoing controversy over the choice of anaesthetic in surgical procedures for epilepsy. The current controversies regarding the necessity for local anaesthesia in temporal lobe epilepsy operations concern the utility of electrocorticography in surgical decision making, its relationship to seizure outcome and the value of intraoperative language mapping in dominant temporal lobe resections.

Infratentorial subdural empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis secondary to paranasal sinusitis: case report.

Objective And Importance: Infratentorial empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis are all rare and potentially lethal conditions. The occurrence of all three in a single patient has not previously been described. We present such a case occurring in a young, otherwise healthy man.

Fatal traumatic vertebral artery aneurysm rupture. Case report.

The authors present the case of a 34-year-old man struck over the left mastoid region by a hockey puck, who suffered a fatal rupture of a left vertebral artery berry aneurysm. He became apneic within seconds of the injury and had no brainstem reflex within minutes. The postmortem examination showed massive subarachnoid hemorrhage in the posterior fossa and the remnants of a berry aneurysm near the intradural origin of the left vertebral artery, 11 mm proximal to the posterior inferior cerebellar artery.

Fatal reaction from inadvertent intrathecal entry of ionic contrast medium during a nephrogram.

A fatal case of inadvertent intrathecal entry of an ionic contrast medium during a nephrogram is reported. The patient developed seizures and failed to regain consciousness following the event. Computerized tomography revealed extensive intraventricular and subarachnoid hyperdensity and cerebrospinal fluid analysis revealed markedly elevated protein content.

Hodgkin's disease of the orbit with intracranial extension.

A rare presentation of intraorbital Hodgkin's lymphoma in a patient without prior history of systemic disease who complained of episodic monocular visual loss with minimal proptosis is reviewed. The case is further distinguished by intracranial extension of the tumor. A literature review highlights such an unusual event against the background of prior experience.

Initial enlargement of the opposite pupil as a false localising sign in intraparenchymal frontal haemorrhage.

Ipsilateral third nerve palsy with early pupillary enlargement is an important sign of transtentorial herniation from a supratentorial mass lesion. A case of frontal, intraparenchymal haemorrhage is reported in which the first ocular manifestation of transtentorial herniation was enlargement of the contralateral pupil. The ipsilateral pupil dilated only after complete oculomotor palsy of the contralateral eye.

Brain metastasis from clear cell sarcoma of the kidney--a case report and review of the literature.

We describe a 5 year old boy with a 5.5 cm right frontal lobe brain metastasis from primary clear cell sarcoma of the kidney without evidence of tumor-associated edema or contrast enhancement on either computed tomography or magnetic resonance imaging. The metastasis regressed but did not disappear with chemotherapy and dexamethasone, and the residual tumor was removed surgically.