The Atkinson Morley's Hospital joint neurosurgical-maxillofacial procedures: cranioplasty case series 1985-2003.

Aims: To present a retrospective case series resulting from the co-operation in cranioplasty procedures between neurosurgeons and maxillofacial surgeons of the Atkinson Morley's and Royal Marsden Hospitals of London, UK for the period 1985-2003.

Materials And Methods: The cranioplasty case series is part of an integrated analysis of the complete Atkinson Morley's Hospital craniofacial procedure database. Cases included both cosmetic and functional procedures.

Skull base techniques for aneurysm occlusion.

Aneurysms of the vertebrobasilar system carry relatively high operative mortality and morbidity due to their anatomical location. A variety of skull base techniques is described to improve access to these lesions and to reduce or abolish the need for retration on neurovascular structures. Surgical results are generally favorable and should encourage a more widespread application of these techniques in appropriate circumstances.

Meningiomas in the region of the cavernous sinus: a review of 21 patients.

This is a review of 21 patients with meningiomas involving the region of the cavernous sinus. All underwent surgery, and the fronto-zygomatic (F-Z) approach, first described by Fujitsu and Kubawara, was employed in every case. The mean age at presentation was 47 years; seven patients were male and 14 female.

Comparison of rates of infection of two methods of emergency ventricular drainage.

The rates of infection of two methods of external ventricular drainage in use at Atkinson Morley's Hospital--namely, (a) percutaneous drainage with Rickham reservoirs and (b) tunnelled ventriculostomies--were compared in this retrospective review. Percutaneous drainage of CSF with Rickham reservoirs was associated with a 27% rate of infection as identified by positive microbiological cultures; tunnelled ventriculostomy catheters had a 10% infection rate. The difference in the infection rate between the two methods was statistically significant (P < 0.

Haemangiopericytoma: a clinical and radiological comparison with atypical meningiomas.

A small number of haemangiopericytomas (HPCs) are compared with a group of cases labelled as atypical meningiomas (AMs) extracted from our records over a 10-year period. There was close convergence between the two groups in terms of clinical presentation. Radiologically, they were quite different.

Adult postrepair myelomeningocoele and tethered cord syndrome: good surgical outcome after abrupt neurological decline.

Adults who have had repair of an open myelomeningocoele at birth are susceptible to a variant of adult onset tethered cord syndrome (ATCS). Precipitous and profound loss of lower extremity motor function occurred in two postrepair adult patients, but was not seen in any of our 12 cases of adult tethered cord with any other aetiologies. Both postrepair ATCS patients made a good recovery after surgical release of the tether.

Outcome after repeat lumbar microdiscectomy.

One of the standard treatments for herniation of lumbosacral disc material has become the microdiscectomy. Although multiple studies have assessed the outcome of microdiscectomy, only a few studies have evaluated the outcome of those patients who have undergone a second microdiscectomy at the same location as the original one. The purpose of this study was to review 55 patients who, over a 4-year period, underwent a second microdiscectomy at the same location as their original operation and to evaluate those factors associated with improved outcomes.

Multiple dural metastases from a pituitary adenoma. Case report.

Only 12 cases of pituitary tumors that metastasized within the central nervous system have been reported. A further case is presented in which the histology of the multiple dural metastases remained identical to that of the original tumor, a pituitary adenoma. The authors discuss management of these rare lesions that appear histologically benign.

Prolactinomas in men masquerading as invasive skull base tumours.

Four giant prolactin-secreting tumours invading the skull base are described. All of them occurred in men. The presenting features were sufficiently diverse to be clinically misleading.

Aspergillosis infection in neurosurgical practice.

Fungal infections including those due to aspergillus are rare in neurosurgical practice despite their possible inclusion in many differential diagnoses. Recently, these diseases have been diagnosed with increasing frequency, principally as opportunistic infections in patients undergoing treatment for diseases resulting in immune compromise. The epidemiology is poorly understood as mycoses are not notifiable diseases.

Primary spinal malignant schwannoma.

Malignant schwannomas are uncommon primary tumours of nerve sheath origin. They are rarely found within the spine and spinal canal, and little is known about their management in this unusual location. We describe the presentation of three patients with primary spinal malignant schwannomas and discuss the surgical management.

Long-term results of microlumbar discectomy.

A long-term prospective study was carried out of 100 consecutive patients undergoing microlumbar discectomy (MLD) and fulfilling stringent selection criteria. A 95% long-term follow-up result was obtained at a mean duration of 8.6 years.

Imaging after titanium cranioplasty.

Titanium cranioplasty has been used in our unit for reconstruction of cranial defects following trauma, tumour resection and bone loss due to postcraniotomy infection. It has previously been assumed that imaging to assess recurrence of disease progression after cranioplasty would be severely compromised in the presence of metallic material. Titanium is a non-ferrous metal of low atomic number, which is relatively radiolucent and allows exceptionally clear images to be obtained without significant degradation of image quality, on CT and magnetic resonance (MR) imaging.

The long-term efficacy of conservative surgery and radiotherapy in the control of pituitary adenomas.

Objectives: We assessed the long-term efficacy and toxicity of conservative surgery and radiotherapy in the control of pituitary adenomas.

Design: Retrospective study of patients treated at the Royal Marsden Hospital.

Patients: Four hundred and eleven patients with pituitary adenomas treated with conventional external beam radiotherapy at the Royal Marsden Hospital between 1962 and 1986.

Chondrosarcoma of the skull base: a series of eight cases.

Chondrosarcomas of the skull base are indolent, locally invasive tumors with a marked tendency to recur. Surgery is the mainstay of treatment because these tumors are generally resistant to other forms of treatment. A surgical approach with wide access to the skull base and one that is easily repeatable is required, because recurrence is common.

Stereotactic aspiration of brain abscesses: is this the treatment of choice?

Despite a reduction in the mortality of patients with brain abscess since the introduction of the computed tomography (CT) scanner, controversy persists as to the preferred method of treatment for this condition. Eleven patients were treated by CT guided stereotactic aspiration of pus and appropriate antibiotic therapy. A total of 14 aspirations were performed.

Invasive aspergilloma of the skull base.

Aspergillus infection originating in the nasal cavity or paranasal sinuses is a rare cause of benign, locally invasive disease affecting the skull base. We describe a case in which extensive disease led to bilateral proptosis and invasion of the anterior cranial fossa.

Intracranial aneurysm formation following radiotherapy.

Two patients sustained a subarachnoid haemorrhage secondary to radiation-induced vasculopathy and associated aneurysm. A 65-year-old woman was treated by radiotherapy for a stereotactically biopsied left parieto-temporal astrocytoma. Three-and-a-half years later, she suffered a subarachnoid haemorrhage secondary to a giant aneurysm arising from the middle cerebral artery bifurcation.

Midline aneurysms of the vertebrobasilar junction: an effective anterior approach.

There are acknowledged difficulties associated with operations on midline aneurysms at the vertebrobasilar junction. This report describes a series of such aneurysms treated by an anterior approach using a Le Fort maxillotomy to gain access via the clivus to the aneurysm. In each case the aneurysm was dealt with satisfactorily with no long-term morbidity or mortality.

The pathophysiology of infant subdural haematomas.

The widely accepted theories concerning the pathophysiology of infant subdural haematoma (SDH) were formulated in the pre-computed tomographic (CT) scan era. Violent shaking is considered to be a crucial cause of SDH in non-accidentally injured infants. This theory has been re-examined in a clinical and CT scan review, and our findings have been correlated with results of recent head injury research.

Gliomyosarcoma: an immunohistochemical analysis.

Tumours of mixed glial and sarcomatous elements occurring in intracranial neoplasms are well recognised and have been termed gliosarcomas. These tumours account for up to 8% of all glioblastomas. The sarcomatous elements are thought to derive from the neoplastic transformation of mesenchymal cells in or adjacent to the tumour.

Giant cell tumors of the sphenoid bone.

Giant cell tumors of the sphenoid are rare; there are 36 previously reported cases. We report two cases of these tumors in women in their thirties, both associated with pregnancy. In the first patient, the tumor was removed via a transnasal transsphenoidal approach.