Mashed-muscle and oxidised regenerated cellulose (Surgicel) hammock: a quick and effective way to repair frontal air sinus.

The authors describe a simple modification of the traditional muscle-packing technique to seal exposed frontal air sinus during neurosurgical, ENT and facio-maxillary trauma and elective procedures. Oxidised cellulose hammock is used to effectively hold the muscle piece in place to seal the sinus.

Penetrating head injury caused by a dart.

In paediatric practice, head injury is a major public health hazard that places considerable demand on health services. It accounts for almost one third of all accidental deaths and for up to two thirds of all trauma deaths in hospital. Common house-hold objects are at times a source of penetrating head injuries in children. These include electric plugs, golf clubs, toys, nails, etc. Fortunately less than 10% of these eventually lead to permanent brain injury. We report a rare case of penetrating head injury caused by a dart.

Superior petrosal vein in trigeminal neuralgia.

During microvascular decompression procedure for trigeminal neuralgia, surgical attention is mainly focused at the neurovascular conflict at trigeminal root entry zone. However, many major complications of this surgery are often related to venous structures in the posterior fossa, including the venous sinuses and the superior petrosal vein(s). The author reviews surgical anatomy of the superior petrosal vein, highlights important surgical steps related to its microsurgical dissection and discusses avoidance of complications, as well as their management during microvascular decompressive surgery in this region. The discussion is mainly focused on the surgical anatomy of the superior petrosal vein along with its significance during surgery and not on the neurovascular relationships of the trigeminal nerve or aetio-pathogenesis of trigeminal neuralgia.

Cutaneous metastasis from glioblastoma.

A rare case of glioblastoma with isolated cutaneous metastasis adjacent to the scar site is described. Its pathogenesis and clinical significance are discussed.

Posterior fossa arachnoid cyst presenting with unilateral tremor.

A rare case of unilateral benign essential tremor is presented that responded to surgical excision of a posterior fossa arachnoid cyst.

Idiopathic spinal epidural lipomatosis.

We report a rare case of paraparesis caused by thoracic spinal epidural lipomatosis in a female patient who did not have any recognized predisposing factor for this condition.

Urinary bladder calculi complicating ventriculo-vesical shunt.

A rare case of vesical calculi complicating the procedure of ventriculo-vesical shunt is presented. In addition to highlighting technical difficulties in placing shunt catheters into the urinary system, the potential complications are discussed. We consider this route of cerebrospinal fluid(CSF) diversion less physiological compared with the peritoneal, pleural or the venous sites, and discourage use of the urinary bladder as the drainage site for the shunting of CSF.

Subarachnoid haemorrhage and akinetic mutism.

Two rare cases of akinetic mutism induced by aneurysmal subarachnoid haemorrhage are reported. The literature is reviewed, the possible pathophysiological mechanism of akinetic mutism is considered and the association between these two conditions is explored with an attempt to address the roles of medical treatment and surgery and to discuss prognosis.

Wrapping and coating of cerebral aneurysms: history, evolution and surgical management after a re-bleed.

Wrapping or coating of ruptured cerebral aneurysms was an acceptable method of surgical treatment until the 1980s. Occasionally, patients still present with a re-bleed. Management of these patients can be challenging. The author describes his experience of surgically treating ruptured aneurysms that have been previously wrapped. Technical issues in the surgical treatment are discussed with three illustrative cases of aneurysms at different locations encountered from 1999 to 2003. Despite operative difficulties satisfactory surgical results can be accomplished in the majority of these cases.

Isolated conjugate gaze palsy after frontal lobe tumour surgery.

Isolated conjugate gaze palsy following unilateral frontal lobe surgery is uncommon. When it does occur, usually it recovers within hours. We report a case of isolated conjugate gaze palsy which persisted for four weeks post-operatively before recovery commenced.

Meningioma presenting with transient ischaemic attacks.

A case of sphenoid wing meningioma mimicking the presentation of a transient ischaemic attack (TIA) is described. Based on findings from neuroimaging in this case, possible explanations of the mechanism of this uncommon presentation of meningiomas are discussed and the literature is reviewed.

Recurrent intracranial abscess after a long latency.

A case of recurrent intracranial abscess at the initial site after a latency of 16 years is presented. The causes and possible mechanisms of recurrence are discussed.

Delayed post-surgical development of dural arteriovenous fistula after cervical meningocele repair.

A 34-year-old female patient presented with an intracranial subarachnoid hemorrhage and was found to have a dural arteriovenous fistula at the site of previous cervical meningocele repair. Subsequent occlusion was achieved with endovascular embolization. To our knowledge, the phenomenon of the development of a spinal dural fistula at the site of a meningocele repair has not been recorded before.

Meningiomas induced by high dose cranial irradiation.

The authors present four patients with a history of high dose cranial irradiation, who were diagnosed years later to have symptomatic meningiomas requiring surgical management. Relevant literature pertaining to these rare tumours is reviewed and their unusual characteristics highlighted. Their aetio-pathogenesis and management strategies are discussed.

Terson's syndrome as the sole presentation of aneurysmal rupture.

The authors report a rare case of aneurysmal haemorrhage that presented with Terson's syndrome without any classical features of subarachnoid haemorrhage. The mechanism of this phenomenon is discussed and the importance of its identification is highlighted.