Unusual appearances of spinal tuberculosis

Nine cases of spinal tuberculosis [TB] with unusual features are reviewed to increase the awareness of neurosurgeons on the various aspects of spinal TB and its unusual forms. The disease affected a single vertebral body in 2 patients, the neural arch in 2 patients, three adjacent vertebrae with the intervening two disc spaces in 2 patients and multiple distant segments in 3 patients. An anterior decompression was performed for 5 patients while the lesion was biopsied only for 4 patients. All the patients made an excellent recovery after anti TB chemotherapy. The difficulties in the clinical distinction between spinal TB and metastatic tumour from an occult primary source is stressed and the value of tissue diagnosis is emphasized

Survival in malignant astrocytoma at King Khalid University Hospital

Malignant astrocytoma [Kernohan grade III and IV] still has one of the worst outcomes of all malignant tumors. To determine factors affecting the survival of patients with malignant astrocytoma in Saudi Arabia, a retrospective study of 76 cases that were treated at King Khalid University Hospital over one decade was carried out. Kaplan-Meier survival diagrams were constructed for each prognostic factor. Twenty-eight percent of cases survived two years. A significantly better survival rate was found in females, patients /= 70 at presentation, patients who had craniotomy and excision and patients who had radiotherapy. It is suggested that to improve the outcome of patients with malignant astrocytoma, aggressive surgical excision with radiotherapy [and possibly chemotherapy] is required

Isolated posterior fossa hypertension and brainstem compression caused by entrapped Dandy-Walker cyst: a case report

Lateral ventricular shunting alone is often considered to be adequate treatment for hydrocephalus caused by Dandy-Walker syndrome. A patient is presented in whom progressive spastic tetraparesis and signs of severe brainstem compression developed due to an entrapped posterior fossa cysts, in spite of an adequately functioning lateral ventricular shunt. Addition of a cystoperitoneal shunt resulted in rapid resolution of symptoms and deficits. This case illustrates that potentially fatal brainstem compression and dangerous posterior fossa hypertension may develop if the posterior fossa cyst does not communicate with the lateral ventricules, where the shunt is placed

Results of surgery for ruptured intracranial aneurysms: the experience at King Khalid University Hospital

To provide information about the results of surgery for ruptured intracranial aneurysm in Saudi Arabia. A review was carried out of 40 consecutive cases, where patients had surgery at King Khalid University Hospital beween 1984 and 1993. Only 48% of patients were Saudis. The median age of the patients was 37 years and the male to female ratio was 1.4:1. Arrival at the neurosurgical unit ranged from 1 to 60 [median 8] days after bleed. On addition 70% of patients were in Hunt and Hess grades I and II, while 30% rebled before surgery. Only 65% of patients were treated with nimodipine which was started after arrival in our unit. There was angiographic evidence of spasm in 48% of patients. The anterior communicating artery was the most common location [50%]. Due to the late arrival of patients, only 28% had early and intermediate surgery. Satisfactory clipping of the neck of aneurysm was achieved in 95%, the others were wrapped. At 6 months follow-up 78% made a good recovery [back to normality], 8% a fair recovery [moderately disabled but independent], 5% a poor recovery [severely disabled and dependent] and 10% died. The presence of angiographic spasm preoperatively proved to be a poor prognostic factor. The results of intracranial aneurysmal surgery in Saudi Arabia are comparable with what is reported in the literature. Early referral of patients with ruptured aneurysms to the neurosurgical unit is strongly advised

Embolization of an intramedullary arteriovenous malformation of the spinal cord

Embolization therapy is increasingly recognized to be the treatment of choice for patients with intramedullary spinal arteriovenous malformations [AVMs] even though in the majority of cases only partial or temporary occlusion of the AVM is achieved. The authors report a case of an 8-year-old boy who had a lower thoracic intramedullary AVM which had bled at least twice in the past. The lesion was totally obliterated by embolization over two sessions. The clinical improvement in his condition is still apparent at 6-months follow-up

Mucoceles of the paranasal sinuses with intraorbital and intracranial invasion

The authors review five cases of paranasal sinus mucocele invading the orbit and cranial cavities which were treated in their neurosurgical unit over a 7-year period. The clinical features of the patients, locations of the lesions, CT findings and operative results are analysed. Early investigation by CT scan and prompt surgical treatment are important if irreversible neurological deficits are to be avoided