Acoustic neuroma (schwannoma) surgery 1978-1990.

A series of 151 patients with 154 acoustic schwannomas have been operated upon in Manchester Royal Infirmary by a joint Otological and Neurosurgical team, employing either the translabyrinthine or the suboccipital approach. The perioperative mortality rate was 3 per cent. Anatomical preservation of the facial nerve was achieved in 89 per cent of tumour removals and a good to normal functional result in 79 per cent of cases. Attempts at hearing preservation have been unsuccessful, largely because of the small number of patients in the series in whom useful hearing was present preoperatively. Complications included major brain stem ischaemia (1.2 per cent), CSF fistula (5 per cent) and facial dysaesthesia (7 per cent). The incidence of mortality and morbidity is directly related to tumour size and to the experience of the surgeons. A number of patients experienced an unusual type of post-operative dreamlike state which appeared to be a form of hypnagogic hallucination, and the possible neurophysiological mechanism responsible for this phenomenon is discussed. The continuing failure to attain the ideal of early diagnosis is lamented, and the importance of a flexible bidisciplinary surgical approach emphasized.

Clinical and pathological studies of brain injuries in horse-riding accidents: a description of cases and review with a warning to the unhelmeted.

We present a clinical and pathological study of brain injuries in horse-riding accidents. Among six fatal cases, all experienced riders varying in age and sex, two were not wearing helmets and four had inadequate protective headgear. Among five non-fatal cases, four wore adequate helmets and only one of these suffered permanent neurological damage. The fifth was not wearing a helmet and although he eventually returned to work, a CT scan following the fall showed a deep-seated perithalamic hematoma. These findings are consistent with those of virtually all other studies in that they suggest that the present type of riding helmet is inadequate and largely unable to absorb the shock of a normal fall. We hope these findings will serve as a warning to those who choose to ride unhelmeted.