Discogenic compression of the cauda equina: a surgical emergency.

The syndrome of cauda equina compression due to central disc rupture is uncommon but its importance greatly transcends its rarity. Key symptoms and signs are bilateral leg pain, weakness or numbness (although unilateral symptoms or even absence of leg pain do not exclude the diagnosis), perineal numbness and, in 60% of patients, bladder and bowel incompetence ranging from dysuria to vesical and anal sphincter paralysis. Diagnosis and treatment are often delayed due to lack of recognition of the condition and failure to appreciate the surgical imperative for its treatment. At the present time myelography is the one essential investigation, although this may become supplanted in time by magnetic resonance imaging. Arrangements for myelography should be planned so that immediate operation can be commenced following the procedure. The onset of disc rupture may be acute and massive and result in intradural sequestration of disc fragments in 7.5% of cases. Intradural exploration and/or transdural sequestrectomy avoids traction on already compromised nerve roots and is often safer than extradural sequestrectomy. The onset of bladder paralysis is a most important indication for immediate surgery. The cases presented show that there is a highly significant difference in the outcome of those cases operated on within 24h of bladder paralysis compared to those operated on after this period.

Extradural haematoma in children. Primary and secondary lucid intervals.

Twenty-six cases of extradural haematoma in children were reviewed over a 10-year period. The incidence of extradural haematoma was 3.3/1000 patients admitted to hospital with head injuries. Of 26 patients, 23% had no skull fracture and, in a further 8%, the fracture was not radiographically detectable. Twenty-three per cent of patients showed papilloedema, and 50% exhibited a fixed dilated ipsilateral pupil. In 62% of patients, there was no initial loss of consciousness; in a further 19%, impairment of consciousness was brief or doubtful. The lucid interval lasted three hours or less in one-third of patients; 24 hours after injury, the level of consciousness had declined in 73% of patients. Of particular interest was the occurrence of a secondary lucid interval, definite and dramatic in 8% of patients, and definite, but slight, in a further 12%. All patients made a good recovery, except one, who died from massive pulmonary fat embolism.

Worldwide survey of neurosurgical training requirements and certifying mechanisms: report of the Committee on Neurosurgical Education of the World Federation of Neurosurgical Societies.

This is the report of the Committee on Neurosurgical Education of the World Federation of Neurosurgical Societies, which report was presented at the Seventh International Congress of Neurological Surgery in Munich in July 1981. The Committee was charged to conduct a survey of neurosurgical training requirements and certifying mechanisms throughout the world. These data are summarized in the tables in this report.

Postirradiation sarcomatous transformation of a pituitary adenoma: a combined pituitary tumor. Case report.

A case is reported in which a fibrosarcoma developed 20 years after irradiation of a pituitary chromophobe adenoma. This rare lesion, like most of the other documented postirradiation pituitary sarcomas, was a combination of fibrosarcoma and pituitary adenoma. These lesions tend to behave in a characteristic fashion, with onset after a long latent interval following irradiation, growth to a large size, and failure to metastasize.

Non-neoplastic stenosis of the aqueduct presenting in adolescence and adult life.

Twenty-six cases of non-neoplastic stenosis of the aqueduct are reviewed. This condition may take a very chronic course and may not be revealed until decompensation of hydrocephalus takes place. Poor athletic record in the school or intellectual impairment in early life, commonly overlooked, can presage the more obvious symptoms. A prolonged follow-up of these cases is essential to exclude a slowly growing neoplasm near the aqueduct. Our management and the outcome of these cases is discussed.