Morbidity after anterior cervical decompression and fusion. The influence of the donor site on recovery, and the results of a trial of surgibone compared to autologous bone.

The Cloward procedure is a routine approach to decompress and fuse the cervical spine. This paper looks at two aspects of the operation. Firstly the morbidity due to the hip wound is assessed, and alternatives to the use of autologous bone graft discussed. Secondly one Neurosurgical Unit's experience in the use of surgibone--an animal bone substitute harvested from steers and fashioned in dowels--is described. In this trial it was not found to be a satisfactory substitute to autologous bone.

The early management of head injury.

Acute management involves triage, well directed investigation and timely surgical intervention when necessary. All are discussed in this review. Cerebral blood flow (CBF) and flow velocity assessment are among the other investigations mentioned. Other topics include paediatric head injury, cerebrospinal fluid (CSF) fistulae, stab wounds and post-traumatic epilepsy.

Passage of tube per rectum: an unusual complication of a ventriculoperitoneal shunt.

A very rare complication of a ventriculoperitoneal (VP) shunt is reported. The peritoneal catheter perforated the colon of a two-year-old child, causing diarrhoea which was misdiagnosed as gastroenteritis. The diagnosis became obvious when the catheter was extruded from the child's anus.

Multiple neurological lesions due to vertebrobasilar dolichoectasia.

Four cases which presented with multiple neurological signs caused by vertebrobasilar dolichoectasia are reported. The pathology was revealed by CT, MRI and angiograms. In one case, hemifacial spasm and other neurological deficits were cured by microvascular facial nerve decompression. The literature on the subject is reviewed.

Airgun injuries of the brain.

Brain injuries caused by airguns are serious. The optimal management is wound exploration, excision of contaminated tissues and removal of loose bone fragments. In addition, careful monitoring, prophylactic antibiotics and anticonvulsants are required. The outcome is dictated by the importance of the intracranial structures which the pellet transects and the development of complications. Removal of the pellet is desirable only if easily accessible. We report five cases, of which four survived without deficits and one remained severely handicapped.

Transnasal hypophysectomy--an unusual sporting injury.

A case is presented of a traumatic penetrating nasal injury, resulting in panhypopituitarism and memory loss. Certain aspects of the diagnosis and treatment are discussed, and in conclusion some principles of management are suggested. The patient was last seen 8 months after the injury and had not required any desmopressin for 6 weeks.

The treatment of hemifacial spasm by sling retraction.

A new method of microvascular decompression of the facial nerve using sling retraction is described. This method may elucidate the way in which this microsurgical exploration in the posterior fossa relieves hemifacial spasm.