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Civilian gunshot wounds to the head and spine in Australia
Neurosurgical Society of Australasia Annual General Meeting in Dunedin, August, 1993 Hydromyelia and chiari malformation in children Essay preparedfor the neumsurgical society prize, 1993 JulianAyer, Final year medical student, The University of New South Wales, Sydney. SponsoringNeurosurgeons:Dr R.F.C. Jones, Dr W.A. Stening, Prince of Wales Children’s Hospital, Sydney. Twenty four patients with Chiari malformation and hydromyelia, treated at the Prince of Wales Children’s Hospital between 1975 and 1991, were reviewed. All patients were less than 20 years of age. Eleven had Chiari 1 malformation and 13 had Chiari 2 malformation and myelomeningocele. In those with Chiari 1 the most common clinical feature was In patients with myeloscoliosis. meningocele a deteriorating gait and increasing lower limb weakness was the usual presentation. The classical syringomyelic syndrome of brachial amyotrophy and dissociated sensory loss was found in only one case. The most common surgical procedure employed in these patients involved posterior fossa decompression and plugging of the central canal at the obex, with or without dural grafting. This resulted in sustained clinical improvement in 56% of patients and clinical stabilization in a further 33%. Following operation, sustained radiological collapse of the cavity occurred in 9 out of the 11 cases of Chiari 1 malformation. Complications following plugging procedures were transient and were not associated with long term morbidity. Posterior fossa decompression, fourth ventriculostomy, obex plugging and dural grafting is recommended in those cases where the surgical anatomy allows dissection of the tonsils from the brainstem. Plugging of the central canal at the obex is only of value if the muscle plug is firmly secured.
Civilian gunshot wounds to the head and spine in Australia J.V. Rosenfeld*, R. Bender-Bather*, P. Lee*, G.S. Merry$j,P.E. Oatleyt, Department of Neurosurgery, Royal Melbourne
208
Hospital*
J. Clin. Neuroscience
Department of Neurosurgery, Royal Adelaide Hospitalt Department of Neurosurgery, Royal Brisbane Hospitals The first Australia-wide survey of civilian gunshot wounds (GSW) to the head and spine for the period 19861993 has been performed under the auspices of the Neuro-trauma Subcommittee of the Neurosurgical Society of Australasia. A standard proforma was sent to all neurosurgery units in Australia and resulted in a good response rate. There were 164 cranial GSW but 14 of these were rejected because of incomplete data. The in-hospital mortality was 50.7% (76/150). Overall 89% (134/150) were male, 73% (110/150) of the wounds were self-inflicted, and the rifle was the most frequently used weapon. Of those with an initial Glasgow Coma Score (GCS) of < 8, 85.5% (65/76) died whereas of those patients with an initial GCS > 8, only 9% (5/55) died. This was a highly significant difference (P < 0.0001). Overall outcome of patients with GCS information was good in 18% (34/131), moderately disabled in 12% (16/131), severe disability in 7% (g/131), vegetative in 1% (2/131) anddeadin53% (70/131). The Australian in-hospital mortality rate is lower than that reported in civilian GSW in USA, Italy, Finland and Israel (range 5693%). Paediatric GSW were uncommon (2% 4/170) and were accidental. Spinal GSW were uncommon (7/171, 4.9%) and often resulted in moderate to severe disability.
The surgical management of metastatic melanoma in the brain M. Besser, M. Dexter, W. McCarthy,D. Moon, K. Peterson-Schaeffer, Royal Prince Alfred Hospital, Sydney. Malignant melanoma has a predilection for spread to the central nervous system and these metastases are the most common cause of death and disability in melanoma patients. Chemotherapy and radiotherapy have been shown to be relatively impotent in alleviating symptoms or prolonging life. A retrospective review of patients with malignant melanoma excised from the brain was used to audit the role of surgery. Cases were identified from the records of the Sydney Melanoma Unit and the Department of Neurosurgery at Royal Prince Alfred Hospital. All patients had evidence of cerebral metastases. There were 14 patients (greater than 10% in total) surviving for more than 2 years since
Volume 1
Number 3
July 1994
the time of surgery for cerebral metastatic melanoma. Of these patients, who had an average age of 40.4 years (range 2364), 57% were male and 78% had a solitary metastasis. In 64% of cases the metastasis was lodged in the parietal lobe. Data relating to surgical mortality, morbidity and degree of resection was analysed as was the extent of neurological disability before and after craniotomy. Surgical excision of brain metastases from malignant melanoma was shown to carry acceptable levels or morbidity and mortality, whilst offering the best chance for symptomatic improvement and extended survival.
Surgical management of 61 consecutive acoustic schwannomas. S.N. Bishara,A.M. Guy, C.B. Donkin, Department of Neurosurgery Department of Otolaryngology
(SNB), (AMG),
Dunedin Hospital, New Zealand. 61 patients with acoustic schwannomas treated in the Neurosurgical Unit, Dunedin Hospital, between 1977 and 1992 were reviewed. There were 32 women and 29 men ranging in age from 17 to 73 years (mean, 48 years). Two patients were considered neurofibromatosis type II. There were 32 large tumours (>2.5cm intracranial extension), 19 were medium sized (1.5-2.5cm), 9 were small (<1.5cm) and one tumour was intracanalicular. Microsurgical tumour removal was carried out via the retrosigmoid transmeatal approach in 50 patients and translabyrinthine in 10. One tumour was removed using the translabyrinthine approach first followed by the retrosigmoid 2 weeks later. Five patients with hydrocephalus had ventriculoperitoneal shunting prior to tumour removal. Complete tumour removal was achieved in 55 patients (90%). There were no deaths but 12 patients developed post-operative complications including intracerebellar haematomas in 2, small subacute extradural haematoma in 1, CSF fistulas in 3, one of whom developed pneumococcal meningitis and 2 patients developed postoperative hydrocephalus. The follow-up period was 8 months to 15 years (mean, 5.8 years). One patient with recurrence had a complete removal 6 years later. 59 patients made a good recovery (Glasgow Outcome Scale) and 2 patients remained moderately disabled. Four patients died during the follow-up period from unrelated causes. The facial nerve was anatomically disrupted in 5 patients (8.2%)) all of
Civilian gunshot wounds to the head and spine in Australia J.V. Rosenfeld*, R. Bender-Bather*, P. Lee*, G.S. Merry$j,P.E. Oatleyt, Department of Neurosurgery, Royal Melbourne
208
Hospital*
J. Clin. Neuroscience
Department of Neurosurgery, Royal Adelaide Hospitalt Department of Neurosurgery, Royal Brisbane Hospitals The first Australia-wide survey of civilian gunshot wounds (GSW) to the head and spine for the period 19861993 has been performed under the auspices of the Neuro-trauma Subcommittee of the Neurosurgical Society of Australasia. A standard proforma was sent to all neurosurgery units in Australia and resulted in a good response rate. There were 164 cranial GSW but 14 of these were rejected because of incomplete data. The in-hospital mortality was 50.7% (76/150). Overall 89% (134/150) were male, 73% (110/150) of the wounds were self-inflicted, and the rifle was the most frequently used weapon. Of those with an initial Glasgow Coma Score (GCS) of < 8, 85.5% (65/76) died whereas of those patients with an initial GCS > 8, only 9% (5/55) died. This was a highly significant difference (P < 0.0001). Overall outcome of patients with GCS information was good in 18% (34/131), moderately disabled in 12% (16/131), severe disability in 7% (g/131), vegetative in 1% (2/131) anddeadin53% (70/131). The Australian in-hospital mortality rate is lower than that reported in civilian GSW in USA, Italy, Finland and Israel (range 5693%). Paediatric GSW were uncommon (2% 4/170) and were accidental. Spinal GSW were uncommon (7/171, 4.9%) and often resulted in moderate to severe disability.
The surgical management of metastatic melanoma in the brain M. Besser, M. Dexter, W. McCarthy,D. Moon, K. Peterson-Schaeffer, Royal Prince Alfred Hospital, Sydney. Malignant melanoma has a predilection for spread to the central nervous system and these metastases are the most common cause of death and disability in melanoma patients. Chemotherapy and radiotherapy have been shown to be relatively impotent in alleviating symptoms or prolonging life. A retrospective review of patients with malignant melanoma excised from the brain was used to audit the role of surgery. Cases were identified from the records of the Sydney Melanoma Unit and the Department of Neurosurgery at Royal Prince Alfred Hospital. All patients had evidence of cerebral metastases. There were 14 patients (greater than 10% in total) surviving for more than 2 years since
Volume 1
Number 3
July 1994
the time of surgery for cerebral metastatic melanoma. Of these patients, who had an average age of 40.4 years (range 2364), 57% were male and 78% had a solitary metastasis. In 64% of cases the metastasis was lodged in the parietal lobe. Data relating to surgical mortality, morbidity and degree of resection was analysed as was the extent of neurological disability before and after craniotomy. Surgical excision of brain metastases from malignant melanoma was shown to carry acceptable levels or morbidity and mortality, whilst offering the best chance for symptomatic improvement and extended survival.
Surgical management of 61 consecutive acoustic schwannomas. S.N. Bishara,A.M. Guy, C.B. Donkin, Department of Neurosurgery Department of Otolaryngology
(SNB), (AMG),
Dunedin Hospital, New Zealand. 61 patients with acoustic schwannomas treated in the Neurosurgical Unit, Dunedin Hospital, between 1977 and 1992 were reviewed. There were 32 women and 29 men ranging in age from 17 to 73 years (mean, 48 years). Two patients were considered neurofibromatosis type II. There were 32 large tumours (>2.5cm intracranial extension), 19 were medium sized (1.5-2.5cm), 9 were small (<1.5cm) and one tumour was intracanalicular. Microsurgical tumour removal was carried out via the retrosigmoid transmeatal approach in 50 patients and translabyrinthine in 10. One tumour was removed using the translabyrinthine approach first followed by the retrosigmoid 2 weeks later. Five patients with hydrocephalus had ventriculoperitoneal shunting prior to tumour removal. Complete tumour removal was achieved in 55 patients (90%). There were no deaths but 12 patients developed post-operative complications including intracerebellar haematomas in 2, small subacute extradural haematoma in 1, CSF fistulas in 3, one of whom developed pneumococcal meningitis and 2 patients developed postoperative hydrocephalus. The follow-up period was 8 months to 15 years (mean, 5.8 years). One patient with recurrence had a complete removal 6 years later. 59 patients made a good recovery (Glasgow Outcome Scale) and 2 patients remained moderately disabled. Four patients died during the follow-up period from unrelated causes. The facial nerve was anatomically disrupted in 5 patients (8.2%)) all of