Fifty-three consecutive adult patients treated surgically for chronic subdural hematoma are reviewed. The current understanding of the pathogenesis of chronic subdural hematoma is discussed. In the current neurosurgical literature, wide discrepancies exist, in patients treated by burr-hole evacuation, regarding the rate of subdural recollection. Possible factors responsible for these discrepancies include (1) failure to recognize and properly treat multiloculated chronic subdural hematomas, (2) too aggressive a surgical approach toward persistent CT-demonstrated but asymptomatic subdural residual or recurrent collections, and (3) failure to use corticosteroids in the post-operative management of patients with persistent or recurrent symptoms as a step prior to re-operation. A prospective controlled clinical trial of glucocorticoids in chronic subdural hematoma is needed to establish their place in the management of this condition.
A patient with a mobile schwannoma of the cauda equina is described. The wide discrepancy between the myelographic and surgical locations of the tumor is most unusual. Awareness of the possibility of such an extreme degree of motility is important when dealing with cauda equina tumors.
A case is reported which questions the absolute significance of the "double-lumen sign" in the diagnosis of arterial dissection. I suggest that when demonstrated in isolation, this sign should be interpreted with caution, giving consideration to the possibility of arterial fenestration, and appropriate diagnostic measures implemented.
A 4th ventricular mature teratoma that became symptomatic in an adult man is reported. The literature on teratomas located in the posterior fossa midline is reviewed, and previously reported cases are tabulated. The differential diagnosis of posterior fossa midline mass lesions is discussed.
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