The present findings suggest that most patients with brain tumors of the frontal or temporal lobes demonstrate impairments of cognitive functioning at the time of diagnosis. Therefore, for quality assessments of neurosurgical procedures, baseline evaluations of cognitive measures should be performed.

Except in the case of working memory, comparisons of pre- and postoperative assessments of cognition revealed no differences in memory, visuoconstructive abilities, or executive functions, although a postoperative improvement in attentional functions was observed. The results of this study indicate that the surgical removal of frontal meningiomas does not impair patients' cognitive functioning. Furthermore, improvements in attentional functions may occur in these patients.

Burr-hole craniotomy (BHC) and closed-system drainage undoubtedly is currently the most accepted treatment offered in chronic subdural haematoma (CSDH). Although twist-drill trephination (TDT) techniques have been available for years, now a special subdural catheter kit has been launched for treatment of CSDH. In a prospective study, 33 patients with 36 CSDH were treated with a 5-mm TDT regimen and insertion of a CORDIS subdural catheter (CORDIS Corp., Miami, USA). The results are compared with a consecutive series of 33 patients treated previously with an 11-mm BHC and closed-system drainage for 40 CSDH: Recurrence and persistence rate of CSDH treated with TDT necessitating a second intervention was 18.1%, no further surgical intervention was necessary. In BHC treated patients, 33.3% of haematomas had to be reoperated on, another 6.0% had to be re-operated on a third time. Infection rate in BHC treated patients was 18.1% as compared with a 0% infection rate in patients treated with the TDT technique. Mortality rate for the BHC method was 9.0% as compared with 6.0% in the TDT treatment regimen. Significantly better clinical results are achieved using the TDT technique with insertion of a special subdural catheter, making this procedure superior to the BHC regimen.

Impaired verbal and figural fluency has been shown to be associated with frontal lobe dysfunction. Jones-Gotman and Milner (1977) demonstrated a double dissociation between verbal and nonverbal fluency in a small sample of patients with frontal lesions of the left or right hemisphere. The present study has examined verbal and nonverbal fluency in 25 healthy participants and 95 patients with mass lesions of the left or right frontal lobes. In comparison with healthy participants, verbal fluency was reduced in patients with frontal lesions of the left hemisphere. Patients with right-sided lesions did not differ from either the control group or from the patients with left-sided frontal mass lesions. In the figural fluency task, the performance of the groups did not differ. The finding that patients with left frontal lesions produced fewer words than healthy participants suggests an association between left frontal lobe pathology and reduced verbal fluency. The results do not support the hypothesis of a double dissociation between verbal/figural fluency and the side of lesion within the frontal lobes.

Despite modern radiological imaging, a transorbital intracranial injury with a wooden foreign body can present a vexing diagnostic problem. The orbit forms an easy path for low-velocity foreign bodies into the intracranial space. Often the severity of the injury is masked by unobtrusive superficial wounds and lack of a primary neurological deficit. Misinterpretation of CT findings may delay adequate treatment, whereas MRI is more sensitive and specific. However, MRI T1-W can demonstrate an isointense or even hyperintense signal. Findings after the use of MRI contrast medium are presented and the diagnostic features of CT and MRI are reviewed. Two cases of such injury are presented.

Few data are available concerning the outcome of surgical removal of intracranial meningioma in elderly patients. Surgical criteria and prognostic factors are considerations in the decision as to whether neurosurgical removal should be attempted in elderly patients. The present study appears to be the first to examine the cognitive functioning of patients (n = 33) with intracranial meningiomas in the seventh and eighth decades of life prior to and following surgery. The time period between pre- and postoperative assessment was between 12 and 23 weeks. Twenty healthy subjects were also examined. For neuropsychological assessment, standardized test procedures including the examination of memory, attention, visuo-constructive abilities and executive functions were used. No significant deterioration of cognitive functioning was found following surgery. Elderly patients should not therefore be denied meningioma surgery purely on the basis of the risk of postoperative deterioration of mental functioning.

The following case report presents a patient exhibiting Gerstmann syndrome accompanied by toe agnosia. A 72 year old right handed woman had a focal lesion in the angular gyrus of the left hemisphere which was caused by a glioblastoma multiforme. The first symptom she had complained of was severe headache. Standardised neuropsychological tests of intelligence, memory, attention, fluency, apraxia, and language functions as well as tests for the assessment of agraphia, acalculia, right-left disorientation, and digit agnosia were performed. The patient displayed all four symptoms of the Gerstmann syndrome-namely, agraphia, acalculia, right-left disorientation, and finger agnosia. The patient did not display aphasia, constructional apraxia, or any other neuropsychological impairment. In addition to the four symptoms of the Gerstmann syndrome an agnosia of the toes was found. Further studies should determine whether finger agnosia in Gerstmann syndrome is usually accompanied by toe agnosia. Finger agnosia in the context of this syndrome may be better named digit agnosia.

The validity of clinical studies on shunt-treated hydrocephalic patients is often hindered by inhomogeneity of the patient population examined, technical devices used, or by other specific factors. In an effort to introduce a homogeneous clinical study on hydrocephalic patients 66 hydrocephalic newborns and infants have been treated exclusively with CORDIS Orbis-Sigma Valve (OSV) System (CORDIS Corporation, Miami, USA) in 1990-1995. The results are compared with an equivalent group of 53 children treated with CODMAN Holter Valve (HV) System (CODMAN Inc., Randolph, USA) during a similar 5-year-period (e.g., 1986-1991). Searching for different reasons of shunt insufficiency in both groups demonstrates a more than double risk of shunt complication for ventriculo-atrial HV treated patients (VA-HV) in comparison with those treated ventriculo-peritoneally with OSV System (VP-OSV): 4.22 versus 1.98 mean surgical procedures per person. The different revision and survival rates are discussed and specific problems are mentioned.