Postoperative headache was studied among 251 patients who underwent operation for vestibular schwannoma. A questionnaire based on the McGill Pain Questionnaire and the Finnish Pain Questionnaire was sent to the patients. Twenty-one expressions describing postoperative headache were extracted with a factor analysis. The pain intensity was expressed on a visual analog scale, and the risk factors for postoperative headache were evaluated. Immediately after the operation, 154 subjects reported headache. Eighty-nine of the patients had had headache before operation, whereas 65 patients experienced headache only after operation. An average of 8.9 years after surgery, 93 patients still reported headache. Headache was a major problem for 27 subjects; 18 of the 27 had suffered from headache before operation. A retrosigmoidal approach, postoperative gait problems, preoperative headache, and small tumor size predicted postoperative problems with headache. When headache is present before operation, it tends to continue after operation, and if headache continues for 1 year, it usually persists without being reduced.

The files of 1143 neurosurgical patients, operated on between November 1, 1979 and June 4, 1981 were examined for records of post-operative infections. Eighty-three patients had developed infections (7%). In addition there were 33 instances of aseptic meningitis. Patients with a shunt were prone to infection (12%). Bone flap infections accounted for more than half of all infections after supratentorial craniotomy. Bacterial meningitis accounted for more than half of all infections after suboccipital craniotomy and translabyrinthine operations. In these patients bacterial meningitis was six times more common, and aseptic meningitis three times more common than in those who had had supratentorial operations. Shunt infection was more common after repeated shunt operations in quick succession. Craniotomy increased the risk of a shunt becoming infected. Antibiotic prophylaxis should be used not only in shunt operations but in all operations performed on patients with a shunt. If bacteria are recovered in a suspected shunt infection, immediate removal of the shunt is the best treatment. However, if the shunt's removal or replacement is exceptionally difficult intraventricular antibiotic treatment may be tried. The age of the patient, the duration of the operation, the individual surgeon and the number of operations did not affect the rate of infection. Clinical signs and conventional laboratory tests, apart from bacterial culture, cannot differentiate between bacterial and aseptic meningitis, but a drop in the level of consciousness suggests bacterial meningitis.

Summary Purpose:  We analyzed clinical and electroencephalography (EEG) outcomes of 13 patients with pharmacoresistant encephalopathy with electrical status epilepticus during sleep (ESES) following epilepsy surgery. Methods:  All patients had symptomatic etiology of ESES and preoperative neuropsychological deterioration. Ten patients had daily atypical absences. Clinical outcome was assessed at 6 months and at 2 years after surgery. Clinical and EEG data were reviewed retrospectively. The spike propagation pattern and area and source strength in source montage were analyzed from preoperative and postoperative EEG studies. Key Findings:  Preoperative sleep EEG showed electrical status epilepticus during sleep (SES) with one‐way interhemispheric propagation in nine patients and with two‐way interhemispheric propagation in four. The age of the patients at the time of surgery ranged from 3.6–9.9 years. Focal resection (two patients) or hemispherotomy (one patient with postoperative EEG) either terminated SES or restricted the discharge to one region. Either reduced SES propagation area or source strength was found in four of eight callosotomy patients with postoperative EEG. Of patients who had seizures preoperatively, Engel class I–II seizure outcome was observed in two of three children after focal resection or hemispherotomy and in two of eight children after callosotomy. None of these patients with Engel class I–II outcome had SES with two‐way interhemispheric propagation on preoperative EEG. Cognitive deterioration was halted postoperatively in all except one patient. Cognitive catch‐up of more than 10 IQ points was seen in three patients, all of whom had shown a first measured IQ of >75. Significance:  Patients with pharmacoresistant ESES based on symptomatic etiology may benefit from resective surgery or corpus callosotomy regarding both seizure outcome and cognitive prognosis.

Microsurgical removal of temporal lobe cavernomas is a safe and effective method to improve seizure outcome in patients with medically intractable epilepsy and to prevent deterioration caused by hemorrhage.

Headache and depression were studied in patients who had undergone operation for acoustic neuroma. A questionnaire with headache and Beck Depression Inventory scale were sent to 228 patients, of whom 192 (84%) responded. Preoperative headache was reported by 61 (32%) of the respondents (47 migraine and nine tension-type headache) and 122 (64%) respondents had postoperative headache (15 new migraine and four new tension-type headache). The new postoperative headache was chronic (>/=3 months) in 86% and continued at the time of the survey in 55% and presented typically as severe short-lasting attacks provoked by physical stress, bending or coughing. Non-steroidal anti-inflammatory drugs were effective in most cases. Depression (usually mild) occurred in 24% of the respondents, being significantly more common in prolonged postoperative headache patients. The operation doubled the prevalence of headache (from 32% to 64%). Headache after acoustic neuroma operation appears to be a specific subgroup of postcraniotomy headache.