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The paraspinal approach for extreme lateral lumbar disc herniations using the minimally invasive microscopically assisted percutaneous technique is reasonable and safe and thus a good alternative to open surgical procedures.

Using transcranial real-time sonography, changes in the axial diameter of the third ventricle during manoeuvres, which increased intracranial pressure (ICP), were measured in 28 patients with moderate to severe head injury. The measurements were correlated with ICP measured by epidural pressure monitoring. We observed reductions in diameter ranging from 0.3 to 1.1 mm with rises in intracranial pressure of at least 5 mm in 22 patients of whom only one died. In 6 additional patients, no changes in diameter were seen, and 5 of the 6 died. We interpret that poor outcome as a measurable inability for the brain to expel cerebrospinal fluid into extracerebral compartments during increased ICP. Transcranial real-time sonography may provide additional information about intracranial cerebral fluid dynamics and compliance.