Selective dorsal rhizotomy significantly improved urgency, frequency, incontinence, and urodynamic bladder capacity at first incontinence in a significant proportion of spastic cerebral palsy children.

Objective : To investigate the epidemiology of newly-diagnosed, histologically-confirmed (NDHC) central nervous system (CNS) tumours and its changes over a 21-year period in a regional hospital in Hong Kong. Methods : This is a single-institute retrospective descriptive study of patients undergoing surgery for CNS tumours in a regional hospital of Hong Kong in the period from January 1996 to December 2016. The histological definition of CNS tumours was according to the World Health Organization classification, while the site definition for case ascertainment of CNS tumours was as set out by the Central Brain Tumour Registry of the United States. Patients of any age, who had NDHC CNS tumours, either primary or secondary, were included. The following parameters of the patients were retrieved : age at diagnosis, gender, tumour location, and histological diagnosis. Population data were obtained from sources provided by the Government of Hong Kong. The incident rate, estimated by the annual number of cases per 100000 population, for each histology grouping was calculated. Statistical analyses, both including and excluding brain metastases, were performed. Statistical analysis was performed with Microsoft Excel, 2016 (Microsoft, Redmond, WA, USA). Results : Among the 2134 cases of NDHC CNS tumours, there were 1936 cases of intracranial tumours and 198 cases of spinal tumours. The annual number of cases per 100000 population of combined primary intracranial and spinal CNS tumours was 3.6 in 1996, and 11.1 in 2016. Comparing the 5-year average annual number of cases per 100000 population of primary CNS tumours from the period 1996-2000 to 2011-2015, there was an 88% increase, which represent an increase in the absolute number of cases by 4.52 cases/100000 population. This increase was mainly contributed by benign histologies. In the aforementioned periods, meningiomas increased by 1.45 cases/100000 population; schwannomas by 1.05 cases/100000 population, and pituitary adenomas by 0.91 cases/100000 population. While gliomas had a fluctuating 5-year average annual number of cases per 100000 population, it only had an absolute increase of 0.51 cases/100000 population between the 2 periods, which was mainly accounted for by the change in glioblastomas. Conclusion : This retrospective study of CNS tumour epidemiology revealed increasing trends in the incidences of several common CNS tumour histologies in Hong Kong, which agrees with the findings in large-scale studies in Korea and the United States. It is important for different geographic locations to establish their own CNS tumour registry with well-defined and structured data collection and analysis system to meet the international standards.

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In a specific group of patients with CRN of the temporal lobe in whom the CRN lesions were causing a mass-occupying effect beyond the temporal lobe, excision of the contrast-enhancing region was safe and could achieve prompt resolution of brain edema and a low incidence of recurrence of CRN.

Objective The effects of selective dorsal rhizotomy (SDR) on the hip development in children with spastic cerebral palsy (CP) are not well defined. The present study was performed to determine the effects of SDR and other associated clinical and radiological factors on the outcome of hip development after SDR. Methods The study included 53 patients who were skeletally immature at the time of SDR. Between 2003 and 2010, they underwent SDR at our institute. The age ranged from 4 to 15 years old. Their preoperative hip status was divided into two groups: normal and abnormal. The final outcome of the hip was considered good if the centre-edge angle of Wiberg (CEA) at last follow-up was more than 20 degrees without the need for orthopaedic intervention. Thirty-seven patients satisfied the inclusion criteria for statistical analysis. Results Seventeen patients were in the “Normal pre-op” group. In all patients (except for two patients), the hip status remained normal after the SDR. Twenty patients were in the “Abnormal pre-op” group. In this group, only two patients returned to normal hips, whereas 11 patients required orthopaedic hip surgery within 5 years after the SDR. The remaining seven patients had hip subluxation, but not to the extent of hip dislocation. The preoperative hip radiological measurements and functional status were positively correlated with the postoperative hip status. The preoperative radiological measurements showed superior predictive value when other covariance were considered. No difference of outcome existed in regard to the different surgical approaches of SDR. Conclusion Selective dorsal rhizotomy has a neutral effect on hip development. The preoperative hip radiological measurement is the most important predictive factor to determine hip status after SDR. Good collaboration between neurosurgeons and paediatric orthopaedists is essential for the best management of these patients.

Developing a surgical plane between the temporalis muscle and the dura is the most technically challenging step when performing cranioplasty for post-decompressive craniectomy defects. The authors report a simple technique to demarcate this surgical plane by laying a multi-slitted, microporous polyesterurethane (MPU) patch during decompressive craniectomy. Specifically, they tried to avoid creating potential spaces around the patch, which is the inherent drawback of published anti-adhesive techniques. In 21 patients undergoing decompressive craniectomy, and in 11 of them subsequently undergoing cranioplasty, there was no wound related complications. During cranioplasty, no epidural fluid collection was found; the patch could be separated from the temporalis muscle and the dura with blunt dissection leaving the muscle intact. They conclude that their epidural MPU patch technique is a safe technique, and appears useful to facilitate cranioplasty by helping the surgeon in developing the surgical plane between the temporalis muscle and the dura during cranioplasty.

Aim: This study aims to review the outcome of patients who have had surgical excision of brain metastasis from undiagnosed lung cancer.Methods: This is a retrospective case series of all patients who had resection of brain metastasis from lung cancer. Data were retrieved from a computer registry. Patient demographics, pre-operative condition, choice of treatment and post-operative outcome were studied.Results: A total of 45 patients were identified within the study period. The median age of these patients was 61 years. After the operation, 71% of the patients had no neurological deficit and 80% attained a Karnofsky Performance Score of at least 70.There was no serious complication requiring reoperation. Median survival was 15 months and 3-year radiological progression-free survival rate was 56%. In terms of overall survival, there was no statistical difference between the groups of patients aged below or above 65 years as well as patients with one or multiple brain metastases.Conclusions: Patients with brain metastasis having the primary presentation of lung malignancy enjoy a reasonable functionality and survival after brain metastasis excision. More aggressive treatment for the brain metastasis should be considered.