Conscious patients with Grade III fourth ventricular compression should undergo urgent clot evacuation before deterioration. Surgical evacuation of the clot may not be required for large hematomas (>3 cm) if the fourth ventricle is not totally obliterated at the level of the clot.

Two patients who developed what appeared to be a granulomatous reaction following muslin wrapping of unclipped aneurysms are reported. They presented with cranial nerve palsies and at operation were found to have an abscess around the wrapped aneurysms. In one of these two patients Staphylococcus epidemidis was isolated from the pus. This, together with further evidence from reported cases in the literature, would suggest that infection may play an additional role at least in some cases in the onset of a foreign-body granulomatous reaction seen following wrapping of aneurysms.

Pseudomeningocele is a rare but well recognised complication of lumbar surgery (microdiscectomy and laminectomy). Most of the patients tolerate the presence of the cyst well, however some present with back pain and spinal claudication, presumably due to neural compression. We report a case who presented following three operations (microdiscectomy, laminectomy and excision of a pseudomeningocele) with symptoms of spinal claudication and bilateral radicular pain. The cause of her pain was evident only at operation and was due to herniation of nerve roots through the dural defect.

Primary presentation of an intradural Non-Hodgkin's lymphoma is rare. Recently these B cell lymphomas of mucosa associated lymphoid tissue (MALT) have gained acceptance as an important pathological subtype and are distinguishable from other primary CNS lymphomas that exhibit aggressive behaviour. Over the past decade a number of these lesions have been reported to resemble a meningioma both intra-operatively and radiologically. The authors outline such a case of marginal zone B cell lymphoma that clinically and radiologically resembled a meningioma. This case illustrates the rare occurrence of low grade dural B cell lymphoma and the need to consider this entity in the differential diagnosis of CNS lesions, if appropriate targeted therapy is to be administered.

The authors present a case of neuromuscular hamartoma of the cochlear nerve, an unusual occurrence in the internal auditory meatus (IAM). A review of the literature shows no previous report of neuromuscular hamartoma of the cochlear nerve. This tumour was clinically and radiologically difficult to distinguish from acoustic neuroma. It is important to consider the diagnosis of these rare small tumours pre-operatively, as it may be appropriate to manage this conservatively.