In a series of 375 patients with anterior cervical fusions, long-term follow-up results complete with laryngeal examination were obtained in 102 patients. One patient was found to have an inferior laryngeal nerve palsy, and one had a superior laryngeal nerve palsy. Both deficits were thought to be the result of surgical trauma. Measures to minimize the incidence of vocal cord paralysis include careful surgical technique and knowledge of the surgical anatomy of the laryngeal nerves. Suggestions are given for the assessment of postoperative hoarseness, and for the management of vocal cord paralysis.

A surgical technique was devised to treat chronic subdural haematomas (SDH) in elderly patients. Initial good results encouraged the author to use this technique in elderly patients with acute SDH. This small group is also reported. The goal was to do definitive, not expectant or incremental surgery on these fragile patients who have a high incidence of co-morbid conditions and cerebral atrophy, and to obliterate the subdural space by allowing the skin to sink into the cranial defect. The surgical technique consists of trephine craniotomy and not closing the dura or replacing the bone plate. Experience with six elderly patients with acute SDH and 23 patients with chronic SDH is reported. Of six patients with acute SDH, mean age 80 years, 2 months, three died, all with a Glasgow Coma Score (GCS) less than 9. Three recovered to preoperative status, one with initial GCS of 7 and the other of 8. Of 23 patients with chronic SDH, mean age 77 years, 21 recovered to preoperative status. The two deaths were in patients with GSC of 5 and 7. There were no recurrent SDH or postoperative surgical or cosmetic complications. All patients were followed for at least 6 months. These excellent results suggest that the procedure could be considered as a first procedure in the elderly patient. At first glance, the operation appears to be overly aggressive, but it is an example of 'aggressive-conservative' treatment which produces good long-term results with few complications and no need for second operations.

A patient with splitting of the optic nerve by a carotid-ophthalmic artery aneurysm is presented. Possible explanations for this previously unreported configuration are discussed.

BackgroundThe purpose of this study is to evaluate and report the feasibility, safety, and initial outcomes of patients with limited localized prostate cancer treated using a trans-rectal magnetic resonance image-guided focused ultrasound (MRGFUS) device. Attempts to focally treat only the index lesion for prostate cancer have been explored to reduce side effects while maintaining oncologic control. MRGFUS allows for precise targeting of thermal ablative therapy with real-time thermometry.MethodsThree patients underwent multiparametric 3T MRI and TRUS-guided 16-sector mapping biopsies of the prostate. The patients were eligible if they had Gleason 6 or 7 (3 + 4) disease, no MRI-visible tumor ≥15 mm, no extracapsular extension, and no more than two discrete cancerous lesions ≤10 mm in length. Acoustic power was adjusted to achieve temperatures of 65 to 85 °C.ResultsAge ranged from 60 to 64 years. The number of biopsy-positive sectors treated ranged from 2 to 4. Post therapy, 16-sector biopsies at 6 months were negative in two patients with one patient still with Gleason 6 cancer (10 %, 2 mm) in one core. 16-sector biopsy in the first patient remains negative at 24 months. PSA continues to remain stable in all patients. IPSS in all patients either remained stable or decreased then stabilized. Erectile function according to the International Index of Erectile Function (IIEF) was excellent for all patients and demonstrated no decline up to the time of last follow-up at 12–24 months.ConclusionsMRGFUS is a feasible alternative for focal therapy in a select subset of patients with prostate cancer. The treatment is well tolerated with no evidence of decline in functional outcomes. Initial post-therapy biopsy results are promising. Long-term treatment efficacy requires further study.