Operative treatment was performed in nine patients with cervical spondylotic myelopathy complicating athetoid cerebral palsy. The first two patients were freated by laminectomy, and the other seven by anterior interbody fusion. The symptoms in both the laminectomy patients improved after operation, but became worse again when cervical instability developed; they then had to have an anterior fusion in addition. In six of the seven patients who had primary anterior fusion a halo-cast (or a halo-vest) was used to keep the cervical spine immobile, and good bony fusion was obtained with satisfactory results. However, in one patient no halo apparatus was used, bony union did not occur and the radiculopathy reappeared. In cervical myelopathy complicating athetoid cerebral palsy laminectomy is contra-indicated; anterior fusion combined with a halo apparatus is, however, satisfactory.

An efficient treatment option for CSF hypovolemia is provided by the new application method of EBP with the aid of an intravenous catheter as a slidable device, which enables infusion of a sufficient amount of autologous blood into multiple epidural areas with a single lumbar entry point.

A 29-year-old man presented with an intramedullary schwannoma of the conus medullaris manifesting as an 8-month history of mild bladder dysfunction, sexual impotence, and paresthesia in the buttocks. Subtotal removal of the lesion was achieved, as part of the tumor showed dense adhesion to the rostral neural tissue, with only postoperative transient deterioration of bladder dysfunction. Intramedullary schwannoma, especially involving the conus medullaris and the proximal spinal cord, is relatively rare and the pathogenesis and pathophysiology are unclear. Complete resection is often advised to avoid recurrence, but tumor adhesion to neural tissue sometimes renders complete resection difficult, and may create the risk of unacceptable operative morbidity. The present case shows that transient neurological deterioration may occur even with just subtotal removal, leaving the adherent part. Therefore, recognition of the particular features and the strategy for treatment in intramedullary schwannoma of the conus medullaris is essential for making appropriate decisions on the degree of removal.

Clinical manifestations of 16 patients with spontaneous spinal epidural hematoma were presented. We examined the point similar to that of stroke. During the initial visit of our hospital, the patients showed the hemiplegia in 10 cases (62.5%), Horner syndrome in 4 cases (25%), the painless onset in 1 case (6.3%). And one case showed the impairment of consciousness due to vagal reflex in severe pain onset, which was similar to those of subarachnoid hemorrhage. MRI images are useful to confirm the diagnosis. The frequent site of hematoma was the lower cervical spinal cord. The oval shaped hematomas shifted to the left or right in spinal canals, compressed spinal cords in axial image, which was a cause of hemiplegia. Many cases developed during active periods, and the hemorrhage might be relevant to oral antithrombotic agent, C hepatitis, and chronic renal failure. Rapidly progressive cases were indications for emergency surgery, but conservative therapy is also possible and was better prognosis.

While there have been a few reports on cases of intradural spinal arteriovenous fistula located on the filum terminale, no cases of its location in a nerve root of the cauda equina have been reported to date. We describe two such cases and describe the intraoperative findings. A 40-year-old man presented weakness of his left leg. Another 62-year-old man presented paraparesis dominantly in his left leg with urinary hesitation. In both cases, spinal T2-weighted magnetic resonance images showed edema of the spinal cord, indicating a flow void around it. Digital subtraction angiography disclosed an anterior radicular artery branching from the anterior spinal artery on the surface of the conus medullaris and a turnaround vein running in the opposite direction within the cauda equina. In the first patient, while the feeding artery running along a nerve root was detected, the draining vein and the fistula were not identified at first sight. An incision into the respective nerve root exposed their location within it. In the second patient, unlike the first case, the feeding artery and the fistula were buried in a nerve root, while the draining vein was running along the nerve's surface. In both cases, permanent clips were applied to the draining vein closest to the fistula. The recognition of a hidden fistulous point in a nerve root of the cauda equina is essential for successful obliteration of the fistula.