Thirty-eight patients with venous malformations of the face, neck, and tongue underwent percutaneous sclerotherapy with direct puncture and instillation of sodium tetradecyl sulphate (Sotradecol) (33-67% solution, mixed with contrast material) into the lesions. Each patient underwent from one to seven treatment sessions (mean 2.2), followed by reconstructive surgery in three cases. Of the 34 patients who responded to the follow-up questionnaire, the late results were excellent or good in 23 patients (68%), moderate in eight, unchanged in three, and were worse in one. Compared with our previous experience of embolisation of such malformations with ethanol, the results with Sotradecol were slightly worse. There was one serious complication, unilateral loss of vision in a patient with a large malformation that extended to the orbit. In conclusion, percutaneous sclerotherapy with Sotradecol is effective treatment for venous malformations of the head and neck. Careful planning is essential to reduce the risks of the treatment.

Twenty-seven patients with normal pressure hydrocephalus were operated upon by a ventriculo-peritoneal shunt. Selection for shunt surgery was based on typical symptoms (gait disturbancy, mental deterioration and urgency incontinence) and characteristic changes at cranial computed tomography and/or radionuclide cisternography. Prior to operation a cerebrospinal fluid tap-test (CSF-TI') was performed with measurements of psychometric functions and gait pattern before and after a lumbar puncture of 50 cc CSF. Nineteen patients improved and 5 were unchanged after shunt operation. Three patients could not be evaluated. Improvement in the psychometric functions and gait pattern after lumbar puncture correlated to improvement after the shunt operation (r = 0.64, p < 0.01: r = 0.96, p < 0.001, respectively). Improvement in 2 or more of the 4 tests used (3 psychometric and 1 gait test) at CSF-TT implied in all cases successful result of the shunt operation. It was concluded that CSF-TT could predict which NPH patient will improve by a shunt operation, and albeit to envisage the degree of improvement.

The incidence of hidden compartments in the AVM population is unknown but further studies, particularly in the realm of superselective embolization, could reveal their presence.

Twenty-seven patients with normal pressure hydrocephalus were operated upon by a ventriculo-peritoneal shunt. Selection for shunt surgery was based on typical symptoms (gait disturbancy, mental deterioration and urgency incontinence) and characteristic changes at cranial computed tomography and/or radionuclide cisternography. Prior to operation a cerebrospinal fluid tap-test (CSF-TT) was performed with measurements of psychometric functions and gait pattern before and after a lumbar puncture of 50 cc CSF. Nineteen patients improved and 5 were unchanged after shunt operation. Three patients could not be evaluated. Improvement in the psychometric functions and gait pattern after lumbar puncture correlated to improvement after the shunt operation (r = 0.64, p less than 0.01: r = 0.96, p less than 0.001, respectively). Improvement in 2 or more of the 4 tests used (3 psychometric and 1 gait test) at CSF-TT implied in all cases successful result of the shunt operation. It was concluded that CSF-TT could predict which NPH patient will improve by a shunt operation, and albeit to envisage the degree of improvement.

Vascular malformations are errors of vascular morphogenesis, and must be differentiated from vascular tumours such as haemangiomas, because the natural history and treatment are different. Vascular malformations may be arteriovenous with high blood flow, or venous with low blood flow. Venous vascular malformations grow among soft tissues and are difficult to delineate at operation. Direct puncture under fluoroscopy with injection of contrast medium is one method of visualising the cavities of a venous malformation. Instillation of concentrated alcohol directly into such cavities is a possible treatment. Forty-four patients with venous malformations of the head or neck have been treated since 1984, of whom 31 responded to a follow up questionnaire. Twenty-three responded to injection of ethanol alone, and eight also required reconstructive surgery; 26 of the 31 described the result as "good" or "excellent" (84%).