A retrospective analysis of data collected prospectively was performed to determine the long-term outcome of lumbosacral selective posterior rhizotomy (SPR) in children with spastic cerebral palsy (CP). The study population comprised children with spastic CP, who had SPR more than 4 years prior to the time of the study and had quantitative standardized assessments of lower limb spasticity (Ashworth scale), range of motion measured goniometrically, muscle strength (MRC scale) and ambulatory function, both preoperatively and at 1 year after SPR. Children meeting these criteria were reassessed at 5 years after SPR using the same measures. Hip adductor spasticity, hip abduction range of motion and quadriceps strength were chosen as the primary outcome measures for statistical analysis. Of 80 patients who met the entry criteria for the study, 33 completed the 5-year assessments. Significant improvements in spasticity, range of motion and muscle strength were noted both at 1 year and at 5 years after SPR. The preoperative, 1-year and 5-year values were as follows: hip adductor spasticity (Ashworth scale) = 4.1, 2.1, 2.2; hip abduction range of motion (degrees) = 20.4, 39.9, 31.7, and quadriceps strength (MRC scale) = 3.6, 4.0, 4.1. Ambulatory function seemed to be better at 1 and 5 years compared to baseline, but no statistical analysis was done for this secondary outcome measure. It was concluded that improvements in lower limb motor outcome are present at 1 year after SPR, and that these improvements are generally maintained at 5 years.

A less aggressive initial surgical approach, supplemented by postoperative chemotherapy, designed to preserve brainstem function, is proposed for patients with interposed non-enhancing tissue continuous with normal cervical cord or medulla and/or a poorly defined ventral tumor/brainstem interface with abnormal low T1 signal extending beyond obvious tumor into the brainstem.

The brain gumma is a rare manifestation of the tertiary stage of syphilis. A case of neurosyphilitic gumma was confirmed by the Treponema pallidum polymerase chain reaction in a 46-year-old HIV-positive homosexual man. The patient presented with a severe headache and was hospitalized. A computed tomography scan was performed which revealed a left frontal lobe mass. Lymphoma was suspected. However, infectious disease diagnostics were performed on the cerebrospinal fluid that included investigations for syphilis and other microbiological agents such as Toxoplasma gondii. This revealed a reactive venereal disease research laboratory test, a reactive syphilis rapid plasma reagin and a reactive T. pallidum particle agglutination test. The patient was treated for syphilis till complete recovery.

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