We report a case of spinal seeding of a pilocytic astrocytoma of the chiasma opticum. Microscopic examination of the optic nerve tumor and the spinal tumor showed the same pathological patterns, without any signs of anaplastic transformation. The clinical course demonstrates the low growth rate of this kind of tumor, but spinal metastasis has not yet been described. We discuss different pathophysiological explanations of this atypical biological behavior with reference to the literature.

For at least 1 year we have done a follow-up on 178 children under the age of 18 years with head injuries treated between 1981 and 1987. The Brussel Coma Scale and the Glasgow Outcome Score were used to determine neurological deficits and patient outcome. In children with coma, there was good recovery or moderate disability in 71.4%, severe disability in 6.1%, and death in 22.5%. When all head injuries were taken into consideration, a satisfactory outcome was found in 84.3%, severe disability in 3.3%, and death in 12.4%. The outcome mainly depended on the initial coma grade, but the duration of coma or advanced age were also negative factors for outcome. In 14.8%, intracranial mass lesions showed no significant correlation with outcome. In contrast to adults, diffuse brain swelling had a satisfactory outcome in 85.1%.

In view of the high incidence of late instability during conservative treatment of cervical spine fractures, operative stabilization should be performed as soon as possible. Besides immediate decompression of the spinal cord, rapid mobilisation of the patient without external fixation is possible. We report on the results of operative treatment in 97 patients with injuries of the lower cervical spine. The indication for spondylodesis as well as the surgical methods and their complications are discussed.

1112 anterior cervical fusion operations were performed on 951 patients according to the method described for the first time by Grote in 1970. The neurogenic, mechanical and inflammatory complications arising with this method are described. The typical complications are demonstrated by means of case reports and their possible causes are discussed. The incidence rate of the individual complications is compared with that reported in the literature for a total of 8366 fusions performed on 6384 patients.

No abstract