Microlumbar discectomy is latest state of art treatment for prolapsed lumbar intervertebral disc. A series of 250 consecutive cases operated over a period of 4 and 1/2 years have been reviewed. There were no significant complications. L4/5 was the most common level followed by L5/SI. All the six cases operated bilaterally were at L4/5 level. Relief of sciatic pain was seen in 98 percent of the patients and six patients (2.4 percent) required to be re-operated over a period of three and half years. The indication for microlumbar discectomy drops sharply after the age of fifty years. Patients also have other pathologies with advancing age such as lateral recess stenosis and hypertrophy of facets requiring alternative treatment. The overall results of microlumbar discectomy are superior in comparison to standard laminectomy.

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Thirty patients with nasal and paranasal sinus lesion involving anterior cranial fossa, underwent craniofacial resection over a three year period were analysed. Nasal mass causing obstruction was the most frequently encountered symptom. Half of the patients had either unilateral or bilateral proptosis. A similar number had history of visual deterioration. Ocular nerve palsies were recorded in over a third of the cases. All the patients had CT scans of Head along with coronal cuts for anterior cranial fossa. A wide range of lesions were encountered, which included malignant lesions in 20 (66 percent) patients, 2 patients had extensive fibrous dysplasia of the sphenoethmoid complex and 3 patients had large osteomas of the anterior skull base. Mucarmycosis, aneurysmal bonecyst, and miningioma were noticed one case each. Two patients had giant cell tumour. Anterior cranial fossa floor was radically excised, posteriorly up to tuberculum orbits. In 9 patients orbital exenteration was also carried out. Total maxillectomy and partial medical maxillectomy was carried out in 8 cases each. Patients had a good cosmetic results, thus justifying the need for extensive cranio facial resection.

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A female patient with Duchenne muscular dystrophy (DMD) with no prior family history of DMD is described. She presented with proximal muscle weakness, enlarged calf muscles and an elevated serum creatine kinase (CK). Histological examination of skeletal muscle revealed myopathic changes and immunoperoxidase examination for dystrophin in muscle biopsy demonstrated a mosaic pattern. Immunostaining of a muscle biopsy with anti-dystrophic serum proved to be valuable in the diagnosis of DMD in a symptomatic female carrier.

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Intraoperative ultrasonography in 68 patients of brain tumours was found to be useful in localising and characterising them, facilitating a direct, precise surgical approach to the tumour. Assessment of extent of resection of tumour lessens the riskof increasing neurological deficit as well as increases surgical precision. Ultrasound guided biopsies of deep seated lesions is an effective, safe and relatively inexpensive procedure with the neurosurgeon being able to see the biopsy needle entering the lesion during the procedure.

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58 Patients with trigeminal neuralgia treated with microvascular decompression are analysed. Arterial compressions of root entry zone of trigeminal nerve were found in 84 percent, venous compression in 5 percent and combined arterial venous compression in 9 percent. Negative explorations were observed in 2percent of cases. Follow up period ranged from 2 to 6 years. Results were excellent in 77 percent good in 9 percent and unsatisfactory in 5 percent of cases. 9 percent of patients had recurrences/failures. Immediate pain relief was seen in 86 percent of patients, but success rate dropped to 77 percent during the follow up. Results were correlated with various factors that influence the outcome. The results could not be correlated with age, sex and main branch involved but severity and nature of cross-compression of trigeminal root entry zone, duration of symptoms, characteristic of pain presentation, prior surgical procedures, postoperative sensory deficit and reexploration for recurrences/failures had significant relationship between operative results and outcome.

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Neurosarcoidosis is rare, accounting for less than 5 percent of all cases of sarcoidosis. We report a case of neurosarcoidosis presenting with neuropsychiatric features and meningitis, confirmed by meningeal biopsy. The difficulties encountered in establishing the diagnosis and treatment are highlighted.

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A seventeen year old male, who presented with progressive behavioral abnormalities, mental deterioration, unsteadiness, myoclonic jerks and generalized tonic-clonic seizures is described. CSF and serum VDRL were positive as also his mother's TPHA. The EEG was consistent with myoclonic jerks.

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Hyperventilation (HV) has traditionally been used to activate epileptiform discharges in EEG, especially in generalized epilepsies. A young girl, with complex partial seizures secondarily generalised had frequent spike discharges (1spike/4.2 sec.) in left anterior temporal region in the resting record. During hyperventilation the spike discharges became less frequent (1 spike/15 sec.) and later disappeared. The spike discharges reappeared gradually in post-hyperventilation period and 2 minutes after stopping hyperventilation the spike frequency increased to 1/3.2 sec. The decrease in spike discharges may be due to hyperventilation induced arousal response or decrease in spike discharges may be due to hyperventilation induced arousal response or decrease in Cerebral blood flow resulting in suppression of spike focus. It is also possible that HV induced slow waves may obscure the spike discharges. Such paradoxical reduction of spike discharge during HV warrants cautions interpretation of the results of EEG when HV is used as a routine activation procedure.

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Forty two consecutive cases of cortical sino venous thrombosis (CSVT) diagnosed by computerised tomographic scan (CT scan) and or magnetic resonance imaging (MRI) constituted the study material. Clinical features are similar despite of varied aetiology. Stroke like presentation was seen in 20 (48 percent) patients, features of raised intracranial pressure were seen in 14 (33 percent) patients and the remaining presented with diffuse encephalopathic features. No definitive aetiological factor could be found in 7 (17 percent) patients. Main CT scan features included empty delta sign (43 percent), cord sign (31 percent) and haemorrhagic or non haemorrhagic infarcts (62 percent), and CT scan was non diagnostic in 6 (14 percent) patients. The MRI imaging features included hyperintense signals in the sinuses more often in sagittal sinus with or without haemorrhagic infarct.

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This study was aimed at establishing a single step method for production of brain abscess in the rat utilizing Staphylococcus aureus inoculum, prepared from a clinical specimen. Adult Wistar rats were stereotactically inoculated with 1 ul of multidrug resistant Methicillin sensitive Staphylococcus aureus inoculum. A dilute non-standardized inoculum and a standardized inoculum containing 1 million organisms/ul were utilized. Rats were sequentially sacrificed from 24 hours to 24 days. Gross and histopathologic studies with H & E, avidin biotin conjugate (ABC) immunoperoxidase technique using monoclonal anti glial fibrillary acidic proteins (GFAP) antibody and Gram's stain were performed. No abscess was formed with the dilute non-standardized inoculum. The overall success rate was 32.14 percent. Cerebritis was evident in the 24 hour specimen. An acute abscess was seen by day 4, and although fibroblasts were noticed on day 10 a well defined capsule was seen only by day 16 when gliosis became evident.Clusters of Gram positive cocci were demonstrable in all specimens. Cultures from abscess specimens yielded pure Staphylococcus aureus growth with a similar drug sensitivity as the parent inoculum.

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Multifocal synchronous gliomas are uncommon in the absence of phakomatosis. Two cases are reported and their possible mode of spread is discussed. A guideline is proposed in the management of such lesions.

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Amaurosis Fugax has not been described in relation to orbital Arterio-venous Malformation, which are tumours of rare occurrence. One such case is being reported.

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Cavernous haemangiomas of cavernous sinus are very rare and behave differently from the much commoner parenchymal cavernous haemangiomas. They resemble meningiomas on CT Scan and MRI. Although they appear avascular or mildly vascular on DSA studies they bleed profusely during excision and carry a high morbidity and mortality. These tumours are usually limited by the dura and do not breach it. C.S.F. rhinorrhoea as a presentation is being reported for the first time. The diagnostic and management difficulties are discussed with presentation of two cases and a brief review of literature.

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A case of an aneurysmal bone cyst of left temporal bone is reported for its rarity. Diagnosis was made by CAT Scan, MRI and biopsy. Preoperative radiotherapy in the dose of 3000 rads was given followed by surgical excision. The patient recovered well after surgery.

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