Includes abstract. / Includes bibliographical references (p. 175-218). / Traumatic brain injury (TBI) is a highly complex clinical condition in the most complex organ of the body. The foundation of care of the patient with severe TBI is the prevention of secondary insults to the brain. This relies on conventional monitoring tools to identify patients at risk, but often these may fail to detect important secondary insults. Moreover, the therapies that are used commonly in the critical care environment all have potential adverse effects, many of which may not be evident. TBI treatment in children is further complicated by changing thresholds with age, and the much smaller evidence base compared to their adult counterparts.

Includes abstract. Includes bibliographical references.

Developmental Venous Anomalies are a normal variant that may be associated with other cerebral vascular malformation. They have bean previously referred to Venous angiomas. DVAs are the most frequently encountered cerebral vascular malformation and their incidence is reported to be high as2.6%. DVAs are classified into two types based on draining veins. Either deep or superficial. Those that drain into sub-ependymal veins are classified as deep and those that drain into cortical pial veins are classified as superficial. The trans-cerebral veins join either the deep or superficial venous systems by crossing a varying length of the brain parenchyma. Controversy surrounds their exact clinical significance, as DVAs are rarely symptomatic. The symptoms displayed by a patient can be related to a lesion that is associated with DVAs, such as a cavernoma. To describe the patients presenting to a single unit over a 10-year period with symptoms attributable to aDVA. Out of 19 patients in the database with the diagnosis of DVA, 10 were identified where the clinical presentation was directly related to the DVA. Seven of the patients presented with haemorrhage, 6 had parenchymal bleeds and one was intraventricular. Two patients had neurological deficit, 1 was transient and one was progressive. One patient had sudden severe headache with no evidence of haemorrhage on CT scan. The age range was from 14 to 55 with a mean of 32,7 years. Four patients were male and 6 were female. Of the patients that presented with haemorrhage only one had a fistula, three other patients with haemorrhage had evidence on DSA of stenosis of the large collector vein, In the remaining 3 patients no reason for the bleed could be detected. One patient presented with left hemianopia that resolved after several hours, DSA showed minimal caput medusa with delayed filling of the collector vein. The other patient that presented with progressive neurological deficit in the form of progressive leg spasticity and dysarthria, Angiography showed a large collecting vein that drains in the jugular bulb was stenosed. The last patient that presented with sudden severe headaches, with no haemorrhage identified on CT scan, On DSA there was early filling of the DVA veins compared to other cerebral veins and two prominent posterior communicating thalamoperforating vessels were seen.

No description available.

Bibliography : leaves 91-107. / Spinal cord compression ( SCC ) constitutes a neurological emergency, and if left untreated, can result in permanent irreversible neurological dysfunction. Disabilities can range from mild weakness to complete quadriplegia with the inherent associated mental, physical and emotional suffering .The burden of cost to the individual and community is enormous.

Includes bibliographical references (leaves 58-72). / Although the conventional role of the operation was that of a salvage procedure when medical therapy failed in the treatment of raised intracranial pressure (ICP), two important concepts have emerged in the recent literature that appear to challenge that approach. In addition to the lack of evidence supporting benefit from current forms of treament, evidence from diverse studies that use data from magnetic resonance images, cerebral owygenation and cerebral blood flow measurements have highlighted potential adverse effects that may occur with these therapies.

Includes bibliographical references. / Object: The aim of this study was to assess outcome following decompressive craniectomy in adults with severe traumatic brain injury (TBI) in a South African neurosurgical unit. Methods: During a 78 month period (January 2005 – June 2011), 76 patients that underwent decompressive craniectomy for TBI in an attempt to lower raised intracranial pressure (ICP) were reviewed . All were older than 14 years and mass lesions were included. Thirty nine point four percent of the patients sustained blunt, low velocity injuries to the head and 19% were involved in motor vehicle accidents. Unilateral hemi-craniectomies were carried out in 81% of patients and 54 (75%) were done as primary decompressive craniectomies. Survivors were followed up for a period of at least six months and functional outcomes were measured using the Glasgow outcomes score. To simplify outcomes the patients were then dichotomised into outcome groups of good (GOS 4 and 5 ), and poor (GOS 1- 3). Results: At six months follow up 24 patients (33.3%) had a good outcome (GOS 4 or 5) and 48 patients (66.7%) had a poor outcome (GOS 1- 3). 32 patients (44.4%) died (GOS 1). There were 16 survivors in the poor group. Sixty percent o f survivors had a good outcome after decompressive craniectomy. Eighteen patients underwent secondary decompressive craniectomies and 54 (75%) primary decompressive craniectomies. Thirty - five percent of patients that underwent primary decompressive cranie ctomy had a good outcome, versus 38% in the secondary decompression group. Mortality was slightly higher in the primary decompression group (43%) than the secondary group (33%) . Factors that showed significant correlation with outcome were age, admission GCS and good response of ICP to decompressive craniectomy. Complications were encountered in 18% of patients with sepsis being the most common (11%). Conclusion: Decompressive craniectomy was associated with a functional outcome that was better than exp ected in patients with severe TBI and should still form part of salvage therapy in adults with TBI and elevated ICP.

Includes abstract (p. [43].) Includes bibliographical references.

Objective: To retrospectively review our institutional experience with the treatment of paediatric craniopharygiomas and assess the evolution in management and influence on patient outcomes. Patients and Methods: A retrospective review from January 1995 to December 2015 of children age <14 treated at a single institution. Data collected included admission clinical features, endocrine function, surgery performed, surgical outcome, intracystic therapy and radiotherapy. Long-term functional outcome was calculated considering hormonal dependence, level of independence and schooling. Results: There were 41 patients with a mean age of 84.2 months: 57% were female. Primary surgical resection was performed in 36 patients: 80.5% had subtotal resection, 11% had gross total resection and the rest had biopsy only. Of surgical approaches, 60,7% had pterional craniotomy and 39,2% supraorbital keyhole craniotomy. No surgical mortalities occurred but 2 patients had new post-operative neurological deficits. Stereotactic placement of intracystic catheters transitioned to endoscopic. Intracystic treatments transitioned from Yttrium (1) to Bleomycin (6) to Interferon Alpha (6). Radiotherapy was given in 30 patients, median dose 54Gy. Final Wen functional outcome was 21,8% Class I, 32% Class II and 46% Class III. There were no early deaths in the series but 5 patients died more than 6 years after diagnosis, mostly due to endocrine crises from poor chronic care. Conclusion: The findings reflect a multidisciplinary team approach consisting of maximal safe resection with radiotherapy, intracystic agents and endocrine support. For a cohort limited to young children, our results are similar in number and outcomes to other published series. Mortality remains low but lifelong dependence on endocrine replacement is a significant contributor to long-term morbidity and mortality. This has important implications for patients referred from large distances and where primary and secondary follow up care is poor.

The aim of this dissertation is to review the current literature on severe head injuries in children, with particular respect to epidemiology, clinical features and investigation, pathophysiology, management and outcome. In addition a retrospective study was carried out on severe head injuries at Red Cross War Memorial Children's Hospital. Finally, the findings of this study are discussed in the light of the experience of other neurosurgical and trauma centres. In this way similarities as well as features peculiar to our setting can be identified with the aim of improving the understanding and management of severe head injuries in children in the Western Cape.