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An unusual combination of a fusiform aneurysm on the middle cerebral artery branch to the central region and cortical lipomatosis is described. The etiology of lipomatous disorders in the brain are multiple. The possibility of a combined dysplasia based on maldifferentiation of primitive meninges and the arterial wall is suggested in this case. Treatment consisted in uneventful, microsurgical image-guided resection of the aneurysm using the Surgiscope robotic system.

Society demands for exactness and low complication rates of surgical treatment are high. Surgical training in the apprentice manner has been significantly reduced in Denmark since 1981 and e.g. the ability to visualize in three dimensions among younger neurosurgeons has diminished. Computer technology now makes it possible to create 3-D images that with incorporation of functionality leads to a faster and better understanding of neuroanatomy. In addition--for the sake of precision--true robotic instrumentation and navigational instruments have been introduced. The technological investments are compensated by reduced costs due to operative complications. A prerequisite for these developments are a close collaboration between medical doctors and engineers, keeping the respect for humanity intact. A survey of developmental areas in the neurosurgical techniques of today is given.

The results after percutaneous lumbar discectomy were evaluated in 52 patients with low back pain corresponding to the L5 or S1 root. All patients were examined with a median follow-up time of 14 weeks. The patients were divided in two groups. Group 1: patients with an obvious indication for surgery (29 patients) and group 2: patients with a relative indication for surgery (23 patients). The follow-up results for patients in group 1 were comparable with the results after conventional discectomy. The results concerning follow-up low back pain in groups 1 and 2 were good or excellent in 69% and 43% of the patients respectively. The corresponding results for sciatica were 69% and 65% respectively. It is concluded that percutaneous lumbar discectomy is a possible alternative to conventional discectomy in selected patients.

During two periods (1.1.1981-3.1.1985 and 1.1.1988-31.12.1992) 57 patients were treated or attempted treated with endovascular embolization. The patients suffered either from arteriovenous malformations (AVM), dural arteriovenous malformations (DAVM), carotico-cavernous fistulas (CCF), giant aneurysms or meningenomas. During the first period the balloon-technique was mainly employed and only one isobutyl-2-cyanoacrylate (IBCA) embolization was carried out. Six AVMs and 11 CCFs were treated, and the complication rate was 33%. During the second period histoacryl/N-butyl-cyanoacrylate (NBCA) embolization was the treatment of choice for AVM and DAVM, and the balloon technique reserved for CCF and test occlusions. The complication rate was 8%. In 83% of the AVMs occlusion of more than 50% of the nidus was achieved. Three of five CCFs were occluded with one occluded internal carotid artery. There were no complications in test occlusions. Two DAVMs were reduced in size and the symptoms reduced. The patient material during this period consisted of 19 AVMs, two DAVMs, five CCFs, nine giant aneurysms (test occlusion) and five basal meningenomas with involvement of the internal carotid artery (test occlusion). The treatment of these relatively rare patients consists of close cooperation between the interventional neuroradiologist and the neurosurgical team.

Results of treatment of 92 supratentorial and 19 infratentorial cerebral arteriovenous malformations from a 10 year period are discussed. The role of interventional embolization is emphasized. The results seems comparable to major international centres. Danish incidence evaluations indicate that it will be possible to gain further experience and thus better results by centralizing the treatment of larger arteriovenous malformations.

During a period of one year, nine patients with traumatic lesions of the spinal medulla were examined and treated urologically. The patients were followed-up for 24-36 months and follow-up will continue. All of the patients were treated primarily with sterile intermittent catheterization by the nursing staff. Exceptions from this were patients in whom indwelling catheters were necessary on account of complicating conditions. During the acute phase, the patients were examined by a urologist and bladder function investigations with cystometry + electromyographic registration from the pelvic floor were undertaken. When patients had recovered from the spinal shock phase, emptying of the bladder supplemented by alpha-adrenergic blocking preparations and clean intermittent catheterization were instituted in the patients with supra-sacral lesions. Patients with infra-sacral bladder paresis were trained in miction on abdominal pressure supplemented by clean intermittent catheterization. No complications from this treatment have occurred and renal function has remained stable. Only one patient has an indwelling catheter and it has not proved possible to persuade the patient to accept removal.