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Objective: To analyze the risk factors of worst outcome associated with moderate head injury., Methods: Data on patients with moderate head injury were collected prospectively in 11 Italian neurosurgical units over a period of 18 months. Patients older than 18 years with blunt head injury and at least one Glasgow Coma Scale (GCS) score between 9 and 13 were enrolled. The outcome was determined at 6 months using the Glasgow Outcome Scale., Results: We analyzed 315 patients. Initial computed tomographic scans showed a diffuse injury type I or II in 63%, a mass lesion in 35%, and traumatic subarachnoid hemorrhage in 42% of the patients. The risk of progression toward a mass lesion was 23% when the admission computed tomographic scan showed diffuse injury type I or II. An emergency craniotomy was performed in 22% of the patients, delayed surgery was performed in 14%, and both were performed in 25%. A favorable outcome was obtained in 74% of the patients. When the GCS score was 9 or 10, the predictor of worst outcome was a motor GCS score of 4 or lower (odds ratio [OR], 8.08; 95% confidence interval [CI], 1.22-67.35; P = 0.008), but when the GCS score was 11 to 13, the factors associated with worst outcome were neuroworsening (OR, 3.43; 95% CI, 1.45-8.17; P = 0.002), seizures (OR, 7.94; 95% CI, 1.18-64.48; P = 0.02), and medical complications (OR, 4.24; 95% CI, 1.74-10.33; P = 0.0006)., Conclusion: There is a high percentage of surgery and worsening on computed tomographic scans in patients with moderate head injury. Neuroworsening, seizures, and medical complications as outcome predictors were more strongly associated with a GCS score of 11 to 13, whereas a low motor GCS score was more outcome-related in patients with GCS scores of 9 and 10.

The city and University of Padua have a long tradition and a great reputation in anatomic studies, dating from the founding of the university in the year 1222. We present a historical review of the study of human anatomy, for which Padua was a most important center. The background for the development of this culture was represented by the scientific freedom and political wisdom of the Serenissima Republic of Venice, a liberal and tolerant state in the midst of a feudal, imperial, and pontifical Europe. During the second half of the 15th century, the flourishing trade and cultural, social, and political life of Venice attracted a great number of scientists and students from all over Europe who contributed to the establishment of Padua as an international center for culture and the sciences. Vesalio, Fabrizio d'Acquapendente, and Giovanni Battista Morgagni represent milestones in the history of anatomy as well as in medicine and surgery. History shows that anatomy and surgery evolved together, just as anatomy of the nervous system and neurosurgery developed in tandem. The tradition of neurosurgery in Padua is considered one the most important schools in Italy.

According to Gardner's hypothesis (1962) later confirmed by Jannetta (1982, 1985), hemifacial spasm can usually be related to a "vascular conflict" which takes place inside the cerebellopontine angle (CPA). Occasionally, the causative lesion can be identified as a mass encasing the facial nerve at its root exit zone (REZ) from the brain stem. The hemifacial spasm has been rarely reported in presence of a contralateral CPA mass ("false localising sign"). Hemifacial spasm in patients with masses in anatomical regions other than the CPA has to be considered exceptional. The case of an adult man harboring an ependymoma of the fourth ventricle whose only neurological sign was a left hemifacial spasm is reported. The rarity of such a condition prompted us to review the literature. Particular attention has been paid to the possible pathogenetic mechanisms and their therapeutic implications.

A case of spontaneous spinal subdural hematoma is reported. Clinical signs at onset, laboratory investigations and bloody CSF at lumbar punction were suggesting of subarachnoid hemorrhage. MRI was fully diagnostic. Surgery was ruled out and spinal compression cleared spontaneously over one week. Etiological factors, possible diagnostic pittfalls and the indication surgical decompression are discussed.

The surgical resection of deep-seated brain tumors may be facilitated by CT guided stereotactic methods. The Authors present a procedure of preoperative localisation and delimitation of the border of a neoplastic mass facing important functional areas. Ideally tumor excision should not be extended beyond that boundary which for this reason is targeted and is stereotactically labeled using non diffusible dyes.

We report on 306 cases of spontaneous intracerebral haematomas located in the supratentorial compartment. 167 patients underwent surgical treatment and 87 died (52.09%); 139 patients were conservatively managed and 30 died (21.5%). We point out some indications and contra-indications to surgical or conservative treatment on the basis of the factors influencing the mortality rate.

Among 851 patients admitted following a head injury at the Neuroradiological Service and Neurosurgical Department of the University Hospital of Padua from January 1979 to June 1981, 51 presented a diffuse damage of the white matter of the brain. The CT scan, the only neuroradiological method able to show such a lesion, does never reveal large lesions but only minimal alterations of the cerebral parenchyma, opposite to the severity of clinical picture. We discuss the etiopathogenetic, anatomopathologic and neuroradiologic aspect of diffuse brain damage, emphasizing, the technical difficulties in the demonstration, on CT scan, of some lesions, particularly at the level of the brainstem.

A report is given on eight cases of epidural haematoma in children aged 0 to 2 (11 per cent of a total of 70 epidural haematomas found in children). The individual clinical phenomena and courses of the disease are shown on the basis of our own patients. The prognosis of epidural haemorrhages is more favourable for such children than for older children and adults.

Changes in brainstem auditory-evoked potential response were serially investigated in 20 head-injury patients with neurologic and computed tomographic signs of brainstem lesion. The reliability of computed tomography in the evaluation of indirect signs of brainstem lesion from the image was investigated with elaboration of the brainstem auditory-evoked potential response. The measurement of auditory brainstem response is thought to be useful in detecting the severity and predicting possible recovery in posttraumatic brainstem injury. Brainstem deformity on computed tomography was a bad prognostic sign, indicating irreversible structural change.