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Introduction: Head injury is a common consequence of accidents and violence. It can result in permanent disability and is one of the leading causes of premature death worldwide. Our aim was to review all visits to Landspitali University Hospital (LUH) from head injuries, to study the incidence, nature and severity of head injuries., Material and Methods: A retrospective study on all visits of Reykjavik's inhabitants to LUH for head injuries in the years 2000-2005 and 2008-2009. Data were collected from patient records at LUH. One main diagnosis was used if head injury diagnoses were many. They were categorised into 5 groups; soft tissue injury, eye injury, injury to cranium, intracranial- and cranial nerve injury and multiple trauma., Results: During the study period 35.031 patients presented with head injuries to LUH. Males were 67%. Mean age was 26 years (0-107). The highest rate was among infants and children aged 0-4 years (20.8%), followed by 5-9 years (11,5%) and 20-24 years (9.4%). The annual incidence decreased between the study periods from 4.2% to 3.3%. The annual incidence for admitted head injury patients decreased from 181/year/100.000 inhabitants to 110/year/100.000 inhabitants. Most often injuries were caused by accidents (80,5%) and violence (12.7%). Soft tissue injury was the most common injury (65%), followed by eye injury (15%) and intracranial- and cranial nerve injury (14%). The injuries that most frequently led to hospital admission were intracranial bleeding (90.1%), followed by skull fracture (79.2%)., Conclusion: Accidents and violence caused most head injuries and they are more common among men than women. Patients with intracranial haemorrhage were usually admitted. Incidence of hospital visits and admissions because of head injuries in Reykjavik has decreased over the last decade. Key words: Head injury, accident, violence, brain injury, intracranial bleeding.

Objective: Neuronavigational devices have traditionally used preoperative imaging with limited possibilities for adjustment to brain shift and intraoperative manipulation of the surgical lesions. We have used an intraoperative imaging and navigation system that uses navigation on intraoperatively acquired three-dimensional ultrasound data, as well as preoperatively acquired magnetic resonance imaging scans and magnetic resonance angiograms. The usefulness of this system for arteriovenous malformation (AVM) surgery was evaluated prospectively., Methods: Nine consecutive patients with Spetzler Grade 1 (n = 3), 2 (n = 3), 3(n = 2) or 4 (n = 1) AVMs underwent operation using this intraoperative imaging and navigation system. The system provides real-time rendering of three-dimensional angiographic data and can visualize such projections in a stereoscopic (virtual reality) manner using special glasses. The experiences with this technology were analyzed and the outcomes assessed. Angiographic reconstructions of three-dimensional images were obtained before and after resection., Results: Conventional navigation on the basis of preoperative magnetic resonance angiography was helpful to secure positioning of the bone flap; stereoscopic visualization of the same data represented a powerful means to construct a mental three-dimensional picture of the extent of the AVM and the feeder anatomy even before skin incision. Intraoperative ultrasound corresponded well to the intraoperative findings and allowed confirmation of feeding vessels in surrounding gyri and rapid identification of the perinidal dissection planes, regardless of brain shift. The latter feature was particularly helpful because the intraoperative navigational identification of surgical planes leads to minimal exploration into the nidus or dissection at a greater distance from the malformation. Application of the system was thought to increase surgical confidence. In two patients, postresection ultrasound prompted additional nidus removal. Ultrasound angiography seemed to allow some degree of resection control, although its sensitivity was not thought to be sufficient. All AVMs were radically removed without new permanent morbidity., Conclusion: The complexities of handling the pathological vessels of AVMs were ameliorated by intraoperative three-dimensional ultrasound and navigation because the three-dimensional outline of the vasculature (feeders, nidus, and draining veins) provided a means to adapt resection strategies, define dissection planes, and interpret intraoperative findings. It is difficult to provide a scientifically valid definition of "added value." However, in our experience, the added confidence and the improved mental image of the lesion that resulted from this technology improved the quality and flow of surgery.

Object: The purpose of this study was to assess the long-term treatment efficacy and morbidity of patients who undergo gamma knife radiosurgery (GKS) for craniopharyngioma., Methods: Twenty-one consecutive Swedish patients were evaluated retrospectively: 11 children (< or = 15 years) and 10 adults. The time from diagnosis to the most recent follow-up imaging study was 6.3 to 34.3 years (mean 18.2 years, median 16.8 years). Tumor volumes and morbidity from GKS or other treatments were assessed at the time of the most recent imaging study or at the time of a subsequent new treatment. The observation period ranged from 0.5 to 29 years (mean 7.5 years, median 3.5 years). The prescription dose ranged from less than 3 Gy to 25 Gy. The mean tumor volume was 7.8 cm3 (range 0.4-33 cm3). There were 22 tumors in 21 patients treated with GKS. Five of these tumors were reduced in size, three were unchanged, and 14 increased. Tumor progression correlated with a low dose to the tumor margin. Eleven (85%) of 13 tumors that received a dose of less than 6 Gy to the margin increased in size, whereas only three (33%) of nine tumors that received 6 Gy increased. This difference was statistically significant (p = 0.01). In five of six patients tumors that became smaller after GKS there were no recurrences within a mean follow-up period of 12 years. Nine (82%) of 11 tumors in children ultimately increased after GKS, compared with five (50%) of 10 in adults. In eight patients there was a deterioration of visual function. In all except one this could be related to a volume increase but radiation-induced damage could not be excluded as a factor in any of them. Four patients developed pituitary deficiencies., Conclusions: Gamma knife radiosurgery is effective in controlling growth of craniopharyngiomas with a minimum dose of 6 Gy. The findings also suggest that other stereotactic techniques, such as cyst aspiration and intracystic treatment, are only of value in reducing tumor volume in preparation for safe GKS.