n human consciousness a world of separated objects is perceived by an inner observer as a feeling of One-self. A topological correlation of the Self to the world, by either emerging all separated objects into one or splitting the Self in as many disconnected Sub-selves as there are objects perceived. The Self is generated in a neural network by algorithmic compression of spatial and temporal information into a toponeuronal structure (TNS). A correlation of an inner observer to parts of a structure inevitably entails a correlation to the whole, serving of the Self. Molecular mechanisms for the generation of a TNS in a neural network will be discussed.

Shunt is a classic treatment for hydrocephalus, whereas these surgery has a high proportion of complications, mainly due to infection and shunt device blockage after shunting. Infection after shunt surgery is still a relatively high incidence of complications, postoperative shunt infections were reported in 0.3-17% of cases in most neurosurgical institutes.

Background: Community mob assault is a significant social problem in the townships of South Africa. We aimed to evaluate the prognostic variables associated with cranial injuries secondary this mechanism of injury over a 2 year period in patients referred to a single Neurosurgical center. Materials and methods: Descriptive cross-sectional data analysis of cranial injuries following community mob assault, from January 2015 to December 2016, was performed. Medical records were analyzed in terms of patient demographics and the subsequent continuity of care from initial patient referral to eventual discharge. The Outcome measure utilized was the Glasgow Outcome Scale (GOS). Results: Of the 41 patients treated, 100% were male. Mean age was 30.5 +/-9.1 years. No statistical significance was demonstrated between age and GOS (p=0.94). Socioeconomic status revealed that 33 (81%) were unemployed and 8 (19%) were employed. Alcohol involvement was confirmed in 14 (34%) of subjects and excluded in 3 (7%) of subjects, however in 24 (58%) of subjects this was unknown. Only 3 (7%) of subjects has isolated head injuries while 38 (93%) had additional injuries. Severity of head injury analysis showed that 15 (41%) presented with mild head injuries, 20 (49%) presented with moderate head injuries, 5 (2.4%) presented with severe head injuries and 1 patient presented with a critical head injury. Statistical significance was demonstrated with the outcome (p=0.02). Site of head trauma recorded showed that 11 (37%) of subjects had isolated parietal injuries, 9 (30%) had isolated frontal injuries, 4 (13%) had base of skull fractures and 5 (17%) had multiple sites of cranial injury. CT features showed that 9 (26.4%) of subjects had an acute subdural hematoma, 8 (24%) of subjects had an extradural hematoma, 7 (21%) of subjects had an intracerebral contusion and 4 (12%) had cerebral edema. At discharge 6 (14.5%) of subjects were GOS 1, 10 (24%) were GOS 3, and 6 (15%) were GOS 4. Only 19 subjects (46%) were GOS 5 at discharge. Conclusion: The study revealed that secondary to Community mob assault 39% of subjects either demised or are so disabled they are dependent in their daily life due to physical or mental disability. Less than half (46%) of subjects resumed normal life post community mob assault. The severity of the head injury was found to be statistically significant in predicting outcome.

ntroduction: Patients with increased pressure hydrocephalus are a common referral to the Department of Neurosurgery at Dr George Mukhari Academic Hospital (DGMAH) in Pretoria, South Africa. Aim: Our study aimed to establish our incidence and evaluate the known risk factors for ventriculo-peritoneal shunt sepsis in all patients whom had a ventriculo-peritoneal shunt inserted during the study period and whom completed 12 months of post-operative follow-up. Methods: A retrospective cross-sectional study was performed considering all ventriculo-peritoneal shunt procedures performed between the 01 January 2013 and the 31 December 2015, consecutively drawn from the Neurosurgical operating room operative logbook. Results: Overall 172 ventriculo-peritoneal shunts were inserted during the study period, 106 (62%) of which were inserted in children and 65 (38%) were inserted in adults. With regards the children (n=106) the most common etiology of hydrocephalus was congenital in 48 (45%) of patients while in adults (n=65) the commonest etiology was tuberculous meningitis in 15 (23%) of cases. Of the 172 patients whom had a ventriculo-peritoneal shunt inserted, 39 (23%) were deceased before completion of the one year post-operative follow-up period. The most common cause of death in this deceased group was progressive neoplastic disease in 20 (51%) of patients and tuberculous meningitis not responsive to cerebrospinal fluid diversion in 12 (31%) of patients. Of the 134 subjects whom had a ventriculo-peritoneal shunt inserted and completed the 1-year post-operative follow-up, 7 (5.2%) developed ventriculo-peritoneal shunt sepsis within the one year follow-up period. The presence of a cerebrospinal fluid leak post the ventriculo-peritoneal shunt procedure (p=0.02) and having had more than two prior ventriculo-peritoneal shunt surgeries (p=0.027) were statistically associated with an increased chance of developing ventriculo-peritoneal shunt sepsis in our study. Conclusion: Our study confirmed our institutional ventriculo-peritoneal shunt sepsis rate to be 5.2% and furthermore confirmed the significance of two of the known risk factors as taken from the literature. A further finding was that in our setting this procedure was often palliative. Thirty nine (23%) of subjects, despite being afforded the benefit of CSF diversion, demised within 1 year of the procedure due to progression of their underlying disease.

Head injuries (HI) are one of the most common causes of death, morbidity and disabilities in young adults. Epidemiological studies allow a quantitative estimation in terms of incidence and a qualitative estimate for the identification of risk factors in specific populations. These estimates may enable appropriate prevention programs. Estimates of annual incidence rates depend on territories, periods and methodological tools. Annual rates for hospitalized patients are found between 150 and 300/100,000 inhabitants. Severity of HI can be assessed by the Glasgow Coma Scale (GCS), the Abbreviated Injury Scale (AIS) or the Post-Traumatic Amnesia duration. Annual incidences of severe HI will depend on the selected score: around 25/100,000 inhabitants for cerebral trauma with intracranial injuries, around 9/100,000 for the most severe HI, with an AIS maximum of 5 with coma. The male:female ratio increases with degree of severity. Traffic accidents were the most frequent cause of HI. Many patients have associated injuries, worsening the outcome. Some risk factors are considered. Preventive measures are mainly conducted for traffic accidents, and include speed limit and regulations on helmet or seat belt use. Results of these measures are analysed Postoperative dysfunction affected one cranial nerve in 25 patients, two nerves in four and three nerves in one patient. Most cranial nerve injuries were asymptomatic or mild in severity, resolved in one to 12 months and probably were caused by intraoperative retraction.