Child's brain最新文献

A case of Arnold-Chiari malformation (Chiari type II) is reported to describe the usefulness of metrizamide cisternography in the diagnosis and management of this condition.

The argon microsurgical laser offers a less traumatic and often more hemostatic technique for the ablation of neural and tumor tissues. Our experience in 15 microsurgical procedures is discussed. The argon laser was essential in the removal of small, moderately vascular, strategically placed intracranial and spinal lesions. In each of these cases, the laser either permitted a complete resection or augmented the amount of tumor resected over that which could be removed by standard microsurgical technique. The laser was not beneficial in operations on large lesions or those with markedly increased blood flow. There were no early or late complications related to the use of the argon laser. Further advances in laser technology will afford significant improvements over the presently available techniques of laser microneurosurgery.

Unlabelled: The therapeutic criteria according to tomographic findings are reviewed. 10 children, 6 male and 4 female, with porencephalic congenital cysts were studied. Early symptoms began within the first 6 months of life in 9 cases, and at the age of 5 years in 1. The most frequent symptoms were: seizures in 3; motor deficit in 5; retarded psychomotor development in 7; endocranial hypertension syndrome in 7; symmetric macrocrania in 7; paresis of the motor ocular nerves in 4. Preoperative studies: X-ray films-1 each patient-showed diastasis of sutures in 6 and cranial asymmetry in 2. Electroencephalograms-6 patients-were abnormal and diffuse in 3, hipsarrhythmic in 2, and focal in 1. CT-1 each patient-showed porencephalic cysts in all the patients; ventricular dilatation in 9; a single ventricle in 1, and a shift of the midline in 5. Postoperative studies: EEG, 1 each patient; CT, 1 each patient.

Surgical treatment: 8 patients underwent peritoneal shunts and 2 atrial shunts. Plastic surgery of the dysraphy was also performed. Postsurgical treatment: Rehabilitation and anti-convulsive treatment-4 patients. There were no deaths among the patients. The morbidity improved.

Pain in children is generally not accorded the same significance by allied health professionals as pain in adults. To some extent this relative neglect may be the result of a general belief that pain is less of a problem in the pediatric age-group. However, it is the author's experience that the management of pain in children with spinal cord tumors reveals the same significance as in adults. From 1970 to 1980, 54 cases of spinal cord tumor were reviewed at the Children's Memorial Hospital and analyzed for their 'verbal' and 'nonverbal' pain descriptions. There were 22 extradural tumors, 20 intradural extramedullary and 12 intramedullary tumors. The patients ranged in age from 5.5 months to 15 years. The patients were divided into two groups. Group I (18 children) were under 3 years of age, and group II (36 children) were over 3 years of age. In both these groups pain was the most common finding (78%), followed by motor weakness (76%), pathological reflexes (74%) and sensory change (50%). Group I has 27 pain expressions (1.5 pain complaints per patient) and group II had 59 pain expressions (1.6 complaints per patient). Thus, the children of group I and group II expressed a similar number of pain complaints. However, in group I the majority (74%) of pain expressions were 'non-verbal', while in group II, the majority (85%) of pain expressions were 'verbal'. 2 typical cases of children with spinal cord tumors whose pain evolved from infantile 'nonverbal' and 'verbal' pain description to adulthood pain descriptions are illustrated.

Computed tomography (CT) of 11 patients with medulloblastoma was evaluated. 6 of them showed solid, nearly homogenous lesions and definite enhancement after infusion of contrast medium. However, 5 cases showed heterogenous mass lesions composed of the areas of low density and iso- or slightly high density which was attenuated by contrast enhancement. Histological examinations revealed that 2 cases had differentiated medulloblastomas, but the other 3 typical medulloblastomas. It should be reminded in the differential diagnosis of cerebellar tumors of pediatric patients that medulloblastoma can reveal heterogenous mass in CT scan.

The occipital transtentorial approach to the high posterior fossa has been previously described for the adult neurosurgical patient. In this presentation 5 pediatric patients with differing pathology in the posterior fossa are reported following successful occipital transtentorial operations. The advantages of this approach over the suboccipital route for microneurosurgery are discussed.

Moyamoya disease is an unusual form of chronic cerebrovascular occlusive disease characterized usually by bilateral stenosis of distal internal carotid arteries and their vicinity, by a hazy network of collateral circulation at the base of the brain called moyamoya vessels and clinically by recurring hemispheric ischemic attacks in children. This disease was first reported by a Japanese neurosurgeon and many reports and studies on this disease have been published in Japan. We report here the recent progress in the diagnosis of the disease and introduce a newly developed operative procedure which we think is an ideal surgical method for treating this disease in children.

Extended craniectomy has been employed in 148 +/- 4 month old infants with bilateral synostosis of lambdoid suture. Intraoperatively the ICP was less than 180 mm H2O in 6, 180-200 in 1, greater than 200 in 7. 18 +/- 10 months following surgery clinical signs as psychomotor retardation and so forth were present in 4 compared to 11 patients preoperatively. With 1 exception there was a distinct remodelling of neurocranium and an almost complete ossification of the operative site.

The present report concerns a 10-year-old boy in whom diabetes insipidus and short stature were the first manifestations of a suprasellar germinoma. Neuroradiological investigations performed when these symptoms appeared were negative. 2 years later, a rapid and early pubertal development was observed and related to secretion by the germinoma of human chorionic gonadotropin (hCG) identified immunohistochemically. This clinical evolution is unusual and indicates that plasma hCG measurements in patients with so-called idiopathic diabetes insipidus can be of clinical value in predicting the presence of an hCG-secreting tumor.

Callosal agenesis and interhemispheral cysts containing ependyma, choroid plexus and glial cells are reported in a male infant. To the authors' knowledge this represents the 4th recorded case. Other findings were: nodular neuronal heterotopias with fully differentiated spiny neocortical neurons, widespread neocortical microgyria, cerebellar hypoplasia and bony abnormalities of the foramen magnum and atlas. This study confirms that glio-ependymal cysts are heterotopias of embryonic ventricular epithelium. The existence of more than one type of heterotopia (i.e. neuronal and ependymal) in 1 individual is significant. This indicates an error of cell generation and cell migration affecting the original structure from which both cell types are derived: the embryonic (sub)ventricular zone.