Child's brain最新文献

All infants of less than 1,500 g birth weight who required a ventriculo-peritoneal shunt were followed for developmental problems over the 1st year of life. There were 19 infants; 2 died within the 1st postoperative week. At 1 year of age corrected for prematurity the mean Bayley Mental Developmental Index was 62 +/- 23.0, and the mean Psychomotor Developmental Index was 61 +/- 19. Only 2 infants attained scores greater than 85 on both scales, while an additional 2 infants attained a score of greater than 85 on one scale. It is concluded that ventriculo-peritoneal shunting procedures performed after progressive ventricular enlargement has taken place are not likely to result in normal development of the infant less than 1,500 g birth weight.

24 patients below 16 years of age with intracranial arteriovenous malformations are considered. Presenting history has been constituted mainly by intracranial hemorrhage, followed by epilepsy and hydrocephalus. The utility of angiography and CT scan is stressed, especially for preoperative evaluation. The arteriovenous malformation was located in noncritical cortical areas in 7 cases, in critical cortical areas in 6 cases, in the midline structures or in the basal ganglia in 8 cases, in the posterior fossa in 2 cases, and was only dural in 1 case. Complete surgical resection of the lesion has been carried out in 18 cases, and embolization in 1 case. The operative microscope, induced hypotension, and the 'backward technique' have been very useful during surgery. Following the operation, good results have been achieved in 83% of cases; mortality has been 11%. In most cases epilepsy has shown improvement after surgery. It is concluded that direct surgical extirpation of the angioma is the treatment of choice for pediatric patients, even in the presence of epilepsy alone.

Serial electroencephalograms were obtained over a 24-hour period in 15 children from 3 months to 17 years following metrizamide CT cisternography. Persistent EEG abnormalities were noted in 8 children, 5 of whom were older than 2 years. Bifrontal slowing was a frequent change in the children older than 2 years.

We studied 21 cases of diastematomyelia associated with myelo-meningocele (3 cases) or congenital spine deformities (18 cases). Analysis of bone and neuraxis abnormalities with special reference to the spinal canal, related to operative findings demonstrate in all cases an embarrassed cord by localized compression or global narrowing of the malformed spinal canal (11 cases), bone spur fixation (13 cases) and tethered cord associated lesions (5 cases). Mechanisms of neural damage and prophylactic value of laminectomy before the orthopedic treatment of the curve during the same operation is discussed.

Between 1954 and 1975, in the Children's Department of our Institute, 137 patients under the age of 14 were treated for cerebellar astrocytoma. Histological re-examination--in accordance with Gjerris and Klinken--showed that only 128 cases could be included into the group of benign cerebellar astrocytomas. The short follow-up period in one part of our material does not allow the establishment of significant differences between the so-called 'juvenile' and 'diffuse' type of astrocytomas. From our investigations, it seems that the only significant factor in the recurrences and in the survival time is the involvement of the brain stem. This involvement is more frequent in the diffuse type. However, we could find long-term survivors in both histological groups.

The authors present 5 cases of posterior fossa tumors in childhood operated on using three laser sources: CO2, Nd: YAG and Argon. Each laser source is used as required during the different steps of the operation: CO2 for cutting and vaporizing, Nd: YAG for shrinking the tumoral mass and deep coagulation and Argon for selective cutting and superficial coagulation of small vessels. The main advantages of multiple laser surgery are: (1) a more radical surgery with less side effects (edema); (2) the possibility of operating near high functional structures with great accuracy, and (3) reduction of blood loss.

A 3-month-old female infant presented a 20-day history of drowsiness and maturing deterioration. The neurological exam showed peripheric facial palsy on the right side and a brachiocrural hemiparesis on the left. A brain scan revealed a lesion of avascular content in the posterior fossa. The computed tomography scan showed hydrocephalus and a high-density lesion, nonenhanced after introduction of the contrast agent, compatible with a clot at posterior fossa level. Likewise, after contrast new images appeared which had not been seen previously, considered as afferent and efferent vascular elements to the lesion. The cerebral angiography showed an avascular lesion in the cerebellar vermis with important hypertrophy of arterial and venous elements, although no steal phenomena of neighbouring areas was evident. These findings, and the absence of cardiac failure, suggested the diagnosis, confirmed by surgery, of giant clotted arteriovenous malformation. The patient has done well postoperatively.

The authors report 3 cases of epidural hematoma of the posterior fossa in children. The clinical signs and symptoms are discussed. Onset of symptoms is not necessarily acute. The radiological findings are discussed. Epidural hematomas of the posterior fossa in children have a tendency to liquefy earlier than supratentorial hematomas. We emphasize the value of computed tomography for the diagnosis of epidural hematoma of the posterior fossa. One should keep in mind the possibility of the presence of an epidural hematoma of the posterior fossa in the treatment of head injury in children, even in the case of a minor head injury.

5 children with six recurrences of cerebellar astrocytoma are reviewed. The clinical course is correlated with the grading system of Gilles for posterior fossa gliomas. Changes in the Gilles classification were found in some tumors at the time of reoperation. The delayed occurrence of hydrocephalus signified recurrence of tumor. Regardless of the apparent histologic benignity of the tumors, cerebellar astrocytomas have the capacity to regrow even after apparent total removal. Routine follow-up CT scans should be performed to detect asymptomatic recurrences.

This case report deals with a 16-year-old girl, admitted for headache and Jacksonian seizures. The clinical examination showed no gross disturbances, but the neuropsychologic examination revealed difficulties in speech-linked abstract thinking. Extensive radiologic investigations revealed the presence of a frontal intracallosal bony tumor, protruding into the lateral ventricles. Histologic examination of the surgical specimen showed a large benign osteoma, without any connection with dura or skull. In view of the paucity of symptoms, a dysontogenetic etiology of the tumor seems obvious.