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Intracranial ependymomas in childhood. Survival and functional results of 47 cases. 儿童颅内室管膜瘤。47例患者的生存和功能结果。
Pub Date : 1983-01-01 DOI: 10.1159/000120108
A Pierre-Kahn, J F Hirsch, F X Roux, D Renier, C Sainte-Rose

A pediatric series of 47 intracranial ependymomas (15 supra- and 32 infratentorial) is presented. All children were operated upon between 1969 and 1979. Among these children, 35 completed the treatment with radiotherapy. The irradiation was usually limited to the intracranial content but in 7 patients, it was extended to the spinal axis as well. Malignant ependymomas represented 69% of the whole series (86% of the supratentorial and 53% of the infratentorial ependymomas). The operative mortality rate was 17%. The 5-year survival rate was 39% in the whole series and 51% when excluding postoperative mortality. Recurrences developed in 41% of cases and metastases in 20%. The study of this series and of the literature points out that: (1) metastases from supratentorial ependymomas are not frequent, almost always supratentorial and secondary to a malignant ependymoma, and (2) metastases from infratentorial ependymomas are almost always intraspinal and occur in one third of these tumors. The rate of seeding is especially high in the case of malignant infratentorial ependymomas (50%) but is also 15% in the case of benign tumors. These data lead the authors to propose a craniospinal irradiation in the case of infratentorial ependymomas whether benign or malignant, an irradiation of only the brain in the case of malignant supratentorial ependymoma, an irradiation of only the tumoral bed when ependymomas are benign and supratentorial.

本文报告47例小儿颅内室管膜瘤(15例幕上瘤,32例幕下瘤)。所有儿童都在1969年至1979年间接受了手术。在这些儿童中,35名完成了放射治疗。照射通常局限于颅内内容物,但在7例患者中,照射也扩展到脊柱轴。恶性室管膜瘤占全部病例的69%(幕上室管膜瘤占86%,幕下室管膜瘤占53%)。手术死亡率为17%。全组5年生存率为39%,排除术后死亡率后为51%。41%的病例复发,20%的病例转移。本系列及文献的研究指出:(1)幕上室管膜瘤的转移并不常见,几乎总是幕上和继发于恶性室管膜瘤;(2)幕下室管膜瘤的转移几乎总是在椎管内,发生在三分之一的此类肿瘤中。恶性幕下室管膜瘤的播种率特别高(50%),但良性肿瘤的播种率也为15%。这些数据使作者提出,对于幕下室管膜瘤,无论是良性的还是恶性的,都要进行颅脊髓照射;对于恶性的幕上室管膜瘤,只进行脑部照射;对于良性和幕上室管膜瘤,只对肿瘤床进行照射。
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引用次数: 111
Testing the hydrocephalus shunt valve. 检测脑积水分流阀。
Pub Date : 1983-01-01 DOI: 10.1159/000120117
C Watts, H D Keith

Unwanted results of shunting for hydrocephalus include slit and asymmetrical ventricles and the conversion of communicating hydrocephalus to noncommunicating hydrocephalus. Evidence suggests this may be due to a mismatch between the pressure/flow performance characteristics of the shunt valve and the pathologic hydrodynamics of the ventricular cerebrospinal fluid. Commercially available shunts are currently tested using a steady-state pressure/flow method. We have utilized a bench testing method which incorporates pulsed flow and varying compliance. Results indicate that with minimal compliance in the system, opening and closing pressures differ markedly in value with pulsed flow as compared to steady-state testing. The greater the compliance the less deviation was noted. It is recommended more effort be made to understand the value of matching pressure/flow characteristics of valve to the individual hydrocephalic state.

脑积水分流治疗的不良结果包括狭缝和不对称脑室,以及沟通性脑积水向非沟通性脑积水的转变。有证据表明,这可能是由于分流阀的压力/流量特性与脑脊液的病理性流体动力学不匹配。目前,市面上的分流器使用稳态压力/流量法进行测试。我们采用了台架测试方法,该方法结合了脉冲流量和不同的顺应性。结果表明,与稳态测试相比,在系统最小顺应性的情况下,脉冲流量下的开启和关闭压力值差异显著。顺应性越大,注意到的偏差就越少。我们建议花更多的精力来了解阀门的压力/流量特性与个体脑积水状态的匹配价值。
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引用次数: 16
Middle fossa arachnoid cyst: clinical, neuroradiological, and surgical features. 中窝蛛网膜囊肿:临床、神经影像学和外科特征。
Pub Date : 1983-01-01 DOI: 10.1159/000120129
K Sato, T Shimoji, K Yaguchi, H Sumie, Y Kuru, S Ishii

16 patients and 4 adult cases of small-or medium-sized middle fossa arachnoid cyst were subjected to various neuroradiological investigations and their results were analyzed in terms of possible mechanisms of cyst expansion. Based on the results of the investigations which strongly suggested that the cyst is an expanding lesion, all cases were surgically treated by the same techniques of craniotomy, excision of the outer cyst membrane, followed by a cystoperitoneal shunt, resulting in complete disappearance of the cyst concomitant with reexpansion of the surrounding brain and marked improvement in the clinical pictures of the patients.

本文对16例中小型中窝蛛网膜囊肿患者和4例成人进行了各种神经影像学检查,并对其结果进行了分析,以探讨囊肿扩张的可能机制。基于强烈提示囊肿为扩张性病变的调查结果,所有病例均采用相同的手术技术,开颅,切除囊肿外膜,然后进行囊腹腔分流术,导致囊肿完全消失,同时周围脑重新扩张,患者的临床表现明显改善。
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引用次数: 82
Stereotactic biopsy of deep brain tumors in infancy and childhood. 婴儿期和儿童期深部脑肿瘤的立体定向活检。
Pub Date : 1983-01-01 DOI: 10.1159/000120102
G Broggi, A Franzini, F Migliavacca, A Allegranza

In 17 patients, 2-16 years old, the clinical and neuroradiological data were unable to give clear-cut information regarding the histology of deep brain neoplasms. The lesions were located within the brain stem in two cases, in the pineal region in two cases, within the third ventricle in two cases, in the sellar and parasellar area in three cases, in the basal ganglia and thalamic region in seven cases, and in the fronto-callosal region in one case. In these patients, serial stereotactic biopsies were performed with the guidance of CT scan in order to assess the nature and the real boundaries of the growths. The choice between conservative or surgical treatment was made after the established histological findings became available. The operative technique of stereotactic biopsy is briefly described and the value of this method is stressed in the treatment of brain tumors in children.

在17例2-16岁的患者中,临床和神经影像学资料无法提供关于深部脑肿瘤组织学的明确信息。病变位于脑干2例,松果体2例,第三脑室2例,鞍区和鞍旁区3例,基底节区和丘脑7例,额胼胝体1例。在这些患者中,在CT扫描的指导下进行了一系列立体定向活检,以评估肿瘤的性质和真实边界。在确定组织学发现后,选择保守治疗还是手术治疗。简要介绍了立体定向活检的手术技术,并强调了该方法在儿童脑肿瘤治疗中的价值。
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引用次数: 24
Brain tumors during the first year of life. 一岁以内的脑瘤。
Pub Date : 1983-01-01 DOI: 10.1159/000120114
A J Raimondi, T Tomita

Among 341 childhood brain tumors treated at Northwestern University--Children's Memorial Hospital during the years 1967-1980, there were 39 children (11%) who presented during the first year of life. Half of the total number of childhood choroid plexus papillomas, meningeal sarcomas and teratomas we treated occurred in this particular age group. Supratentorial tumors were more common than infratentorial, a rate of 1.8:1. Medulloblastoma and benign astrocytoma were the most common histological types. Hydrocephalus was present in 82% of the children and papilledema in 28%, so that progressive enlargement of head circumference was the most common reason for referral. For the 37 patients who underwent surgical removal or biopsy of the tumor, the 1-month mortality rate was 19% and the 1-, 3- and 5-year survival rates were 46, 30 and 22%, respectively. Whenever tolerated, roentgen therapy was given. Most of the 24 deaths occurred within 6 months of the time of diagnosis. 5 patients (1 each with malignant astrocytoma, medulloblastoma, meningeal sarcoma, and 2 with choroid plexus papilloma) are still alive 5 years later, without neurological or mental deficit, and with no sign of recurrence. There were three exceptions to Collin's rule. Among the 15 survivors, 5 suffer mental retardation.

在西北大学儿童纪念医院1967-1980年间治疗的341例儿童脑瘤中,有39例(11%)儿童在出生后第一年出现。我们治疗的儿童脉络膜丛乳头状瘤、脑膜肉瘤和畸胎瘤的总数中有一半发生在这个特殊年龄组。幕上肿瘤较幕下肿瘤多见,发生率为1.8:1。髓母细胞瘤和良性星形细胞瘤是最常见的组织学类型。82%的儿童存在脑积水,28%的儿童存在乳头水肿,因此头围逐渐增大是转诊的最常见原因。37例接受手术切除或肿瘤活检的患者,1个月死亡率为19%,1、3和5年生存率分别为46%、30%和22%。只要耐受,就给予x射线治疗。24例死亡中大多数发生在诊断后6个月内。5例患者(恶性星形细胞瘤、髓母细胞瘤、脑膜肉瘤各1例,脉络膜丛乳头状瘤2例)5年后仍存活,无神经或精神缺陷,无复发迹象。科林的规则有三个例外。在15名幸存者中,有5人患有智力障碍。
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引用次数: 56
Gray scale ultrasound studies in neonatal infants with malformation of the brain. 新生儿脑畸形的灰度超声研究。
Pub Date : 1982-09-01 DOI: 10.1159/000120069
P A Dubbins, G Carpenter, L Waldroup, B B Goldberg, L Graziani, R Berry

Ultrasound findings in four newborn infants with neurological abnormalities and abnormal facies are described. The ultrasound images are compared with the images achieved by computerized tomography and with the findings at postmortem in 3 of the patients. Accurate neuroanatomical diagnosis confirmed by CT and/or autopsy findings is demonstrated in all 4 cases. It is concluded that ultrasound, particularly using an automated water path scanner, is a viable alternative in the investigation of brain malformation in the neonate.

超声发现在四个新生儿与神经异常和异常相描述。将超声图像与计算机断层扫描所获得的图像以及3例患者的尸检结果进行比较。所有4例病例均通过CT和/或尸检结果证实了准确的神经解剖学诊断。结论是超声,特别是使用自动水路扫描仪,是一种可行的替代方法,在新生儿脑畸形的调查。
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引用次数: 1
Total vertex craniectomy for the treatment of scaphocephaly. 全颅顶点切除术治疗舟头畸形。
Pub Date : 1982-09-01 DOI: 10.1159/000120068
N Epstein, F Epstein, G Newman

Sutural stripping, morcellation, subtotal craniectomy, and even subtemporal decompression, have been employed in the treatment of sagittal synostosis. This report describes a further modification of past techniques, the total vertex craniectomy. This procedure, employed in 9 patients, has achieved uniformly excellent cosmetic results.

缝线剥离、碎裂、颅骨次全切除术,甚至颞下减压,已被用于治疗矢状面滑膜紧闭。本报告描述了对过去技术的进一步改进,即全颅顶点切除术。9例患者采用该方法,均取得了优异的美容效果。
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引用次数: 76
Posttraumatic cerebellar hematoma. 创伤后小脑血肿。
Pub Date : 1982-09-01 DOI: 10.1159/000120074
E Fernández-Alvarez, I Fábregues, M Pineda, J Costa, J Lafuente

A posttraumatic cerebellar hematoma in a 12-year-old boy is reported. It was observed by CT scan that the hematoma is discharged incompletely into the subdural space. The surgical treatment was successful with complete recovery. It is suggested that CT scan should be performed as soon as possible in cranial trauma with cerebellar signs.

报告一例12岁男孩创伤后小脑血肿。CT显示血肿不完全排出至硬膜下间隙。手术治疗成功,完全恢复。建议对有小脑征象的颅脑外伤应尽早行CT扫描。
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引用次数: 1
Subacute cervical myelopathy in a child with cerebral palsy. Secondary to torsion dystonia? 脑瘫患儿的亚急性颈脊髓病。继发于扭转肌张力障碍?
Pub Date : 1982-09-01 DOI: 10.1159/000120072
L Angelini, G Broggi, N Nardocci, M Savoiardo

A 12-year-old girl with a spastic dystonic tetraparesis due to cerebral palsy showed a subacute cervical myelopathy. X-ray films of the cervical spine demonstrated a subluxation of C4 on C5. Myelography and computerized tomography of the cervical spine performed under general anesthesia demonstrated only a minimal rotation of C3 with respect to C4 and a rather narrow cervical canal. In the reported case the most important factor in the spinal cord impairment was probably the anterior-slipping of the 4th cervical vertebra. The subluxation, secondary to torsion dystonia as demonstrated by its relief during general anesthesia, very likely caused a long-standing, although intermittent, spinal cord compression.

一个12岁的女孩因脑瘫而出现痉挛性张力障碍四瘫,表现为亚急性颈脊髓病。颈椎x线片显示C4对C5的半脱位。在全身麻醉下进行的颈椎脊髓造影和计算机断层扫描显示,C3相对于C4只有很小的旋转,颈椎管相当狭窄。在报告的病例中,脊髓损伤的最重要因素可能是第4颈椎前滑。继发于扭转肌张力障碍的半脱位,在全身麻醉时得到缓解,很可能导致了长期的,尽管是间歇性的脊髓压迫。
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引用次数: 32
Melanotic neuroectodermal tumor of the neurocranium in infancy. 婴儿期神经头盖骨黑色素神经外胚层肿瘤。
Pub Date : 1982-09-01 DOI: 10.1159/000120070
J W Walsh, R D Strand

Melanotic neuroectodermal tumors of the neurocranium are a rare but life-threatening disorder of infancy. 11 previously reported cases are reviewed in terms of clinical presentation, radiological diagnosis, and management. A twelfth case, a 4-month-old infant who developed three discrete sites of tumor unilaterally in the neurocranium is presented. Several hypotheses for the mechanism of formation of these tumors are reviewed. The authors propose that the mechanism of formation involves a dysontogenesis of neural crest tissue and that these tumors form, at least in part, from fragments of melanin-containing arachnoid villi which are displaced during embryonic development.

黑色神经外胚层肿瘤的神经头盖骨是一种罕见的,但危及生命的疾病的婴儿期。从临床表现、放射学诊断和治疗方面回顾了11例先前报告的病例。第十二例,一个4个月大的婴儿谁发展了三个离散的肿瘤单侧在神经颅骨提出。对这些肿瘤形成机制的几种假设进行了综述。作者提出,形成机制涉及神经嵴组织的发育异常,这些肿瘤的形成,至少部分是由胚胎发育期间移位的含有黑色素的蛛网膜绒毛碎片形成的。
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引用次数: 23
期刊
Child's brain
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