Child's brain最新文献

A neuropsychological battery was given to a CT-defined group of children shunted for uncomplicated hydrocephalus with estimated normal range IQs. When no other brain anomalies were present, verbal IQ estimates were inferior to age and sex matched controls, but still in the normal range. In the presence of average academic performance and normal range IQ, impairment of neuropsychological functioning in verbal and nonverbal memory, fine motor speed, and visuospatial problem solving was observed. Successful neurosurgical management of hydrocephalus is not necessarily equated with achieving normal neuropsychological functioning.

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.

The clinical course and surgical treatment of 48 children with lipomatous lesions of spinal dysraphism are presented. Preoperative studies consisted of complete neurological examination, IVP, myelography and CT scan if indicated. The complete clinical course and surgical treatment of the children with lipomatous lesions of the lower spine is reviewed. The surgical aim was to free all intra- and extradural adhesions by dural grafting if necessary. The results of surgical treatment are dependent upon the time of treatment (as early as possible), the location and extent of the malformation and the quality of surgical treatment.

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.

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.

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.

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.

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.

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.

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.