bluuebunny/crossref_metadata_2025 huggingface dataset:
Seeding of Intracranial Ependymomas in Children
Authors: Renaudin Justin W. , Di Tullio Michael V. , Brown Jann
Published: March 2008

19 cases of intracranial ependymomas were reviewed to determine the incidence of seeding. 4 patients demonstrated conclusive evidence of seeding in sites remote from the operative and irradiated field, 3 of whom had high-grade ependymomas. Clinical-pathological correlation disclosed a greater tendency to seeding and a worse prognosis among patients with high-grade ependymomas. A more aggressive therapeutic approach is indicated when high-grade ependymomas are involved.
Peculiar Congenital Parieto-Occipital Head Tumor
Authors: Yamada Hiromu , Sakata Kazuki , Kashiki Yoshitomo , Okuma Akio , Takada Mitsuaki
Published: March 2008

3 infantile cases of congenital parieto-occipital midline soft tumor, the clinical and pathological findings of which did not correspond precisely to a known congenital head tumor, are reported. One of them probably belongs to McLaurin’s type of encephalocele with heterotopic glial rest, and the remaining two to McLaurin’s type of meningocele without central connection. The types of anomaly shown by the present cases should generally be called ‘atretic cephalocele’ or ‘rudimentary cephalocele’.
Childhood Moyamoya Syndrome
Authors: Rajakulasingam Kandavanam , Cerullo Leonard J. , Raimondi Anthony J.
Published: March 2008

The development of typical clinical and radiological features of moyamoya syndrome is described in 3 children following radiation therapy for a gliomatous tumor at the base of the brain. The effect of radiation therapy on the medium-sized arteries is discussed with a review of the literature. Radiation therapy as the causative factor for the narrowing or occlusion of the carotid siphon is discussed.
Comparison of the Effects of Surgical Decompression and Resection of Local Edema in the Therapy of Experimental Brain Trauma
Authors: Gaab M. , Knoblich O.E. , Fuhrmeister U. , Pflughaupt K.W. , Dietrich K.
Published: March 2008

The effect of decompressive trepanation was compared to that of surgical resection of the traumatized tissue in the course of traumatic brain edema in standardized experimental brain trauma. Following a right parietal cold injury, the following parameters were monitored continuously in 12 cats: ventricular pressure, epidural pressure over both hemispheres, arterial and central venous pressure and heart rate. The EEG was evaluated continuously, using a computer (power spectra). After catheterization of the superior sagittal sinus, cerebral arteriovenous differences of glucose, lactate, O2 and CO2 were calculated. 6 animals were treated surgically when showing elevated intracranial pressure ICP and markedly altered EEG. In 3 animals, the right hemisphere was decompressed by extensive resection of bone and dura. In 3 further animals, the softened brain tissue of the cold lesion was resected and the skull defect closed. 6 untreated animals were used as controls.A decompression by skull hemiresection for ablation of the injured cortex abolished the high intracranial pressure, but only the latter method seemed to prevent further damage. This could be demonstrated by the EEG registration, and by the normalization of arteriovenous metabolite differences. Only animals treated with edema resection had a normal arousal reaction and survived the trauma. The results indicate, that only an ablation of the local injury will prevent further damage to the brain. After decompressive trepanation alone, the progression of tissue edema is not interrupted. As can be seen from the literature, the poor results obtained even from extensive decompressive operations in traumatic brain edema, indicate that the further development of edema is independent of the intracranial pressure, whereas the Comparison of the Effects of Surgical Decompression and Resection of Edema 485 favorable results of resection of lobar contusions show an interruption of the spread of dysbolism.
Clinical Analysis of Arteriovenous Malformations in Children
Authors: Mori Koreaki , Murata Takaho , Hashimoto Nobuo , Handa Hajime
Published: March 2008

28 cases of arteriovenous malformations (AVMs) in children were analyzed and compared with 18 adolescent and 106 adult cases. The findings were: (1) intracerebral hematoma due to rupture of AVMs and focal neurologic deficits were more frequent in children. (2) Operative mortality was higher in children than in adults in cases where total removal was not feasible. (3) Follow-up results suggested that the prognosis in children was less favorable than in adults. (4) When dealing with spontaneous intracerebral hematoma in children care should be taken to search for underlying cryptic AVMs.
Cerebrospinal Fluid Levels of Cyclic Nucleotides in Non-Neoplastic Hydrocephalus: Preliminary Report
Authors: Gerosa Massimo A. , Carteri Alessandro
Published: March 2008

Cerebrospinal fluid levels of cyclic nucleotides in children with hypertensive communicating hydrocephalus secondary to leptomeningitis were investigated. 3’:5’-cAMP and 3’:5’-cGMP values were uniformly increased in pre-operative findings, suggesting a ‘passive’ behaviorur of the blood brain barrier after the inflammatory lesion. After ventriculo-peritoneal shunt, the mean ratio between the two nucleotides gradually became negative, with a marked increase of cGMP levels, probably related to selective barrier damage. In patients with shunt obstruction, the altered cAMP/cGMP ratio showed a gradual regression towards normal, due to a decrease in the cGMP level. The important role of endocranial pressure changes in the ‘second messenger’ turnover is stressed.
Traumatic Cerebral Aneurysm Associated with Widening Skull Fracture
Authors: Endo Shunro , Takaku Akira , Aihara Hiromichi , Suzuki Jiro
Published: March 2008

Two cases of traumatic cerebral aneurysm associated with widening skull fracture are reported. Cases of traumatic aneurysms in infants are particularly rare, and there have been no reported cases associated with widening skull fracture.
Exophthalmos from Aneurysmal Bone Cyst of the Orbital Roof
Authors: Iraci Giorgio , Giordano Renzo , Fiore Daniele , Pizzi Gianbeppi , Tomazzoli-Gerosa Laura , Gerosa Massimo
Published: March 2008

An aneurysmal bone cyst of the orbital roof, causing a monolateral exophthalmos in a 15-month-old child with no previous history of head injury, was operated upon and histologically misdiagnosed as a giant cell tumor. Radiation treatment in a dosage (3,740 rad) appropriate for the latter diagnosis apparently caused a massive calcification of the residual mass with persisting exophthalmos. At a second operation the lesion was removed completely and a radical change in the histopathological features was found. 12 years after surgery, there is no evidence of residuals upon roentgenographic and CT scan examinations and the exophthalmos has practically disappeared, while there is a normal visual function in the affected eye. Some points of histopathological and gross pathological differential diagnosis between aneurysmal bone cysts and giant cell (‘myeloplaxis’) tumors are discussed.
A Critical Evaluation of Continuous Intracranial Pressure Monitoring in Pediatric Hydrocephalus
Authors: McCullough David C.
Published: March 2008

An evaluation of continuous intracranial pressure (ICP) monitoring in 42 hydrocephalic infants and children helps to establish the role of this method in comparison with other clinical techniques for estimating the occurrence of progressive hydrocephalus. Transducer monitoring via ventricular catheters in term and premature infants revealed average ICP in the 5–12 mm Hg range. The higher values were recorded from patients with noncommunicating hydrocephalus but did not correlate with the extent of ventriculomegaly. The method has very little predictive value in estimating the progressive nature of infantile hydrocephalus. In older children ICP monitoring provides a useful adjunct in decisions for shunting after intracranial surgery and in suspected ‘normal pressure’ hydrocephalus. Monitoring from shunt reservoirs in cases of suspected shunt obstruction, although accurate in most situations, is probably inferior to clinical examination and serial computed tomography considering the expense and the risk of introducing shunt sepsis.
Ultrastructure of the Vasculature of Central Nervous System Tumors of Childhood
Authors: McLone David G.
Published: March 2008

Developing cell systems involving the central nervous system are ultimately dependent upon acquisition of a vascular supply for continued growth. Tumor cells proliferate to a critical mass beyond which metabolic exchange cannot be maintained by diffusion alone. The growth of this blood supply is stimulated by the tumor and grows into the cell mass from the surrounding brain. These ‘tumor vessels’ have anomalies of structure and function which explain many pathological changes seen in brain tumors and probably have therapeutic significance. 83 primary brain tumors were obtained at surgery and studied with the electron microscope with particular emphasis on the structure of the microvasculature. Open junctions, fenestra, and increased pinocytosis were seen in almost all tumors. The basal lamina was thickened and usually multilayered. The perivascular space was large and contained a dense granular material which usually spread into the surrounding extracellular space of the tumor. The more malignant the tumor, the more frequent were these changes.
Multiple Meningiomas in Separate Neuroaxial Compartments in a Child
Authors: Schiffer J. , Mundel G. , Lahat E. , Schwarzmann H. , Shental I.
Published: March 2008

A case of a child with multiple meningiomas in separated neuroaxial compartments is reported. The first tumor was in the frontal region and was removed surgically when first diagnosed 8 years prior to the appearance of the other tumor. The second tumor was located in the foramen magnum region, and reached considerable dimensions before becoming symptomatic and giving signs of brain stem compression as evidenced by progressive spastic tetraparesis and respiratory disturbances, without hydrocephalus. The diagnosis was confirmed by a low CT scan section, the tumor was successfully removed with the aid of the microscope and the patient made a good recovery.
Abnormalities of the Cranio-Vertebral Junction with Cervico-Medullary Compression
Authors: Menezes Arnold H. , Graf Carl J. , Hibri Nadi
Published: March 2008

8 children with cranio-vertebral abnormalities and neurological deficits are reviewed. The specific treatment is dependent on etiology, mechanisms of compression, and whether the bony abnormality can be reduced to its normal position. Irreducible ventral compression of the cervico-medullary junction was relieved by transoral removal of the odontoid-clivus complex in 3 patients. Primary posterior decompression was done in 4 children with dorsal encroachment. A reducible Cl–C2 dislocation in 1 child with juvenile rheumatoid arthritis underwent primary posterior fusion. A detailed surgical physiological approach is described.
Delayed Cauda Equina Reconstruction in Meningomyelocele
Authors: Epstein Fred , Spielholz Neil , McCarthy Joseph , Battista Arthur , Ransohoff Joseph
Published: March 2008

Infants afflicted with meningomyelocele are paralyzed as a result of physiologic disconnection of the neural plate from the spinal cord. Intact neural elements within the placode often maintain segmental reflex innervation of paralyzed lower extremity muscles. It was hypothesized that bridging this central peripheral gap with viable intercostal nerves would restore limited voluntary movement to paralyzed muscles. The surgical technique and initial results are the subject of this report.
Brain Tumors Presenting as Small Calcified Lesions on Computerized Tomography
Authors: Sundaresan Narayan , Larsen Marianne , Deck Michael D.F. , Fraser Richard A.R.
Published: March 2008

3 children were found to have small focal calcifications on computerized tomography. These lesions ultimately proved to be malignant gliomas in 2 children, and a mixed glioma in the third. Focal calcification on CT scans may pose a diagnostic dilemma for the clinician, and these patients should be carefully followed as possible early brain tumors.
Clinical and Surgical Aspects of Hypothalamic Hamartoma Associated with Precocious Puberty in a 15-Month-Old Boy
Authors: Kammer Kenneth S. , Perlman Kusiel , Humphreys Robin P. , Howard Neville J.
Published: March 2008

A case is reviewed of precocious puberty associated with hypothalamic hamartoma in a 15-month-old boy. The authors believe this to be the first documented case in which significant reductions occurred in the level of serum testosterone and in the result of the luteinizing hormone-releasing hormone (LHRH) infusion test following surgical removal of the turner. Such surgery appears to be safe when a planned micro-surgical course is employed.
Percutaneous Choroid Plexus Coagulation in Hydranencephaly
Authors: Albright Leland
Published: March 2008

Percutaneous intracranial endoscopy, performed on 3 infants with hydranencephaly and signs of intracranial hypertension, showed normal choroid plexus and choroid arteries in 2 patients. Transendoscopic coagulation of the arteries and plexus alleviated intracranial hypertension postoperatively. Minimal choroid plexus and no choroid arteries were present in the 3rd patient and coagulation did not alter the clinical course. Computerized tomography scans of the infants with normal choroid plexus demonstrated cerebral tissue in the region of the caudate nucleus; the child with minimal choroid plexus had tissue only in the region of the posterior thalamus.
Clinicotherapeutic Aspects in the Growing Skull Fracture
Authors: Arseni Constantin , Ciurea A.V.
Published: March 2008

The authors present an extensive review of data concerning the growing skull fracture, a well-defined entity in the craniocerebral traumatology of infants and young children. Etiopathogenic, radiological and therapeutical data in connection with this affection are discussed. Original contributions, as well as therapeutic results are also presented, obtained in a series of 21 cases.
Orbital Meningocele Presenting as Periorbital Cellulitis
Authors: Weizman Z. , Tenembaum A. , Perlman M. , Sahar A.
Published: March 2008

A case of orbital meningocele in a 15-day-old infant presenting as periorbital cellulitis, followed by meningitis, is described. Unlike other cases with the same anomaly, signs were not noted in the involved eye, neither before the cellulitis nor after recovery following antibiotic treatment. Preoperative diagnosis was confirmed by tomography of the orbit. On operation a bony defect was found in the orbital roof, which was repaired. Recovery was uneventful.
The Epidemiology of Congenital Hydrocephalus
Authors: Stein Sherman C. , Feldman Joseph G. , Apfel Stewart , Kohl Schuyler G. , Casey, A.B. Glenn
Published: March 2008

In a hospital-based study of almost 174,000 total births during 1968–1976, the authors found the incidence of congenital hydrocephalus to be 66 cases per 100,000 births. There was a significantly higher frequency in children born to mothers who themselves had been born in Puerto Rico but no significant difference in incidence between whites and blacks. The influences of maternal age, previous pregnancies, socioeconomic status, temporal and other factors are assessed and compared to previous reports.
Subdural Effusion Following Radical Surgery for Chiasmal Region Tumors in Children
Authors: Mizoi Kazuo , Takaku Akira , Suzuki Jiro
Published: March 2008

4 cases of subdural effusion occurring after radical surgery for chiasmal region tumors in children are reported. The pathogenetic mechanisms of this disorder are explained at least partly by a change from internal to external hydrocephalus or brain atrophy in 2 of the 4 cases, whereas the pathogenesis is unclear in the remaining 2 cases. In all 4 cases meningitis did not supervene postoperatively. The subdural effusion may be divided roughly into two types according to symptomatology:’serious type’ which presents with severe symptoms and ‘mild type’ which is virtually asymptomatic. The serious type requires immediate surgical procedure, such as continuous subdural drainage and subduroperitoneal shunt, while the mild type should be carefully monitored for the course of subdural effusion by CT scan.
Congenital Intraspinal Lipomas
Authors: Chapman Paul H.
Published: March 2008

Theoften extensive nature of intraspinal lipomas and their complex relationship to neural elements can make spinal cord untethering difficult to achieve. Based on anatomic observations at operation, we have adopted a systematic surgical approach which permits untethering with minimal risk of injury to nervous tissue. By considering the site of attachment of lipoma to cord and the position of the posterior nerve roots in relationship to the mass, the location of neural elements can be predicted. We have used this approach in 14 recently operated cases. Our experience corroborates the views of others that the high incidence of progressive neurologic deficits in these patients warrants prophylactic surgical intervention.
Intermediate Filaments in a Human Medulloblastoma Cell Strain
Authors: Ammirati Mario , Signorelli Cosma D. , Tajana Gianfranco
Published: March 2008

The fine structure of a human medulloblastoma cell strain characterized by the emission of two types of cytoplasmic processes was studied with particular regard to the cytoskeleton organization of the cell processes. A particular abundance of intermediate filaments (6–11 nm) was found in the primary processes. This study suggests that this abundance can strongly condition the cell shape of in vitro medulloblastoma cells and can represent a marker of this type of cells.
Posterior Fossa Subdural Hemorrhage in the Newborn as a Result of Birth Trauma
Authors: Takagi Takuji , Fukuoka Hidekazu , Wakabayashi Shiego , Nagai Hajime , Shibata Takashi
Published: March 2008

During the past 19 years, 229 autopsies of intracranial hemmorrhages were performed at the Depratment of Pathology, and 23 cases of posterior fossa subdural hemorrhages were discovered (10.0%). 25 cases of posterior fossa subdural hemorrhages (2 of our own treated surgically and 23 untreated found at autopsy) are described in detail. 2 cases treated surgically responded favorably to surgical treatment. The mechanism of hemorrhage into posterior fossa subdural spaces is investigated and reconsidered following a review of the literature. The necessity for CT is emphasized for early diagnosis of posterior fossa subdural hemorrhage.
Craniopharyngioma
Authors: Till Kenneth
Published: March 2008

The author reviews the currently accepted concepts in the treatment of craniopharyngioma in children in the light of his personal experience and of a large number of cases reported in the literature.
Craniopharyngiomas
Authors: McLone David G. , Raimondi Anthony J. , Naidich Thomas P.
Published: March 2008

The pathogenesis, ultrastructure, and location of craniopharyngiomas of childhood are discussed. CT scanning and contrast cisternography have added to our ability to characterize these tumors. The operative approach is dictated by the size and location of the tumor. Our experience with 25 tumors indicates the majority of these tumors can be totally removed. Unfortunately, some children die later, tumor free, of minor respiratory illness.
Stroke-Like Onset of Pineal Region Tumors in Two Children
Authors: Scarfò Giovanni B. , Piane Riccardo , Mencattini Giorgio , Tomaccini Daniela
Published: March 2008

In 2 children, both 8 years of age, a subarachnoid hemorrhage (SAH) was the singular onset of a tumor in the pineal region. The SAH was repeated three times in the first case, in which the tumor had a rapid growth with exitus within less than 3 years, while no other ulterior hemorrhage and no neurological deficits are seen after VP shunt within a period of 4 years in the second case.
Growth and Hormonal Status of Children Treated for Brain Tumours
Authors: Shalet S.M.
Published: March 2008

The adult survivors of the treatment of brain tumours in childhood are often short. Several adverse factors contribute to the impaired growth of these children including growth hormone (GH) deficiency, impaired spinal growth following spinal irradiation, chemotherapy, poor nutritional intake and recurrent tumour. The GH deficiency is due to radiation-induced damage to the hypothalamic-pituitary axis. GH is always the first pituitary hormone to be affected by such radiation damage but panhypopituitarism may occur if the radiation dose is sufficiently great. Preliminary results suggest that GH therapy will improve the growth rate of children with radiation-induced GH deficiency. Additional endocrine complications, which may occur following spinal irradiation, include thyroid dysfunction and ovarian failure due to direct radiation damage to the thyroid and the ovary.
Gray Scale Ultrasound Studies in Neonatal Infants with Malformation of the Brain
Authors: Dubbins P.A. , Carpenter G. , Waldroup L. , Goldberg B.B. , Graziani L. , Berry R.
Published: March 2008

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.
Subacute Cervical Myelopathy in a Child with Cerebral Palsy
Authors: Angelini L. , Broggi G. , Nardocci N. , Savoiardo M.
Published: March 2008

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.
Choroid Plexus Papillomas of the Fourth Ventricle
Authors: Pascual-Castroviejo I. , Roche M.C. , Villarejo F. , Gutierrez Molina M. , Pérez Higueras A.
Published: March 2008

3 cases with benign choroid plexus papillomas (CPP) in the fourth ventricle are described. All patients were less than 2 months of age. They were among 14 cases with intracranial CPP in a series of 100 tumors of the posterior fossa. Correct diagnosis was not obtained by means of pneumoencephalography, with apparently normal repletion of the fourth ventricle being visualized. 2 of the 3 patients died after application of the ventnculoperitoneal shunt and before extirpation of the tumor. All 3 patients soon presented hydrocephalus in 1 case already ‘intra utero’.
Cystic Thalamic Gliomas
Authors: Wald Steven L. , Fogelson Harold , McLaurin Robert L.
Published: March 2008

Primary tumours of the thalamus are rare and present several diagnostic and therapeutic problems. Cystic thalamic lesions tend to be low grade astrocytomas and have only been reported in children. Signs and symptoms can be divided into those due to intra-cranial hypertension and those due to loss of function of thalamic nuclei and surrounding structures. Histologic diagnosis can be established by CT-guided needle biopsy and therapy begun by evacuation of the cyst contents. The prognosis remains uncertain.
Treatment of Moyamoya Disease by Temporal Muscle Graft Encephalo-Myo-Synangiosis’
Authors: Takeuchi Shigekazu , Tsuchida Tadashi , Kobayashi Keishi , Fukuda Mitsunori , Ishii Ryoji , Tanaka Ryuichi , Ito Jusuke
Published: March 2008

10 young patients from 7 to 16 years of age with moyamoya disease were treated by temporal muscle graft (encephalo-myo-synangiosis: EMS) for the purpose of increasing extracranial and intracranial collateral circulation. Ischemic cerebrovascular symptoms and signs were encountered in all of them without intracranial hemorrhage. The patients were observed for 6–26 months after the first operation. Transient ischemic attacks disappeared in 4 out of 7 patients, and improved in frequency and duration in the remaining 3. Paresis of the limbs disappeared in 1 patient and improved in 2. In 2 patients, facial palsy disappeared and dysarthria improved as well. Ataxia disappeared in 2 patients, and involuntary movement of the extremities disappeared in 2. There were no ineffective cases clinically. In postoperative carotid angiography, the middle cerebral arteries were visualized clearly to the peripheral portion mainly via the thickened deep temporal arteries, and the abnormal vascular networks in the region of the basal ganglia reduced in size in most of patients. Improvements in intelligence quotient, electroencephalogram and cerebral blood flow were also obtained in several patients, respectively. EMS seemed to be an effective surgical treatment in young patients with moyamoya disease who suffered from cerebral ischemic symptoms.
Prognosis of Benign Cerebellar Astrocytomas in Children
Authors: Szénásy József , Slowik Felicia
Published: March 2008

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 Klìnken – 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.
Opto-Chiasmatic Arachnoiditis in the Young
Authors: Iraci Giorgio , Gerosa Massimo A. , Tomazzoli Laura , Pardatscher Kurt , Fiore Daniele L. , Secchi Antonio G. , Tormene Patrizia , Javicoli Raffaele , Giordano Renzo , Olivi Alessandro
Published: March 2008

14 young patients, operated upon for opto-chiasmatic arachnoiditis by craniotomy are presented. 2 main etiopathogenetic forms (and their respective clinical equivalents) of the disease could be recognized. Only 1 postoperative death occurred, in a patient with a dominant clinical picture of intracranial hypertension. Results of surgery (craniotomy and lysis of adhesions) could be distinguished as positive (functional improvement) in 5 cases, indifferent or negative in the others, with a follow-up duration of up to 23 years. The role of the diagnostic value of the pneumoencephalogram as a basis for surgical indication is discussed: it is felt that this examination, when reported as negative, is not of sufficient value to rule out the diagnosis, which must essentially rely upon clinical data.
Giant Arteriovenous Aneurysm of the Posterior Fossa in a Three-Month-Old Infant
Authors: Schijman Edgardo , Monges Jorge A.
Published: March 2008

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 hyperthrophy 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.
Intracranial Ependymomas in Childhood Survival and Functional Results of 47 Cases
Authors: Pierre-Kahn A. , Hirsch J.F. , Roux F.X. , Renier D. , Sainte-Rose C.
Published: March 2008

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.
Developmental Outcome of Very Low Birth Weight Infants Requiring a Ventriculo-Peritoneal Shunt
Authors: Liechty Edward A. , Bull Marilyn J. , Bryson Carolyn Q. , Kalsbeck John E. , Jansen Robert D. , Lemons James A. , Schreiner Richard L.
Published: March 2008

All infants of < 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 > 85 on both scales, while an additional 2 infants attained a score of > 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 < 1,500 g birth weight.
Chiasmatic Gliomas of Childhood
Authors: Packer Roger J. , Savino Peter J. , Bilaniuk Larissa T. , Zimmerman Robert A. , Schatz Norman J. , Rosenstock Jeffrey G. , Nelson Diana S. , Jarrett Patricia D. , Bruce Derek A. , Schut Luis
Published: March 2008

Disagreement exists concerning the natural history and treatment of chiasmatic gliomas (CG) of childhood. We reviewed our experience in 21 cases of surgically verified CG with a median age of 4 years at time of diagnosis, followed for a median of 5.3 years (range 3–14.8 years). Initial treatment included radiation therapy (RT) in 18 patients, chemotherapy in 2, and observation in 1. Disease recurrence, defined as progressive visual or neurological deterioration, was documented in 10 children (48%), occurring at a median of 6 years after diagnosis. 5-year actuarial survival was 89%, but fell to 60% by 10 years. Visual improvement after RT was uncommon, occurring once. Intellectual deficits were noted in 5 of 17 survivors. We compared our results to that of other patients reported and concluded that: (1) CG may act aggressively independent of their location in the visual pathway at time of diagnosis; (2) the beneficial effects of RT are difficult to document; (3) progressive disease may occur late in the course of illness, and (4) intellectual sequelae are common in long-term survivors.
Intracerebral Schwannoma in a Child: Report of a Case
Authors: Rodriguez-Salazar Antonio , Carrillo Rafael , de Miguel Joaquín
Published: March 2008

A rare case of an intracerebral schwannoma in a 10-year-old girl is presented. To our knowledge, only 4 cases of intracranial schwannoma not related to cranial nerves have been previously published, in the absence of von Reckhnghausen’s disease.
The Clinical Significance of Bilateral Synostosis of the Lambdoid Suture and the Usefulness of Its Treatment
Authors: Kaiser G.
Published: March 2008

Extended craniectomy has been employed in 14 8 ± 4 month old infants with bilateral synostosis of lambdoid suture. Intraoperatively the ICP was < 180 mm H2O in 6, 180–200 in 1, > 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.
Cerebellocele and Associated Central Nervous System Anomalies in the Meckel Syndrome
Authors: Aleksic S. , Budzilovich G. , Greco M.A. , Reuben R. , Feigin I. , Pearson J. , Epstein F.
Published: March 2008

Three cases with the Meckel syndrome were autopsied and found to have: arhinencephaly, polymicrogyria, aqueductal stenosis, heterotopia of glial tissue, hypoplasia or agenesis of the cerebellar vermis, cranium bifidum associated with large occipital ventriculocele and others. The anomalies at the level of posterior fossa in this condition are classified as those belonging to the Chiari type IIIgroup of anomalies. This unusual set of anomalies which forms pathogenetic link between the Dandy-Walker and Chiari-Arnold group of anomalies in the posterior fossa seems to be very frequent in the Meckel syndrome. The therapeutic emphasis is on genetic counseling in view of the recessive inheritance of this syndrome.
Effect of Meningomyelocele Closure on the Intracranial Pulse Pressure
Authors: Linder Martin , Nichols John , Sklar Frederick H.
Published: March 2008

Intracranial pressure (ICP) was monitored in a 12-year-old child before and after closure of a large, skin-covered meningomyelocele. Significant cerebrospinal fluid pulse pressure augmentation was observed over a spectrum of pressures following sac closure. Linear regression analysis was done to define pulse pressure-ICP relationships before and after surgery, and a significant increase in the regression slope was noted postoperatively. It is suggested that the unoperated meningomyelocele defect served as a shock absorber to dampen the intracranial pulse pressure. Meningomyelocele closure removes this shock absorber effect, resulting in pulse pressure augmentation.
Evidence of Spinal Cord Injury in an Infant Delivered by Cesarean Section
Authors: Hernandez-Marti Miguel , Dal Canto Mauro C. , Kidd James M.
Published: March 2008

A 3-month-old female infant is reported with upper spinal cord injury at birth. Breech presentation and hyperextension of head were observed 1 week prior to delivery. She was delivered by elective cesarean section. The absence of fetal movements 1 day prior to delivery and the uneventful cesarean section strongly suggest a spinal cord injury in utero secondary to hyperextension of the neck.
Intracranial Lipomas, Hydrocephalus and Other CNS Anomalies in Oculoauriculo-Vertebral Dysplasia (Goldenhar-Gorlin Syndrome)
Authors: Aleksic S. , Budzilovich G. , Greco M.A. , McCarthy J. , Reuben R. , Margolis S. , Epstein F. , Feigin I. , Pearson J.
Published: March 2008

13 cases of Goldenhar-Gorlin syndrome are presented in which numerous central nervous system anomalies have been found. These include occipital encephalocele, hydrocephalus, aqueductal stenosis, agenesis of corpus callosum, multiple congenital lipomas and many others. Pertinent literature has been reviewed. It is concluded that any part of the central nervous system can be involved in this condition and that careful evaluation is indicated in order to rule out a treatable intracranial anomaly.
Germinoma in a Boy with Precocious Puberty: Evidence of hCG Secretion by the Tumoral Cells
Authors: Pomarède R. , Finidori J. , Czernichow P. , Pfister A. , Hirsch J.F. , Rappaport R.
Published: March 2008

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.
Factors Affecting Outcome in the Pediatric Patient with Multiple Trauma
Authors: Walker Marion L. , Storrs Bruce B. , Mayer Thorn
Published: March 2008

In a 5-year period of prospective study, 369 pediatric patients with multiple trauma (injury to at least two body areas) had injuries scored by a Modification of Injury Severity Scale (MISS). This scale uses the caregories and rankings of the Abbreviated Injury Scale-1980 (AIS-80) except that the classification of neurological injuries are scored by the Glasgow Coma Scale (GCS) and other neurological findings (presence of a surgical mass lesion, pupillary light response, and oculocephalic reflexes). The MISS is calculated as the sum of the squares of the three most severely injured body areas.
External Hydrocephalus in Infants
Authors: Andersson Hugo , Elfverson Jörgen , Svendsen Pål
Published: March 2008

External hydrocephalus means abnormal fluid accumulation in the subarachnoid space under increased pressure with no or slight widening of the ventricles. 9 children were investigated because of pathologically increasing head circumference and abnormal transillumination. PEG and/or CT showed widened sulci frontally, parietally and interhemispherically but no widening of the ventricles. 7 patients were subjected to exploratory craniotomy which disclosed a deep arachnoid space. 2 patients were shunted . All follow-up CT examinations showed normal conditons. We suggest that infants with clinical signs of hydrocephalus and CT picture of external hydrocephalus should not be treated with shunt. The widening of the subarachnoidal space will normalize. The rate of headgrowth will also normalize.
Failure of Encephaio-Duro-Arterio-Synangiosis Procedure in Moyamoya Disease
Authors: Cahan Leslie D.
Published: March 2008

Moyamoya disease is an uncommon cerebrovascular disease characterized angiographically by progressive stenosis of the distal internal carotid arteries and proximal anterior and middle cerebral arteries coupled with the development of a fine network of vessels at the base of the brain. In children, the disease causes recurrent hemisphere ischemia. A newly described operative procedure (encephalo-duro-arterio-synangiosis) was recently recommended by Matsushima and Inaba [Child’s Brain 11: 155–170, 1984] and was used in a recent patient treated at the UCLA Medical Center. The procedure did not succeed in revascularizing the brain in spite of clinical and angiographic progression of the disease, but a conventional superficial temporal to middle cerebral bypass operation did.
Computed Tomogram-Guided Stereotactic Brain Biopsy in the Pediatric Patient
Authors: Nauta Haring J.W. , Briner Rudy P. , Eisenberg Howard M.
Published: March 2008

Experience with computed tomogram-guided stereotactic biopsy is described with special reference to technical considerations important to the application of the Brown-Roberts-Wells system in pediatric patients. Eleven procedures were performed in 9 patients aged 9 months to 16 years of age. In all cases, the lesion was either deep seated or related to deficit prone areas making open biopsy hazardous. Since the stereotactic frame may interfere with intubation, it is important to apply it only after the patient has been anesthetized and intubated. In very small children, special attention is required to avoid over tightening of the fastening pins and to avoid excessive pressure when making the calvarial opening. In an effort to reduce the risk of hemorrhage, vasculature at the entry site was visualized and avoided by making a standard burr hole opening. Improved imaging of the vasculature at the deep biopsy site was obtained in most cases by intra-arterial contrast enhancement. No complications of the procedure were encountered and a diagnosis was obtained in all cases, although in 2 cases the procedure was repeated before adequate tissue was obtained. In 3 cases the procedure was therapeutic as well as diagnostic in that a tumor cyst or abscess could be drained.
Abdominal CSF Pseudocyst
Authors: Hahn Yoon S. , Engelhard Herbert , McLone David G.
Published: March 2008

Twenty-six cases of abdominal cerebrospinal fluid (CSF) pseudocyst have been reviewed and the clinical features identified. Typical presentation includes abdominal pain and/or distention, with nausea or vomiting. Manifest shunt malfunction is not a prominent feature. Diagnosis can usually be confirmed by abdominal ultrasound and/or CT scan. No clear predisposing factors were identified, although a prior shunt infection was found in 62% of the patients. The number of previous shunt revisions ranged from 0 to 51 (average 11.2). This revision rate is significantly higher than in other groups of patients. CSF obtained at the time of surgery was infected 36% of the time. CSF appearance and laboratory value did not reliably indicate infection as a cause of the pseudocyst. Suggested surgical management consists of a contralateral ventriculoperitonal shunt or a ventriculoatrial shunt.
New Insights into Mechanisms of Neuronal Damage in the Developing Brain
Authors: Johnston Michael V. , Silverstein Faye S.
Published: March 2008

Hypoxia-ischemia, hypoglycemia, and status epilepticus damage specific regions in the developing brain. The factors which determine selective neuronal vulnerability have remained obscure but recent research suggests that the patterns may be related to dysfunction of specific sets of synapses. An important current hypothesis suggests that hyperactivity of excitatory synapses, which use neurotransmitters such as glutamate, may cause excessive transmitter release and lead to damage of adjacent neurons. Excessive stimulation of excitatory neurotransmitter receptors triggers a cascade of biochemical reactions and potentially lethal ionic shifts. Recent observations suggest that drugs acting at these receptors could be used to reduce brain injury caused by a variety of insults to the developing brain.
Functional and Anatomic Recovery in the Monkey Brain following Excision of Fetal Encephalocele
Authors: Michejda Maria , Bacher John
Published: March 2008

Teratogen-induced herniation of the occipital lobes (encephalocele) in monkey fetuses was repaired by amputation and cranioplasty in utero or postnatally. The in utero-treated animals had normal vision, CT scans indicated normal brain density, and autoradiographic visualization of the striate cortex by the [14C]-2-deoxyglucose mapping revealed almost complete functional and anatomic recovery. The animals treated postnatally were blind, and exhibited significant structural deficit in the operated area.
Etiology of Ventriculomegaly in Choroid Plexus Papilloma
Authors: Rekate H.L. , Erwood S. , Brodkey J.A. , Chizeck H.J. , Spear T. , Ko W. , Montague F.
Published: March 2008

In order to test the hypothesis that overproduction of cerebrospinal fluid can cause the hydrocephalus seen in choroid plexus papillomas, adult mongrel dogs with and without hydrocephalus were subjected to high pressure intraventricular infusions of artificial cerebrospinal fluid (CSF). Pre- and postinfusion volumes were calculated, using a new method for on-line measurement of ventricular volume involving linear measurements from Conray® ventriculograms. Ventricular volumes increased an average of 8%in 36 h. The dogs previously made hydrocephalic by the intracisternal injection of kaolin had a significant volume increase (34% in 36 h). Overproduction of CSF alone can produce hydrocephalus, but the presence of hydrocephalus in choroid plexus papillomas is more likely to be a result of the complex interaction of CSF overproduction and partial restriction of CSF flow.
Ectopic Secreting Choroid Plexus in the Oropharynx
Authors: Lasjaunias P. , Ginisty D. , Comoy J. , Landrieu P.
Published: March 2008

The authors report a case of an ectopic secreting choroid plexus in the oropharyngeal region of a neonate. The lesion presented as a rapidly growing tumor, containing CSF. No communication with the cranial cavity could be found. Following two surgical interventions the lesion was entirely removed and pathological examination revealed choroid plexus.
Pediatric Neurosurgical Implications of the Amniotic Band Disruption Complex
Authors: Hudgins Roger J. , Edwards Michael S.B. , Ousterhout Douglas K. , Golabi Mahin
Published: March 2008

Defects caused by the amniotic band disruption complex (ABDC) may vary from simple malformations caused by digital constriction to major scalp, craniofacial, and visceral malformations. ABDC may cause 7–14% of stillbirths. The etiology is unclear, but the most commonly accepted mechanism involves rupture of the amnion followed by fetal malformation, deformation, and compression. This mechanism does not adequately explain all anomalies such as hydrocephalus and holoprosencephaly that are seen in the ABDC. The use of prenatal ultrasound has allowed the diagnosis of the ABDC in utero. Since 1980, four children with the ABDC who required neurosurgical intervention were seen at the University of California, San Francisco; the presentation and subsequent surgical treatment of 2 of these children are discussed. A combined craniofacial team approach to the management of these children can maximize reconstructive and neurologic outcome.
Glycosaminoglycans and Outflow Pathways of the Eye and Brain
Authors: Knepper Paul A. , McLone David G.
Published: March 2008

The etiology of the majority of defects of the outflow pathways of aqueous humor (glaucoma) and cerebrospinal fluid absorption (hydrocephalus) is unknown. A considerable amount of evidence indicates that glycosaminoglycans have a role in regulating fluid movement through connective tissues such as the trabecular meshwork of the eye and the arachnoid of the brain. Both the eye and the brain outflow pathways have hyaluronic acid and chondroitin sulfate within the filtration barrier. The physiological significance of glycosaminoglycans in the outflow pathways may be their ability to form highly viscous and elastic gel-like solutions that function as a selective biological gel filtration system, which maintains normal intraocular and intracranial pressure. We suggest that glycosaminoglycans may act to maintain the unidirectional character, low-flow fluid movement, and pressure gradient between the trabecular lamellae and the drainage channels of the eye and the brain. This review of the outflow pathways of the eye and the brain discusses the cell biology of glycosaminoglycans in regulating normal aqueous outflow and cerebrospinal fluid absorption.