bluuebunny/crossref_metadata_2025 huggingface dataset:
Intramedullary Spinal Teratoma and Diastematomyelia
Authors: Hader Walter J. , Steinbok Paul , Poskitt Ken , Hendson Glenda
Published: April 2003

The authors present a patient with diastematomyelia and a spinal intramedullary teratoma, remote from the split cord malformation. A split cord malformation at the L2–L3 level was initially discovered during investigations for thoracic congenital scoliosis, and this was treated surgically. The teratoma, which was at the level of the scoliosis, went undiagnosed until neurological deterioration occurred many years later. Surgical removal of the teratoma resulted in return to normal function. The potential for coexisting congenital anomalies at separate levels of the spinal cord must be considered in radiological investigations of a developmental spinal lesion.
Cervical Spine Evaluation in Obtunded or Comatose Pediatric Trauma Patients: A Pilot Study
Authors: Scarrow Alan M. , Levy Elad I. , Resnick Daniel K. , Adelson P. David , Sclabassi Robert J.
Published: April 2003

A uniformly accepted protocol for evaluation and clearance of the cervical spine of pediatric trauma patients with altered mental status does not currently exist. We sought to detect cervical spine injuries in this group with minimal risk. Patients were evaluated with standard three-view cervical spine radiographs and CT when necessary. Those patients without radiographic abnormality and altered mental status underwent flexion-extension of the cervical spine using fluoroscopy with somatosensory evoked potential (SSEP) monitoring. Those with abnormal movement by fluoroscopy or changes in SSEP underwent MRI. Fifteen patients were evaluated with this protocol. Two patients had movement on flexion-extension of the cervical spine and 5 had SSEP changes. Three patients had an MRI with only 1 showing injury. Five patients had residual hemiparesis. Evaluation of the cervical spine in obtunded or comatose pediatric trauma patients can be done safely with flexion-extension under fluoroscopy and SSEP monitoring. Further prospective studies are required to determine the efficacy of SSEP monitoring for cervical spine clearance in this select population.
Filum Terminale Fusion and Dural Sac Termination: Study in 27 Cadavers
Authors: Hansasuta Ake , Tubbs R. Shane , Oakes W. Jerry
Published: April 2003

The standard approach for sectioning of the filum terminale for a tethered spinal cord can be achieved via a limited S1 exposure. This is performed with the commonly believed idea that the filum fuses with the dura at S2. We dissected 27 cadavers to exclusively look at the level at which the filum pierces/fuses with the dura and also the level at which the dural sac ends. Most of the fila fused at S2 with a range from L5 to S3. The majority of dural sacs ended at S2 with a range from S1 to S3. However, 15% of the fila (4 of 27) fused above the S1 level. In addition, 11% of the fila (3 of 27) fused off the midline. We hope that this anatomical information may be useful for neurosurgeons when standard approaches fail to identify the filum at its usual level and location.
Cranial Growth Unrestricted during Treatment of Deformational Plagiocephaly
Authors: Kelly Kevin M. , Littlefield Timothy R. , Pomatto Jeanne K. , Manwaring Kim H. , Beals Stephen P.
Published: April 2003

Objectives: The Dynamic Orthotic Cranioplasty (DOC) BandTM is a cranial orthosis used to treat deformational plagiocephaly. The ability of this device to redirect growth and thus, improve craniofacial asymmetry has raised concerns regarding the potential restriction of cranial growth. The purpose of this study was to evaluate the growth of the head during correction of plagiocephaly. Methods: The study sample consisted of 190 children: 81 females (42.6%) and 109 males (57.4%) All patients had been diagnosed with nonsynostotic plagiocephaly, did not have other significant medical conditions, were compliant with DOC protocol, and had complete anthropometric measurements at entrance and exit from treatment. Growth of the head was evaluated using head circumference, maximum cranial width and maximum cranial length. Correction of plagiocephaly was evaluated by documenting the reduction of craniofacial asymmetry of the cranial vault, skull base and face. Paired t tests were used to assess the significance of changes in these anthropometric measurements. Differences were considered significant if p < 0.05. Results: Average entrance age was 6.5 months with a mean treatment time of 4.1 months. Statistical analysis demonstrated highly significant reductions in asymmetry in all three regions (p < 0.001). More importantly, these corrections were achieved with synchronous growth of the skull as demonstrated by highly significant increases (p < 0.001) in head circumference, maximum cranial width and maximum cranial length. Conclusions: These findings document statistically significant increases in cranial growth in association with concomitant reductions of the cranial asymmetries associated with deformational plagiocephaly.
Intracranial Metastasis of Wilms’ Tumor Involving the Tectal Plate without Pulmonary Involvement
Authors: Harada Katsumi , Nishizaki Takafumi , Kwak Taeshik , Fujisawa Hirosuke , Nishikawa Miki , Ito Haruhide
Published: April 2003

Intracranial metastasis without pulmonary involvement of Wilms’ tumor is very rare, and most previously reported metastatic sites have been in the cerebral parenchyma. We experienced a rare case of metastasis of Wilms’ tumor in the tectal plate without pulmonary involvement. A 3-month-old boy was admitted to our hospital due to hydrocephalus. After insertion of a ventriculoperitoneal shunt, there were no neurological deficits. Five months after the operation, a mass 5 cm in diameter extending from the tectal plate into the third ventricle was found. A mass 10 cm in diameter within the retroperitoneal space, which occupied the right kidney, was also found. Both tumors were resected and diagnosed histologically as Wilms’ tumor. Despite every effort including chemotherapy and radiotherapy, the patient died at 14 months old. The majority of children with hydrocephalus showing thickening of the tectal plate would most likely have tectal glioma; however, this unusual case report reminds us that metastasis of Wilms’ tumor can occur in the tectal plate causing hydrocephalus.
Measurement of Ventricular Size: Reliability of the Frontal and Occipital Horn Ratio Compared to Subjective Assessment
Authors: Kulkarni Abhaya V. , Drake James M. , Armstrong Derek C. , Dirks Peter B.
Published: April 2003

Introduction: The frontal and occipital horn ration (FOR) has recently been described as a simple, linear measurement of ventricular size that correlates very well with ventricular volume. This study further characterizes the measurement properties of the FOR by investigating its interobserver reliability and comparing it to a subjective assessment of ventricular size. Methods: Axial images (CT and MR) of children with hydrocephalus taken before and after third ventriculostomy were reviewed by 4 independent observers. Two observers were blinded to patient identity and clinical status and 2 observers were nonblinded. Each observer independently recorded linear measurements from which the FOR was calculated for each image. Each reviewer also made a separate subjective assessment of the degree of hydrocephalus on a 9-point adjectival scale. Reliability was calculated using a repeated-measures analysis of variance (ANOVA) and an intraclass correlation coefficient (ICC) with random image and observer effects. Results: There were 120 separate observations (4 observers, 30 images). The FOR ranged from 0.33 to 0.75 (mean 0.55, standard deviation 0.11). The reliability coefficient was 0.93 (95% confidence interval, CI 0.80–0.97) between the 2 blinded observers and 0.98 (95% CI, 0.95–0.99) between the 2 nonblinded observer. The overall interobserver reliability for all 4 observers was 0.95 (95% CI 0.92–0.98). The mean FOR for each observer was very similar, regardless of the observer’s blinding status. However, the reliability of the observers’ subjective assessment of the hydrocephalus was much lower (ICC = 0.77, 95% CI 0.60–0.88). Conclusions: The FOR demonstrates excellent interobserver reliability (>0.9) and was superior to subjective assessments of hydrocephalus. In this study, excellent reliability was maintained regardless of the blinding status of the observers. This further demonstrates the properties of the FOR as a simple and reproducible measure of ventricular size. It is suitable for use in clinical studies, possibly even in situations in which observer blinding is not possible.
Long-Term Outcome after Selective Posterior Rhizotomy in Children with Spastic Cerebral Palsy
Authors: Gul Shahid M. , Steinbok Paul , McLeod Kim
Published: April 2003

A retrospective analysis of data collected prospectively was performed to determine the long-term outcome of lumbosacral selective posterior rhizotomy (SPR) in children with spastic cerebral palsy (CP). The study population comprised children with spastic CP, who had SPR more than 4 years prior to the time of the study and had quantitative standardized assessments of lower limb spasticity (Ashworth scale), range of motion measured goniometrically, muscle strength (MRC scale) and ambulatory function, both preoperatively and at 1 year after SPR. Children meeting these criteria were reassessed at 5 years after SPR using the same measures. Hip adductor spasticity, hip abduction range of motion and quadriceps strength were chosen as the primary outcome measures for statistical analysis. Of 80 patients who met the entry criteria for the study, 33 completed the 5-year assessments. Significant improvements in spasticity, range of motion and muscle strength were noted both at 1 year and at 5 years after SPR. The preoperative, 1-year and 5-year values were as follows: hip adductor spasticity (Ashworth scale) = 4.1, 2.1, 2.2; hip abduction range of motion (degrees) = 20.4, 39.9, 31.7, and quadriceps strength (MRC scale) = 3.6, 4.0, 4.1. Ambulatory function seemed to be better at 1 and 5 years compared to baseline, but no statistical analysis was done for this secondary outcome measure. It was concluded that improvements in lower limb motor outcome are present at 1 year after SPR, and that these improvements are generally maintained at 5 years.
Intrauterine Myelomeningocele Repair Reverses Preexisting Hindbrain Herniation
Authors: Tulipan Noel , Hernanz-Schulman Marta , Lowe Lisa H. , Bruner Joseph P.
Published: April 2003

Background: It has been reported that intrauterine myelomeningocele repair reduces the amount of hindbrain herniation normally seen in association with the Chiari type II malformation. It is not yet known, however, whether hindbrain herniation is prevented, or whether preexisting herniation is reversed. The following study was designed to elucidate this issue. Methods: A series of 9 patients underwent intraoperative ultrasound examinations immediately prior to intrauterine myelomeningocele repair. These same patients were then evaluated postnatally using ultrasound and/or MRI. The degree of hindbrain herniation before and after repair was compared using a grading system devised by the authors. Results: Eight patients had clear evidence of moderate to severe hindbrain herniation on intraoperative scans while one was mild. In contrast, on postnatal studies 5 of 9 patients had no evidence of hindbrain herniation, while the other 4 had only mild herniation. Conclusion: Intrauterine myelomeningocele repair appears to reverse preexisting hindbrain herniation. It is postulated that continuous flow of cerebrospinal fluid through the neural placode is the force responsible for inducing migration of the cerebellum and brain stem downward through the foramen magnum. By interrupting that flow during gestation, intrauterine myelomeningocele repair enables the cerebellum and brain stem to resume a normal, or nearly normal, configuration.
Medical Management of Eosinophilic Granuloma of the Cervical Spine
Authors: Levy Elad I. , Scarrow Alan , Hamilton Ronald C. , Wollman Michael R. , Fitz Charles , Pollack Ian F.
Published: April 2003

We report a case of eosinophilic granuloma involving the vertebral bodies of the cervical spine in a 33-month-old girl. This lesion was diagnosed by needle biopsy and treated with prednisone and vinblastine therapy along with immobilization in a Minerva brace. The child has done well over a 9-month follow-up and has shown MRI evidence of resolution of the lesion, reestablishment of structural integrity within the cervical spine and potential reconstitution of the involved vertebral bodies.
Intracranial Nasal Dermoid Sinus Cyst Associated with Colloid Cyst of the Third Ventricle
Authors: Cheng Ming L. , Chang Steven D. , Pang Dachling , Adler John R.
Published: April 2003

A case of a 16-year-old male with both a nasal dermoid sinus cyst (NDSC) and a third ventricle colloid cyst is presented. The NDSC was excised via a single-stage combined intracranial-extracranial approach and the third ventricle colloid cyst was resected endoscopically. The pathogenetic theories of NDSC and third ventricle colloid cyst are discussed, and an embryological explanation for the simultaneous development of the two lesions in this patient is explored. This case is best classified among congenital developmental malformations in a category we propose to call ‘anterior neuropore corridor defects.’
Skull Base Growth in Craniosynostosis
Authors: Sgouros S. , Natarajan K. , Hockley A.D. , Goldin J.H. , Wake M.
Published: April 2003

Although considerable scientific work has been published on the role of the skull base in craniosynostosis, the changes with age throughout childhood have not been fully outlined. The realisation that little attention has been paid to the posterior skull in craniosynostosis, resulted in renewed interest in skull base growth. The availability of computer-based image analysis provides a new accurate method of study in three dimensions. Using three-dimensional visualisation techniques, 34 points of the skull base were identified on CT scans of 50 children with craniosynostosis of various types, aged from 1 month to 5 years. Several distances and angles between the various landmarks were measured in an attempt to quantify the growth of skull fossae with age. Comparisons were made with normal controls. In children with craniosynostosis, the anterior fossa was overdeveloped in the males, whereas in the females remained underdeveloped throughout the first 2 years of life. The body of the sphenoid showed moderate underdevelopment in the first 2 years in both sexes, the effect being more prominent in the males. The middle fossae showed overdevelopment in both sexes in the first 2 years of life. The posterior fossa was underdeveloped in both sexes in the first 2 years of life, the effect being more prominent in the females. Craniosynostosis seems to affect both sexes to a similar degree, but there are regional differences in the growth pattern. Better understanding of the normal growth pattern of the skull base and the effect of craniosynostosis upon it may assist our approach to surgical treatment and in particular the role of anterior and posterior skull expansive surgery.
Melatonin as a Free Radical Scavenger in Experimental Head Trauma1
Authors: Cirak Bayram , Rousan Nidal , Kocak Ayhan , Palaoglu Ozden , Palaoglu Selçuk , Kilic Kamer
Published: April 2003

Head trauma causes two kinds of injury in the neural tissue. One is the primary injury which occurs at the time of impact. The other one is a secondary injury and is a progressive process. Free radicals are produced during oxidative reactions formed after trauma. They have been thought to be responsible in the mechanism of the secondary injury. Some studies have been conducted to demonstrate the role of free oxygen radicals in neuronal injury. The alterations in the free radical level during the early posttraumatic period and the effect of a free radical scavenger on these alterations have not been studied as a whole. We aimed to demonstrate the free oxygen radical level changes in the early posttraumatic period and the effect of melatonin, which is a potent free radical scavenger, on the early posttraumatic free radical level. A two-staged experimental head trauma study was designed. In stage one, posttraumatic free radical level changes were determined. In the second stage, the effect of melatonin on the free radical level changes in the posttraumatic period was studied. Two main groups of rats each divided into four subgroups were studied. Rats in one of the main groups underwent severe head trauma, and malondealdehyde (MDA) levels were measured in the contused cerebral tissue at different time points. Rats in the other main group also underwent the same type of trauma, and melatonin was injected intraperitoneally at different time points after trauma. The MDA level alteration in the tissue was determined after the injection of melatonin. The MDA level increased rapidly in the early posttraumatic period. But in time, it decreased in the groups with only trauma. In the melatonin-treated group, the MDA level decreased after the injection of melatonin, when injected in the early posttraumatic period, compared to the control and trauma groups. However, melatonin increased MDA to a higher level than in the groups with only trauma and the control group when injected later than 2 h after trauma. The MDA level increases in the very early posttraumatic period of cerebral trauma and decreases in time. Melatonin, which is the most potent endogenous free radical scavenger, when injected intraperitoneally to the cerebral traumatized rats in the very early posttraumatic period, causes a significant decrease in the MDA level. But, melatonin, when injected more than 2 h after trauma, increases the MDA level in experimental cerebral trauma in rats.
The Effect of Surgery for Split Spinal Cord Malformation on Neurologic and Urologic Function
Authors: Proctor Mark R. , Bauer Stuart B. , Scott R. Michael
Published: April 2003

The split spinal cord malformation (SSCM) is an occult spinal dysraphism which causes tethering of the spinal cord. We performed a retrospective analysis of 15 patients who had split cord malformations (without associated open neural tube defect) who underwent both pre- and postoperative urodynamic studies (UDS) in order to determine if a significant percentage of these patients, even in the absence of overt urologic symptoms, had evidence of urologic dysfunction. Eleven patients presenting in early childhood and 4 patients presenting later in life are reviewed. Despite the lack of preoperative urologic symptoms in almost all patients, 73% of patients had voiding abnormalities on formal testing. UDS on these patients before and after surgery was a useful adjunct to perioperative management and decision making, helped define the success of surgery, and gave objective information for cases in which retethering was suspected.
Aerobic and Anaerobic Microbiology of Wound Infection following Spinal Fusion in Children
Authors: Brook Itzhak , Frazier Edith H.
Published: April 2003

Objective: To study the aerobic and anaerobic microbiology of wound infections following spinal fusion in children. Methods: Retrospective review of clinical and microbiological records. Results: Aspirates of pus from 18 infection sites showed bacterial growth. Anaerobic bacteria only were recovered in 3 (17%) specimens, aerobic bacteria only in 3 (17%) and mixed aerobic and anaerobic bacteria in 12 (67%). Forty-two isolates were recovered: 18 anaerobes (1.0 isolates per specimen) and 24 aerobes (1.3 per specimen). The predominant anaerobes were Bacteroides sp. (9 isolates, including 8 Bacteroides fragilis group) and 5 Peptostreptococcus sp. The predominant aerobes were Escherichia coli (6) and Proteus sp. (5). An increase in recovery of E. coli and B. fragilis was noted in children with bowel or bladder incontinence. Conclusions: This study highlights the polymicrobial nature and predominance of anaerobic bacteria in wound infections following spinal fusion in children.
Fronto-Orbitonasal Intradiploic Meningioma in a Child
Authors: Cirak Bayram , Guven Mehmet Bahadır , Ugras Serdar , Kutluhan Ahmet , Unal Ozkan
Published: April 2003

Intradiploic meningioma, which may be classified as a subgroup of intraosseous meningioma, is a rarely encountered disorder. To date, less than 10 cases have been reported. Here, we report a case of fronto-orbitonasal intradiploic meningioma. A 12-year-old female with exophthalmos and diplopia was operated on for a cranial intradiploic mass lesion. Histopathological evaluation of the specimen confirmed the diagnosis of intradiploic psammomatous meningioma. Her exophthalmos did not change, but the diplopia disappeared. This case is unique in that it is an extensive case of intradiploic meningioma of the orbital roof and frontal base in a child. Intradiploic meningiomas generally are of psammomatous type. Especially tumors adjacent to the orbita cause exophthalmos; cases located on the other side of the calvarium may not cause any symptom or sign other than headache or sometimes a mass on the scalp. Treatment, as with meningiomas located in the intracranial cavity, is total resection of the lesion.
Use of Bipedicular Advancement Flaps for Intrauterine Closure of Myeloschisis
Authors: Mangels Kyle J. , Tulipan Noel , Bruner Joseph P. , Nickolaus Delia
Published: April 2003

Several groups have begun to explore the feasibility and utility of intrauterine closure of myelomeningocele. A subset of these fetuses have defects which fall into the category of myeloschisis, and therefore have inadequate skin to enable primary closure. After considerable discussion, it was decided to utilize bipedicular flaps to close these lesions. The procedure is described, and representative examples are shown. To date, 13 of 56 fetuses have required this approach for closure in utero. While this technique generally provides adequate coverage of the dural sac, the cosmetic results have been less than optimal.
Craniocervical Neurenteric Cyst without Associated Abnormalities
Authors: Ergün Rüçhan , Akdemir Gökhan , Gezici A. Rıza , Kara Cengiz , Ergüngör Fikret
Published: April 2003

Spinal neurenteric (NE) cyst is an uncommon congenital cyst and frequently found in the cervical region. The clinical symptoms associated with this entity depend on the site of the lesion and are not typical for all such cysts. A definitive diagnosis can only be made by biopsy and histological examination. MRI can confirm these cystic masses and is the method of choice for their imaging investigation. They are often connected by a fibrous tract, fistula or cleft to structures derived from the primitive gut in the thoracic or abdominal cavities and are commonly associated with anterior spina bifida or other vertebral anomalies. We report a case of craniocervical NE cyst without associated abnormalities and discuss the implications for clinical diagnosis and management by a thorough review of the literature.
Epidemiology of Infantile Hydrocephalus in Saudi Arabia: Birth Prevalence and Associated Factors
Authors: Murshid Waleed Rida , Jarallah Jamal Saleh , Dad Mohammad Imam
Published: April 2003

Introduction: Hydrocephalus is a common central nervous system disorder in children. In spite of its importance, it has not been subjected to sufficient epidemiological studies, particularly in the developing countries. The aim of this study was to provide information from a representative series of newly diagnosed cases of infantile hydrocephalus on the birth prevalence, associated factors and mortality. Methodology: A prospective study was conducted over a 1-year period from April 1996 to March 1997 in the city of Al-Madinah Al-Munawarah, Saudi Arabia. Except for neural tube defects and brain tumors, all cases of hydrocephalus diagnosed within the first 28 days of life were included. A control group of 104 subjects was studied for comparison. Information about antenatal, natal and early postnatal periods were obtained by interviewing the mothers of the newborns. Results: During the study period, 26 cases of infantile hydrocephalus were detected. The birth prevalence was 1.6 per 1,000 live births. There was no sex preponderance as the male to female ratio was 1.2:1. Multiple pregnancies were detected in 21 (81%) cases. Nineteen (73%) cases were the product of consanguineous parent and 4 patients had a positive family history of hydrocephalus. The number of preterm infants was 16 (62%). The number of low birth weights (less than 2,500 g) was 18 (69%). An Apgar score of less than 8 occurred in 18 (69%) cases. The mode of delivery was vaginal in 15 (58%) women. The 6 months mortality rate was 23% (6 infants). Conclusion: The birth prevalence of infantile hydrocephalus in this study was significantly higher than in the developed countries. A positive family history of hydrocephalus, low birth weight, low Apgar score and abdominal delivery were found to be associated factors. The mortality rate in the first 6 months of life was significantly higher in hydrocephalus infants than in controls.
Spontaneous Regression of Low-Grade Astrocytomas in Childhood
Authors: Schmandt Susanne M. , Packer Roger J. , Vezina L. Gilbert , Jane John
Published: April 2003

An 8-year-old boy with neurofibromatosis type 1 (NF1) and a biopsy-proven juvenile pilocytic astrocytoma of the hypothalamic/chiasmatic region was followed with serial MRIs over 4 years. Spontaneous tumor regression was followed by progression and biopsy; 6 months later, the tumor regressed again. This bimodal regression is rare, but highlights the variable natural history of low-grade gliomas in children with NF1 and the difficulty in evaluating response of such tumors to therapy.
Recurrent Craniopharyngioma with Nasopharyngeal Extension
Authors: Taguchi Yoshio , Tanaka Katsuyuki , Miyakita Yasuji , Sekino Hiroaki , Fujimoto Masatoshi
Published: April 2003

We report the case of a 10-year-old boy having a recurrent craniopharyngioma with nasopharyngeal extension during a course of growth hormone therapy, in whom the nasopharyngeal craniopharyngioma was totally resected despite its extensive growth by using a transbasal approach. There has been no evidence of recurrence during 6 years of follow-up. A literature review was made with respect to nasopharyngeal extension of craniopharyngiomas, and the efficacy of the transbasal approach for those tumors is discussed.
Trampoline Injuries of the Cervical Spine
Authors: Brown Peter G. , Lee Mark
Published: April 2003

Trampolines were responsible for over 6,500 pediatric cervical spine injuries in 1998. This represents a five-fold increase in just 10 years. While most have been minor, paraplegia, quadriplegia and death are all reported. We present 2 cases of trampoline-related cervical spine injury and review the relevant literature. Additionally, we examine the efforts made to reduce the incidence of trampoline injuries, and discuss why these have failed. We conclude that safety guidelines and warnings are inadequate. In addition, we support recommendations for a ban on the use of trampolines by children.
Traumatic Acute Giant Epidural Hematoma in a Hydrocephalic Shunted Child
Authors: Bor Seng Shu Edson , Leme Ricardo Jose de Almeida , Aguiar Paulo Henrique , de Andrade Almir Ferreira , Teixeira Manoel Jacobsen , Plese José Píndaro Pereira
Published: April 2003

Extradural hematoma (EDH) is considered to be a rare complication of head trauma in children, and represents a serious and urgent pathology from which complete recovery can be expected if specialized treatment is instituted in time. In this article, the authors report the potential danger to a hydrocephalic shunted child who was apparently asymptomatic at the time of hospital admission with a mild head injury and developed an EDH of venous origin. This child had a rapid (time interval from injury to decerebrate posture of about 2 h), atypical (remained asymptomatic most of the time until abruptly deterioration) and fatal course, stressing the importance of early diagnosis and rapid therapy in order to avoid the death of the patient. The authors discuss the role of the ventriculoperitoneal shunting system in the lack of clinical symptoms associated with the presence of a giant EDH and a rapid and fatal course, and stress the importance of computed tomographic (CT) scanning in these patients, even if they are asymptomatic. If a skull fracture is suspected, a CT scan must be performed without delay.
Management of Choroid Plexus Tumours in Children: 20 Years Experience at a Single Neurosurgical Centre
Authors: McEvoy Andrew W. , Harding Brian N. , Phipps Kim P. , Ellison David W. , Elsmore Andrew J. , Thompson Dominic , Harkness William , Hayward Richard D.
Published: April 2003

Objective:  Tumours of the choroid plexus are rare tumours of neuro-ectodermal origin, accounting for less than 1% of all intracranial tumours. Most cases present in children less than 2 years of age. While choroid plexus carcinomas (CPC) are reported to have an extremely poor prognosis, choroid plexus papillomas (CPP) are generally regarded as benign tumours with a very favourable long-term outcome. Management dilemmas are associated with the choice of surgical procedure, tumour vascularity, the treatment of hydrocephalus and the value of adjuvant therapy. The objective of this study was to review our experience with this rare tumour over a 20-year period. Methods: Patients were identified from the Great Ormond Street Neurosurgical Brain Tumour Database. Over a 20-year period (1979–1999), 34 children were identified with a choroid plexus tumour. There were 25 cases of CPP and 9 cases of CPC. A retrospective review of case notes, radiological imaging, operation reports and pathology was performed. Results: The median age at presentation was 17 months (1–138) for CPP and 13 months (2–102) for CPC. There was no sex difference for CPP. However, 8 of the 9 CPCs were male (89%). A complete surgical resection was achieved in all 25 cases of CPP and in 3 cases of CPC (33%). The median survival for CPPs was 75.5 months (2–228), with a median follow-up of 73.5 months (2–228). The median survival for CPCs was 6 months (1–90), with a median follow-up of 6 months (1–90). Conclusion: With modern neurosurgical practise, a cure should be the aim for all children with CPP. There is no evidence that adjuvant therapy has any role in the primary management of these children. However, CPC still has an extremely poor prognosis, and the efficacy of adjuvant therapy remains to be established.
Successful Treatment of a Neonate with Vein of Galen Aneurysmal Malformation
Authors: Hamasaki Tadashi , Kai Yutaka , Hamada Jun-ichiro , Miura Masaki , Kondo Yuichi , Ushio Yukitaka
Published: April 2003

We present a follow-up study on a 5-year-old boy who was born with vein of Galen aneurysmal malformation (VGAM) accompanied by extreme cardiovascular distress. He was successfully treated by the staged endovascular technique during the neonatal stage. Postoperative angiographic study confirmed complete occlusion of the VGAM and the establishment of normal brain perfusion. At 5 years of age, the child is growing normally without neurological deficits or developmental retardation. We suggest that the restoration of normal brain perfusion in neonates with VGAM can cause normal brain development.
Surgical Treatment of Temporal Tumors Associated with Epilepsy in Children
Authors: Iannelli Aldo , Guzzetta Francesco , Battaglia Domenica , Iuvone Laura , Di Rocco Concezio
Published: April 2003

Seizures are a frequent sign of cerebral supratentorial tumors in children, especially when the location of the neoplasm is the temporal lobe. We report a series of 37 pediatric patients with temporal epileptogenic tumors. They represent 80.4% of children affected by temporal neoplasms, confirming the high incidence of seizures when neoplasms are located in this cerebral area. There was a slight male predominance. Epilepsy was the first symptom in all the patients of our series, as well as the only clinical manifestation present until surgery in 62% of patients. In the remaining children, hemiparesis, intracranial hypertension, psychosocial or neuropsychological disabilities, and delayed milestones arose before diagnosis and surgical treatment. The most frequent type of seizures was the partial complex (56%), but simple partial or generalized fits, as well as more than one type of seizures, were observed. The medial temporal structures were those more commonly involved, although seizures were observed also in cases where they were spared by tumors located exclusively in the temporal neocortex. On histology, most of the tumors showed a benign phenotype. Tumor resection was complete in 60% of cases; the excision of the tumor was incomplete in subjects whose lesion involved surgically inaccessible cerebral regions, as language areas, insular structures, and basal nuclei. As for epilepsy, 26 among the 32 long-term survivors can be classified in class I of Engel’s classification; 4 of them did not receive any antiepileptic treatment. Four patients showed a significant reduction in the frequency of their fits. In 2 subjects, only the frequency of seizures was minimally reduced after tumor excision; in both, a partial removal of their tumor was performed. The relationship among the results on epilepsy and the extent of surgery removal of the tumor, brain tissue removal if any, frequency of seizures in the preoperative period and the time interval between the first epileptic manifestation and surgery show that the most significant prognostic element predictive of a good control of seizures is radical resection of the tumor.
MR Venography in Children with Complex Craniosynostosis
Authors: Rollins Nancy , Booth Timothy , Shapiro Kenneth
Published: April 2003

Purpose: Chronic venous hypertension due to jugular foramen stenosis has been proposed as an etiology for the hydrocephalus and tonsillar herniation seen in some patients with complex craniosynostosis. We report the use of MR venography (MRV) to evaluate venous outflow obstruction in this clinical setting. Materials and Methods: We studied 17 patients, (ages 4 months to 34 years; mean 7.3 years) with complex craniosynostosis; 8 patients with Crouzon’s syndrome, 2 with Apert’s, 1 with Pfeiffer’s and 6 patients without an eponymous classification. MR imaging included routine imaging sequences and axial 2D TOF MRV. Patterns of venous drainage and the presence of hydrocephalus and tonsillar herniation were noted. Results: Jugular vein obstruction was seen in 12/17 patients; in 5/8 patients with Crouzon’s, 1/2 with Apert’s, the single patient with Pfeiffer’s and 5/6 patients with nonsyndromic craniosynostosis. The predominant collateral drainage was via the posterior condylar veins. Nine of 12 (75%) of the patients with abnormal MRV had hydrocephalus; 3/8 patients with Crouzon’s, 1/2 patients with Apert’s, and 5/6 nonsyndromic patients. Two patients had hydrocephalus with normal MRV. Ten patients had tonsillar herniation, which was associated with shunted hydrocephalus in 7/10 patients, and hydrocephalus seen prior to shunt placement in 3/9. Nine of 10 patients with tonsillar herniation had an abnormal MRV, while 1 patient had a normal MRV. Venous pressures measured in 1 patient showed an 8-mm-Hg differential across the skull base. Conclusions: The posterior condylar veins appear pivotal in maintaining venous drainage when the jugular bulbs are occluded. Although the association between venous outflow obstruction, hydrocephalus and tonsillar herniation is intriguing, evidence of venous outflow obstruction by MRV may not be indicative of significant intracranial venous hypertension.
Basal Meningoencephalocele, Anomaly of Optic Disc and Panhypopituitarism in Association with Moyamoya Disease
Authors: Komiyama Masaki , Yasui Toshihiro , Sakamoto Hiroaki , Fujita Keinosuke , Sato Toshihiko , Ota Mariko , Sugita Masahiko
Published: April 2003

Basal meningoencephalocele is frequently associated with midfacial anomaly, optic disc anomaly, brain anomaly, cerebrospinal fluid rhinorrhea, chiasma syndrome, and endocrinologic disturbance. The combination of basal meningoencephalocele and moyamoya disease is extremely rare. A 29-year-old man had basal meningoencephalocele (transsphenoidal type), anomaly of the optic disc (morning glory syndrome), panhypopituitarism and moyamoya disease. The patient was treated by hormone replacement, but surgical intervention was not required. Basal meningoencephalocele and moyamoya disease are a possible combination of the diseases.
Rathke’s Cleft Cyst Abscess
Authors: Israel Zvi H. , Yacoub Mufid , Gomori John M. , Dotan Shlomo , Fellig Yakov , Shoshan Yigal , Spektor Sergei
Published: April 2003

Pituitary abscesses are rare. Occasionally they will arise in pre-existing pituitary pathology. We report such an occurrence within a Rathke’s cleft cyst. On the basis of history and imaging, this was indistinguishable from more commonly encountered pituitary pathology.
Whatever Happened to Delusional Perception?
Authors: Rossi Monti M.
Published: April 2003

Thanks to the analysis of delusional perception’s formal binary structure, generations of psychiatrists believed that the problem of delusion, at least from a descriptive point of view, had been resolved. The first-rank Schneiderian symptoms, and delusional perception in particular, had become reference points for the diagnosis of delusion and schizophrenia. Today, however, the phenomenon of delusional perception no longer seems to be taken into serious consideration by psychiatrists and psychopathologists. The crisis of the nosographic specificity of Schneiderian first-rank symptoms and the development of a transnosographic perspective in the study of delusion have definitively loosened the ties that existed in traditional psychopathology between delusional perception, delusion and schizophrenia. Despite the fact that delusional perception has lost its fundamental role in the nosographic sector, it still maintains its importance when studied in an interpersonal context. The significance of formal discontinuity evident in delusional perception authorized the psychiatrist to pause on the threshold of delusion without making allowances for the disastrous lack of comprehension so typical of delusional perception, which in turn must be studied from an interpersonal perspective, not as if it were an aseptic object in a laboratory. The therapeutic relationship can therefore provide an opportunity to recuperate those experiences which the patient was unable to store in his memory and concentrated in delusional perception.
The Concept of Generalized Anxiety Disorder: Between the Too Narrow and Too Wide Diagnostic Criteria
Authors: Starcevic Vladan , Bogojevic Goran
Published: April 2003

The Structured Clinical Interview for DSM-III-R, modified for DSM-IV and ICD-10 Diagnostic Criteria for Research (ICD-10-DCR), was administered to 73 consecutive patients with agoraphobia/panic disorder in order to determine diagnostic agreement for comorbid generalized anxiety disorder (GAD) between DSM-IV and ICD-10-DCR and reexamine the GAD symptom structure and significance of each symptom as diagnostic criterion for GAD. The diagnostic agreement for GAD (kappa) was 0.86. The analysis of the frequency of GAD symptoms in 45 patients suggests that in order to better differentiate GAD from depression and other anxiety disorders, a diagnostic conceptualization of GAD may be improved with the requirement of the presence of at least 4 of the 7 first-rank symptoms (pertaining to tension, vigilance and scanning) and 1 of the 5 second-rank symptoms (pertaining to physiological hyperarousal).
Delusion of Infestation with Post-Partum Onset: Case Report
Authors: Lanczik Mario , Hofberg Kristina , Brockington Ian F.
Published: April 2003

Compared with men, women have a greater lifetime risk of delusions of infestation, with the risk appearing to increase around the menopause, when the blood levels of reproductive hormones are decreasing. Women also have a greater lifetime risk of depression and an increased incidence of depressive symptoms post partum, when the blood levels of these hormones are decreasing as well. The first case of a delusion of infestation with post-partum onset is described, and possible associations with reproductive function in women are discussed.
Naturalistic Course of Obsessive Compulsive Disorder and Comorbid Depression
Authors: Zitterl Werner , Demal Ulrike , Aigner Martin , Lenz Gerhard , Urban Claudia , Zapotoczky Hans-Georg , Zitterl-Eglseer Karin
Published: April 2003

Seventy-four patients who met DSM-III-R criteria for obsessive compulsive disorder (OCD) were studied in a prospective follow-up study in order to investigate course and prognosis of OCD with or without comorbid depressive symptomatology. Subjects were examined three times: at admission (baseline), 6 months later (follow-up 1) and 12 months after follow-up 1 (follow-up 2). At admission, 51 (72.9%) OCD patients were assessed as depressive by the Hamilton Depression Scale score. Between admission and follow-up 1, all patients received behavior therapy and a serotonin reuptake inhibitor, between follow-up 1 and follow-up 2 they received different kinds of treatment in order to maximize therapeutic effects. A 25 % Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score reduction from admission to follow-up 2 and in addition, a total Y-BOCS score of below 16 at follow-up 2 was defined as ‘good prognosis course’. The results obtained showed that OCD patients who followed a good prognosis course, showed no significant depressive symptomatology at follow-up 2 (p = 0.001). These results imply that patients with a diagnosis of OCD may present depression at admission and/or follow-up 1; however, if OC symptomatology decreases longitudinally, depressive symptoms disappear too. We may assume that OCD is dominant over depression, and it seems that a comorbid depression does not have any major influence on the prognosis of OCD.
Age- and Gender-Related Psychological Characteristics of Adolescent Ballet Dancers
Authors: Neumärker Klaus-Jürgen , Bettle Norman , Neumärker Ursula , Bettle Oliver
Published: April 2003

Ballet school students (n = 90) aged 11–17 years, and nondancing adolescents (n = 156) aged 13–17 completed the Eating Disorder Inventory (EDI). Significant differences between female dancers and controls were seen in five subscales, with higher scores for the dancers (‘Drive for thinness’, ‘Bulimia’, ‘Interpersonal distrust’, ‘Ineffectiveness’ and ‘Perfectionism’). Their highest scores on most subscales were for the 16-year-olds. The only difference between male dancers and controls was seen for Ineffectiveness. Our data suggest important psychological inconsistency in the course of the adolescence of female ballet dancers, whilst the psychological profile of male ballet dancers appeared quite similar to that of nondancing adolescents.
The Role of Psychopathology and Suicidal Intention in Predicting Suicide Risk: A Longitudinal Study
Authors: Scocco Paolo , Marietta Paola , Tonietto Monica , Dello Buono Marirosa , De Leo Diego
Published: April 2003

Objective: In this study, we describe psychological symptoms, any relationship with suicidal intention in a sample of subjects recently attempting suicide and the predictive value of this association in later completed suicide. Methods: An assessment was made of 467 suicidological consultations carried out by the Suicidology Unit of the Department of Neurology and Psychiatry, University of Padua, on 421 patients admitted to hospital following attempted suicide in the 5-year period 1990–1994. Suicidal intention was appraised by the Intent Score Scale (ISS). Suicide mortality was assessed after a mean follow-up period of 3.5 years. Results: Psychiatric evaluation was completely negative in only 8% of cases. The most commonly identified symptom was depressed mood (79% of cases, 22% severe depression), followed by anxiety (43% of cases, 32% severe anxiety). From the study, it emerged that psychopathology seemed to influence suicidal intent, where this was characterized by severe depression. Anxiety and other symptoms appeared to have a secondary role. Assessments of suicidal intent showed that intention heightened as the number of symptoms increased. The symptom ‘anxiety’ did not prove to have a significant bearing on assessment of the seriousness of suicidal intention, whereas severely depressed mood did. The total number of subsequent suicide victims was 5.5%. During consultation relating to the index parasuicide, these subjects did not manifest a discriminate psychopathological profile (the only distinguishing characteristic was anxiety, which was less frequently identified in suicide victims), but did present a more positive personal and family psychiatric history. Conclusions: In subjects who had recently attempted suicide, the psychopathological profile appeared to be related to suicidal intent, where this was characterized by severe depression. Anxiety and other symptoms seemed to have a secondary role. Nonetheless, both total scores and subscores should be taken into consideration when assessing suicidal intention through the ISS. The psychopathological profile and ISS score following attempted suicide do not appear to permit prediction, in the medium to long term, of subsequent completed suicide.
Suppressive BALF Lymphocyte Phenotype in a Patient with Prolonged Stable Alveolar Proteinosis
Authors: Panagou P. , Loukides S. , Tsipra S. , Kalogeropoulos N.
Published: April 2003

The case history of a 25-year-old man suffering from idiopathic alveolar proteinosis is described. The patient showed a prolonged stable mild disease and a distinct suppressive phenotypic profile of BALF lymphocytes. Specifically, a low T4/T8 ratio and a high percentage of CD11b+ T8 lymphocytes was found. Correlations with disease expression are made.
Prevalence of Deep-Vein Thrombosis of the Leg in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Authors: Schönhofer B. , Köhler D.
Published: April 2003

Acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with dyspnea and, consequently, reduced mobility. Immobility is a recognized risk factor of deep-vein thrombosis (DVT), but few data exist regarding the prevalence of DVT in patients with acute exacerbation of COPD. Real-time B-mode ultrasonography (US) is a noninvasive screening method for the diagnosis of DVT. We therefore used US to investigate the prevalence of DVT in patients with an acute exacerbation of COPD. In a prospective cohort study, 196 patients with COPD were studied [110 males, 86 females, age: 66.9 ± 9.1 years, weight: 63.5 ± 12.7 kg, forced expiratory volume in 1 s (FEV1): 0.7 ± 0.2 liters, and a ratio of FEV1 to vital capacity (VC): 37 ± 6%] in a respiratory intensive care unit on the day of admission. Patients with reduced mobility due to other diseases were excluded. All US were performed by one experienced person with a 5-MHz linear scanner. The veins of the lower extremity were subdivided into three segments: (1) the common femoral, (2) superficial femoral veins including the long saphenous vein and (3) the popliteal vein. In 21 of 196 COPD patients (10.7%), DVT were demonstrated; 18 of these were asymptomatic. Bilateral DVT were not found. In 6 patients, additional diagnoses were: Baker’s cyst (n = 3), inguinal lymph node (n = 1) and knee joint effusion (n = 2). There were no differences between patients with and without DVT with respect to age, hemoglobin, PO2, PCO2, pH, FEV1, VC or dyspnea scale. DVT in the lower extremity, which was not detectable on clinical examination, was relatively common in patients with an acute exacerbation of COPD. All clinical variables measured (age, weight, dyspnea scale, lung function, hemoglobin, hematocrit and blood gases) failed to predict patients more likely to have DVT.