bluuebunny/crossref_metadata_2025 huggingface dataset:
The Recurrent Cerebellar Astrocytoma
Authors: Shapiro Kenneth , Katz Marcia
Published: March 2008

5 children with six recurrences of cerebellar astrocytoma are reviewed. The clinical course is correlated with the grading system of Gilles for posterior fossa gliomas. Changes in the Gilles classification were found in some tumors at the time of reoperation. The delayed occurrence of hydrocephalus signified recurrence of tumor. Regardless of the apparent histologic benignity of the tumors, cerebellar astrocytomas have the capacity to regrow even after apparent total removal. Routine follow-up CT scans should be performed to detect asymptomatic recurrences.
Electroencephalographic Changes in Pediatric Patients following Metrizamide Cisternography
Authors: Crumrine Patricia K. , Drayer Burton P. , Rosenbaum Arthur E.
Published: March 2008

Serial electroencephalograms were obtained over a 24-hour period in 15 children from 3 months to 17 years following metrizamide CT cisternography. Persistent EEG abnormalities were noted in 8 children, 5 of whom were older than 2 years. Bifrontal slowing was a frequent change in the children older than 2 years.
Failure of Prophylactically Administered Phenytoin to Prevent Post-Traumatic Seizures in Children
Authors: Young Byron , Rapp Robert P. , Norton J.A. , Haack Dennis , Walsh John W.
Published: March 2008

We report the results of a randomized, double-blind, placebo-controlled study to determine whether phenytoin administered soon after a head injury lessens the incidence of late post-traumatic epilepsy in children. 41 patients were randomized into either a phenytoin or placebo group and followed for 18 months. The patients were administered phenytoin or placebo intravenously or intramuscularly within 24 h of hospital admission. The patients were parenterally administered phenytoin or placebo until oral doses could be tolerated. There was no significant difference in the percentage of children having seizures in the treated and placebo groups (p = 0.25).
Brain Tumors during the First Year of Life
Authors: Raimondi Anthony J. , Tomita Tadanori
Published: March 2008

Among 341 childhood brain tumors treated at Northwestern University – Children’s Memorial Hospital during the years 1967–1980, there were 39 children (11%) who presented during the first year of life. Half of the total number of childhood choroid plexus papillomas, meningeal sarcomas and teratomas we treated occurred in this particular age group. Supratentorial tumors were more common than infratentorial, a rate of 1.8:1. Medulloblastoma and benign astrocytoma were the most common histological types. Hydrocephalus was present in 82% of the children and papilledema in 28%, so that progressive enlargement of head circumference was the most common reason for referral. For the 37 patients who underwent surgical removal or biopsy of the tumor, the 1-month mortality rate was 19% and the 1-, 3- and 5- year survival rates were 46, 30 and 22%, respectively. Whenever tolerated, roentgen therapy was given. Most of the 24 deaths occurred within 6 months of the time of diagnosis. 5 patients (1 each with malignant astrocytoma, medulloblastoma, meningeal sarcoma, and 2 with choroid plexus papilloma) are still alive 5 years later, without neurological or mental deficit, and with no sign of recurrence. There were three exceptions to Collin’s rule. Among the 15 survivors, 5 suffer mental retardation.
Testing the Hydrocephalus Shunt Valve
Authors: Watts Clark , Keith Dean
Published: March 2008

Unwanted results of shunting for hydrocephalus include slit and asymmetrical ventricles and the conversion of communicating hydrocephalus to noncommunicating hydrocephalus. Evidence suggests this may be due to a mismatch between the pressure/flow performance characteristics of the shunt valve and the pathologic hydrodynamics of the ventricular cerebrospinal fluid. Commercially available shunts are currently tested using a steady-state pressure/flow method. We have utilized a bench testing method which incorporates pulsed flow and varying compliance. Results indicate that with minimal compliance in the system, opening and closing pressures differ markedly in value with pulsed flow as compared to steady-state testing. The greater the compliance the less deviation was noted. It is recommended more effort be made to understand the value of matching pressure/flow characteristics of valve to the individual hydrocephalic state.
Third Ventricle Choroid Plexus Papillomas
Authors: Jooma Rashid , Grant Norman
Published: March 2008

Choroid plexus papillomas are only infrequently located in the third ventricle. Two infants with such lesions are presented and the diagnosis by computed tomography described. The transcallosal approach to the third ventricle was employed in both cases and led to successful excision. This approach is recommended for lesions in the anterior third ventricle in children, and the occurrence of subdural effusions as a complication is pointed out.
Postpartum Perfusion of the Preterm Brain: Relationship to Neurodevelopmental Outcome
Authors: Ment L.R. , Scott D.T. , Lange R.C. , Ehrenkranz R.A. , Duncan C.C. , Warshaw J.B.
Published: March 2008

Bayley developmental assessments were performed at 12 months corrected age on 11 preterm infants, all of whom had undergone 133-Xenon cerebral blood flow measurements (CBF) on the 1st day of life and neonatal computerized tomography scans for the detection of intraventricular hemorrhage. The Bayley mental index was found to vary as a quadratic function of CBF to the left hemisphere, with moderate CBF values associated with more favorable outcomes than either low or high CBF values.
An Animal Model to Detect Learning Deficits following Treatment of the Immature Brain
Authors: Yadin E. , Bruno L. , Micalizzi M. , Rorke L. , D’Angio G.
Published: March 2008

Learning deficits have been noted in children with acute leukemia given methotrexate (MTX) with and without cranial irradiation (RT) for prophylaxis. A rat model has been developed to assess treatment effects on learning. The test used was altered performance of a simultaneous discrimination task in a standard operant conditioning box, employing the mean number of days needed to score 80% correct responses as the criterion. An illustrative experiment distributed suckling rats among four groups: (1) 36 controls; (2) 14 cranial RT (1,000 R); (3) 14 MTX (5 mg/kg i.p.); (4) 36 RT+ MTX 24 h later, and (5) 12 undernourished controls (to match poor weight gain patterns of treated animals). Survivors were tested 10–12 weeks later: values for groups 1–5 in order were 3.9, 4.1, 4.7, 5.0 and 4.0 days. Only group 4 results were significantly different from group 1 (p = < 0.05).
Intracerebral Osteoma: A Clinicopathologic and Neuropsychologic Case Study
Authors: Vakaet An , De Reuck Jacques , Thiery Evert , Eecken Vander
Published: March 2008

This case report deals with a 16-year-old girl, admitted for headache and Jacksonian seizures. The clinical examination showed no gross disturbances, but the neuropsychologic examination revealed difficulties in speech-linked abstract thinking. Extensive radiologic investigations revealed the presence of a frontal intracallosal bony tumor, protruding into the lateral ventricles. Histologic examination of the surgical specimen showed a large benign osteoma, without any connection with dura or skull. In view of the paucity of symptoms, a dysontogenetic etiology of the tumor seems obvious.
Surgical Management of Subdural Empyema
Authors: Hockley Anthony D. , Williams Bernard
Published: March 2008

The methods and results of surgical management in 42 patients under 20 years of age with subdural empyema are described. Based on this experience and on a review of the literature, primary craniotomy with radical removal of pus has increasingly become the authors’ preferred method of treatment, in addition to appropriate antibiotic treatment with survival figures of around 90% expected.
Middle Fossa Arachnoid Cyst: Clinical, Neuroradiological, and Surgical Features
Authors: Sato Kiyoshi , Shimoji Takeyoshi , Yaguchi Katsumi , Sumie Hirotoshi , Kuru Yutaka , Ishii Shozo
Published: March 2008

16 pediatric and 4 adult cases of small-or medium-sized middle fossa arachnoid cyst were subjected to various neuroradiological investigations and their results were analyzed in terms of possible mechanisms of cyst expansion. Based on the results of the investigations which strongly suggested that the cyst is an expanding lesion, all cases were surgically treated by the same techniques of craniotomy, excision of the outer cyst membrane, followed by a cystoperitoneal shunt, resulting in complete disappearance of the cyst concomitant with reexpansion of the surrounding brain and marked improvement in the clinical pictures of the patients.
Surgical Treatment of Spinal Lipomas in Infancy and Childhood
Authors: Mircevski M. , Mircevska D. , Bojadziev I. , Basevska R.
Published: March 2008

The clinical course and surgical treatment of 48 children with lipomatous lesions of spinal dysraphism are presented. Preoperative studies consisted of complete neurological examination, IVP, myelography and CT scan if indicated. The complete clinical course and surgical treatment of the children with lipomatous lesions of the lower spine is reviewed. The surgical aim was to free all intra- and extradural adhesions by dural grafting if necessary. The results of surgical treatment are dependent upon the time of treatment (as early as possible), the location and extent of the malformation and the quality of surgical treatment.
Diastematomyelia: Report of 21 Cases Surgically Treated by a Neurosurgical and Orthopedic Team
Authors: Frerebeau Ph. , Dimeglio A. , Gras M. , Harbi H.
Published: March 2008

We studied 21 cases of diastematomyelia associated with myelo-meningocele (3 cases) or congenital spine deformities (18 cases). Analysis of bone and neuraxis abnormalities with special reference to the spinal canal, related to operative findings demonstrate in all cases an embarrassed cord by localized compression or global narrowing of the malformed spinal canal (11 cases), bone spur fixation (13 cases) and tethered cord associated lesions (5 cases). Mechanisms of neural damage and prophylactic value of laminectomy before the orthopedic treatment of the curve during the same operation is discussed.
Successful Removal of an Acute Brain Stem Hematoma in a Young Child
Authors: Umansky Felix , Toledo Ezra , Cohen Mathias , Israeli Jacob , Shalit Mordechai
Published: March 2008

Several days after receiving a blow to the occipital region, a 5-year-old boy presented with acute symptoms and signs of a space-occupying-lesion in the posterior fossa. A CAT scan revealed a mass with increased density in the region of the fourth ventricle. A suboccipital craniectomy disclosed a subependymal hematoma bulging into the fourth ventricle. The hematoma was evacuated, and the child subsequently made a complete recovery. It is stressed that surgical intervention should be considered in all such cases and particularly in young patients who show progressive neurological deficits.
Clinical and Experimental Observations with Fontanel Pressure Measurements
Authors: Ivan Leslie P. , Badejo A.
Published: March 2008

Using the Ladd fiberoptic system, fontanel pressure measurements were performed in infants from 1 to 219 days of age. Various holding devices were used for standardizing the application force and remarkably consistent values were found among three different holders. In group I (neonates), 9.45, 8.45 and 8.2 mm Hg were the mean values. In group II (4 days to 4 weeks), 10.3 and 9.2 were the mean values. In group III (34–219 days), the mean values were 9.9 and 12.4. In a group of 36 hydrocephalic children, epidural, ventricular and fontanel pressures were compared during surgery, and linear correlation was found but the ventricular fluid pressure readings were consistently lower. In dogs with artificial fontanels, asternal and fontanel pressure was monitored while volume pressure studies were performed. In 80% of the cases, close linear correlation was found. Fontanel pressure measurement and monitoring give very valuable data on ICP. The correct zero reference point is a difficulty which can be eliminated with standardized holding devices.
Intracranial Arteriovenous Malformations in the Pediatric Age: Experience with 24 Cases’
Authors: Mazza Carlo , Pasqualin Alberto , Scienza Renato , Bazzan Alberto , Da Pian Renato
Published: March 2008

24 patients below 16 years of age with intracranial arteriovenous malformations are considered. Presenting history has been constituted mainly by intracranial hemorrhage, followed by epilepsy and hydrocephalus. The utility of angiography and CT scan is stressed, especially for preoperative evaluation. The arteriovenous malformation was located in noncritical cortical areas in 7 cases, in critical cortical areas in 6 cases, in the midline structures or in the basal ganglia in 8 cases, in the posterior fossa in 2 cases, and was only dural in 1 case. Complete surgical resection of the lesion has been carried out in 18 cases, and embolization in 1 case. The operative microscope, induced hypotension, and the ‘backward technique’ have been very useful during surgery. Following the operation, good results have been achieved in 83% of cases; mortality has been 11%. In most cases epilepsy has shown improvement after surgery. It is concluded that direct surgical extirpation of the angioma is the treatment of choice for pediatric patients, even in the presence of epilepsy alone.
Limberg-Latissimus Dorsi Myocutaneous Flap for Closure of Myelomeningocele
Authors: Munro Ian R. , Neu Bernd R. , Humphreys Robin P. , Lauritzen Claes G.
Published: March 2008

A method is presented in which two well-recognized plastic surgical flap techniques are coupled: the Limberg rhomboid transposition flap and the latissimus dorsi myocutaneous flap. The technique was used in 2 patients to provide ample, innervated, and well-vascularized skin cover over myelomeningocele defects.
Sturge-Weber Syndrome without Port-Wine Facial Nevus
Authors: Ambrosetto Paolo , Ambrosetto Giovanni , Michelucci Roberto , Bacci Antonella
Published: March 2008

2 cases of Sturge-Weber syndrome without facial nevus are reported. The patients presented different forms of epilepsy. The diagnosis was made by computed tomography (CT) which showed typical intracranial calcifications in both occipital regions. The problems concerning the atypical and incomplete forms of the syndrome are briefly discussed. The importance of CT as a diagnostic procedure for this disease is emphasized.
Experience with Ventriculo-pleural Shunts
Authors: Hoffman Harold J. , Hendrick Bruce , Humphreys Robin P.
Published: March 2008

Ventriculo-pleural shunting for the management of hydrocephalus was initially introduced by Ransohoffin 1954. However, because of the reported cases of pleural effusion with this procedure, the operation has not achieved popularity in the management of hydrocephalus. In the course of a review of 1,500 patients with hydrocephalus treated at the Hospital for Sick Children over the years 1960–1981, we encountered 59 patients who had been treated with a ventriculo-pleural shunt during the years 1971–1981. The commonest reason for insertion of the ventriculo-pleural shunt was a preexisting infected ventriculo-peritoneal shunt. 12 of the 59 patients developed pleural effusions, and 6 of these 12 patients were under 11 months of age. The incorporation of an antisiphon device in the shunting system seemed to decrease the possibility of a pleural effusion. 23 of the 59 patients continue to function on their inserted ventriculo-pleural shunt, and in 9 of these the shunts have been functioning for over 5 years. Ventriculo-pleural shunting seems to be a safe and simple form of diversionary CSF bypass. The risk of pleural effusion seems to be highest in the infant, but can occur at any age. However, even in the infant the ventriculo-pleural shunt provides a good temporary site for diversion of CSF when the peritoneal cavity is contaminated or hazardous to shunt function. Ventriculo-pleural shunting provides a valuable alternative for the management of hydrocephalus in those patients where the heart or the peritoneal cavity are unsuitable sites.
Diencephalic Syndrome Due to a Suprasellar Epidermoid Cyst
Authors: Eliash Achiah , Roitman Abraham , Karp Moshe , Reichental Eli , Manor Riri S. , Shalit Mordechai , Laron Zvi
Published: March 2008

A 5-year-old child with the unusual association of late-onset diencephalic cachexia and pituitary insufficiency is described. At operation a suprasellar epidermoid cyst was found and excised. This curable tumor should be added in the differential diagnosis of diencephalic syndrome.
Arteriovenous Malformations of the Brainstem in Childhood
Authors: Humphreys Robin P. , Hendrick Bruce , Hoffman Harold J.
Published: March 2008

Brainstem vascular malformations are an uncommon but lethal problem in pediatric neurosurgery. 9 children with confirmed vascular malformations in the brainstem are presented, and the treatment options considered. The recent encouraging results concerning the operative management of these lesions, deserves fullest consideration with the hope that an aggressive management plan can be instituted for the child who otherwise will experience repeated hemorrhage and die from the malformation.
Head Injury in the Infant and Toddler
Authors: Raimondi Anthony J. , Hirschauer Jeffrey
Published: March 2008

This is a retrospective review of all closed-head injured children, ages 1–36 months, admitted to the Children’s Memorial Hospital from 1959 to 1978. Injuries ranged from trivial to those producing deep coma. A coma scoring system (to correlate level of consciousness with age and outcome) was devised. Lateralizing neurological signs, fontanelle status, retinal hemorrhages, seizures, and skull fractures were correlated with age, outcome, and late onset of seizures. Children of 1 year and younger were more prone to have a poor outcome in all coma grades except the deepest, where the trend apparently reversed. Of the three components of the coma score (ocular, motor, verbal) the ocular score more constantly reflected neurological damage. Subdural hematomas, which were largely responsible for poorer outcomes in infants, occurred almost exclusively in children under 1 year of age. Lateralizing neurological signs, which were not found to correlate directly with a poor outcome, were unilateral Babinski, ataxia, and the combination of ocular deviation and hemiparesis (which is probably a seizure variant). Hemiparesis alone, however, did correlate directly with a poor outcome, as did full, and especially tense, fontanelle, and split sutures or diastatic fractures. Linear fractures, when unilateral, were not associated with a poor outcome, although bilateral linear and depressed fractures were. Bilateral retinal hemorrhages were found to be both quantitatively and qualitatively different from unilateral retinal hemorrhages, and to be statistically more often associated with subdural hematoma.
Pain in Children with Spinal Cord Tumors
Authors: Sun Hahn Yoon , McLone David G.
Published: March 2008

Pain in children is generally not accorded the same significance by allied health professionals as pain in adults. To some extent this relative neglect may be the result of a general belief that pain is less of a problem in the pediatric age-group. However, it is the authors’ experience that the management of pain in children with spinal cord tumors reveals the same significance as in adults. From 1970 to 1980, 54 cases of spinal cord tumor were reviewed at the Children’s Memorial Hospital and analyzed for their ‘verbal’ and ‘nonverbal’ pain descriptions. There were 22 extradural tumors, 20 intradural extramedullary and 12 intramedullary tumors. The patients ranged in age from 5.5 months to 15 years. The patients were divided into two groups. Group I (18 children) were under 3 years of age, and group II (36 children) were over 3 years of age. In both these groups pain was the most common finding (78%), followed by motor weakness (76%), pathological reflexes (74%) and sensory change (50%). Group I has 27 pain expressions (1.5 pain complaints per patient) and group II had 59 pain expressions (1.6 complaints per patient). Thus, the children of group I and group II expressed a similar number of pain complaints. However, in group I the majority (74%) of pain expressions were ‘non-verbal’, while in group II, the majority (85%) of pain expressions were ‘verbal’. 2 typical cases of children with spinal cord tumors whose pain evolved from infantile ‘nonverbal’ and ‘verbal’ pain description to adulthood pain descriptions are illustrated.
CT Findings of Medulloblastoma
Authors: Tsuchida Tadashi , Tanaka Ryuichi , Fukuda Mitsunori , Takeda Norio , Ito Jusuke , Honda Hiraki
Published: March 2008

Computed tomography (CT) of 11 patients with medulloblastoma was evaluated. 6 of them showed solid, nearly homogenous lesions and definite enhancement after infusion of contrast medium. However, 5 cases showed heterogenous mass lesions composed of the areas of low density and iso- or slightly high density which was attenuated by contrast enhancement. Histological examinations revealed that 2 cases had differentiated medulloblastomas, but the other 3 typical medulloblastomas. It should be reminded in the differential diagnosis of cerebellar tumors of pediatric patients that medulloblastoma can reveal heterogenous mass in CT scan.
Porencephalic Congenital Cysts with Hydrocephalus
Authors: Suarez J.C. , Sfaello Z.M. , Albarenque M. , Viano J.C.
Published: March 2008

The therapeutic criteria according to tomographic findings are reviewed. 10 children, 6 male and 4 female, with porencephalic congenital cysts were studied. Early symptoms began within the first 6 months of life in 9 cases, and at the age of 5 years in 1. The most frequent symptoms were: seizures in 3; motor deficit in 5; retarded psychomotor development in 7; endocranial hypertension syndrome in 7; symmetric macrocrania in 7; paresis ofthe motor ocular nerves in 4. Preoperative studies: (1) X-ray films- 1 each patient – showed diastasis of sutures in 6 and cranial asymmetry in 2. (2) Electroencephalograms – 6 patients
Hydrocephalus Diagnosed Prenatally
Authors: Amacher A.L. , Reid W.D.
Published: March 2008

4 children with hydrocephalus diagnosed prenatally by uterine ultrasound are presented. In spite of severe hydrocephalus at birth, 3 of the 4 are normal 3.5–5.5 years following surgical therapy. The implications of hydrocephalus diagnosed prenatally are discussed.
Neuropathologic Features, Including Pontine Schwannosis, in a Four-Year Survivor of Probable Reye’s Syndrome with Secondary Möbius Syndrome
Authors: Manz H.J. , Cochran W.
Published: March 2008

Frequent seizures and loss of motor, language, and intellectual skills necessitated care in an institution for the physically and mentally handicapped for 4 years after diagnosis of presumed Reye’s syndrome in a 10-month-old boy. Möbius syndrome was diagnosed and bilateral tarsorrhaphy performed for exposure keratitis. Postmortem examination revealed multiple old boundary zone infarcts in the cerebral cortex, small cavitated infarcts in basal ganglia and thalami, diffuse neuronal loss and gliosis, and a focus of old necrosis in the pons; brain stem hemiation during the acute phase of Reye’s syndrome was responsible for the latter lesion. Irregular congeries of proliferated peripheral nerves, confirmed by ultra-structural study, were ramifying in the gliotic pontine tegmentum. The pathologic substrate for the neurovegetative state in a long-term survivor of probable Reye’s syndrome appears to be multifocal cerebral infarction.
The Occipital Transtentorial Approach to the Posterior Fossa in the Pediatric Patient
Authors: Barba D. , James H.E.
Published: March 2008

The occipital transtentorial approach to the high posterior fossa has been previously described for the adult neurosurgical patient. In this presentation 5 pediatric patients with differing pathology in the posterior fossa are reported following successful occipital transtentorial operations. The advantages of this approach over the suboccipital route for microneurosurgery are discussed.
Moyamoya Disease in Children and Its Surgical Treatment
Authors: Matsushima Yoshiharu , Inaba Yutaka
Published: March 2008

Moyamoya disease is an unusual form of chronic cerebrovascular occlusive disease characterized usually by bilateral stenosis of distal internal carotid arteries and their vicinity, by a hazy network of collateral circulation at the base of the brain called moyamoya vessels and clinically by recurring hemispheric ischemic attacks in children. This disease was first reported by a Japanese neurosurgeon and many reports and studies on this disease have been published in Japan. We report here the recent progress in the diagnosis of the disease and introduce a newly developed operative procedure which we think is an ideal surgical method for treating this disease in children.
Argon Laser Surgery of Pediatric Neural Neoplasms
Authors: Edwards Michael S.B. , Boggan James E.
Published: March 2008

The argon microsurgical laser offers a less traumatic and often more hemostatic technique for the ablation of neural and tumor tissues. Our experience in 15 microsurgical procedures is discussed. The argon laser was essential in the removal of small, moderately vascular, strategically placed intracranial and spinal lesions. In each of these cases, the laser either permitted a complete resection or augmented the amount of tumor resected over that which could be removed by standard microsurgical technique. The laser was not beneficial in operations on large lesions or those with markedly increased blood flow. There were no early or late complications related to the use of the argon laser. Further advances in laser technology will afford significant improvements over the presently available techniques of laser microneurosurgery.
Shunt Nephritis: A Report on Five Children
Authors: Zamora I. , Lurbe A. , Alvarez-Garijo A. , Mendizabal S. , Simon J.
Published: March 2008

Of 5 children with glomerulonephritis with infected ventriculoatrial shunt, 3 had improved renal function after antibiotic therapy and removal of the infected shunt. 1 patient with endoextracapillary proliferative glomerulonephritis with 70% glomerular crescents developed a rapidly progressive renal insufficiency. Renal failure was successfully managed by hemodialysis and kidney transplantation. 1 patient died from extrarenal causes in the course of a septic episode.
Intracerebellar Hemorrhage Due to Rupture of Angiomatous Malformations in the Cerebellum
Authors: Aki Toshio , Ichikizaki Kiyoshi , Iwata Takanobu , Miyahara Yasuyuki , Dohmoto Yoichi , Sato Shyuzo , Toya Shigeo
Published: March 2008

Two infants were reported with intracerebellar hemorrhage due to rupture of angiomatous malformations in the cerebellum. There have been only a few reports on intracerebellar hemorrhage under 6 years of age, which was due to angiomatous malformation in all cases. The results of operations for intracerebellar hemorrhage in infants were more favorable than those in adults, so even if the infant patient shows severe neurological symptoms preoperatively, an operation should be performed.
Infantile Hydrocephalus: Long-Term Results of Surgical Therapy
Authors: Amacher A.L. , Wellington J.
Published: March 2008

A personal series of 170 children who underwent 636 operative procedures for hydrocephalus have been followed for 5–12 years. The results of treatment have been analyzed by etiology, years of follow-up, and summarized generally. 5-year survival was 83.5%, current survival is 78.8%. Normal intelligence was found in 63.4% of 5-year survivors, in 64.2% of current survivors. The procedural risk for early shunt infection was 5.8%, while 6.5% of the patients developed a late infection. There is no difference in results based upon measurement of the initial thickness of the cerebral mantle. The mean of the cumulative shunt procedures per patient is 3.72 ± (SEM) 0.37, and for 5-year survivors it is 3.85 ± (SEM) 0.39.
Metrizamide Cisternography and the Management of the Chiari II Malformation
Authors: Faria, Jr. Miguel A. , Hoffman, Jr. James C. , O’Brien Mark S.
Published: March 2008

A case of Arnold-Chiari malformation (Chiari type II) is reported to describe the usefulness of metrizamide cisternography in the diagnosis and management of this condition.
Epidural Haematoma in a Paediatric Population
Authors: Singounas E.G. , Volikas Z.G.
Published: March 2008

Over a period of 3 years, 23 cases of epidural haematoma were observed in our department. The Data of these 23 cases were analyzed; in a few of them the statistics of the world literature was confirmed, but 17 of the 23 had a few interesting and characteristic features, which are studied and discussed.
Neural Defects in Say-Gerald (VATER) Syndrome
Authors: Aleksic S. , Budzilovich G. , Greco M.A. , Reuben R. , Feigin I. , Pearson J.
Published: March 2008

The Say-Gerald (VATER) syndrome consists of vertebral defects, anal atresia, tracheoesophageal fistula, radial dysplasia and renal defects. 2 children with Say-Gerald (VATER) syndrome were autopsied: the first child was found to have hydrocephalus, aqueductal stenosis and probable craniosynostosis, and the second child had hypoplasia of the nerve roots and anterior and posterior horns of the spinal cord, corresponding to the hypoplastic limb. It is suggested that the Say-Gerald syndrome is a multifocal developmental disorder in which central nervous system anomalies may be found. The children with Say-Gerald syndrome should have a complete neurological examination in order to rule out a potentially treatable central nervous system defect.
Evidence for Late Developmental Deficit in Very Low Birth Weight Infants Surviving Intraventricular Hemorrhage
Authors: Scott David T. , Ment Laura R. , Ehrenkranz Richard A. , Warshaw Joseph B.
Published: March 2008

88 very low birth weight preterm infants who had been evaluated with neonatal computed tomography scanning and/or echoencephalography were subsequently brought to follow-up. Serial neurodevelopmental testing at 6, 12, and 18 months corrected age demonstrated that even the lesser grades of germinal matrix and intraventricular hemorrhage may be associated with a relatively less favorable neurodevelopmental outcome.
Extradural Meningeal Cyst
Authors: Roski Richard A. , Rekate Harold L. , Kurczynski Thaddeus W. , Kaufman Benjamin
Published: March 2008

Extradural meningeal cysts are rare spinal lesions. The clinical presentation is most often characterized by a slowly progressive spastic paraparesis, frequently associated with pain. Adequate drainage of the cyst with obliteration of the neck of the cyst or complete removal of the cyst can bring about a permanent resolution of the symptoms. The use of somatosensory cortical evoked responses also has an important role in the surgical management of this problem.
Cystoperitoneal Shunting for Congenital Arachnoid Cysts
Authors: Kaplan Barry J. , Parker Mickle J. , Parkhurst Robert
Published: March 2008

Between 1980 and 1982, 8 children with congenital arachnoid cysts were treated at the University of Florida, 2 patients presented with unusual clinical syndromes, including isosexual precocity and a cephalic movement disorder. Cystoperitoneal shunting in combination with ventriculoperitoneal shunting for associated hydrocephalus was employed in the treatment of all supratentorial lesions, and proved to be a safe, efficacious mode of therapy.
Dorsal Cyst Malformations
Authors: Yokota Akira , Oota Tatsuhiko , Matsukado Yasuhiko
Published: March 2008

Among the cerebral malformations accompanying cystic cavity in the dorsal midline, common radiological findings of galenic dysgenesis are found in 10 cases, which are now reported as dorsal cyst malformations. The authors classified dorsal cyst malformations into prosencephalic, interhemispheric, and porencephalic types according to clinical, radiological, and presumed pathogenetic characteristics. In contrast to recent trends that most of cerebral malformations with dorsal midline dysgenesis are included in the holoprosencephalic category, the authors emphasize that these interhemispheric and porencephalic types of dorsal cyst malformations, though presenting interhemispheric cyst with callosal defect or broad communication between the lateral ventricles, should be separated from holoprosencephaly, because they are completely hemispheric.
Congenital Anaplastic Ependymoma: A Case Report of Familial Glioma
Authors: Sato Toshihiro , Shimoda Akihisa , Takahashi Tatsuro , Kurokawa Hiroshi , Ando Masakatsu , Goto Satoshi , Takamura Haruo
Published: March 2008

A congenital anaplastic infratentorial ependymoma, occurring in a female infant whose sister also died of brain tumor, is described. The tumor, located in the cerebellum and the fourth ventricle, is characterized by predominantly undifferentiated neuroepithelial cells associated with numerous mitoses, and partially of the cells demonstrating differentiation into ependymal cells and astrocytes. Of special interest is the fact that the elder sister of the patient had also died of a congenital glioma located in the cerebellum and the fourth ventricle, which leads to the discussion about the influences of genetic factors in the development of the familial gliomas as well as about the histogenesis of the tumor examined.
Surgically Treatable Growth Retardation Due to Non-Neoplastic Pituitary-Hypothalamic Dysfunction
Authors: DiRocco Concezio , Iannelli Aldo , Borrelli Patrizia , Cappa Marco , Colosimo, Jr. Cesare
Published: March 2008

Out of 90 children, examined because of growth failure, 15 have been treated surgically. The diagnoses were intrasellar arachnoid diverticulum or empty sella (5 cases), enlarged chiasmatic cisterns (5 cases), chronic ‘occult’ hydrocephalus (5 cases). Surgery was followed by an immediate increase in growth rate in almost all the cases, even if the result was persistent only in some subjects. In percentage, better results were obtained in patients with enlarged chiasmatic cisterns and chronic occult hydrocephalus than in patients with arachnoid diverticulum or empty sella. The evaluation of prolactin serum levels was demonstrated to be useful both in preoperative diagnosis and postoperative control.
High-Dose 1-(4-Amino-2-methyl-5-pyrimidinyl)-methyl-3-(2-chloroethyl)-3-nitrosourea Hydrochloride (ACNU) with Autologous Bone Marrow Rescue for Patients with Brain Stem Tumors
Authors: Hara Toshiro , Miyazaki Sumio , Ishii Eiichi , Yoshida Nobuyuki , Inaba Koichi , Ikeda Kimiaki , Goya Nagahide
Published: March 2008

4 patients with brain stem tumors were treated with high-dose ACNU with autologous bone marrow rescue. Hematologic and nonhematologic toxicities were not profound. There was objective evidence of response in 2 out of the 4. All were alive for 11–21 months from onset. Safe administration of high-dose ACNU with marrow rescue will warrant further control studies to determine its superiority over conventional doses.
Dorsal Cyst Malformations
Authors: Yokota Akira , Oota Tatsuhiko , Matsukado Yasuhiko , Okudera Toshio
Published: March 2008

In the preceding part, galenic dysgenesis was stated to be a diagnostic hallmark of dorsal cyst malformations. Failed formation of the galenic drainage system conducts the diencephalic drainage laterally into the transverse sinuses as in the embryonal stage, and it is frequently associated with arrested descent of the torcular portion or other anomalies of the dural sinuses. Highly malformed structures of the deep cerebral veins and the dural sinuses seen in this malformation are correctly interpreted in comparison with findings of venous injection studies performed in human fetuses. Pathogenesis of this malformation is also discussed on the basis of embryological studies of the dural sinuses and falcotentorial structures.
Role of Complex Carbohydrates and Neurulation
Authors: McLone David G. , Knepper Paul A.
Published: March 2008

Extracellular and cell-coat complex carbohydrates play a major role in critical cellular functions, e.g., cell recognition and cell-to-cell adherence, which are involved in neurulation. To date, available evidence suggests that neurulation is a combination of intercellular and extracellular biochemical and morphological events which are under the direction of the genome. To define the carbohydrate components that are essential to neurulation, normal C-57 and abnormal splotch (Sp/Sp) mouse embryos were studied using fluorescein-labeled lectins and computer-aided microspectrophotometric analysis of hyaluronate lyase and chondroitin ABC lyase-sensitive Alcian blue staining. Preliminary results of these studies indicate that the neuroepithelium of the splotch Sp/Sp mutant, a genetic model of a primary neural tube defect, is characterized by alterations in the type and amount of glycoconjugates and in the concentration of individual glycosaminoglycans. This review of mammalian neurulation discusses the importance of complex carbohydrates on the cell surface of the neuroepithelium of the closing neural fold.
Intraspinal Masses: Efficacy of Plain Spine Radiography
Authors: Naidich Thomas P. , Doundoulakis Stephen H. , Poznanski Andrew K.
Published: March 2008

Plain spine radiographs from 31 patients with pathologically proven intraspinal tumors were analyzed retrospectively by an experienced pediatric radiologist unfamiliar with the cases in order to evaluate the applicability and reliability of the radiographic signs commonly used for diagnosis. Interpediculate distances (IPDs) were graphed onto standard curves to assess whether graphic analysis aided in diagnosis. In this group of patients, no single radiographic criterion permitted better than 40% true-positive diagnosis. False-positive diagnoses were made in 0–10% of cases, depending on the sign employed. Use of multiple roentgen signs in conjunction achieved 55% true-positive and 3% false-positive diagnoses, while use of graphed IPDs alone achieved 57% true-positive and 11% false-positive diagnoses. Addition of graphed IPDs to visual inspection of the radiographs led to detection of 6 tumors (19%) not otherwise appreciated, but tripled the false-positive rate from 3 to 10%.
Skeletal Morphology of Anterior Encephaloceles Defined through the Use of Three-Dimensional Reconstruction of Computed Tomography
Authors: Hemmy David C. , David David J.
Published: March 2008

We have used three-dimensional reconstruction of computed tomography to study the morphology of anterior encephaloceles. The findings based on living patients rather than cadaver specimens confirm previous findings suggesting ‘blow out’ defects which displace otherwise normal osseous structures.
Lasers in Pediatric Neurosurgery
Authors: Walker Marion L. , Storrs Bruce B.
Published: March 2008

The carbon dioxide (CO2) laser is a microsurgical instrument to be used in conjunction with good neurosurgical technique. Laser surgery has special applications in pediatric neurosurgery because of the type and location of many pediatric tumors as well as the laser qualities of precision and decreased tissue trauma. The CO2 laser has proven to be a valuable surgical tool in this series of pediatric spinal cord and brain tumor patients. The areas of most effective laser treatment were the posterior fossa, ventricles, spinal cord and the suprasellar area. The laser was least helpful in tumors of the hemispheres and the hypothalamus. Criteria need to be developed for absolute and relative indications for CO2 laser use.
Guidelines for Illustrations
Authors: Vetter John P.
Published: March 2008

Illustrations are frequently employed to support or amplify the textual content of an article. When illustrations fail to support the needs of the text, the result may be confusing and detrimental to the reader. Guidelines are presented to ensure that the illustration on the printed page provides all the visual information intended by the author.
Experience with 1201 Cerebrospinal Fluid Shunt Procedures
Authors: Shurtleff David B. , Stuntz Timothy , Hayden Patricia W.
Published: March 2008

This report of our experience with 1,201 cerebrospinal fluid shunt procedures over a 17-year period includes two time periods: from 1965 to 1974 and from 1975 to 1982. The overall operative infection rate fell from 10.7% in the former period to 3.6% in the latter period. The overall average number of revisions fell from 1.8 to 0.77. The number of revisions for patients with infected shunts in the latter period was 4.07. Three hundred and eighty-four shunts were studied in the latter period for the effects of prophylactic antibiotics. No significant difference was found between the infection rate of 5.6% in the nonantibiotic group and the infection rate of 2.1% in the group receiving intravenous and intraventricular methicillin and gentamicin. Differences in the operative infection rates for patients with and without meningomyelocele and those operated on by different surgeons were not significant. The only mortalities were from nonoperative and noncerebrospinal fluid shunt causes.
Animal Bites Causing Central Nervous System Injury in Children
Authors: Steinbok Paul , Flodmark Olof , Walton Scheifele D.
Published: March 2008

Three cases of animal bites causing central nervous system injury in children are reported. Two infants suffered compound depressed skull fractures as a result of dog bites to the head. An older child suffered direct injury to the spinal cord from a tiger bite. In 2 cases, Pasteurella meningitis occurred. Pitfalls in the management of this type of problem are discussed.
Frequency of Agenesis of the Corpus Callosum in the Developmentally Disabled Population as Determined by Computerized Tomography
Authors: Jeret Joseph S. , Serur David , Wisniewski Krystyna , Fisch Clifford
Published: March 2008

Agenesis of the corpus callosum (ACC) is an infrequent congenital abnormality that has been diagnosed by necropsy, surgery, pneumoencephalography, computerized tomography (CT), and magnetic resonance imaging. The reported prevalence has varied as a function of disability status of the population studied and diagnostic technique. This report found 33 cases of ACC in a consecutive series of 1,447 CTs of developmentally disabled individuals. The prevalence, 2.3%, is consistent with studies using other techniques. However, the significantly higher (p < 0.01) rate from 1978 to 1979 suggestes an initial tendency of neuroradiologists to overdiagnose ACC, and CT data from the 1970s may need to be reexamined.
Intracranial Meningiomas in Children
Authors: Drake James M. , Hendrick Bruce , Becker Laurence E. , Chuang Sylvester H. , Hoffman Harold J. , Humphreys Robin P.
Published: March 2008

Thirteen cases of intracranial meningioma presenting in childhood were encountered at the Hospital for Sick Children in Toronto over a 51-year period. The clinical features, radiology, operative findings and outcome are reviewed.
Benign Extra-Axial Collections of Infancy
Authors: Carolan Patrick L. , McLaurin Robert L. , Towbin Richard B. , Towbin Jeffery A. , Egelhoff John C.
Published: March 2008

The clinical histories, physical examinations and results of head computed tomography and head ultrasound scans were reviewed in a group of 15 infants who had macrocrania, excessive extra-axial fluid and normal development. Diagnostic evaluations demonstrated mild ventriculomegaly and extra-axial fluid collections. No treatment was undertaken. All infants continued to exhibit normal development during a period of extended follow-up. In this select group of infants exhibiting these findings, treatment appears to be unnecessary and the prognosis for continued normal development is excellent.
Mode of Prevention by Phototherapy of Cerebellar Hypoplasia in a New Sprague-Dawley Strain of Jaundiced Gunn Rats
Authors: Keino Hiroomi , Sato Hiroshi , Semba Reiji , Aono Sachiko , Aoki Eiko , Kashiwamata Shigeo
Published: March 2008

Postnatal changes in cerebellar wet weight and the effect of phototherapy were studied using a new strain of Gunn rats with a genetic background of the Sprague-Dawley strain (SDGR). The cerebellar wet weight of homozygous rats reached a maximum at postnatal day 10 and then it gradually decreased up to day 20, suggesting that the cerebellar hypoplasia of the rats was a consequence both of cellular underdevelopment and degeneration. Histological examinations of the 10 cerebellar lobules showed that lobules I-VIII of homozygotes were severely damaged while lobules IX and X were less affected, coinciding with previous reports of Wistar strain Gunn rats. Photoirradiation with blue light of homozygous rats from day 1 through 15 markedly improved their cerebellar development, and the cerebellar wet weight of these rats was almost comparable to that of heterozygous rats as examined at day 30. Photoirradiation from day 1 to 5 protected, though not fully, lobules I-V and VIII against damage, but not lobules VI and VII at all. Photoirradiation from day 6 to 10 prevented all the lobules from hypoplasia. Irradiation from day 11 to 15 was effective only at the tips of lobules VI and VII. These results indicate that the cerebellar hypoplasia of jaundiced Gunn rats can be effectively prevented by a series of photoirradiation during a particular period after birth and also that the most effective period is different among the lobules.
Magnetic Resonance Imaging of the Dandy-Walker Malformation
Authors: Hanigan William C. , Wright Robert , Wright Steven
Published: March 2008

Five cases of the Dandy-Walker malformation are described using the magnetic resonance (MR) scan as a primary imaging technique. The patients’ ages ranged from 34 weeks (in utero) to 41 years; their clinical and neuroanatomical characteristics encompassed the entire spectrum of the malformation. Clear visualization of the greatly enlarged posterior fossa, Dandy-Walker cyst, and absence of the inferior vermis established the pathological diagnosis and excluded other structural defects. In 3 patients, MR demonstration of the aqueduct and evidence of pressure on adjacent tissue aided in the surgical planning for ventricular decompression. The MR scan is a significant advancement in the radiological diagnosis of the Dandy-Walker malformation. The major technical advantage of the scan consists in its ability to delineate intracranial morphology in multiple planes.
Spinal Metastasis in Primitive Neuroectodermal Tumors (Medulloblastoma) of the Posterior Fossa: Evaluation with CT Myelography and Correlation with Patient Age and Tumor Differentiation
Authors: George Richard E. , Laurent John P. , McCluggage Charles W. , Cheek William R.
Published: March 2008

Twelve consecutive children with primitive neuroectodermal tumors of the posterior fossa (PNET-PF) were evaluated for spinal metastases with CT metrizamide myelography (CTMM) in the early postoperative period. Metastases were identified in 5 children (42%) and all were noted to have deposits in the thoracic region. All children with metastases were less than 3 years old and had differentiated PNET-PF.
The Neuroleptic Malignant Syndrome: Occurrence in a 15-Year-Old Boy and Recovery with Bromocriptine Therapy
Authors: Tenenbein Milton
Published: March 2008

The neuroleptic malignant syndrome (NMS) is an idiosyncratic reaction to neuroleptic medication not previously described in the pediatric literature. It is characterized by hyperthermia, extrapyramidal disorders, decreased level of consciousness and autonomic dysfunction. A 15-year-old boy with acute lymphoblastic leukemia developed the NMS after a brief exposure to chlorpromazine and promethazine. He responded favorably to the dopamine agonist bromocroptine. A review of the recent literature suggests bromocriptine as the most efficacious specific therapy. Management of the NMS includes immediate discontinuation of all neuroleptic agents, intense supportive care and prompt institution of bromocriptine therapy.