bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasonographic Evaluation of Intraperitoneal CSF Pseudocyst
Authors: Raghavendra B.N. , Epstein Fred J. , Subramanyam Bala R. , Becker Melvin H.
Published: March 2008

3 patients with intraperitoneal cerebrospinal fluid pseudocyst occurring as a complication of ventriculoperitoneal shunt procedure are reported. Early utilization of sonography helped establish the diagnosis rapidly and noninvasively in all cases.
Pinealoma (Germinoma) Treated by Direct Surgery and Postoperative Irradiation
Authors: Sano Keiji , Matsutani Masao
Published: March 2008

60 cases of histologically verified pinealoma of the two-cell-pattern type (the so-called germinoma) experienced from 1962 to 1979 were submitted to direct surgery (by occipital transtentorial approach or infratentorial supracerebellar approach in case of tumors in the pineal region and subfrontal approach in cases of suprasellar tumors) and postoperative irradiation. Locations of tumors were 32 in the pineal region, 20 in the suprasellar region, and 8 in other areas. There was no operative mortality. The postoperative survival rates (the observed survival rates) of these cases were as follows: the 1-year survival rate (1 YSR) was 94.8%, the 5-year survival rate (5 YSR) was 74.8% and 10-year survival rate (10 YSR) was 69.3%. As for pinealomas in the pineal region, 1 YSR was 93.5%, 5 YSR was 64.7% and 10 YSR was 60.1 %; for tumors in the suprasellar region, 1 YSR was 100%, 5 YSR was 100% and 10 YSR was 92.3%. In cases aged from 15 years up, 1 YSR was 93.7%, 5 YSR was 65.0% and 10 YSR was 60.2%, and in cases under 15 years (children), 1 YSR was 95.1%, 5 YSR was 86.9% and 10 YSR was 86.9%. Thus, the results were much better in suprasellar germinoma cases than in pineal cases and in children than in adolescents and adults. Suprasellar germinoma cases under 15 years showed 100%in 1 YSR, 5 YSR and 10 YSR. The reason for this is probably that surgical removal of tumors or reduction of the bulk of tumors may be easier or more extensive in suprasellar germinomas than in pineal germinomas. Among these 60 cases, 2 died of recurrence of tumor, 3 died of dissemination metastases in the cerebrospinal fluid space and the other 11 died of other diseases or due to unknown cause. Besides these 60 cases, 10 cases of probable pinealomas (germinomas) were treated by irradiation without direct surgery. Among these, 1 case died 3 years and 1 month later and 1 case had recurrence and was irradiated again. Most of these cases were experienced in the past 2 years and the follow-up was not long enough. All these cases had rather small tumors, single or multiple. The histogenesis of the tumor and the causes of its radiosensitivity are discussed.
Characteristics of Intracranial Meningiomas in Childhood
Authors: Sano Keiji , Wakai Susumu , Ochiai Chikayuki , Takakura Kintomo
Published: March 2008

18 cases of meningiomas in childhood below the age of 15 years at the onset of symptoms and signs were experienced in our clinic. They were studied as for the incidence, age and sex distributions, symptoms and signs at the onset, tumor locations, histological types, presence of cyst, dural attachments, and prognosis, in comparison with cases in adolescence (18 cases) and in adults (498 cases). Distinctive features in childhood meningiomas were: (1) relatively high incidence in the lateral ventricles (11.1%), (2) high incidence of cyst formation in the tumor (16.7%), and (3) of cases without any dural attachment (12.5%). These features were statistically significant as compared to adult cases (p<0.05). Features 1 and 2 were also true for adolescence cases. It was also revealed that male patients were predominent in childhood and adolescence (M:F= 10:8) in contrast to female predominance in adults (M: F = 1:1.6). The most frequent histological type was sarcomatous type (6 out of 18). It may be of interest that 3 cases of this malignant type have been alive for more than 10 years.
Multidisciplinary Treatment of Medulloblastoma: A 5-year Experience with the SIOP Trial
Authors: Gerosa Massimo A. , di Stefano Enzo , Olivi Alessandro , Carteri Alessandro
Published: March 2008

A 5-year experience of the multidisciplinary treatment of pediatric medulloblastoma with the SIOP (International Society of Pediatric Oncology) trial is presented. 33 eligible patients finally reduced to a total of 30 evaluative cases were treated with major surgical resection, extensive irradiation, and combined chemotherapy (vincristine + CCNU). The overall survival rate without recurrence was encouraging, and the actuarial survival rate is satisfactory. At follow-up controls, most of the patients showed a good performance status and a promising neurological stage. However, the problem concerning quality of life remains unsolved: morbidity and sequelae following high-dose radiotherapy and concomitant antiblastic treatment were noticeable.
Infratentorial Arachnoid Cysts in Children
Authors: di Rocco Concezio , Caldarelli Massimo , di Trapani Girolamo
Published: March 2008

8 Children surgically treated for posterior fossa arachnoid cyst are described. In all the cases an enlarging head was the presenting sign; intracranial hypertension was evident in 6 patients; 2 children were clinically regarded as being affected by ‘arrested’ hydrocephalus. Preoperative subarachnoid lumbar infusion tests (8 cases) and prolonged intraventricular CSF pressure recordings (2 cases) demonstrated abnormal CSF dynamics in 6 cases. Ultramicroscopic examinations of the cyst wall (4 cases) suggest alterations in the anatomical arrangement of the arachnoid membrane, which supports the hypothesis of maldevelopment as the origin of the lesion.
Total Craniopagus Twins
Authors: Villarejo F. , Soto M. , Amaya C. , Pascual-Castroviejo I. , Morales C.
Published: March 2008

The frequency of craniopagus twins is very low and so far only 32 cases have been reported in the literature. Most of authors give a frequency of 1 in 2.5 million births, although, since numerous cases are not reported, it is probable that the occurrence is greater than this figure indicates. A new case of conjoined twins by the head is presented.
Dandy-Walker Malformation and Associated Cardiac Anomalies
Authors: Olson Gary S. , Halpe Dudley C.E. , Kaplan Allen M. , Spataro Joseph
Published: March 2008

2 patients with Dandy-Walker malformations (DWM) and cardiac anomalies are presented. The types of cardiac defects with septal involvement are suggestive of an early embryonic abnormality occurring before 6 weeks’ gestational age. This correlates with the postulated timing of the development of the DWM and suggests a complex developmental anomaly. Awareness of the associated systemic and central nervous system anomalies in patients with the DWM in regard to management and prognosis is emphasized.
Sacral Intraspinal Lipoma Associated with Congenital Iliac Anomaly
Authors: Cohen J.Y. , Lebatard-Sartre R. , Lajat Y. , Mitard D. , David A.
Published: March 2008

2 cases of a peculiar unilateral protuberance near the iliac bone with intraspinal abnormalities are reported. 8 cases have been described in the literature with this characteristic congenital association; they indicate the frequency of an occult spinal dysraphism which must be proved by myelography. In each case, surgical treatment of bone abnormality or of intraspinal lesions, or of both, should be discussed.
Effect of Multiple Trauma on Outcome of Pediatric Patients with Neurologic Injuries
Authors: Mayer Thorn , Walker Marion L. , Shasha Itzhak , Matlak Michael , Johnson Dale G.
Published: March 2008

In a 3-year period, 95 patients with severe head injury (unconsciousness greater than 6h duration) were treated at our institution. Of these, 46 patients (48%) had isolated head injury and 49 (52%) had head injury plus severe multiple trauma. Multiple trauma was scored using the Modified Injury Severity Scale. All patients in the multiple trauma group had at least one additional area of severe injury. Severity of head injury, judged by Glasgow Coma Score, presence of mass lesions, abnormal posturing or flaccidity, impaired or absent oculocephalic reflexes, and fixed, dilated pupils, was much greater in the isolated head injury group. Inspite of this, poor outcome (death or vegetative/severe disability) was 2½ times as frequent in the multiple trauma group. Shock, refractory hypoxemia and sepsis were contributing factors in this increased morbidity and mortality. Increasing Modified Injury Severity Scale scores were associated with increased morbidity and mortality.
Spinal Chordomas in Infancy
Authors: Occhipinti Emanuele , Mastrostefano Roberto , Pompili Alfredo , Carapella Carmine M. , Caroli Fabrizio , Riccio Antonio
Published: March 2008

Chordomas are extremely rare among the spinal tumors in pediatric age. The sacrococcygeal region is the typical site of such a lesion. A case of spinal chordoma in a child 4 years old, at the T12-L1 level, is reported. The tumor was surgically removed and a local radiotherapy was performed, but 9 months later spreading of lung metastases was observed. The unusual site along the vertebral column and the metastatic potential of this tumor are discussed. The very few cases reported in the literature are analyzed.
Hemorrhagic Brain Tumors in Pediatric Patients
Authors: Laurent John P. , Bruce Derek A. , Schut Luis
Published: March 2008

In an unselected pediatric series of 113 newly tissue verified intracranial tumors, intracranial hemorrhage was the initial presentation in 10% of the cases. Review of all cases of subarachnoid hemorrhage admitted to Children’s Hospital of Philadelphia during the period of 1976-1979 revealed that intracranial tumors were present in 15%. The largest hemorrhagic pathological group was medulloblastoma-primitive neuroectodermal tumors. No particular age predominance was noted. The high incidence of intracranial tumoral hemorrhage in this series of pediatric patients suggests that this may be a more common presentation than previously reported.
Brain Tumors in Tuberous Sclerosis
Authors: Tsuchida Tadashi , Kamata Kenichi , Kawamata Masaharu , Okada Kohei , Tanaka Ryuichi , Oyake Yo
Published: March 2008

We report on 4 cases of brain tumors associated with tuberous sclerosis. In each case the tumor was in the region of Monro’s feramen and was associated with ventricular dilatation. Computer tomography scans, which were performed in 3 cases, revealed well-circumscribed high-density masses which were markedly enhanced by contrast medium. 3 patients underwent craniotomy. Total extirpation was performed in 2 patients. Both of them are doing well postoperatively. However, 1 patient whose tumor had been partially resected died of recurrence 6 years after surgery. The pathology of three tumors was different in each case: plump cell astrocytoma, hemangioma and astroblastoma.
Microscopic Studies in Shunts for Hydrocephalus
Authors: Guevara Juan A. , La Torre José , Denoya Claudia , Zúccaro Graciela
Published: March 2008

Valve-regulated systems, used for the treatment of hydrocephalus, were studied with the scanning electron microscope. The study was performed on unused systems of shunt replaced after different pathologies and on systems removed due to cerebrospinal fluid infection. Defects in the material, such as holes and protrustions, were systematically found in new systems. Aged shunts (1–8 years of implantation) as well as those removed in cases of cerebrospinal fluid infections showed important changes in the structure of the material too; it was also found that biological material, such as fibrin, red blood cells and bacteria, were able to adhere to the walls of the catheter tubing. These results indicate that the scanning electron microscope could be a complementary tool to be used in research, diagnosis, and quality control of silicone rubber prosthesis.
A Scale for the Assessment of Neonatal Neurologic Status
Authors: Duncan Charles C. , Ment Laura R. , Smith Barbara , Ehrenkranz Richard A.
Published: March 2008

We have described early experience with the neonatal arousal scale. The infant’s best response to bell and light are assessed and scored in addition to the observation of his spontaneous motor activity or response to tactile stimulation. This approach offers the prospect that rapid, reliable, and repetitive neurologic assessment may be carried out by all levels of personnel caring for small and critically ill neonates. The results of our experience in 100 consecutive patients who survived longer than 24 h have been reported.
Gliomas of the Optic Nerve and Chiasm
Authors: Iraci Giorgio , Gerosa Massimo , Tomazzoli Laura , Pardatscher Kurt , Fiore Daniele L. , Javicoli Raffaele , Secchi Antonio G.
Published: March 2008

A series of 24 children with anterior optic gliomas, observed and for the most part operated upon in a neurostirgical service, is reviewed. A low incidence of unilateral nerve tumors and of associated neurofibromatosis, and a rather high frequency of precocious or pseudoprecocious puberty were noted in comparison with other series. Most tumors were low-grade growths. The results of surgical treatment reflect a good prognosis for unilateral tumors and an increasing prognostic ominousness for the posterior neoplastic development. Cerebrospinal fluid shunts and radiation treatment do have a role as adjuncts to surgical exploration and biopsy, which are generally indicated since no preoperative test seems to grant an absolute diagnosis. The opinion that chiasmal tumors should not be treated at all is not shared.
Influence of Closure Technique on Results in Myelomeningocele
Authors: Guthkelch Norman , Pang Dachling , Vries John K.
Published: March 2008

The results of the repair of myelomeningoceles by, respectively, reconstitution of the neural tube and simple replacement of the placode within the dural sheath are examined. It is concluded that neither offers any significant advantages over the other. When no neurologic function is present below the upper level of the lesion, no method of repair is likely to result in improvement, while the mere preservation of reflex activity in the distal segment of cord may be counterproductive. It is suggested, therefore, that there is a place for immediate excision of the lesion in properly selected cases.
Cerebral Arteriovenous Malformations in Children (56 Cases)
Authors: Gerosa Massimo A. , Cappellotto Paolo , Licata Claudio , Iraci Giorgio , Pardatscher Kurt , Fiore Daniele L.
Published: March 2008

A survey of 56 patients aged ≤ 16 years, admitted (1954–1979) for cerebral arteriovenous malformations, is presented. The clinical manifestation was mostly related to hemorrhage, less frequently to epilepsy or to a cerebral ‘steal’ syndrome. The most frequent site was the parietal lobe, with supply from the middle cerebral artery. Deep malformations were not uncommon and most lesions were of medium or large size. 38 patients were operated upon, and 18 were given treatment other than surgical (including radiotherapy). 23 malformations were completely excised, in 4 patients only a partial excision could be carried out, and in 10 patients surgery consisted of occlusion (clipping or coagulation) of feeding vessels. In 1 patient, surgery had to be limited to removal of an intracerebral hematoma. The immediate and long-term results of treatment are much better in the surgical than in the nonsurgical group.
Period of Risk Hypothesis after Prophylactic Radiotherapy
Authors: Dell Stephen , Cohen Michael , Kushner Michael
Published: March 2008

A critical review is given of the period of risk hypothesis (Collins’s law) in regard to treated medulloblastoma. Exceptions to the law are seen to be of two types. The first type involves recurrence of the primary tumor, either local or disseminated, and is normally observed close to the limit of the risk period. The second type usually presents a malignant astrocytoma at a considerable multiple of the risk period. The relevant pathological and cellular kinetic data are reviewed to answer the question whether glial tumor recurrence is due to dedifferentiation of the primary cell line or is secondary to the therapeutic irradiation.
Intraspinal Meningioma in Childhood
Authors: Nishio Shunji , Fukui Masashi , Kitamura Katsutoshi , Numaguchi Yuji
Published: March 2008

This is a report of a surgically proven meningioma en plaque of the cervical region in a 10-year-old girl.
Chronic Meningococcal Meningitis in an Infant
Authors: Findler Gideon , Hoffman Harold J.
Published: March 2008

The characteristic presentation of meningococcal meningitis is acute and clinically dramatic. This article describes an infant who presented with a bulging fontanelle and left arm weakness, but no signs of infection. Routine CT scan clearly showed hydrocephalus, but did not reveal the underlying ventriculitis which was subsequently disclosed by contrast enhancement. Subsequent CSF cultures grew Neisseria meningitidis.
Spinal Tumors and Hydrocephalus
Authors: Schijman Edgardo , Zúccaro Graciela , Monges Jorge A.
Published: March 2008

Spinal tumors associated with hydrocephalus is a rare condition. The clinical, radiological and pathological features of 6 such cases are reported and correlated with those already published. Hyperproteinorrhachia and arachnoiditis, with basal or cortical blockage of the cerebrospinal fluid pathways have been consistently found and the subsequent hydrocephalus seems to be unrelated to the level, location or the pathology of the spinal lesion.
Pathogenesis of Congenital Midline Porencephaly
Authors: Stein Sherman C.
Published: March 2008

A recent report in this journal described 5 children with holoprosencephaly, parietal scalp anomalies and midline intracranial cysts. The authors coined the term ‘congenital midline porencephaly’ for the clinical syndrome and described the cysts as diverticula of hydrocephalic lateral ventricles. This report describes 3 further children with the same syndrome. The author proposes that the midline cyst is simply a variant of the dorsal cyst reported in other cases of holoprosencephaly. It is further concluded that the cyst arises from primary dysgenesis of cerebral midline structures and is not the result of hydrocephalus. The monoventricle and cyst in these children have the CT scan appearance of the head of a primitive arrow. This ‘arrowhead’ sign may be helpful in the diagnosis of holoprosencephaly with congenital midline porencephaly.
Electroencephalographical-Anatomical Correlation of Brain Tumours in Infancy and Childhood
Authors: Chiofalo N. , Armengol V. , Fuentes A. , Olivares O. , Madsen J. , Vidal P.
Published: March 2008

EEG correlated with anatomical aspects of 198 brain tumours in children gave the following results in hemispheric neoplasms: a rather precise location in 40% of the cases; lateralized in 42%; 14% showed only generalized anomalies and 4% were normal tracings. The findings depended on location and ICP condition, but not on neurological signs nor on histological nature. Basal-midlìne location (88 tumors) displayed 82.4% abnormal EEGs; 50% pointed to the more invaded hemisphere, mainly from the upper brain stem, ventricles and basal ganglia regions. Hypophyseal tumours gave 50% abnormalities with proved compression of the third ventricle, hypothalamus and cerebral peduncles. In posterior fossa tumours (60 cases), abnormalities are frequent (86.7%), but the localizing value of EEG is uncertain due to bisynchronous bursts mainly in the occipital region; 15% were lateralized with correlating asymmetrical location and/or growth of tumours. Differences compared to adult tumours are mentioned as specially influenced by maturational processes of the brain.
Traumatic Brain Lacerations in Children: Surgical Results and Follow-Up
Authors: Tomei Giustino , Gaini Sergio M. , Giovanelli Massimo , Pagni Carlo A. , Villani Roberto
Published: March 2008

75 children ranging in age from 3 months to 14 years, operated on for post-traumatic cerebral lacerations, within an 18-year period, have been analyzed. These represent 2.1% of 3,460 children sustaining head injury and hospitalized during this same period. Total mortality was 16%. The cases were divided into 2 groups: (A) cerebral lacerations underlying a depressed fracture (coup lesion) – 68 cases. In 42 cases the lacerations were focal without edema and/or intracerebral hematoma. 1 child died and 41 survived. In 26 cases the laceration was diffuse and accompanied by cerebral edema and/or intracerebral hematoma. 6 children died and 20 survived. (B) Brain lacerations following a contrecoup lesion – 7 cases. 5 of these children died and 2 survived. The follow-up of the surviving patients in the above two groups hase been discussed.
Intrathecal Chemotherapy for Leptomeningeal Dissemination of Medulloblastoma
Authors: Edwards Michael S. , Levin Victor A. , Seager Margaret L. , Wilson Charles B.
Published: March 2008

Cerebrospinal fluid dissemination of medulloblastoma occurs despite adequate systemic chemotherapy, and unless it is present at the time of initial diagnosis, occurs late in the course of the disease. Intrathecal chemotherapy with an implanted Ommaya reservoir can produce short-term benefit. We report here our protocol for and the results of intrathecal chemotherapy for leptomeningeal dissemination of medulloblastoma.
Computed Tomography in von Recklinghausen’s Disease
Authors: Maki Yutaka , Enomoto Takao , Nose Tadao , Maruyama Hiroshi , Maekawa Kihei
Published: March 2008

Though we knew it would be difficult to predict whether a child having von Recklinghausen’s disease would develop a central nervous system lesion in the future, we tried to find a clue to this question in our study, by comparing computed tomography (CT) findings of 18 children with those of 21 adults. 55% of the children and 85% of the adults showed abnormal findings on CT. The most common finding was mild ventricular dilatation without periventricular hypodensity. Some of them showed ventricular stasis without block on radioisotope cisternography.
Congenital Multiple Angiomatosis with Brain Involvement
Authors: Smit L.M.E. , Barth P.G. , Stam F.C. , Valk J.
Published: March 2008

A case of congenital multiple angiomatosis with cerebral involvement is presented. Postmortem investigation showed identical angiomas on skin and brain. The cerebral vascular tumor has caused altered vascularization of the hemisphere, resulting in a development arrest of the corpus callosum and a fetal appearance of the parietal and temporal vessels.
High Resolution Computerized Tomography with Coronal and Sagittal Reconstruction in the Diagnosis of Brain Tumors in Children
Authors: Snead, III Carter , Acker James D. , Morawetz Richard W. , Benton John W.
Published: March 2008

We present 4 children with brain tumors that were missed or incompletely characterized by conventional computerized tomography (CT) scanning. Using high resolution CT with high dose contrast and three-dimensional reconstruction, we were able to define the anatomy of each tumor and its associated aberrant vasculature. High resolution CT scanning with reconstruction is very helpful in diagnostic problems in which conventional CT scanning fails to provide a clear diagnosis.
Prophylactic Methicillin for Shunt Operations: Effects on Incidence of Shunt Malfunction and Infection
Authors: Haines Stephen J. , Taylor Floyd
Published: March 2008

In a double-blind study, 74 children were randomly treated with prophylactic methicillin at the time of ventriculo-peritoneal shunting. There were 7 infections in the placebo group and 2 in the methicillin-treated group. There was no statistically significant difference in infection or overall malfunction rate between the two groups. The risk of shunt malfunction in the 2nd to 6th month after surgery was significantly greater in the placebo group (7 of 26 patients) than in the methicillin-treated group (1 of 26 patients). Delayed shunt malfunction may be prevented by a short course of perioperative antibiotics.
Meningocele of the Asterion
Authors: Martinez-Lage J.F. , Gonzalez-Tortosa J. , Poza M.
Published: March 2008

The case of a 41-day-old girl with a cranial meningocele at the level of the posterolateral fontanel (asterion) is reported, stressing the rarity of its location far from the midline.
Intractable Hiccups as Presenting Symptom of Brainstem Tumor in Children
Authors: Fischer Asma Q. , McLean, Jr. William T.
Published: March 2008

Hiccups are an unusual presenting symptom of brainstem tumors in children. An 8-year-old boy is described who presented with hiccups 2½ years prior to any major neurological manifestation. Central nervous system etiologies of hiccups are discussed. Intractable hiccups have seldom been described as a presenting symptom of brainstem tumors. We present a patient who presented to us with this symptom and a protracted course.
Sequelae of Transcallosal Surgery
Authors: Beneš V.
Published: March 2008

The sequelae of transcallosal surgery were assessed clinically in 15 children. Isolated transection of the corpus callosum does not leave any pronounced sequelae when there are no lesions of the cerebral hemisphere. In cases with disturbances of some centers or analyzers, especially in the proprioceptive analyzer in the cortex of the parietal lobe, loss of recent memory, hypokinesia, ideomotor apraxia and astereognosia may develop. The signs are mixed and it is difficult to classify them. We can speak of disjunctive syndromes. The transcallosal approach is suitable in the case of lesions in the anterior part of the third and lateral ventricles.
Spinal Dysraphism in the Cervical and Dorsal Regions in Childhood
Authors: Schiffer Juana , Till Kenneth
Published: March 2008

Spinal dysraphism entirely confined to the cervical or dorsal levels is uncommon. In a large series affecting all levels, only 26 such cases that required operation were found. These are described in order to determine their particular features which include a high incidence of expanding lesions (dermoid cyst and neurenteric cyst) and are therefore associated with a much higher risk of morbidity than dysraphism at lower levels.
Fatty Acid of Cerebrospinal Fluid in Arrested Hydrocephalus
Authors: Onodera Yoshihisa , Kawaguchi Takashi , Itoh Hiroshi
Published: March 2008

The fatty acid composition of cerebrospinal fluid in hydrocephalic patients was analyzed by gas chromatography and fatty acid content was determined using arachidic acid as an indicator. In 40 cases of congenital hydrocephalus, total fatty acid values were found to be significantly higher than normal in the preoperative period. After shunt operation, hydrocephalus came to a standstill in 6 cases. They were not dependent on the shunting system. Their quantitative fatty acid composition was maintained within normal limits after removal of the shunting system.
Giant Cerebral Capillary Telangiectasis in an Infant
Authors: Pozzati Eugenio , Gaist Giulio , Galassi Ercole , Tognetti Francesco
Published: March 2008

The authors describe an unusual and unique case of a giant capillary telangiectasis of the right frontal lobe encountered in a 10-month-old child. The patient presented with progressive neurologic symptoms mimicking a brain tumor. The lesions was resected in toto with good clinical results.
Chronic Cerebellar Stimulation in Cerebral Palsy
Authors: Ivan L.P. , Ventureyra E.C.G.
Published: March 2008

This is a report of 14 patients suffering from cerebral palsy who were treated with chronic cerebellar stimulation and followed for 2 years. At the time of the last follow-up, only 6 patients continued the stimulation, 2 stimulators were removed because of infection and 5 patients stopped using them because of the lack of benefit from stimulation. Using a very close follow-up system with multiple assessors, this mode of treatment showed extremely low efficacy in relieving symptoms of cerebral palsy.
Excision, Repair and Corrective Surgery for Fronto-Ethmoidal Meningocoele
Authors: Dhawan I.K. , Tandon P.N.
Published: March 2008

This presentation deals with our experience of surgery on 8 patients with fronto-ethmoidal meningocoele. 7 of these patients had an intracranial repair of the meningocoele, coupled with or followed by an orbital osteotomy, to correct the associated hypertelorism. We feel that an orbital osteotomy done at the time of meningocoele repair improves the results of surgery, without adding to its risk. The osteotomy practised by the authors includes resection of a central wedge of bone and a medial shift of the roof and medial wall of the orbit.
Pituitary Adenomas and Other Tumors: Review in Perspective of Diagnosis and Treatment
Authors: Raiti Salvatore
Published: March 2008

Pituitary region tumors are accompanied by endocrinological alterations, both in the preoperative and postoperative phases. Their occurrence may be utilized for the surgical decision as well as for evaluating the results of the surgical treatment; their correction is mandatory for improving the quality of the life after surgery.
Radiological Study of Infantile Sella turcica in Microadenomas Diagnosis
Authors: Malena S. , Fileni A. , Barbuti D. , Fariello G. , Gugliantini P.
Published: March 2008

The authors evaluate the radiological alterations in children examined for suspected hypophyseal microadenoma. They point out the possibilities of traditional radio-graphic methods and of CT in the study of this type of infantile pathology.
Pituitary Microadenomas in Children
Authors: Di Rocco Concezio , Maira Giulio , Borrelli Patrizia
Published: March 2008

The successful transsphenoidal removal of pituitary microadenomas in 15 children is reported. In 2 of them precocious puberty was the presenting sign; in the remaining cases growth failure was the most prominent clinical feature, associated with pubertal failure in older children. A normalization in clinical and endocrinological status was obtained through surgery in all but 1 patient.
Hypopituitarism after Surgery for Craniopharyngioma
Authors: Grant D.B. , Lyen K.
Published: March 2008

The endocrinological sequelae in 73 operated children with craniopharyngioma are described. A comparison is made between children treated only by aspiration of the cyst of the tumour and children who underwent direct removal of the lesion.
Hyperprolactinemia as the First Symptom of Craniopharyngioma
Authors: Maira G. , Di Rocco C. , Anile C. , Roselli R.
Published: March 2008

The endocrinological alterations related to craniopharyngiomas are usually described as panhypopituitansm. The growth failure in the prepuberal child and/or the puberal retard are the clinical symptoms usually related to it. Nevertheless, for the peculiar diencephalic control of the prolactin (PRL) pituitary secretion, different endocrinological pictures can be observed, related to the different degree of pituitary-hypothalamic compression from the craniopharyngioma. For these reasons a dynamic PRL pre- and postoperative evaluation has been performed in 4 patients operated on for craniopharyngioma. A correlation has been made between hormonal picture, size and location of the tumor, and surgical results. The value of these data in performing an early diagnosis in children with craniopharyngioma is discussed.
Hypothalamo-Pituitary Function in Four Cases of True Precocious Puberty
Authors: Buonaguidi Roberto , Ferdeghini Marco , Leoncini Rossella , Tusini Giorgio
Published: March 2008

3 boys and 1 girl with a true precocious puberty have been studied. Neuroradiologic investigation and surgery allowed us to diagnose an astrocytoma of the anterior part of the third ventricle, involving the chiasm; an optic-chiasm glioma and a hydrocephalus secondary to aqueductal stenosis in the presence of neurofibromatosis; a third ventricle arachnoid cyst; a postinfectious hydrocephalus. We present endocrinological data, in particular on the hypothalamo-pituitary function in these patients, before and after surgery.
Hamartomas of the Tuber cinereum and Precocious Puberty
Authors: Frank Giorgio , Cacciari Emanuele , Cristi Gianfranco , Frejaville Elisabetta , Galassi Ercole , Pirazzoli Piero , Frank Franco , Gaist Giulio , Cicognani Alessandro , Balsamo Antonio
Published: March 2008

5 cases of true precocious puberty (TPP) of cerebral origin are presented. The clinical and radiological features and the protracted follow-up allow, also in view of the literature, a highly presumptive diagnosis of a hamartoma of the tuber cinereum. The high incidence of these lesions in cases of TPP is emphasized, together with the importance of early neuroradiological assessment.
Medical Therapy of True Precocious Puberty due to Hamartoma of the Tuber cinereum
Authors: Piccolo F. , Conti S. , Bozzao L. , Bianco F. , Galletti F. , Giuffrè G. , Pasquino A.M. , Finocchi G. , Boscherini B.
Published: March 2008

2 patients with true precocious puberty and hamartoma of the tuber cinereum are described. Diagnosis was established by the presence of accelerated puberty, elevated blood gonadotropins, without other evidence of central nervous system dysfunction and positive computed tomography scans. 2 patients were treated with cyproterone acetate and abstention from surgery was achieved with close observation of the tumor’s size by computed tomography.
Pineal Tumors in Childhood
Authors: Raimondi Anthony J. , Tomita Tadanori
Published: March 2008

For the purposes of surgical indications and considerations, we prefer that the general, anatomical term ‘pineal tumors’ be used for all tumors in the region of the pineal gland, and that such developmental, histological, or congenital terms as dysgerminoma, pinealoma, and teratoma be reserved exclusively for neuropathological descriptive purposes. Of our 26 children – age range from 7 months to 16 years – treated for pineal tumors during the 9-year period 1972–1980 inclusive, all presented with hydrocephalus necessitating ventriculoperitoneal shunts. This incidence of pineal tumors represents 9.4% of the total number of brain tumors in childhood (275) which were managed by the senior author during this period of time. 23 of the 26 children were operated for direct attack of the tumor, with the postoperative mortality being 1 (as defined by death preceding discharge from hospital): a 7-month-old child with a medulloepithelioma which rapidly, within 3 weeks, invaded the thalamus, corpus callosum, brain stem, and cerebellum, causing death. It is recommended that cerebral spinal fluid (CSF) be taken from the ventricular system at the time of insertion of the ventriculoperitoneal shunt and that this fluid be analyzed for alpha-fetoprotein (AFP), human chorionic gonadotrophins (HCG), and carcinoembryonic antigen (CEA), and that cytology be performed to search for neoplastic cells. If the marker studies are positive, or malignant neoplastic cells identified at cytology, then it is recommended that Roentgen therapy be given to the patient and that no direct surgical attack of the tumor be attempted. On the other hand, if the marker studies and cytology are negative, direct surgical attack is recommended after the ventriculoperitoneal shunt, when all signs of an increase in intracranial pressure disappear. None of our patients had steroid management for the increase in intracranial pressure. The shunt sufficed. We suggest that the surgical approach (parasagittal, occipital-transtentorial, suboccipital-supracerebellar) be planned on the basis of the direction of displacement of the Galenic (internal cerebral vein, and great vein of Galen) and supraculminate (pre-central and superior cerebellar) venous systems: (1) when the Galenic system is displaced inferiorly, a parasagittal approach is recommended; (2) when the Galenic system is displaced superiorly, a suboccipital supracerebellar approach is recommended; (3) when the supraculminate system is displaced posteriorly, an occipital transtentorial approach is recommended.
Pineal Region Tumors: Endocrinological Aspects
Authors: Giovannelli Giorgio
Published: March 2008

The pineal gland and the superior cervical ganglia represent an integration center for hormonal and neural signals, and play an important role in modulating basic hormonal secretions. The prevalence of pineal tumors in the male sex and their frequent association with precocious puberty has been known for a long time. However, the rarity of ascertained cases investigated by means of direct and sensitive methods (RIA; tests applying hypothalamic releasing factors) is still preventing the proper knowledge of the endocrinological aspects of pinealomas. On the basis of the recent literature, the importance of diabetes insipidus as a very early symptom of pineal region tumors should be emphasized; in some cases, it preceded the appearance of precocious puberty or neuro-ophtalmologic signs by some years. A variable pattern of anterior pituitary impairment is also a rather common finding. In rare cases (males, with few exceptions), the precocious puberty may be explained by the presence in the pineal tumor of trophoblastic tissue secreting hCG; some of these tumors produce also α-fetoprotein (evidence of a yolk-sac tumor).
Medulloblastomas in Children
Authors: Choux M.
Published: March 2008

The author reviews the results of treatment of medulloblastomas in children, pointing out the factors which influence the final outcome.
Chemotherapy for Medulloblastoma in Children Current Status and Future Prospects
Authors: Pezzotta S. , Knerich R. , Butti G.
Published: March 2008

Surgery and radiotherapy are the most common modalities in the treatment of medulloblastoma in children. Our previous experience and that of others suggest that chemotherapy is useful in prolonging the survival of these patients. Since August 1979, the Italian Child’s Neurooncology Group (ICNG) has adopted a controlled and randomized protocol which calls for two types of treatment: (1) surgery + radiotherapy + CCNU, vincristine; (2) surgery + radiotherapy + CCNU, vincristine, procarbazine. An analysis of this trial is presented.
Medulloblastoma in Childhood
Authors: Casotto Alessandro , Buoncristiani Pio
Published: March 2008

20 medulloblastomas in children were treated at the Neurosurgical Department of Perugia over the last 6 years. The age ranged between 1.2 and 15 years, with a mean of 8 years. The ratio between males and females was 3/1. Only three tumors were localized within one cerebellar hemisphere. A shunt was performed before the removal of the tumor in 12 cases. Radical resection was completed in 15 cases, whereas a subtotal removal was performed in the cases with involvement of the brain stem. The postoperative mortality rate was 5%. The 3-year survival rate was 40% and the 5-year 25%. The postoperative radiotherapy was given at lower doses than usually reported by other authors: this seems to reduce the neuropsychological and endocrinological sequelae. CCNU or BCNU were given after radiotherapy, but this monochemotherapy seems to be less effective than polychemotherapy with CCNU, vincristine, procarbazine and dexamethasone, used in this series when relapse occurred. Radical resection improved the prognosis. The opportunity of using different protocols for ‘low risk’ and for ‘high risk’ patients is finally discussed.
Total Vertex Craniectomy for the Treatment of Scaphocephaly
Authors: Epstein Nancy , Epstein Fred , Newman Georg
Published: March 2008

Sutural stripping, morcellation, subtotal craniectomy, and even subtemporal decompression, have been employed in the treatment of sagittal synostosis. This report describes a further modification of past techniques, the total vertex craniectomy. This procedure, employed in 9 patients, has achieved uniformly excellent cosmetic results.
Melanotic Neuroectodermal Tumor of the Neurocranium in Infancy
Authors: Walsh John W. , Strand Roy D.
Published: March 2008

Melanotic neuroectodermal tumors of the neurocranium are a rare but life-threatening disorder of infancy. 11 previously reported cases are reviewed in terms of clinical presentation, radiological diagnosis, and management. A twelfth case, a 4-month-old infant who developed three discrete sites of tumor unilaterally in the neurocranium is presented. Several hypotheses for the mechanism of formation of these tumors are reviewed. The authors propose that the mechanism of formation involves a dysontogenesis of neural crest tissue and that these tumors form, at least in part, from fragments of melanin-containing arachnoid villi which are displaced during embryonic development.
CT and ACTH Treatment in Infantile Spasms
Authors: Carollo C. , Marin G. , Scanarini M. , Ori C. , Drigo P. , Casara G.L. , Laverda A.M.
Published: March 2008

Computed tomography of 8 cases with West’s syndrome before, during and after ACTH treatment are reported. The scans, performed at the third week of therapy, showed consistent widening of the sulci, cisterns and ventricles in all the patients. Of these, 2 patients underwent ICP monitoring which showed higher than normal values. A return to the normal ICP values in association with the disappearance of the CT findings was observed in both cases. It is concluded that widening of the sulci, cisterns and ventricles are not findings of atrophy, but a condition of initial communicating hydrocephalus, which is in accordance with the hypotheses of Riikonen and Lyen.
Intracranial Aneurysms in the Pediatric Age-Group
Authors: Storrs Bruce B. , Humphreys Robin P. , Hendrick E.B. , Hoffman H.J.
Published: March 2008

29 cases of intracranial aneurysms in children under 16 years of age are reviewed. The prodrome, presentation, location of aneurysm, and outcome are discussed. Evidence is presented to encourage a more aggressive evaluation of suspected subarachnoid hemorrhage in children.
Posttraumatic Cerebellar Hematoma
Authors: Fernández-Alvarez E. , Fábregues I. , Pineda M. , Costa J. , Lafuente J.L.
Published: March 2008

A posttraumatic cerebellar hematoma in a 12-year-old boy is reported. It was observed by CT scan that the hematoma is discharged incompletely into the subdural space. The surgical treatment was successful with complete recovery. It is suggested that CT scan should be performed as soon as possible in cranial trauma with cerebellar signs.
Hydrocephalic Infants: Developmental Assessment and Computed Tomography
Authors: Thompson Maryann G. , Eisenberg Howard M. , Levin Harvey S.
Published: March 2008

29 hydrocephalic infants (< 30 months) who had shunts were studied with the `Bayley Mental Scale’ and with computed tomography. It was found that patients with a medical history indicating brain injury in addition to hydrocephalus had lower scores on the `Bayley Mental Scale’ than a comparable group whose hydrocephalus had been uncomplicated. Dilatation of the lateral ventricles was assessed by computing the ventricle-brain ratio (VBR) from the CT scan. The VBR was inversely correlated with the ‘Bayley Mental Scale’ score. Two thirds of the sample were reevaluated after 1 year; there was a significant decrease in VBR, but mental quotient was unchanged. These findings are in agreement with studies on older children in that the prognosis for cognitive functioning in hydrocephalic children is affected by brain injury. A correlation between brain mass and intelligence has been reported in older children with uncomplicated hydrocephalus, but not in groups with mixed etiology.
Spinal Intradural Lipoma with Intracranial Extension
Authors: Rappaport Harry , Tadmor Rina , Brand Nathan
Published: March 2008

2 cases of intradural spinal lipomas with extension into the posterior fossa in infancy are presented. Clinical features included associated subcutaneous posterior spinal lipomas and hypotonia. The cases were diagnosed by metrizamide myelography and spinocranial computerized tomography scanning. Operative therapy consisted of combined suboccipital craniectomy, spinal laminotomy, flap elevation and subtotal tumor decompression. The entity is reviewed.
Aicardi’s Syndrome: a Result of Overdistention of the Neural Tube
Authors: Gardner James
Published: March 2008

The clinical picture of the Aicardi syndrome consists of a mentally retarded female infant with seizures, who lacks a corpus callosum and a pineal gland. There is Dandy-Walker malformation, vertebral anomalies, chorioretinopathy, coloboma, and heterotopia of gray matter. Since overdistention of the neural tube is the cause of each of these anatomic features, the same cause is responsible for the complete syndrome.
Computer Tomographic Long-Time Results after Surgical Removal of Subdural Fluid Collections in Infancy and Childhood
Authors: Dietrich Uwe , Sakellariou Paulos , Seibert Horst
Published: March 2008

61 infants and children underwent surgery of acute hygroma, acute subdural hematoma, chronic subdural hygroma, chronic subdural hematoma, and subdural empyema. Long time-follow up including computerized tomography could be performed in 20 of these cases. Only 3 CT-scans had been without pathological finding. The most common finding had been an enlargement of the inner and outer CSF spaces suggesting cerebral atrophy. No correlation had been found to kind of surgical treatment and clinical status.
Large Infratentorial Multilocular Arachnoid Cyst
Authors: Kuratsu Junichi , Matsukado Yasuhiko , Kodama Takafumi
Published: March 2008

Clinical and radiological findings in a 2-year-old boy with a large multilocular infratentorial arachnoid cyst are presented. The cyst was extended in the bilateral paracollicular and retrocerebellar region and was communicating with each other but not with the ventricular system. Associated with those cysts was a significant degree of hydrocephalus due to compression of the fourth ventricle. Delayed metrizamide CT scan showed totally isolated cysts from CSF circulation although the cystic content was determined as the CSF.
Myelomeningocele: New Technique for Skin Repair
Authors: Macías Rogelio , Tena Luis
Published: March 2008

A useful technique for skin repair in medium-sized lumbar or lumbosacral myelomeningoceles is described. It consists in the displacement towards the midline of two lateral triangular flaps located on each side of the lesion. This technique has been used to cover skin defects in other regions of the body, but not in the lumbar region for myelomeningoceles. The results are encouraging.
Cystic Cerebral Astrocytomas in Infancy and Childhood: Long-Term Results
Authors: Palma Lucio , Russo Antonio , Mercuri Sandro
Published: March 2008

24 cases of cystic cerebral astrocytoma represent 11% of 217 supratentorial tumors of the pediatric age group operated. Both macro- and microscopically, such tumors resembled in most cases the well-known cerebellar astrocytoma, presenting as a large cyst with a mural nodule with the pattern of a pilocytic astrocytoma (i.e. spongioblastoma of the German school). The preferential site of incidence was the temporal lobe and the age peaks were of 7 and 16 years without sex prevalence. The surgical technique consisted in the extirpation of the mural nodule, preceded by emptying the cyst, followed by opening the contiguous ventricular wall. The extirpation was partial in one-third of the cases of whom the minority underwent radiotherapy. 1 patient died after the operation while 2 others died from tumor recurrence after 3 and 4 years, respectively, both being mixed tumors (oligoastrocytoma) that were irradiated postoperatively. The follow-up ranged from 10 to 29 years in 70% of the cases. The long-term functional results of the available 17 patients are as follows: good (perfectly well), 12 cases (70%); fair (minor troubles), 5 cases (30%). 3 of the 5 cases with a fair result all had a partial resection.
Neuropsychological Functioning in Children with Shunted Uncomplicated Hydrocephalus
Authors: Prigatano Georte P. , Zeiner Harriet K. , Pollay Michael , Kaplan Ralph J.
Published: March 2008

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