bluuebunny/crossref_metadata_2025 huggingface dataset:
The Results of Operating upon Cerebral Aneurysms and Angiomas in Children and Adolescents
Authors: Amacher Loren , Drake Charles G.
Published: March 2008

This paper summarizes the clinical presentation, location, surgical management, and results in 32 patients with cerebral aneurysms. Surgical mortality has been 21.9% for aneurysms (all grades). For good risk aneurysms (Botterell 1 and 2), the surgical death rate was 8.0% (2/25). Clinical presentations and techniques of treatment are summarized.
Pathophysiology, Treatment and Outcome following Severe Head Injury in Children
Authors: Bruce Derek A. , Raphael Russell C. , Goldberg Allen I. , Zimmerman Robert A. , Bilaniuk Larissa T. , Schut Luis , Kuhl David E.
Published: March 2008

The pathophysiology and outcome following severe head injury in 85 children are presented. The commonest initial CT diagnosis was of acute brain swelling. This swelling was associated with an increased white matter density on the CT scan which decreased to normal concomitant with recovery and increased ventricular size. CBF measurements in 6 of these patients revealed an increased blood flow despite a decreased CMRO2 and clinical coma. This CT pattern of diffuse swelling is believed to be due to acute cerebrovascular congestion and hyperemia and not to edema. Because of this, all children were treated with endotracheal intubation and controlled hyperventilation as part of the initial management. Mass lesions were uncommon, 20%. 1CP was monitored in 40 children. The ICP rose above 20 Torr despite therapy in 80% of children with decerebrate or flaccid coma and in only 20% of children with spontaneous motor function. The ICP was at its highest between the second and fifth day. Aggressive therapy to control the ICP, with barbiturates if necessary, was successful in 80% of the patients. The overall results were useful recovery in 87.5% of the children, 3.5% were left vegetative or severely disabled and 9% died.
Spinal Lipomas in Infancy and Childhood
Authors: Bruce Derek A. , Schut Luis
Published: March 2008

The clinical course of 42 children with lipomatous lesions of the lower spine is reviewed. Good neurological exam, IVP and myelography are considered essential components of the preoperative studies. The surgical aim is to free all intra- to extradural adhesions with dural grafting, if necessary. The results suggest that early corrective surgery within the first few weeks to months of life is the most satisfactory approach to preserving normal neurological and urological function in these children. 88% of children not operated on early developed progressive loss of neurological function and while delayed surgery frequently stopped progression of the disease it rarely returned the children to a normal state.
Prophylactic Craniofacial Surgery
Authors: Epstein Fred , McCarthy Joseph G. , Coccaro Peter J.
Published: March 2008

One-stage radical reconstructive surgery for the common craniofacial deformities has become standard procedure in a few medical centers. With increasing experience and expertise, young children und adolescents, as well as a few adults have been greatly benefited. It has long been recognized that both the cranial and facial deformities of Couzon’s disease and Apert’s syndrome are progressive, having their inception either before birth or in the neonatal period, and evolving to the full blown syndrome during the first years of life. The authors believe that the progressive nature of these anomalies is secondary to a combination of permaturely fused sutures of the calvarium and cranial base (coronal, sphenozygomatic, frontoethmoidal and frontosphenoidal).
Hemispherectomy for Sturge-Weber Syndrome
Authors: Hoffman Harold J. , Hendrick Bruce , Dennis Maureen , Armstrong Dawna
Published: March 2008

Patients with Sturge-Weber disease who have the onset of seizures in infancy invariably face a progressively downhill course which leaves them severely hemiplegic, demented and usually institutionalized because of uncontrolled seizures. During the past 12 years, we have carried out 6 hemispherectomies in infants under 1 year of age who presented with seizures and Sturge-Weber disease. The results have been gratifying. Seizures have stopped, hemipareses have been minimal and intellectual development has been good.
Radiopharmaceutical Bone Scanning in Pediatric Neurosurgery
Authors: Humphreys Robin P. , Gilday David L. , Ash Judith M. , Hendrick Bruce , Hoffman Harold J.
Published: March 2008

Radionuclide bone scanning is an extremely sensitive, safe and widely applicable investigative aid. In most circumstances it cannot be employed to the exclusion of plain radiography as the two procedures – one dynamic and the other static – complement each other. In children, bone imaging demonstrates physiologic characteristics of bone growth and early suture closure, delineates obscure tumors and infection, recent or old trauma not always visible on orthodox radiography and may solve the diagnostic dilemma of a child with heretofore undiagnosed head, neck or back pain.
A Comparison of Computed Tomography and Air Ventriculography in Diagnosis of Progressive Hydrocephalus of Infancy
Authors: Klein David M. , Berger Paul E.
Published: March 2008

We have compared the efficacy of computed tomography (CT) and air ventriculography (VGM) in the diagnostic evaluation of progressive nontumoral infant hydrocephalus where both examinations have been done without significant intervening time or treatment in infants under 12 months of age. CT alone was judged to be adequate for diagnosis and treatment in 21 of 30 cases reviewed, provided that cerebrospinal fluid studies were available to complete diagnosis where necessary, and provided that the question of ventriculocisternal communication was not a factor in treatment selection. The ability to visualize cerebral aqueduct and 4th ventricle on CT was not always a reliable indicator of ventriculocisternal communication. CT was most adequate as the sole radiographic study in cases of myelodysplasia with Arnold-Chiari malformation, and in premature infants with intraventricular hemorrhage.
Neuropsychological Outcome of Closed Head Injury in Children and Adolescents
Authors: Levin Harvey S. , Eisenberg Howard M.
Published: March 2008

45 children and adolescents recovering from closed head injury underwent neuropsychological testing. Multiple indices were used to classify the severity of injury but most important in this study were the persistence of coma indexed by grades I–III and the Glasgow Coma Scale. Although the presence of early neuropsychological sequelae and long-term intellectual deficit was generally related to the severity of injury, residual impairment was also found in patients with relatively mild injuries. Analysis of memory and learning demonstrated disruption of both storage and retrieval processes.
Management of Ventricular Shunt Infections
Authors: O’Brien Mark , Parent Andrew , Davis Barbara
Published: March 2008

The authors report the incidence (2.7%) of shunt infection in a series of 778 consecutive shunt procedures. The management of these infections and an additional group of infected patients operated elsewhere is discussed. A protocol is given for the treatment of external infections, gram-positive internal infections and gram-negative internal infections.
Medulloblastoma in Childhood
Authors: Raimondi Anthony J. , Tomita Tadanori
Published: March 2008

51 medulloblastomas under 12 years of age were treated from 1966 through 1977. 50 patients underwent craniotomy and 39 of them completed postoperative radiation therapy. Surgical mortality rate of primary posterior fossa craniotomy was 8%. One year survival rate was 71.4%, 3 years 45.6% and 5 years 34.5%. Extent of surgical resection was found to affect the survival, and a group of radical or visibly total resection showed higher postoperative survival. Female patients enjoyed longer survival. The patients under 12 months of age showed poor prognosis. Reexploration of the posterior fossa failed to prolong the survival by more than 3 months.
Biopsy of Pediatric Brain Stem Tumors
Authors: Reigel D.H. , Scarff T.B. , Woodford J.E.
Published: March 2008

26 patients, average age of 7.3 years, had biopsies of a brain stem tumor. 62% of the patients presented with hydrocephalus, and ventriculoperitoneal shunts were placed 7–10 days prior to biopsy. The midbrain was biopsied 13 times, the pons 3 and the medulla 12 times. Tissue for histopathologic examination was obtained at each operation and demonstrated astrocytoma in 13 patients, glioblastoma in 6, ‘no tumor seen’ in 5 and ependymoma in 2. Astrocytomas were usually located in the upper brain stem, and all of the glioblastomas were located in the medulla. The operative mortality was zero, and the morbidity was largely related to increased cranial nerve deficit. All the astrocytoma patients were treated with radiation only; whereas, 4 patients with glioblastoma were treated with vincristine, CCNU and methylprednisone in addition to radiation as described by the Children’s Cancer Study Group (CCG-944). 3 patients with ‘no tumor’ were not treated and are alive and well 15-41 months following operation. 2 patients with no tumor were treated, one as a glioblastoma multiforme, subsequently verified at postmortem examination, and one as a midbrain astrocytoma. 1 patient with astrocytoma died 3 months following operation, all the remainder are living and well 4–51 months following operation. Irrespective of the treatment, all 7 patients with glioblastoma expired within 9 months of diagnosis. The prognosis for survival for patients with brain stem astrocytoma is superior to those with glioblastoma multiforme. Specific histopathologic correlation with clinical management may lead to improved and prolonged survival for patients with brain stem glioma.
B Waves – a Reflection of Cardiorespiratory or Cerebral Nervous Systems Rhythm?
Authors: Venes Joan L.
Published: March 2008

A review of 92 consecutive shunt revisions is presented in an attempt to assess the contribution of computerized axial tomography to the long-term management of the child with shunted hydrocephalus. 20-22 percent of all cases of acute shunt malfunction presented with small ventricles, indicating that absence of ventricular enlargement should not be interpreted as demonstrating adequate shunt function. The single most useful application of computerized axial tomography in our hands is the detection of indolent shunt malfunction associated with ventriculomegaly and decline of cognitive function in the older child.
Hydrocephalus in Myelomeningocele
Authors: Stein Sherman C. , Schut Luis
Published: March 2008

156 children born with myelomeningocele were studied over a 3- to 10-year follow-up period. The appearance, type and rate of development of hydrocephalus were noted and correlated with the findings on neonatal and follow-up physical examination. 80% of the children developed overt hydrocephalus; 73.4% of these cases were secondary to aqueductal stenosis. Only 15.3% of the cases showed physical evidence of hydrocephalus at birth. Another 64.8% of the children developed clinical signs of hydrocephalus during the follow-up period, most during the first few weeks but some as late as the third year of life. The neonatal examination is unable to predict the subsequent appearance of hydrocephalus or its rate of development, and even serial determinations of head circumference are often of limited value. The authors conclude that the early diagnosis of hydrocephalus in children with myelomeningocele cannot reliably be made on physical examination alone and that other means of assessing ventricular size should be employed.
Effect of Dantrolene Sodium on the Incidence of Seizures in Children with Spasticity
Authors: Nogen Alan G.
Published: March 2008

In this two-phase study, 21 pediatric patients with epilepsy and spasticity were initially treated with dantrolene sodium suspension and, after a washout period, began a double-blind portion where one half received dantrolene sodium suspension and the other half received a placebo suspension. The frequency of seizures, serum anticonvulsant levels and electroencephalograms were compared with control values. On dantrolene sodium suspension, there was no persistent change in these parameters. Therefore, it is concluded that dantrolene sodium does not adversely affect the frequency of seizures in children with epilepsy and spasticity, who are being maintained on anticonvulsant medications.
Radioimmunoassay of Alpha-Fetoprotein in Children with Primary Intracranial Tumors
Authors: Shinomiya Youichi , Toya Shigeo , Iwata Takanobu , Hosoda Yasuhiro
Published: March 2008

Serum alpha-fetoprotein (AFP) was measured in 10 cases of primary brain tumors in children (4 cases of medulloblastoma, 4 cases of germ cell tumor and 2 cases of astrocytoma). As a result, elevation in AFP was observed only in a case of embryonal carcinoma that showed partial mixture of germinoma. The absence of AFP elevation in 3 other cases of pure germinoma (atypical teratoma; pinealoma) agrees with reports which describe that, in the germ cell tumor of the gonads, a rise in AFP is not observed in pure seminoma but is found in embryonal carcinoma and endodermal sinus tumor (yolk sac tumor). The fluctuations in AFP in serum and cerebrospinal fluid are considered to be of significance in the diagnosis and treatment of primary intracranial malignant germ cell tumors.
Optic Glioma in Children
Authors: Brand William N. , Hoover Stanley V.
Published: March 2008

From 1967 to 1975, 16 consecutive children with optic-tract glioma were treated with postoperative irradiation. Clinical, surgical and pathologic findings have been summarized. Doses ranged from 4,000 to 6,000 rad. As of 1976, follow-up had been obtained in 13 of 16 children. 9 of 13 survived and 3 were lost to follow-up. We have been unable to relate survival to age, sex, pathologic grade, radiation dose or field size. Although all patients in our series were irradiated, it appears that survival is excellent for those with gliomas that are confined to the optic nerve or chiasm without hydrocephalus even if postoperative irradiation is not given. In patients with extension beyond the chiasm or with hydrocephalus, survival may be improved by the addition of irradiation. A staging system is proposed.
The So-Called Ectopic Pinealomas
Authors: Izquierdo J.M. , Rougerie J. , Lapras C. , Sanz F.
Published: March 2008

We present the results of a cooperative study of 15 cases of suprasellar dysgerminomas (ectopic pinealomas) and a review of cases of the literature with histological confirmation. In all the cases, histological similarities to the germinomas which appear extracerebrally, particularly testicular seminomas, were observed. We were unable to find in the sellar region tumors of true pineal histology and tend therefore to confirm the germinal origin of these neoplasms. From a clinical point of view, we define a syndrome that these tumors produce, consisting of diabetes insipidus as the first sign, visual impairment and endocrine disturbances, with few or no radiological signs in plain studies.
Dogenital Vascular Malformation of Spinal Cord Simulating Diastematomyelia
Authors: Ouaknine George E. , Gadoth Natan , Matz Shoshana , Shalit Mordechai
Published: March 2008

Diastematomyelia is usually caused by a midline bony, cartilaginous or fibrous spur. A case is presented with splitting of the spinal cord by a large arteriovenous malformation at the thoracolumbar junction. A hairy skin patch, kyphoscoliosis, vertebral anomalies and an arachnoidal cyst were found adjacent to the vascular and neural malformations.
Intracranial Tumefactions in Children
Authors: Amacher Loren , Hovind Laila
Published: March 2008

This paper summarizes a 26.5-year experience in one centre with intracranial tumefactions in children. In 337 craniotomies done on 285 patients, the death rate within 30 days of operation was 6.7% for cases and 5.6% for procedures. Since 1965, the case and operative mortalities have been 2.0 and 1,7%, respectively. There have been no operative deaths in the last 109 patients, 124 craniotomies, done during the past 6.5 years. Operative mortality for primary procedures was 6.0%, 1.5% since 1965. For patients operated upon more than once (52 times on 38 patients), the case mortality has been 5.3%, procedural mortality 3.8%; since 1965 these figures have been 3.8 and 2.8%, respectively. The operative deaths are analysed, and some conclusions drawn. At the present time, surgical mortality from intracranial tumefactions in children should be less than 5%.
A Long-Term Postoperative Follow-Up in Craniopharyngioma
Authors: Humphreys Robin P. , Hoffman Harold J. , Hendrick Bruce
Published: March 2008

The long-term postoperative follow-up of children treated for craniopharyngioma is influenced by the patient’s age at time of diagnosis, tumor location, texture, interface and adherence to brain, and achievements of the first operation. These factors will be examined as they apply to 51 children treated at the Hospital for Sick Children, Toronto. A brief comment on the role of irradiation treatment is also provided.
Cerebellar Abscess in Early Infancy
Authors: Garijo Alvarez , Gomila Taboada , Mengual Vila
Published: March 2008

The authors report an unusual case of cerebellar abscess in a 6-week-old infant without an antecedent of sepsis or congenital heart disease. The abscess was treated successfully by percutaneous punction-aspiration and further excision. Shunting procedure was not necessary.
Extradural Hemorrhage in the Newborn as a Result of Birth Trauma
Authors: Takagi Takuji , Nagai Ryoji , Wakabayashi Shigeo , Mizawa Ikuo , Hayashi Katsuji
Published: March 2008

During the past 18 years, 134 autopsies of intracranial hemorrhages were performed in the Department of Pathology, and 2 cases of extradural hemorrhages were discovered (2.2%). 5 cases of extradural hemorrhage (2 of our own treated surgically and 3 untreated found at autopsy) are described in detail. 1 of the 2 cases treated surgically responded favorably to surgical treatment. The mechanism of hemorrhage into extradural spaces is investigated and reconsidered following review of the literature. The necessity for right reflux brachial angiography is emphasized for early diagnosis of extradural hemorrhage.
Development of the Cerebrospinal Fluid Pathway in the Normal and Abnormal Human Embryos
Authors: Osaka Kunihiko , Handa Hajime , Matsumoto Satoshi , Yasuda Mineo
Published: March 2008

The subarachnoid space, the chorioid plexus and the arachnoid villi are microscopically studied in 60 normal human embryos and in 3 abnormal human embryos with rhombencephaloschisis and cervical myeloschisis. The subarachnoid space has been generally considered to be developed by outflow of cerebrospinal fluid (CSF) of the choroid-plexus origin from the IVth ventricle. This generally accepted concept does not meet with our findings: (1) cavity formation in the meninx primitiva is seen before appearance of the choroid plexus; (2) the primitive subarachnoid space is developed earlier in the prepontine region than in the area dorsal to the rhombic roof, and (3) the primitive subarachnoid space is formed in the embryos with dysraphism where the perineural subarachnoid space is separated from the ventricles. Apparently the embryonic pattern of CSF circulation should be much different from the generally believed pattern of adult, since the arachnoid villi are absent in the embryos and the ability of production of CSF in the embryonic choroid plexus is questionable. It is suggested that such embryonic pattern of CSF production and absorption may partly persist in adult human being.
Craniopharyngioma: The Controversy Regarding Radiotherapy
Authors: Amacher A.L.
Published: March 2008

In an attempt to derive a consensus for rational therapy of craniopharyngioma, pertinent recent literature has been reviewed. By seeking answers to specific questions, I have tried to remove personal bias from the conclusions. A consensus is suggested.
Technique for Closure of Myelomeningocele
Authors: McLone David G.
Published: March 2008

Closure of a myelomeningocele should be based on an understanding of the altered anatomy. Reconstruction of the defect, including the form of the spinal cord, is dependent on this understanding. Assuming the exposed neural plaque is potentially functional tissue is the principle reason for preserving all neural tissue and for anatomical reconstruction of the spinal cord. Closure of the central canal of the spinal cord and suspension of neural tissue in a pia-arachnoid lined CSF compartment establishes a more normal microenvironment. It is hoped that this closure will prevent adhesion of neural elements to the closure and subsequent tethering of the spinal cord later in the child’s life.
Neurosurgical Shunt Infections A Review
Authors: Yogev Ram , Davis Todd
Published: March 2008

Shunt infections occur in 6–25% of hydrocephalic patients with shunts. Although Staphylococcus epidermidis and Staphylococcus aureus cause the majority of such infections, enteric bacteria account for at least 10–15%. The clinical presentation in most patients is nonspecific. Most investigators agree that the entire infected shunt should be removed before antibiotic therapy is initiated. The choice of an antibiotic should be guided by in vitro susceptibility of the etiologic agent, and the ability of the drug to pass the blood-brain barrier. The efficacy of prophylactic antibiotics in reducing shunt infections is controversial.
Cranioplasty in Children
Authors: Blair G.A.S. , Gordon D.S. , Simpson D.A.
Published: March 2008

In children, acquired skull defects often close spontaneously. This is most likely to take place when the dura mater and the pericranium are intact. Congenital skull defects rarely close spontaneously. Cranioplasty will be needed when a bone defect has failed to close or when it is unlikely to do so. Various methods are available: autogenous bone, acrylic resin, and metal prostheses have been widely used. A series of 68 operations performed on children under the age of 15 years is reviewed. It is concluded that shaped titanium plates are usually preferable. These can be formed by hand, or in a pressure chamber; simple defects can be closed with ready-made titanium strips. Fixation by screws is recommended. Titanium plates have been used successfully even in very young children.
Immunobiology of Primary CNS Tumors in Infancy and Childhood
Authors: Gerosa Massimo A. , Amadori Giuseppe , Semenzato Piero , Gasparotto Giuseppe , Carteri Alessandro
Published: March 2008

The authors report their experience on the immunological monitoring of children with posterior fossa medulloblastomas. The most important findings concerning humoral and cell-mediated immunity in this kind of patient are discussed. Among the main immunobiological pictures, the authors stress the remarkable failure of the T-cell dependent immune response, generally correlated to the degree of malignancy of the tumor, and the characteristic appearance of cells with natural cytotoxic activity, whose precise outlining is, at present, in progress. The B-cell dependent pool, mostly investigated through immunofluorescence studies, turned out to be very close to normal.
The Subarachnoid Space: A Review
Authors: McLone David G.
Published: March 2008

A historical review of our knowledge of the subarachnoid space dates from the ancients through the modern electron microscope era. Conflicting observation resulted from various methods of tissue preservation and species variability. A comparative sub-microscopic study shows striking similarities in the ultrastructure and distribution of the subarachnoid space in mice, cats, monkeys and man. Development of the pia-arachnoid membranes in the mouse occurs in four stages: the first follows closure of the neural tube and is a period of initial vascularization of the developing telencephalon; the second is a period of delineation during which the limits of the subarachnoid space are defined; the third is a period of ensheathment of pia-arachnoidal blood vessels; and the fourth includes addition of smooth muscle to larger vessels, the appearance of macrophages in the subarachnoid space, and a general increase in extracellular collagenous and elastic fibers. The subarachnoid space over the telencephalic surface in the 10-day fetus exists prior to the secretion of cerebrospinal fluid as the typically large extracellular space of mesenchyme. By the 13th fetal day cerebrospinal fluid begins to seep into and replace the ground substance of the mesenchyme. The mesenchymal extracellular compartment is reduced peripherally, resulting in a compacted pia-arachnoidal tissue which limits the peripheral extent of the subarachnoid space. By the 21st postnatal day a subarachnoid space typical of the adult animal has been established. The developmental sequence occurring in the tissues surrounding the central nervous system is important to our understanding of the pathogenesis of hydrocephalus and congenital anomalies.
Polyacrylamide Gel Electrophoresis of Cerebrospinal Fluid Proteins in Children with Nontumoral Hydrocephalus
Authors: Cerda M. , Vielma J. , Martinez C. , Basauri L.
Published: March 2008

The changes occurring in the electrophoretic pattern of the cerebrospinal fluid (CSF) proteins in 37 children with nontumoral hydrocephalus, and the protein pattern of 12 children without organic neurological disease, were studied with polyacrylamide gel electrophoresis. In nontumoral hydrocephalus protein was frequently increased in lumbar and ventricular fluid, in this condition, in intraventricular obstruction, the protein fractions showed a decrease in the prealbumin and an increase in the γ-globulin fractions, and in extraventricular obstruction, the protein fractions showed a decrease in the prealbumin and an increase in the γ-globulin and α2-globulin fractions. With CSF proteins within normal ranges we found that in intraventricular obstruction, the proteins of the ventricular CSF showed an increase in the prealbumin and/or albumin fractions, and in extraventricular obstruction, the proteins of the ventricular CSF showed an increase in the prealbumin and β-globulin fractions, and the proteins of the lumbar CSF showed an increase in the prealbumin fraction. The diagnostic implications of these findings are discussed.
Development of the Limiting Glial Membrane of the Brain
Authors: McLone David G.
Published: March 2008

The development of the limiting glial epithelium begins following closure of the neural tube. Early, the changes are mostly in cellular organelles with little change in cell form. Postnatally, the process is rapidly accelerated to accommodate and probably direct the development of the underlying cerebral cortex. Besides directing the development of the underlying cortex, the limiting glial layer may participate in cerebral function.
Peculiar Cerebrospinal Fluid Protein Patterns in Two Cases of Infantile Hydrocephalus
Authors: Silva Alberto , Lavandeira Teresa , Fontes João
Published: March 2008

Cerebrospinal fluid (CSF) protein abnormalities in 2 hydrocephalic children are described. 1 of the cases presented a degenerative pattern in lumbar CSF protein electrophoresis in spite of high total protein content. This is thought to be due to an excess of tissue proteins as a result of abnormal conditions of circulation and absorption of CSF in hydrocephalus. The other case makes clear the role of inflammation on CSF protein electrophoretic patterns.
Friedreich’s Ataxia forme fruste and Elevated Creatine Phosphokinase in a Child with Pseudohypoparathyroidism
Authors: Millichap Gordon
Published: March 2008

A 14-year-old boy with focal seizures, syncopal attacks, and progressive intellectual deterioration had intracranial calcifications on a CT scan and hypocalcemia unresponsive to parathyroid hormone. The commonly recognized neurological manifestations of pseudohypoparathyroidism were complicated by signs of Friedreich’s ataxia. A marked elevation of serum CPK was unexplained and was unrelated to seizures.
Early Diagnosis and Surgical Indication in Craniosynostosis
Authors: Di Rocco Concezio , Iannelli Aldo , Velardi Francesco
Published: March 2008

9 children, presenting with clinical symptoms of craniosynostosis, and 4 with microcrania underwent calvaria bone scanning and a lumbar subarachnoid constant-infusion manometric test as integrating procedures for the diagnosis and surgical indication. In all the patients with craniosynostosis, calvaria bone scanning revealed the pathological sutures as areas of diminished or absent radionuclide accumulation, while a normal isotope uptake was observed at all the cranial sutures in the children with microcrania. A biphasic response to the infusion test, with an early rapid increase in the intracranial pressure and a late compensation, characterized 8 of the 9 children with craniosynostosis. The response to the infusion test was normal in all the cases with microcrania and in 1 child regarded as affected with coronal synostosis on the grounds of clinical and calvaria bone scanning findings.
Nephritis Secondary to Chronic Cerebrospinal Fluid – Vascular Shunt Infection: ‘Shunt Nephritis’
Authors: Finney Lee , Roberts Theodore S.
Published: March 2008

Chronic indolent shunt infection can lead to intermittent transient bacteremia and secondary deposition of immune complexes in the kidney. The infective organism is usually one of low virulence, resulting in vague symptoms and a delay in diagnosis. Resolution of the infection usually results in return of renal function to normal.
Postoperative Evaluation of Third Ventriculostomy Patients Using 111In-DTPA
Authors: Vries John K. , Friedman William A.
Published: March 2008

A radioisotope scanning and clearance procedure has been developed for the postoperative assessment of third ventriculostomy patients. The patency of third ventriculostomy sites can be verified by this procedure, and the bulk flow clearance of CSF can be quantitated. 4 postoperstive third ventriculostomy patients have been evaluated by this procedure to date. In each case the third ventriculostomy site was shown to be patent. The bulk flow clearance of CSF ranged from 170 to 342 cm3/24 h. Comparison of these figures with estimates of CSF production suggests that the majority of CSF reabsorption in these patients occurs through the arachnoid villi.
Ganglioglioma of the Entire Spinal Cord
Authors: Albright Leland , Byrd Ryland P.
Published: March 2008

The clinical findings of an 11-year-old boy with a ganglioglioma that extended from the medulla to the conus medullaris are presented and the details of tumor removal are described.
Experimental Brain Stem Displacement
Authors: DeFeo Don R. , Ramshaw Bruce , Foltz Eìdon L. , Sheets Joel
Published: March 2008

6 dogs were anesthetized and a silver clip attached to a cotton plug as surgically placed in the aqueduct of Sylvius. An immediate postoperative lateral skull film was obtained to demonstrate the position of the clip. The animals developed signs of hydrocephalus within hours after the procedure. 2 weeks after placement of the aqueduct plug, the animals received a permanent ventriculostomy. Immediate pre- and postoperative ventriculostomy lateral skull films were taken again to indicate position of the silver clip. Finally, a lateral skull film was taken 2 weeks after ventriculostomy and just prior to sacrifice. Radiological techniques were standardized. In this experimental setting downward brain stem herniation predominated and upward herniation of the brain stem was an infrequent occurrence.
Results of Treatment for Craniopharyngioma
Authors: Mori Koreaki , Handa Hajime , Murata Takaho , Takeuchi Juji , Miwa Soichi , Osaka Kunihiko
Published: March 2008

A review of the results of treatment for 155 cases of craniopharyngioma during the past 47 years by the palliative operation was made. Steroid and operative microscope reduced operative mortality and gave more chance of total extirpation, but survival rate was almost unchanged. It is noteworthy that 3 cases who underwent palliative operation more than 30 years ago are still alive and leading useful lives. The quality of survival was somewhat less favorable in pediatric than adult cases. Morbidity frequently encountered in pediatric cases was growth retardation. Craniopharyngioma is a benign tumor pathohistologically, but it should be considered as malignant because of the region it occurs in. Therefore, no forceful attempt to total extirpation should be made and the operations should, as a rule, be palliative.
Intracranial Meningiomas of Infancy, Childhood and Adolescence
Authors: Herz David A. , Shapiro Kenneth , Shulman Kenneth
Published: March 2008

The authors add 9 cases of pediatric meningiomas to 112 previously published cases and review clinical findings. Characteristic clinical and radiologic features are discussed in an attempt to identify settings where the diagnosis of intracranial meningioma should be considered in a child. Preoperative evaluation and outcome are also reviewed.
Suprasellar Cysts: Surgical Treatment and Results
Authors: Raimondi A.J. , Shimoji T. , Gutierrez F.A.
Published: March 2008

The purpose of this paper is to present the clinical picture, diagnostic studies, and treatment of 5 cases of suprasellar cyst. The clinical symptoms and signs result from increased intracranial pressure without lateralizing signs (midline syndrome) and direct compression of the adjacent structures (hypothalmopituitary syndrome). The findings of computerized transmission tomography (CTT) and cerebral angiography in patients with suprasellar cyst are very similar to those of severe hydrocephalus. Cerebral angiography, however, reveals an inordinate mass effect in the parasellar area. Even though the location of the parasellar cyst is well demonstrated on postventriculoperitoneal shunt CTT scans, pneumonencephalography is necessary to confirm the diagnosis. We treated our patients with uni- or bilateral ventriculoperitoneal shunts, followed by craniotomy and cystosubarachnoid marsupialization. Cystoperitoneal shunting was performed after craniotomy in some instances, in place of it in others.
Parasellar Tumors in Children
Authors: Richmond Isabelle L. , Wilson Charles B.
Published: March 2008

Despite the predominance of histologically benign tumors in the parasellar region of children, their proximity to the hypothalamus, optic nerves and tracts, and the internal carotid artery and its branches often renders surgical removal exceptionally difficult. The possible presence of a variety of tumor types makes biopsy verification of tumor diagnosis essential. The surgical management, radiotherapeutic treatment, and clinical follow-up of a group of 74 children whose preoperative findings were reviewed in the preceding paper are presented to illustrate the management of four major tumor types encountered: craniopharyngioma, pituitary adenoma, germinoma, and diencephalic glioma. Both subfrontal and transsphenoidal surgical approaches were used. Although total resection of benign tumors is desirable, prudent use of a variety of techniques can achieve effective neurosurgical management and optimal long-term results.
Congenital Intradural Neuroblastoma
Authors: Kauten James R. , Pearson Donald H.
Published: March 2008

A case of congenital intradural neuroblastoma with paraspinous involvement in a newborn is reported. A newborn presenting with paraplegia was treated with decompressive laminectomy and an attempt to debulk the tumor followed by postoperative radiation and chemotherapy. Literature review and treatment of the intraspinal neuroblastoma is presented along with the differential diagnosis of infantile intraspinal tumors. This is the first reported case describing congenital intradural neuroblastoma with no extradural component in a newborn.
Injuries of Basal Ganglia following Head Trauma in Children
Authors: Maki Yutaka , Akimoto Hiroshi , Enomoto Takao
Published: March 2008

7 pediatric patients with injuries of basal ganglia following head trauma were reported. They ranged in age from 10 months to 10 years. 5 boys and 2 girls comprised the patients. Cases 1–4 are mild cases in which the children fell down backward while playing, followed by a minimum loss of consciousness. In every case there was hemiparesis, but all of them showed remarkable recovery. CT findings are that of unilateral basal ganglia infarction. In cases 5–7, patients suffered from symptoms of brain contusion after running out in front of an oncoming car, and they developed hemiparesis. CT findings in cases 5 and 6 showed unilateral infarction. CT of case 7 showed a massive unilateral hemorrhage of the basal ganglia. All 7 cases sustained only slight scalp wounds and no skull fracture in spite of the severity of injuries signs and CT findings. This discrepancy seems to be explained only by the so-called shearing strain theory. But we have hypothesized that anterior stretch of the lateral branch of the perforator of the middle cerebral artery plays a major role in its pathogenesis.
Hypoxic Lesions in Areas of Primary Myelination
Authors: Azzarelli Biagio , Meade Peter , Muller Jans
Published: March 2008

The stage of regional structural and biochemical development of the central nervous system appears to be a critical factor determining the topistic distribution of ‘hypoxic’ lesions during the perinatal period. This report describes the brain lesions of 6 patients who suffered ‘hypoxia’ or ischemia during the perinatal period. 5 of these cases uniformly displayed symmetric ulegyria limited to areas of primary myelination, white matter damage subjacent to the cortical lesions, and status marmoratus of the basal ganglia and thalami. Areas of association which myelinate later in the postnatal period were basically normal. It is postulated that the damaged areas, at the moment of ‘hypoxic’ insult, had higher respiratory rates than the undamaged areas and, therefore, were more susceptible to oxygen deprivation.
Intraoperative Autonomic Dysfunction Associated with Arnold-Chiari Malformation
Authors: Ishak Badr A. , McLone David , Seleny Frank L.
Published: March 2008

This is a report of 2 infants with Arnold-Chiari malformation who showed various degrees of cardiovascular instability prior to and during surgical decompression of the posterior fossa which was abruptly terminated with successful decompression.
Isoelectric Focusing of Cerebrospinal Fluid Proteins in Children with Nontumoral Hydrocephalus
Authors: Cerda Maya , Basauri Luciano
Published: March 2008

The cerebrospinal fluid (CSF) protein patterns of 42 children with nontumoral hydrocephalus, 33% with associated congenital malformations (meningocele, myelomeningocele, spina bifida, monoventricular prosencephalon) were determined by isoelectric focusing and polyacrylamide gel electrophoresis. 50% of the patients showed a barrier damage pattern, 19% showed a degenerative pattern, a block pattern or a normal pattern were less frequently found. 14 children presented hydrocephalus associated with other malformations, 44% of these cases showed a degenerative pattern. Combining results from quantitative polyacrylamide gel elctrophoresis and qualitative isoelectric focusing, resulted in better characterization of CSF protein abnormalities, the high resolution capacity of these techniques may give a new approach to the evaluation of the blood CSF barrier in the management of hydrocephalus.
Antibiotic Prophylaxis in Ventricular Shunt Surgery
Authors: McCullough David C. , Kane James G. , Presper John H. , Wells Maurean
Published: March 2008

Administration of prophylactic antibiotics is not a proven or universal practice in cerebrospinal fluid (CSF) shunt surgery although case and operative infection rates in hydrocephalic patients average 20 and 8%, respectively. In sequential series from 1969 through 1978 the authors achieved a reduction in case infection rates from 10.9 to 8.9% and in operative infections from 8 to 2.6% with the use of short-term prophylactic methicillin. Comparison of these results to those of other reported series supports the case for short-term prophylactic antibiotics in shunt surgery. Further reduction in shunt sepsis may be possible with the appropriate selection of other semisynthetic penicillins which achieve higher levels in CSF.
Antibiotic Prophylaxis in Ventricular Shunt Surgery
Authors: McCullough David C. , Kane James G. , Harleman Gwen , Wells Maurean
Published: March 2008

Investigation of cerebrospinal fluid (CSF) antibiotic levels from patients operated upon under short-term prophylactic protocols for shunt insertions or revisions revealed low-level CSF penetration by nafcillin and virtually no methicillin activity. Nafcillin levels were not influenced by route of injection or CSF sampling time, but were inversely proportional to ventricular size. The authors recommend nafcillin over methicillin as the preferred prophylactic agent in shunt surgery. Although the 25 mg/kg preoperative dose may be adequate for reducing infection risk, higher dosages should be considered when the ventricles are markedly dilated.
Prognosis of Four Cases of Primary Middle Fossa Arachnoid Cyst in Children
Authors: Kato Makoto , Nakada Yoshitaka , Ariga Naobumi , Kokubo Yoshihiko , Makino Hiroyasu
Published: March 2008

The treatment and prognosis of 4 cases of primary middle fossa arachnoid cyst in children were analyzed with computed tomography, carotid angiography and Radio isotope cisternography at preoperative and postoperative states. In 2 of 4 cases the cysts reduced their sizes and in the other 2 cases they disappeared after operation. Three surgical methods were performed. The postoperative courses of all cases were good. The disappearance of cysts does not depend on the surgical methods.
Facial Nerve Schwannoma in a 16-Year-Old Girl
Authors: Gonzales-Pardo Lillian , Brackett Charles E. , Lansky Lester L.
Published: March 2008

A 16-year-old girl with unilateral facial nerve schwannoma in the cerebellopontine angle is presented in this report. The characteristic computerized tomography (CT) findings described in schwannomas and the patient’s clinical findings established the preoperative diagnosis of a rare but benign tumor in the pediatric age group. The value of early diagnosis of potentially resectable benign tumors is emphasized.
Intracranial Pressure Monitoring in Perspective
Authors: Venes Joan
Published: March 2008

Monitoring of intracranial pressure has become increasingly widespread in a variety of conditions. The information gained has allowed for the development of certain principles of management in patients with presumed or potential intracranial hypertension. These principles are applicable whether ICP monitoring is employed or not. Aggressive management of severe intracranial hypertension may improve survival; however, data from several studies are inconclusive. The author attempts to review developments in the field and assess the impact of this modality of therapy in pediatric neurosurgical practice.
Chemotherapy of Pediatric Posterior Fossa Tumors
Authors: Edwards Michael S. , Levin Victor A. , Wilson Charles B.
Published: March 2008

Results of chemotherapy of recurrent posterior fossa tumors in children are presented. Cerebellar astrocytoma, ependymoma, and brain stem glioma have all shown objectively determined responses to treatment with nitrosourea compounds (BCNU or CCNU). Medulloblastoma has shown objectively determined response to various chemotherapeutic agents; but in our experience the best responses have been obtained with a combination of a nitrosourea (CCNU), vincristine, and procarbazine. Although chemotherapy after recurrence has significantly prolonged the life of the patients, cure has not yet been achieved. Theoretical considerations regarding the failure of initial therapy and the inadequacy of subsequent chemotherapy are discussed.
Retroperitoneal Neuroblastoma Metastatic to Brain
Authors: Koizumi June H. , Dal Canto Mauro C.
Published: March 2008

Brain metastases from extracranial neuroblastoma are rare. They are generally produced by direct extension from metastatic lesions of skull or dura. Very few cases with primary cerebral metastases have been described. We reviewed all autopsy cases of extracranial neuroblastoma at Children’s Memorial Hospital in the 12-year period from 1967 to 1978. Of 27 cases in which the brain was examined, 14 had intracranial involvement but only one presented parenchymal metastases in the absence of skull or dural involvement. This case is reported in detail and the literature is reviewed.
Subdural Hygroma: Results of Treatment by Ventriculo-Abdominal Shunt
Authors: Njiokiktjien C.J. , Valk J. , Ponssen H.
Published: March 2008

Subdural hygromas, which differ from acute and chronic subdural haematomas in clinical features and pathogenetic mechanism, can occur as isolated lesions or in association with ventricular dilatation and/or subarachnoid cysts which are mistaken for atrophy. On the basis of the postulate that these fluid accumulations might be related to a disturbance in CSF circulation, we treated them by ventriculoperitoneal CSF drainage. This was regarded as indicated only for children with symptoms of retardation and a distended ventricular system. Disappearance of the hygroma or the cortical cysts and ventricular dilatation was demonstrated in 9 of 14 children treated by ventriculo-abdominal shunt and in 4 of 7 less seriously affected untreated children. Clinical improvement came later than neuroradiological improvement, and was incomplete in a number of children. Although there are anamnestic factors with an unfavourable effect on development, the hygromas per se can cause cerebral dysfunction which is associated with their bifrontal localization. The principal symptoms are those of retardation in the development of verbal expression, leg motor function and manipulation.
Intracranial Pressure Monitoring with the Fiberoptic Transducer in Children
Authors: Ivan Leslie P. , Choo S.H. , Ventureyra E.C.G.
Published: March 2008

Observations on 52 patients with continuous intracranial pressure (ICP) monitoring are reported. The authors used a fiberoptic epidural transducer with digital readout and paper-recording facilities in the intensive care unit of a children’s hospital. They confirm the reports of others that [1] ICP monitoring is an extremely useful aid in the management of patients in coma and that [2] epidural pressure measurement is a safe and accurate method. No infection occurred in this series nor were there any other complications arising from the epidural method of ICP monitoring. Apart from three episodes of breakage of the transducer cable, they did not encounter technical difficulties with the system.
Anterior Optic Gliomas with Precocious or Pseudoprecocious Puberty
Authors: Iraci Giorgio , Gerosa Massimo , Scanarini Massimo , Tomazzoli Laura , Fiore Daniele L. , Pardatscher Kurt , Rigobello Luca , Secchi Antonio G.
Published: March 2008

5 patients with gliomas of the anterior optic pathways, histologically assessed or with strong diagnostic evidence, who developed precocious or pseudoprecocious puberty (2 cases) before the operation or after radiation treatment, are presented. Only 2 patients presented familial and/or personal evidence of neurofibromatosis. The production mechanism of these sexual changes is discussed.
Subdural Hematomas in Neonates
Authors: Alvarez-Garijo Jose A. , Taboada Gomila Dario , Perez Aytes Antonio , Vila Mengual Manuel , Martin Adela Alonso
Published: March 2008

7 cases of acute subdural hematomas diagnosed and surgically treated during the first week of life are presented. 5 of them are alive and well at 6 and 7 months and 3, 4 and 6 years of follow-up. Free interval, raised intracranial pressure, lateralizing signs, fall of hematocrit and pressence of blood in CSF were constant. Subdural puncture was negative in 6 cases, including a hemophilic patient (hemophilia B). Clinical diagnosis was ratified by means of neuroradiological procedures. The authors conclude that craniectomy is the treatment of choice and subdural tapping a useless procedure.