bluuebunny/crossref_metadata_2025_split huggingface dataset:
Boost radiosurgery as a strategy after failure of initial management of pediatric primitive neuroectodermal tumors
Authors: Flannery Thomas , Kano Hideyuki , Martin Juan J. , Niranjan Ajay , Flickinger John C. , Lunsford L. Dade , Kondziolka Douglas 
Published: September 2009

Object
The aim in this study was to determine the outcomes of boost stereotactic radiosurgery, specifically Gamma Knife surgery (GKS), for recurrent primitive neuroectodermal tumors (PNETs) in children in whom initial multimodality management had failed.

Methods
The authors performed a retrospective analysis of 7 patients who underwent a total of 15 GKS procedures for locally recurrent or metastatic PNETs. Nine procedures were directed at the primary site, whereas 6 were directed at distant brain sites. All patients received multimodality therapy, including resection, fractionated radiotherapy, and chemotherapy. The mean interval from diagnosis to first stereotactic radiosurgery was 25.8 months (range 11–35 months). The mean tumor volume was 3.9 cm3 (range 1.1–13.1 cm3), and an average marginal dose of 14.5 Gy (range 9–20 Gy) was administered.

Results
Following salvage GKS, 2 patients had early disease progression (median survival of 5 months after GKS). Five patients had late disease progression (complete response in 3, partial response in 1, and stable disease in 1) and a median survival of 30 months after GKS. Four of the 5 patients who had late progression underwent repeat GKS for marginal recurrence. No adverse radiation effects were observed in these 7 patients.

Conclusions
The GKS modality was a well-tolerated and useful boost strategy in pediatric patients with PNET and a poor prognosis in whom initial multimodality management had failed. However, local or distant disease progression or diffuse leptomeningeal spread ultimately proved fatal to these patients.
Ventricular reservoirs and ventriculoperitoneal shunts for premature infants with posthemorrhagic hydrocephalus: an institutional experience
Authors: Willis Brian , Javalkar Vijayakumar , Vannemreddy Prasad , Caldito Gloria , Matsuyama Junko , Guthikonda Bharat , Bollam Papireddy , Nanda Anil 
Published: September 2009

Object
The aim of the study was to analyze the outcome of surgical treatment for posthemorrhagic hydrocephalus in premature infants.

Methods
From 1990 to 2006, 32 premature infants underwent surgical treatment for posthemorrhagic hydrocephalus, and their charts were retrospectively reviewed to analyze the complications and outcome with respect to shunt revisions. Multivariate analysis and time series were used to identify factors that influence the outcome in terms of shunt revisions.

Results
The mean gestational age was 27 ± 3.3 weeks, and mean birth weight was 1192 ± 660 g. Temporary reservoir placement was performed in 15 patients, while 17 underwent permanent CSF diversion with a ventriculoperitoneal (VP) shunt. In 2 patients, reservoir tapping alone was sufficient to halt the progression of hydrocephalus; 29 patients received VP shunts. The mean follow-up period was 37.3 months. The neonates who received VP shunts first were significantly older (p = 0.02) and heavier (p = 0.04) than those who initially underwent reservoir placement. Shunts were revised in 14 patients; 42% of patients in the reservoir group had their shunts revised, while 53% of infants who had initially received a VP shunt required a revision. The revision rate per patient in the reservoir group was half that in the direct VP shunt group (p = 0.027). No patient in the reservoir group had > 2 revisions. Shunt infections developed in 3 patients (10.3%), and 2 patients in the reservoir group died of nonneurological issues related to prematurity.

Conclusions
Birth weight and age are useful parameters in decision making. Preterm neonates with low birth weights benefit from initial CSF drainage procedures followed by permanent CSF diversion with respect to the number of shunt revisions.
Angiocentric glioma: a case series
Authors: Shakur Sophia F. , McGirt Matthew J. , Johnson Michael W. , Burger Peter C. , Ahn Edward , Carson Benjamin S. , Jallo George I. 
Published: September 2009

Object
Angiocentric glioma was recently recognized as a distinct clinicopathological entity in the 2007 World Health Organization Classification of Tumours of the Central Nervous System. The authors present the first 3 pediatric cases of angiocentric glioma encountered at their institution and review the literature of reported cases to elucidate the characteristics and outcomes of pediatric patients with this novel tumor.

Methods
The children in the 3 cases of angiocentric glioma were 10, 10, and 13 years old. Two presented with intractable seizures and 1 with worsening headache and several months of decreasing visual acuity. Twenty-five cases, including the 3 first described in the present paper, were culled from the literature.

Results
In all 3 cases, MR imaging demonstrated a superficial, nonenhancing, T2-hyperintense lesion in the left temporal lobe. Histologically, the tumors were composed of monomorphous cells with a strikingly perivascular orientation that were variably reactive for glial fibrillary acidic protein and epithelial membrane antigen. Surgical treatment resulted in gross-total resection in all 3 cases. By 24, 9, and 6 months after surgery, all 3 patients remained seizure free without focal neurological deficits.

Conclusions
Among 25 cases of angiocentric glioma, seizure was the most common symptom at presentation. Magnetic resonance imaging demonstrated supratentorial, nonenhancing, T1-hypointense, T2-hyperintense lesions. Gross-total resection of this lesion yields excellent results.
Human fetal medial striate artery or artery of Heubner
Authors: Vasović Ljiljana , Ugrenović Sladjana , Jovanović Ivan 
Published: September 2009

Object
The authors describe some of the features of the medial striate branch or recurrent artery of Heubner (RAH). This structure has indisputable functional, neurological, and neurosurgical significance, and originates from the A1 and/or A2 segments of the anterior cerebral artery.

Methods
Microdissection of 94 human fetal specimens was performed. The RAH was observed in 97.3% (single in 71.6%, double in 25.1%, and triple in 3.3%) of the cases. Its origin was from A2 in 42.3% of specimens, from the A1–A2 junction in 25.7%, and from A1 in 20%.

Results
Five types and 14 subtypes of the RAH were identified, determined based on vessel origin and number. In its course, the RAH gave 1–12 branches, and the terminal part most frequently penetrated into the brain through the anterior perforated substance at the level of the sphenoid segment of the middle cerebral artery. The specimens with a single RAH fenestration, abnormal double RAH anastomosis, and unusual RAH origin and relationship to the surrounding vessels represented new data.

Conclusions
The authors' observations of common anatomical variations in the number and origin of the RAH, as well as its abnormalities, may assist neuroradiologists in the interpretation of diagnostic test results and neurosurgeons in performing procedures in the anterior cerebral circulation.
Agitation and/or aggression after traumatic brain injury in the pediatric population treated with ziprasidone
Authors: Scott L. Keith , Green Rebecca , McCarthy Paul J. , Conrad Steven A. 
Published: September 2009

Object
Agitation and aggression are common after traumatic brain injury (TBI) and can hamper recovery and rehabilitative efforts. To date, there is no consensus on pharmaceutical intervention for these conditions after TBI. Ziprasidone has been reported efficacious in this population but the evidence is limited. The authors report their experience of using ziprasidone to treat posttraumatic brain injury agitation in 20 consecutive pediatric patients. A secondary objective of this case series was to attempt to establish an age-specific dosage and identify possible side effects of this medication.

Methods
This case series study was performed at a university hospital and pediatric trauma center. Over an 18-month period, all patients who presented to the pediatric intensive care unit with TBI and later developed agitation and/or aggression were treated with ziprasidone as the sole intervention. Pre- and posttreatment scores on the Riker Sedation-Agitation Scale (SAS) were recorded along with demographic data.

Results
Twenty children received ziprasidone for agitation and/or aggression during the immediate recovery period from TBI. The median patient age was 8 years (range 9 months–17 years). Children were stratified into 4 age groups: < 2 years old (Group 1), 2–6 years old (Group 2), 7–12 years old (Group 3), and ≥ 13 years old (Group 4). The SAS score, before and 24 hours after the initiation of ziprasidone, demonstrated a significant reduction after initiation of the medication (p < 0.001). The initial dose for Groups 1–4 was 1.7, 0.9, 0.7, and 0.6 mg/kg, respectively, with final doses of 1.8, 1.5, 1.7, and 0.07 mg/kg, respectively. The duration of therapy for Groups 1–4 was 5, 8, 6, and 3 days, respectively. All patients received continuous cardiac and blood-pressure monitoring. No adverse events were reported in any of the age groups.

Conclusions
Based on this limited patient series, ziprasidone appears to be safe and effective in pediatric patients with closed head injuries who develop agitation and/or aggression in the immediate postinjury period. Ziprasidone consistently lowered SAS scores and did so in all age groups. There were minimal dose adjustments and the duration of therapy was relatively brief. No adverse events were reported. A prospective trial of ziprasidone in this population appears warranted.
Hemiparkinsonism due to a pontomesencephalic cavernoma: improvement after resection
Authors: Ghaemi Kazem , Krauss Joachim K. , Nakamura Makoto 
Published: September 2009

Cavernous angiomas of the upper brainstem causing hemiparkinsonism are very rare. Due to their difficult-to-reach localization, brainstem cavernomas, in particular those in anterior locations, continue to present a therapeutic challenge.
The authors report on a 16-year-old boy with a pontomesencephalic cavernoma who developed hemiparkinsonism and hemiparesis after hemorrhage. After complete surgical removal of the pontomesencephalic cavernoma via a pterional transsylvian approach, his symptoms resolved.
Although pontomesencephalic cavernomas occupying the ventral portion of the brainstem are regarded as problematic for resection, the pterional transsylvian approach provides an excellent route for removal of cavernomas that are in contact with the ventral surface of the midbrain in the interpeduncular cistern. Surgical removal of this type of lesion is recommended because resolution of clinical symptoms, including hemiparkinsonism, can be achieved.
Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States
Authors: Simon Tamara D. , Hall Matthew , Riva-Cambrin Jay , Albert J. Elaine , Jeffries Howard E. , LaFleur Bonnie , Dean J. Michael , Kestle John R. W. , _ _ 
Published: September 2009

Object
Reported rates of CSF shunt infection vary widely across studies. The study objective was to determine the CSF shunt infection rates after initial shunt placement at multiple US pediatric hospitals. The authors hypothesized that infection rates between hospitals would vary widely even after adjustment for patient, hospital, and surgeon factors.

Methods
This retrospective cohort study included children 0–18 years of age with uncomplicated initial CSF shunt placement performed between January 1, 2001, and December 31, 2005, and recorded in the Pediatric Health Information System (PHIS) longitudinal administrative database from 41 children's hospitals. For each child with 24 months of follow-up, subsequent CSF shunt infections and procedures were determined.

Results
The PHIS database included 7071 children with uncomplicated initial CSF shunt placement during this time period. During the 24 months of follow-up, these patients had a total of 825 shunt infections and 4434 subsequent shunt procedures. Overall unadjusted 24-month CSF shunt infection rates were 11.7% per patient and 7.2% per procedure. Unadjusted 24-month cumulative incidence rates for each hospital ranged from 4.1 to 20.5% per patient and 2.5–12.3% per procedure. Factors significantly associated with infection (p < 0.05) included young age, female sex, African-American race, public insurance, etiology of intraventricular hemorrhage, respiratory complex chronic condition, subsequent revision procedures, hospital volume, and surgeon case volume. Malignant lesions and trauma as etiologies were protective. Infection rates for each hospital adjusted for these factors decreased to 8.8–12.8% per patient and 1.4–5.3% per procedure.

Conclusions
Infections developed in > 11% of children who underwent uncomplicated initial CSF shunt placements within 24 months. Patient, hospital, and surgeon factors contributed somewhat to the wide variation in CSF shunt infection rates across hospitals. Additional factors may contribute to variation in CSF shunt infection rates between centers, but further study is needed. Benchmarking and future prospective multicenter studies of CSF shunt infection will need to incorporate these and other patient, hospital, and surgeon factors.
Mixed germ cell tumor of the midbrain
Authors: Koh Eun Jung , Phi Ji Hoon , Park Sung-Hye , Kim In-One , Cheon Jung-Eun , Wang Kyu-Chang , Cho Byung-Kyu , Kim Seung-Ki 
Published: September 2009

This 14-year-old boy presented with left hemiparesis, gait disturbance, and multiple cranial nerve palsies. Magnetic resonance imaging revealed a multicystic mass with hemorrhagic fluid–fluid levels in the right midbrain, suggesting the presence of a cavernous malformation. Diffusion tensor imaging showed the mass to be close to the right corticospinal tract and ipsilateral medial lemniscus. Subtotal removal of the mass was performed via a right subtemporal approach. The histopathological diagnosis was of a mixed germ cell tumor (GCT) comprising mature teratoma and germinoma cells with syncytiotrophoblastic giant cells. The patient underwent postoperative chemotherapy and radiotherapy, and no tumor progression was found during 1 year of follow-up.
Intracranial GCTs arise mainly in the pineal and the suprasellar area. Germ cell tumors in the brainstem are rare, with only 12 reported cases. Among these, 4 were in the midbrain and histologically were pure germinomas. To the authors' knowledge, this is the first reported case of a mixed GCT in the midbrain combining mature teratoma and germinoma cells.
Longitudinal diffusion-weighted imaging in infants with hydrocephalus: decrease in tissue water diffusion after cerebrospinal fluid diversion
Authors: Leliefeld Paul H. , Gooskens Rob H. J. M. , Braun Kees P. J. , Ramos Lino M. P. , Uiterwaal Cuno S. P. M. , Regli Luca P. E. , Tulleken Cees A. F. , Kappelle L. Jaap , Hanlo Patrick W. 
Published: September 2009

Object
Progressive hydrocephalus may lead to edema of the periventricular white matter and to damage of the brain parenchyma because of compression, stretching, and ischemia. The aim of the present study was to investigate whether cerebral edema can be quantified using diffusion-weighted imaging in infants with hydrocephalus and whether CSF diversion could decrease cerebral edema.

Methods
Diffusion-weighted MR imaging was performed in 24 infants with progressive hydrocephalus before and after CSF diversion. Parametric images of the trace apparent diffusion coefficients (ADCs) were obtained. The ADCs of 5 different cortical and subcortical regions of interest were calculated pre- and postoperatively in each patient. The ADC values were compared with age-related normal values. Mean arterial blood pressure and anterior fontanel pressure were measured immediately after each MR imaging study.

Results
After CSF diversion, the mean ADC decreased from a preoperative value of 1209 ± 116 × 10−6 mm2/second to a postoperative value of 928 ± 64 × 10−6 mm2/second (p < 0.005). Differences between pre- and postoperative ADC values were most prominent in the periventricular white matter, supporting the existence of preoperative periventricular edema. Compared with age-related normal values, the preoperative ADC values were higher and the postoperative ADC values were lower, although within normal range. The decrease in ADC after CSF drainage was more rapid than the more gradual physiological decrease that is related to age.
The preoperative ICP was elevated in all patients. After CSF diversion the ICP decreased significantly to within the normal range. A linear correlation between ADC values and ICP was found (correlation coefficient 0.496, p < 0.001). In all patients the mean arterial blood pressure was within physiological limits both pre- and postoperatively.

Conclusions
This study shows a rapid and more extensive decrease in ADC values after CSF diversion than is to be expected from physiological ADC decrease solely due to increasing patient age. The preoperative ADC increase can be explained by interstitial edema caused by transependymal CSF leakage or by vasogenic edema caused by capillary compression and stretching of the brain parenchyma. This study population of infants with (early recognized) hydrocephalus did not suffer from cytotoxic edema. These findings may help to detect patients at risk for cerebral damage by differentiating between progressive and compensated hydrocephalus.
Evolution in the frequency of nonsyndromic craniosynostosis
Authors: Di Rocco Federico , Arnaud Eric , Renier Dominique 
Published: September 2009

Object
The prevalence of the different subtypes of craniosynostosis varies greatly. The aim of this study was to analyze the prevalences of the different subtypes of craniosynostosis at a single major craniofacial center and their changes during a 20-year period.

Methods
The medical charts of 2808 children hospitalized between 1988 and 2007 for a true craniosynostosis were retrospectively reviewed. Patients were divided according to their subtype of craniosynostosis (sagittal, plagiocephaly, brachycephaly, metopic, oxycephaly, syndromic cases, or unclassifiable).

Results
The total number of patients according to their craniosynostosis subtype were as follows: 1224 cases of scaphocephaly, 315 cases of plagiocephaly, 598 cases of trigonocephaly, 105 cases of brachycephaly, 69 cases of oxycephaly, 396 syndromic cases, and 101 unclassifiable cases. The prevalences of these craniosynostoses evolved differently over time. The number of children hospitalized each year increased over time from 106 to 181 cases, but this increase varied according to the subtype of craniosynostosis. Cases of scaphocephaly, plagiocephaly, brachycephaly, and syndromic cases increased similarly (170% increase on average), whereas trigonocephalies dramatically increased (420% increase).

Conclusions
The evolution observed in the prevalence of craniosynostosis might result from several factors. An increased recruitment of patients at the center and an improvement in the diagnosis of craniosynostosis might explain the overall increase. However, other mechanisms should be examined to explain the great increase in the number of cases of trigonocephaly (environmental or pharmacological).
Neuroleptic malignant syndrome from central nervous system insult: 4 cases and a novel treatment strategy
Authors: Wait Scott D. , Ponce Francisco A. , Killory Brendan D. , Wallace Donna , Rekate Harold L. 
Published: September 2009

Neuroleptic malignant syndrome (NMS) is a potentially life-threatening entity characterized by hyperthermia, autonomic deregulation, decreased mental status, increased muscle tone, and, frequently, by renal failure due to rhabdomyolysis. Classically, it follows administration of antipsychotic medication.
The authors report on 4 patients (2 children and 2 adults) in whom NMS was diagnosed after a CNS insult. No patient was receiving antipsychotic medication. The patients' hospital and clinic charts, radiographic data, and follow-up telephone conversations were reviewed retrospectively.
All 4 patients met diagnostic criteria for NMS. Three patients presented with shunt failure, and 1 patient had undergone a functional hemispherectomy 2 days earlier. One patient with shunt failure received the diagnosis retrospectively. An endoscopic third ventriculostomy alleviated his shunt failure and he remains free of NMS. The other 2 patients underwent treatment for shunt failure, but NMS remained. These 2 patients and the one who had undergone hemispherectomy underwent a trial of intrathecal baclofen, and the NMS resolved. Subsequently, an intrathecal baclofen infusion device was placed in all 3 patients, and the NMS resolved. The 2 patients in shunt failure had a lumbar intrathecal baclofen infusion device. The patient who had undergone hemispherectomy had an intracranial baclofen catheter.
Neuroleptic malignant syndrome is a rare, life-threatening disorder that can occur without the administration of neuroleptic medications. Alleviation of any CNS insult is the first order of treatment. Some patients with persistent symptoms of NMS may benefit from intrathecal delivery of baclofen.
Urological outcome following multiple repeat spinal cord untethering operations
Authors: Maher Cormac O. , Bauer Stuart B. , Goumnerova Liliana , Proctor Mark R. , Madsen Joseph R. , Scott R. Michael 
Published: September 2009

Object
Patients who have undergone myelomeningocele or lipomyelomeningocele repair may present with symptomatic retethering of the spinal cord. The authors describe the results as well as the utility of urological testing in pediatric patients undergoing multiple repeat untethering operations.

Methods
The authors reviewed the records of 13 patients with lipomyelomeningocele or myelomeningocele who underwent at least 2 untethering procedures after their initial repair and who had urodynamic testing within 6 months prior to and 6 months following each untethering operation. In each case, urological testing included a slow-fill cystometrogram and an external urethral sphincter electromyogram using a concentric needle electrode to analyze individual motor unit action potentials at rest, in response to sacral reflexes, and during bladder filling and emptying.

Results
New urinary symptoms were identified in 7 of 13 cases prior to surgery. Postoperative subjective improvement in urinary symptoms was noted in 5 of these 7 cases. Improvement in bladder function on urodynamic testing correlated with symptomatic improvement. Sphincter electromyography findings did not correlate with changes in preoperative symptoms or postoperative improvement.

Conclusions
In patients undergoing multiple repeat spinal cord untethering operations, measuring bladder function is more useful than sphincter electromyographty when selecting candidates for surgery and for measuring surgical outcomes.