Cerebral perfusion pressures (CPP) of less than 50 torr are associated with marginal cerebral blood flow and poor outcome. We report our experience with a group of 7 children who survived long period with CPP of less than 50 torr during treatment with pentobarbital. The study group was identified through a retrospective review of all head-injured patients admitted to Cardinal Glennon Memorial Hospital for Children between 1984 and 1986. All of the patients presented had sustained intracranial pressure of greater than 20 torr which was resistant to conventional therapy. All patients received pentobarbital for at least 24 h and all had documented CPP of less than 50 torr for more than 30 min during that time. Of these 7 children: 3 made good recoveries; 2 are moderately disabled, and 2 are vegetative. Neither the CPP nor the length of pentobarbital coma was an accurate predictor of outcome. It seems likely that these children are a subset of those previously defined as having resistant intracranial hypertension and that, as a group, they may have benefited from pentobarbital administration. It is also apparent that, in this group, low CPP was not indicative of irreversible brain damage or brain death.
Brain stem glioma is the third most common childhood brain tumor, comprising 10-15% of this group of neoplasms. Typical presenting symptoms include ataxia, diplopia and headache, while signs of increased intracranial pressure occur later in the clinical course. Although prolonged failure to thrive, characterized by cachexia and vomiting are rare manifestations of brain stem lesions, in this study we report a 9.5-year-old boy with failure to thrive since infancy which remitted after excision of a brain stem astrocytoma.
There has been experimental evidence of the tethered cord syndrome being a gray matter disease resulting from excessive tensile force in the lumbosacral cord. Clinical findings also support this concept. This study was designed to elucidate the possibility of the involvement of the long tract in tethered cord. Long tract continuity was evaluated utilizing the retrograde axonal transport of horseradish peroxidase in fasciculus gracilis. There were no significant differences between the normal and experimental tethered cord in the number of labeled dorsal root ganglion cells of the lumbosacral cord. From this we conclude that involvement of the long sensory tract during steady state of severe cord traction at best is minimal. This study supports the hypothesis that tethered cord syndrome primarily is a gray matter disorder.
We reviewed 114 childhood brain tumors and brain sections from 30 children with no nervous system lesions to determine the incidence of vascular bundles (VB) and vascular wickerworks (VW). VB consist of a group of small blood vessels running parallel to each other. VW denote spiralling or twisting of two or more small blood vessels around one another, resembling vines. By light microscopy, VB cannot be differentiated from VW; both appear as a group of small blood vessels oriented in the same direction. VB and VW have been described in normal and abnormal brains at all ages, in association with aging, in neovascularization following necrosis, and in brain tumors. They occur rarely in normal brains, but are a common histological feature of cerebellar pilocytic astrocytomas in contrast to diencephalic pilocytic astrocytomas, anaplastic astrocytomas of cerebrum and cerebellum, and meningiomas.
Thirty-five patients with the Dandy-Walker syndrome (DWS) treated over the years 1964-1987 at the Hospital for Sick Children, Toronto, were reviewed. Thirty-three patients (94%) had hydrocephalus at the time of diagnosis. The primary association of aqueduct stenosis was excluded by radiological investigation and clinical course in all patients. Associated central nervous system (CNS) anomalies were present in 10 patients. Seven had occipital encephalocele and in 1 of these there was an associated Klippel-Feil syndrome. Four patients had agenesis of the corpus callosum and 1 patient had polyporencephaly. The treatment of these patients has changed over the years in our institution so that during an earlier period, 3 patients were treated by resection of the cyst membranes. We then went through a period of shunting the lateral ventricle so that 21 patients were treated with either a lateral ventricle to peritoneal or lateral ventricle to atrial shunt. More recently, patients with the DWS have been treated with a cyst-peritoneal shunt and 10 patients were thus treated. Only 1 patient was treated with a simultaneous lateral ventricle and cyst-peritoneal shunt. Nine of the twenty-one patients (43%) with a primary lateral ventricle to peritoneum or lateral ventricle to atrial shunt developed a secondary aqueduct stenosis and an isolated fourth ventricle which required additional cyst-peritoneal shunting. Only 1 of the 10 patients treated with a primary cyst-peritoneal shunt required an additional lateral ventricle peritoneal shunt. Two patients initially treated with a lateral ventricle peritoneal shunt and with a primary cyst-peritoneal shunt subsequently had a percutaneous stereotactic third ventriculostomy.(ABSTRACT TRUNCATED AT 250 WORDS)
Research Articles| March 05 2008 Feeding Problems and Lactic Acidosis in a 10-Week-Old Boy Subject Area: Neurology and Neuroscience , Surgery , Women's and Children's Health Joan Robinson; Joan Robinson Departments of Pediatrics and Pathology, BC's Children's Hospital and University of British Columbia, Vancouver, B.C., Canada Search for other works by this author on: This Site PubMed Google Scholar Margaret G. Norman Margaret G. Norman Departments of Pediatrics and Pathology, BC's Children's Hospital and University of British Columbia, Vancouver, B.C., Canada Search for other works by this author on: This Site PubMed Google Scholar Pediatr Neurosurg (1989) 15 (1): 28–35. https://doi.org/10.1159/000120437 Article history Published Online: March 05 2008 Content Tools Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Joan Robinson, Margaret G. Norman; Feeding Problems and Lactic Acidosis in a 10-Week-Old Boy. Pediatr Neurosurg 1 January 1989; 15 (1): 28–35. https://doi.org/10.1159/000120437 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsPediatric Neurosurgery Search Advanced Search Article PDF first page preview Close Modal This content is only available via PDF. 1989Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. You do not currently have access to this content.
Congenital arachnoid cysts (CAC) are benign developmental disorders. A number of theories have been proposed to explain the origin and progression to the symptomatic stage. Management strategies range from not treating the asymptomatic cysts to craniotomy, excision of cyst wall and establishment of a communication with the adjacent subarachnoid cistern or ventricle. Other lesions may resemble CAC, and can be differentiated from CAC only by a critical review of the biopsy specimen. We have reviewed our experience with true CAC and similar lesions. Based on our experience we recommend craniotomy, excision of cyst wall and establishment of a communication with an adjacent subarachnoid cistern or ventricle as the primary procedure.
A rare case with Guillain-Barré syndrome complicated by inappropriate secretion of antidiuretic hormone (SIADH) and hypertension was reported. This case showed clinically mild symptoms without respiratory muscle paralysis and had a complete neurological recovery. It should, therefore, be considered that the Guillain-Barré syndrome may cause SIADH and hypertension independent of the severity of the disease.
The paper describes a so far unreported combination of Dandy-Walker syndrome and chronic hereditary polyneuropathy in 2 boys. One of the boys has a de- and remyehnating motor and sensory polyneuropathy, with either an autosomal recessive mode of inheritence or a sporadic occurrence. The other has an autosomal dominant form of mild polyneuropathy with tomaculum formations in myelinated fibers, corresponding to hereditary neuropathy with liability to pressure palsies.
Research Articles| March 05 2008 Eight-Year-Old Girl with Psychomotor Retardation and Seizures Subject Area: Neurology and Neuroscience , Surgery , Women's and Children's Health Venita Jay; Venita Jay aDepartments of Pathology and Search for other works by this author on: This Site PubMed Google Scholar Gabriel Ronen; Gabriel Ronen bNeurology, The Dr. Charles A. Janeway Child Health Centre, St. John's, Nfld., Canada; Search for other works by this author on: This Site PubMed Google Scholar Samuel H. Tucker Samuel H. Tucker cThe Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa., USA Search for other works by this author on: This Site PubMed Google Scholar Pediatr Neurosurg (1989) 15 (4): 207–214. https://doi.org/10.1159/000120469 Article history Published Online: March 05 2008 Content Tools Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Venita Jay, Gabriel Ronen, Samuel H. Tucker; Eight-Year-Old Girl with Psychomotor Retardation and Seizures. Pediatr Neurosurg 1 April 1989; 15 (4): 207–214. https://doi.org/10.1159/000120469 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsPediatric Neurosurgery Search Advanced Search Article PDF first page preview Close Modal This content is only available via PDF. 1989Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. You do not currently have access to this content.
Numerous reconstructive methods have been described for the soft tissue closure of large myelomeningoceles. Recent advances in techniques of soft tissue expansion provide yet another reconstructive option. Tissue expansion allows for primary closure of the defect with surrounding tissue, resulting in minimal donor site morbidity. This report illustrates the technique of tissue expansion in the closure of a large myelomeningocele.
Upward transtentorial herniation of a Dandy-Walker cyst is a potentially fatal complication, particularly after solitary shunting of the lateral ventricle for associated hydrocephalus. Two patients with upward transtentorial herniation of their Dandy-Walker cysts are presented to illustrate the diagnostic value of magnetic resonance (MR) imaging with the demonstration of unique 'keyhole' and 'snail' signs on the axial and sagittal MR images, respectively. In both patients, double and simultaneous shunting en-Y of a lateral ventricle and the posterior fossa cyst resulted in the resolution of the herniation syndrome.
We examined the treatment of hydrocephalus in children with posterior fossa tumors to (1) compare the use of external ventricular drainage (EVD) with ventriculoperitoneal shunts (VPS), (2) determine the frequency of postoperative hydrocephalus requiring permanent shunts, and (3) determine which factors predict the need for a permanent shunt. The records of 58 children with posterior fossa tumors and associated hydrocephalus treated at our institution from 1979 to 1987 were retrospectively reviewed. Initial management of hydrocephalus included VPS in 25 patients, EVD in 17, and no treatment in 16. Patients in the 'VPS', 'EVD', and 'no treatment' groups differed only in the severity of hydrocephalus (less severe in the no treatment group than in the VPS and EVD groups) and in the method of dural closure following tumor resection (dura was left open more often in the EVD and no treatment groups). Of the 33 patients not initially shunted, only 9 (27%) subsequently required a shunt. These patients were compared with the remaining 24 patients who did not require a shunt. Two features predicted the need for a subsequent shunt: (1) resection of only a small volume of tumor and (2) leaving the dura open following tumor resection. Complications of EVD were few; no patient deteriorated neurologically during or after ventricular catheter removal. We conclude that between two thirds and three quarters of patients with childhood posterior fossa tumors and associated hydrocephalus may be managed with perioperative EVD and will not require shunts. Patients in whom only a minimal tumor resection is performed and those in whom the dura is left open are more likely to need permanent VPS.
Two cases of intrauterine depressed fracture are presented. In each case, the mother had no history of abdominal trauma during pregnancy, the children were delivered normally without the use of forceps, but a round depression was present in the left frontal bone at time of delivery. CT scans demonstrated a depressed fracture of the left frontal bone and stagnation of cerebrospinal fluid around the fracture. Elevation of the depression was therefore made through a small incision along the rear edge of the frontal bone using a periosteal elevator. A review of intrauterine depressed skull fracture is made and the concept, mechanism, surgical indications and operative methods of this rare fracture are discussed.
The clinical, radiological and pathological features of two cases of intraventricular meningioma in a 9-year-old boy and a 9-year-old girl are reported. Presenting features included headache, vomiting and somnolence with no localizing neurological signs on physical examination. Neither patient showed evidence of neurofibromatosis. CT scans were helpful in establishing the preoperative diagnoses with uniformly hyperdense, well-circumscribed lesions showing bright enhancement after contrast within the lateral and third ventricles respectively. Histological examination revealed mixed fibroblastic/angioblastic and fibroblastic patterns, with typical electron-microscopic and immunohistochemical features of meningioma. Successful surgical removal was achieved in both cases.
A family with two sisters and their mother’s male cousin had ependymomas. Of note is the fact that chromosome analysis on the tumour of the younger sister showed two cell lines, one a normal female line, the other with monosomy of chromosome 22.
Over a period of 34 months from 1987 to 1990 we inserted ventricular catheter reservoirs (VCR) into 20 premature low-birth-weight infants who had developed progressive, symptomatic posthemorrhagic hydrocephalus following grade III or IV intraventricular hemorrhages. The mean estimated gestational age was 27.7 +/- 5.3 weeks and mean birth weight was 1,041 +/- 699 g. The ventricular catheter reservoirs were placed on day of life 30.7 +/- 29.7 and tapped for a total of 3-34 days at varying frequencies and for varying volumes. Of the 20 patients, 4 died on days of life 25, 76, 88, and 187. There were two reservoir infections, both occurring in infants who eventually died. The 16 survivors have been followed from 2 to 24 months (adjusted age). Four (25%) remain shunt-free and 3 have undergone VCR removal. There have been two shunt infections in the 12 shunted patients; ten shunt revisions have been performed overall. At the time of last follow-up, 14 patients were old enough to undergo neurodevelopmental evaluation. Five patients (36%) were 'normal' on gross neurological screening examination, 5 (36%) had 'mild developmental delay' and 4 (28%) had 'significant developmental delay'. We feel these data support the continued use of ventricular catheter reservoirs in the management of posthemorrhagic hydrocephalus and offer hope that some of these patients might remain shunt-free and most will have a normal or mildly delayed neurodevelopmental outcome.
Intracranial aneurysms are rare in children although several features distinguish them from adult aneurysms including variation in anatomic distribution and an increased incidence of giant and posterior circulation aneurysms. Subarachnoid hemorrhage is the most frequent presentation; however, clinical presentation suggestive of intracranial tumor is not uncommon making accurate diagnosis difficult. Direct clipping is recommended whenever possible although alternative techniques may sometimes be necessary. This report of a giant aneurysm of the distal posterior inferior cerebellar artery in an 11-month-old child illustrates the occasional difficulty in diagnosis and management of these unusual aneurysms.
