Management of lipomyelomeningoceles

1985 ◽  
Vol 62 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Harold J. Hoffman ◽  
Chopeow Taecholarn ◽  
E. Bruce Hendrick ◽  
Robin P. Humphreys
Keyword(s):  
Common Factor ◽  
Early Age ◽  
Neurological Sequelae ◽  
Content Type ◽  
Dural Graft ◽  
Cosmetic Effect ◽  
Appropriate Therapy ◽  
Sick Children ◽  
Time Of Presentation ◽  
Fine Print

✓ Ninety-seven children with lipomyelomeningoceles were operated on at the Hospital for Sick Children between January, 1960, and December, 1982. The most common factor that caused these patients to seek help was the cosmetic effect of the mass on their back. However, 22 patients had urinary incontinence and 15 patients had a deformed or weak leg. Sixty of the 97 patients were female and 37 were male. The patients presented for treatment between 6 days and 18½ years of age with a median age of 7½ months. Fifty-six patients presented before the age of 6 months and 35 of these were perfectly normal at the time of presentation. On the other hand, of the 41 patients who were brought for treatment after the age of 6 months, only 12 were normal prior to surgery. When patients were appropriately treated at an early age, with their spinal cords untethered and their dura securely closed with a dural graft, then they remained unchanged neurologically or even improved. However, when treatment was delayed or not done appropriately then they were left with significant neurological sequelae. Lipomyelomeningoceles are serious lesions which without appropriate therapy can result in gross impairment of neurological function.

Craniocerebral missile injuries in the monkey: an experimental physiological model

1972 ◽  
Vol 36 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Arthur M. Gerber ◽  
Robert A. Moody
Keyword(s):  
Rhesus Monkeys ◽  
Common Factor ◽  
Blood Gases ◽  
Physiological Model ◽  
Content Type ◽  
Epidural Compression ◽  
The Brain ◽  
Strong Suspicion ◽  
Fine Print ◽  
Carotid Flow

✓ Experiments were carried out on rhesus monkeys to determine what physiological parameters were most closely correlated with death due to craniocerebral missile injuries. Observations of intracranial pressure, blood pressure, carotid flow, blood gases, respiratory rate, depth and volume, and electroencephalograms were made. These parameters were compared in survivors and nonsurvivors as were the pathological injuries. The most important single parameter that correlated with death was the drop in carotid flow. As this same correlation has been observed in epidural compression experiments in the monkey, there is a strong suspicion that reduced blood flow to the brain as measured by carotid flow is a common factor in craniocerebral missile injuries and epidural compression injuries.

Complications of invasive subdural grid monitoring in children with epilepsy

2003 ◽  
Vol 98 (5) ◽  
pp. 1017-1026 ◽  
Author(s):  
Çagatay Önal ◽  
Hiroshi Otsubo ◽  
Takashi Araki ◽  
Shiro Chitoku ◽  
Ayako Ochi ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Intracerebral Hematoma ◽  
Content Type ◽  
Acceptable Risks ◽  
Grid Monitoring ◽  
Superficial Wound ◽  
Cerebrospinal Fluid Leaks ◽  
Sick Children ◽  
Fine Print

Object. This study was performed to evaluate the complications of invasive subdural grid monitoring during epilepsy surgery in children. Methods. The authors retrospectively reviewed the records of 35 consecutive children with intractable localization-related epilepsy who underwent invasive video electroencephalography (EEG) with subdural grid electrodes at The Hospital for Sick Children between 1996 and 2001. After subdural grid monitoring and identification of the epileptic regions, cortical excisions and/or multiple subpial transections (MSTs) were performed. Complications after these procedures were then categorized as either surgical or neurological. There were 17 male and 18 female patients whose mean age was 11.7 years. The duration of epilepsy before surgery ranged from 2 to 17 years (mean 8.3 years). Fifteen children (43%) had previously undergone surgical procedures for epilepsy. The number of electrodes on the grids ranged from 40 to 117 (mean 95). During invasive video EEG, cerebrospinal fluid leaks occurred in seven patients. Also, cerebral edema (five patients), subdural hematoma (five patients), and intracerebral hematoma (three patients) were observed on postprocedural imaging studies but did not require surgical intervention. Hypertrophic scars on the scalp were observed in nine patients. There were three infections, including one case of osteomyelitis and two superficial wound infections. Blood loss and the amounts of subsequent transfusions correlated directly with the size and number of electrodes on the grids (p < 0.001). Twenty-eight children derived significant benefit from cortical resections and MSTs, with a more than 50% reduction of seizures and a mean follow-up period of 30 months. Conclusions. The results of this study indicate that carefully selected pediatric patients with intractable epilepsy can benefit from subdural invasive monitoring procedures that entail definite but acceptable risks.

Early management of aneurysmal subarachnoid hemorrhage

1981 ◽  
Vol 54 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Harold P. Adams ◽  
Neal F. Kassell ◽  
James C. Torner ◽  
Donald W. Nibbelink ◽  
Adolph L. Sahs
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Medical Management ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Aneurysm Rupture ◽  
Early Management ◽  
Neurological Sequelae ◽  
Content Type ◽  
Antifibrinolytic Therapy ◽  
Effective Reduction ◽  
Fine Print

✓ The overall results are presented of early medical management and delayed operation among 249 patients studied during the period 1974 to 1977, treated within 3 days of subarachnoid hemorrhage (SAH) and evaluated 90 days after aneurysm rupture. The results included 36.2% mortality, 17.9% survival with serious neurological sequelae, and 46% with a favorable outcome. Of the patients admitted in good neurological condition, 28.7% had died and only 55.7% had a favorable recovery at 90 days after SAH. These figures represent the results despite effective reduction in early rebleeding by antifibrinolytic therapy and successful surgery in those patients reaching operation. Further therapeutic advances are needed for patients hospitalized within a few days after SAH.

Tonsillar herniation: the rule rather than the exception after lumboperitoneal shunting in the pediatric population

1993 ◽  
Vol 78 (4) ◽  
pp. 568-573 ◽  
Author(s):  
Paul D. Chumas ◽  
Derek C. Armstrong ◽  
James M. Drake ◽  
Abhaya V. Kulkarni ◽  
Harold J. Hoffman ◽  
...  
Keyword(s):  
Morphological Changes ◽  
Pediatric Population ◽  
Pseudotumor Cerebri ◽  
Foramen Magnum ◽  
Tonsillar Herniation ◽  
Content Type ◽  
Asymptomatic Patients ◽  
The Mean ◽  
Sick Children ◽  
Fine Print

✓ Although the development of tonsillar herniation (acquired Chiari malformation) in association with lumboperitoneal (LP) shunting is well recognized, it has previously been considered rare. In order to ascertain the incidence of this complication after LP shunting, the authors undertook a retrospective study of all patients in whom this form of shunt had been inserted between 1974 and 1991 at The Hospital for Sick Children, Toronto. In the 143 patients, the mean age at insertion was 3.3 years and the indications for shunt placement were hydrocephalus (81%), pseudotumor cerebri (7%), cerebrospinal fluid fistula (6%), and posterior fossa pseudomeningocele (6%). The mean follow-up period was 5.7 years, during which time there was one shunt-related death due to unsuspected tonsillar herniation. Five other patients developed symptomatic tonsillar herniation treated by suboccipital decompression. Review of all computerized tomography (CT) scans not degraded by artifact showed evidence of excess soft tissue at the level of the foramen magnum in 38 (70%) of 54 patients so studied. In order to confirm that this CT finding represented hindbrain herniation, sagittal and axial magnetic resonance (MR) images were obtained for 17 asymptomatic patients and revealed tonsillar herniation (range 2 to 21 mm) in 12 (70.6%). In addition, some of these asymptomatic patients had evidence of uncal herniation and mesencephalic distortion. Similarities and distinctions are drawn between the morphological changes occurring after LP shunting and those seen in association with the Chiari I and II malformations. Although less than 5% of this study population required treatment for tonsillar herniation, the incidence of this complication was high in asymptomatic patients; MR imaging surveillance for patients with LP shunts is therefore recommended.

A clinicopathological study of collagen sponge as a dural graft in neurosurgery

1995 ◽  
Vol 82 (3) ◽  
pp. 406-412 ◽  
Author(s):  
Pradeep K. Narotam ◽  
James R. van Dellen ◽  
Keshavlal D. Bhoola
Keyword(s):  
Inflammatory Cells ◽  
Wound Infection Rate ◽  
Collagen Sponge ◽  
Neurosurgical Procedures ◽  
Dural Repair ◽  
Content Type ◽  
Initial Surgery ◽  
Dural Graft ◽  
Delayed Hemorrhage ◽  
Fine Print

✓ There is frequently a need for dural grafts to cover defects resulting from retraction, shrinkage, or excision following neurosurgical procedures. Several materials have been evaluated both experimentally and clinically, and then discarded. Collagen, in its various forms, continues to be an area of intense interest. In this study the authors examined the suitability of collagen sponge to effect dural repair. In a 5-year clinical study 102 collagen sponge implants were examined macroscopically and histologically. Graft encapsulation, neomembrane formation, delayed hemorrhage, and foreign body reactions were not found. The porous nature of the collagen sponge encouraged fibroblastic ingrowth and dural repair. Meningocerebral adhesions were present in 11 patients, all of whom had required significant cortical resection or had pia-arachnoid disruption during the initial surgery. Inflammatory cells were seen only in response to infection. Postoperative cerebrospinal fluid leaks developed in only three of 67 patients who underwent an intradural posterior fossa procedure. In a prospective arm of the study involving 459 patients, the wound infection rate using collagen sponge was 6.1%, which compared favorably (p = 0.67) with the 5.7% rate in a similar group of 637 patients in whom collagen sponge had not been used.

Vascular malformations of the brain stem

1989 ◽  
Vol 70 (6) ◽  
pp. 847-852 ◽  
Author(s):  
Douglas Chyatte
Keyword(s):  
Brain Stem ◽  
Vascular Malformation ◽  
Vascular Malformations ◽  
Surgical Removal ◽  
Content Type ◽  
Appropriate Treatment ◽  
Complete Obliteration ◽  
Time Of Presentation ◽  
The Brain ◽  
Fine Print

✓ Vascular malformations of the brain stem are unusual lesions that may pose a diagnostic and therapeutic challenge. Seven patients with vascular malformations involving the brain stem were evaluated; six were treated surgically, with complete obliteration of the lesion in five patients. In five patients symptoms developed only after a hemorrhage had occurred, and three of these suffered a rebleed before appropriate treatment was given. Angiography failed to demonstrate lesions in three cases, which did not appear to protect from repeat hemorrhage since two of the three rebled. There were no operative deaths, and no patients were made permanently worse after surgery. Useful recovery occurred commonly after appropriate treatment and appeared to be possible even in patients who had suffered a catastrophic neurological deficit at the time of presentation. These data indicate that surgical removal of the lesion may be warranted in some patients with symptomatic brain-stem vascular malformation.

Nasal encephaloceles: definitive one-stage reconstruction

1988 ◽  
Vol 68 (4) ◽  
pp. 571-575 ◽  
Author(s):  
Larry A. Sargent ◽  
Alan E. Seyfer ◽  
E. Neal Gunby
Keyword(s):  
Lateral Displacement ◽  
Bone Grafts ◽  
Early Age ◽  
Normal Position ◽  
Facial Skeleton ◽  
Skeletal Deformity ◽  
Content Type ◽  
Facial Contour ◽  
One Stage Reconstruction ◽  
Fine Print

✓ Nasal encephaloceles can cause complex deformities of the naso-orbital skeleton. As the encephalocele pushes through a defect in the facial skeleton it causes lateral displacement of the medial orbital walls. Correction of this skeletal deformity is necessary to achieve a normal facial contour. Two examples of nasal encephaloceles are presented and the classification, diagnosis, and treatment of this entity are discussed. The correction of these deformities at an early age is recommended. The suggested method of reconstruction is a combined intracranial and extracranial approach with mobilization of the nasal skeleton and medial orbital walls to their normal position. The remaining defects are treated with bone grafts.

Shunt-independent arrest of hydrocephalus

1973 ◽  
Vol 39 (6) ◽  
pp. 698-701 ◽  
Author(s):  
Gerard J. Holtzer ◽  
Samuel A. de Lange
Keyword(s):  
Obstructive Hydrocephalus ◽  
Common Factor ◽  
Ventricular Size ◽  
Content Type ◽  
Fine Print ◽  
Psychological Studies

✓ Between 1959 and 1970, 202 infants were treated for progressive hydrocephalus by means of an atrial (Holter) shunt. Of these, 127 are still alive; in 34 the shunt had been removed and the patients proved to be compensated and shunt-independent. Etiology, initial air studies, ventricular size, and psychological studies of these 34 compensated patients were reviewed in a search for a common factor, but none was determined. Half of these compensated children had communicating, and half obstructive, hydrocephalus. Compensation occurred equally in children with large and small ventricles.

Chemotherapy as the initial treatment of spinal cord compression due to disseminated neuroblastoma

1989 ◽  
Vol 70 (5) ◽  
pp. 688-690 ◽  
Author(s):  
I. R. Sanderson ◽  
Jon Pritchard ◽  
Henry T. Marsh
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Initial Treatment ◽  
Cord Compression ◽  
Response To Treatment ◽  
Trial Period ◽  
Content Type ◽  
Sick Children ◽  
Spinal Cord Function ◽  
Fine Print

✓ During a 12-month trial period, all children attending the Hospitals for Sick Children, London, England, for management of spinal cord compression due to disseminated neuroblastoma were given chemotherapy as initial treatment rather than radiotherapy or laminectomy. Response to treatment was evaluated by a neurosurgeon as well as by oncologists. Four children were treated in this way and all made a full recovery of spinal cord function.

Long-term neurological residua in patients surviving brain abscess with surgery

1971 ◽  
Vol 34 (5) ◽  
pp. 652-656 ◽  
Author(s):  
Michael E. Carey ◽  
Shelley N. Chou ◽  
Lyle A. French
Keyword(s):  
Brain Abscess ◽  
Adult Survivors ◽  
Neurological Status ◽  
Long Term Results ◽  
Neurological Sequelae ◽  
Content Type ◽  
Brain Abscesses ◽  
Treatment Comparisons ◽  
Fine Print

✓ Long-term neurological sequelae were analyzed in 40 patients (24 adults and 16 children) who survived a brain abscess with surgery. Median follow-up was 6 years. The brain abscesses were secondary to hematogenous spread, sinus and mastoid infections, and trauma. Hemiparesis, seizures, visual defects, and learning problems (in children) were the most common sequelae observed. Abscess location played a significant role in determining sequelae. Only two of 16 patients with frontal polar and temporal lobe abscesses had unsatisfactory long-term results, while eight of 16 individuals with abscesses near the sensorimotor strip were left with permanent unsatisfactory neurological sequelae. Nineteen of 24 adults (80%) had a satisfactory long-term neurological status, but only 10 of 16 children (63%) had a similar outcome. In adult survivors, hemiparesis and seizures were mild, and emotional changes rare. Children were often severely paretic, had poorly controlled seizures, suffered from personality impairment, and were occasionally totally disabled. If the postoperative neurological condition is used to evaluate various types of surgical therapy for the treatment of brain abscess, then the therapies under study must be matched for patient age and abscess location before treatment comparisons can be made.

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