[Neurosurgical treatment of children with spina bifida associated with congenital spinal lipoma in the lumbosacral region]. / Neurokirursko lijecenje djece sa spinom bifidom udruzenom sa spinalnim kongenitalnim lipomom u lumbosakralnom podrucju.

This paper presents twelve neurosurgically treated children with spina bifida associated with congenital spinal lumbosacral lipoma over a 3-year period. The introduction deals with various types of lipoma, their development, clinical presentation, local findings in children with spinal lipoma, as well as with the significance of neurosurgical treatment. The age span of children with occult spina bifida and spinal lumbosacral lipoma was from 3 months to 2 years, and there were seven girls and five boys. In all the twelve children, a smaller or bigger fatty mass in the lumbosacral area was noticed immediately after birth, gradually increasing in size. Neurologic examination revealed weakness of lower extremities, with somewhat atonic sphincters, in only two of the children. Spinal dysraphism was demonstrated by plain roentgenograms in all the twelve children, while CT-scans, CT-myelography and recently MR-scans, confirmed the diagnosis of spinal lipoma. In all the twelve children the spinal lipoma and the adherences between the lipoma and the low-lying conus or an enlarged filum terminale were removed by the neurosurgical excision. Follow-up of children 6 and more months following the surgery showed improvement of their condition. Spina bifida associated with congenital spinal lumbosacral lipoma is a condition that although benign in histology, can have devastating effects if not surgically corrected early. Children who are asymptomatic at the time of repair will tend to remain asymptomatic. Those who are not repaired early will develop and show subsequent deterioration as time progresses.(ABSTRACT TRUNCATED AT 250 WORDS)

Diastematomyelia--case report.

An eight-month-old infant with diastematomyelia, as a very rare variety of spinal dysraphism is presented in this article. The introduction deals with a detailed description of diastematomyelia, its development, local, neurological, and orthopedic signs in affected patients, diagnostic procedures and significance of neurosurgical treatment in patients with diastematomyelia. In the particular child, immediately upon birth, a thornlike bulging was noticed in the L2-L3 region. Neurological deficit, established at the time of surgery, was due to the perinatal brain damage and corresponded to the spastic syndrome of the central origin with the right-hand side predomination, and there was no predomination in the lower extremities, which could be expected in regard to the spinal dysraphism. Plain X-ray film revealed a thornlike bulging at the L2-L3 level. Lumbar myelography showed a distinctly enlarged dural sac at the level of L2 to S1 with a well pronounced contrast medium passage defect at the L3 level. The spinal canal CT-findings revealed a bony bulging between L1 and L2, starting from the posterior arches towards the spinal canal. Besides a markedly broadened lumbar spinal canal, MR-findings also showed a well pronounced bony septum from the L2 posterior edge, and a low-lying conus medullaris with an accompanying spinal lipoma. By the neurosurgical operation bony septum and extradural lipoma were radically removed, and the spinal cord was set free from adhesions. In that way a later onset of neurological signs, due to the "tethered cord syndrome", was prevented. Six months following surgery the child's condition was still unchanged.

Cranial vault and gigantic intracranial hydatid cyst in a young woman.

The case of a young woman (20 years) with a gigantic intracranial hydatid cyst (110 x 90 x 65 mm) is presented. The first manifestation was a grand mal seizure followed by symptoms of raised intracranial pressure. The origin of the cyst was in the diploe of the right cheek, frontal, temporal, and parietal bones. An osteoplastic craniotomy was performed, and more than 100 fertile daughter cysts were removed, together with the wall of the cyst. A modification in the standard operative procedure is proposed for gigantic cysts that emerge from the diploe of the cranial vault and extend intracranially. Therapy with dexamethasone and phenobarbital was instituted preoperatively and continued postoperatively. The 3-month follow-up showed no relapse.