Transcallosal-lateral ventricle-choroid fissure approach for excising large pineal region tumors extending into the third ventricle: experience in 15 pediatric cases.

Pineal region is deep located and tightly connected with surrounding important nerves, blood vessels, and other critical structure. Tumors in the regions are more commonly observed in children with complex pathology, difficult surgery, and poor prognosis. However, excision surgery on large tumor in the pineal region and extending into the third ventricle is characterized by high difficulty and uneasy treatment. Related experience and knowledge about excising large tumor in children pineal region which extending into the third ventricle by transcallosal-lateral ventricle-choroid fissure approach was described in the paper. Clinical data of 15 children patients with large tumors in pineal region which extending into the third ventricle treated by our group from 2011 to 2015 was retrospectively analyzed (< 15 years of age, tumor size > >3 × 3 × 3 cm3). Fifteen cases underwent tumor excision with surgery by transcallosal-lateral ventricle-choroid fissure approach including 11 male patients and 4 female patients with average age of 9.1 years and tumor volume from 3 × 3 × 3 to 5 × 6 × 7 cm3. They were assessed according to postoperative clinical symptom remission rate, blood loss during surgery, tumor removal rate, postoperative recurrence rate, etc. as indicators. Five cases belonged to germ cell tumors, 4 for teratoma, 1 for malignant teratoma, 2 for glioma, 2 for meningioma, and 1 for pineocytoma. Surgical total excision rate was 100%, while the mean intraoperative blood loss was about 300 ml. No case was dead due to surgery, and all cases had good postoperative recovery. Children patients are characterized by less blood than adults, larger volume size during surgery treatment, poor postoperative anti-infectious ability, etc. High requirements are proposed on surgery treatment, by long-term clinical exploration and experience accumulation. Our group believes that surrounding structures such as veins and dome are stretched and stimulated rarely in excision of children in large and medium tumor in pineal region which extending into the third ventricle by transcallosal-lateral ventricle-choroid fissure approach; thereby, the tumor can be completely excised, and larger veins and other important structures can be well-preserved with fewer complications, high full cut rate, and rapid recovery.

Clinical analysis of ventriculoperitoneal shunt for grade Ⅳ tuberculous meningitis children with hydrocephalus / 中华实用儿科临床杂志

Objective To explore the effects of ventriculoperitoneal shunt(VPS) placement in those children with grade Ⅳ tuberculous meningitis with hydrocephalus (TBMH) clinical analysis.Methods Nine cases of grade Ⅳ TBMH who received VPS from Jan.2006 to Dec.2009 were retrospectively reviewed,including age,gender,disease development,clinical manifestations,laboratory data,treatment,prognosis and complications.All children received VPS placement combined with pharmacal treatment.External ventricular drainage(EVD) were given only 2 cases with severe biochemical derangements or brainstem dysfunction requiring correction before shunt surgery.Outcomes were divided into normal,mild sequelae,severe sequelae,death or vegetable status.Results The average follow-up period was 15 months.Two patients had a full recovery,3 patients had slight sequelae,2 patients had severe sequela,and another 2 patients expired.Four cases complications related to the shunt surgery were seen,1 patient had shunt block,2 patients had infections and 1 patient had subdural effusion and ventricular hemorrhage.Conclusions Directly VPS surgery can improve the outcome of grade Ⅳ TBMH.The response of EVD is not a reliable indication for selecting patients who would benefit from shunt surgery.

Changes of neuroglobin in the pathologic process of contusion and laceration of brain in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the role of neuroglobin (Ngb) in the pathologic process of contusion and laceration of brain in children.</p><p><b>METHODS</b>The proteins in the brain tissue were extracted by two-dimensional gel electrophoresis in 3 children undergoing brain ventricular neoplasms resection (normal brain tissue) and in 8 children with contusion and laceration of brain. The image analysis was done using the PDQuest 7.0 software. The differential protein spots were detected and analyzed with Applied Biosystems Voyager System 4307 MALDI-TOF Mass Spectrometer and bioinformatical skills. Ngb expression in the brain tissue was measured using immunohistochemisty. Ngb expression in plasma was measured using ELISA in 15 children with contusion and laceration of brain and 10 healthy children.</p><p><b>RESULTS</b>Expression maps of the brain tissue were established by two-dimensional gel electrophoresis in children with contusion and laceration of brain and healthy children. Six differential protein spots were found and 5 of them were identified by mass spectrum. Immunohistochemisty assay showed that Ngb expression in the brain tissue in children with contusion and laceration of brain was significantly higher than in normal controls (P<0.05). ELISA results showed that Ngb expression in the plasma increased significantly 6, 12, 18, 24 and 48 hours after trauma in children with contusion and laceration of brain compared with healthy children (P<0.01).</p><p><b>CONCLUSIONS</b>Ngb may play an important role in the pathologic process of contusion and laceration of brain in children.</p>

Neuroendoscopy for treatment of multilocular brain abscess in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Multilocular brain abscess in children is a serious neurosurgical emergency and remains a serious, life-threatening disease. This study evaluated the role of neuroendoscopy in treating multilocular brain abscess in children.</p><p><b>METHODS</b>Between January 2002 and June 2007, 16 children with multilocular brain abscess underwent an operation using a pure endoscopic procedure.</p><p><b>RESULTS</b>Increased intracranial pressure was relieved after operation in the 16 patients. CT/MRI after operation showed the abscess cavities disappeared and only the residual abscess walls existed in the 16 patients. Fourteen patients were followed up for 6 months to 5 years after surgery. Abscess walls disappeared in 13 patients and abscess recurred only in 1 patient.</p><p><b>CONCLUSIONS</b>Neuroendoscopy for treatment of multilocular brain abscess is safe and effective in children.</p>