[Resorbable osteosynthesis material in craniosynostosis]. / Resorbierbares Osteosynthesematerial bei Kraniosynostosen.

BACKGROUND: The results of using resorbable plates and screws (82% polylactic acid and 18% polyglycolic acid) in craniofacial surgery for the correction of craniosynostosis after more than 4 years of experience are presented. Special attention is focussed on the degree of stability and the clinical tissue response to the material employed to answer the question of whether the material is an adequate alternative to titanium. METHODS: Thirty patients who had been treated with this method for craniosynostoses were examined at regular intervals regarding the shape and stability of the forehead region, visibility and palpability of the plates, and tissue reactions. RESULTS: The technical handling of the osteosynthesis material proved to be simple and reliable. In one case the bone was not strong enough for the screw pitch. After an observation period of a maximum of 4 years and 1 month, the fixations were stable with no signs of adverse reactions. DISCUSSION: If the long-term results remain favorable, we consider the use of resorbable material a promising method for the stabilization of segments in craniofacial surgery in children.

[Peri-osseous intracranial translocation of titanium osteosynthesis plates and screws after fronto-orbital advancement]. / Perossäre intrakraniale Translokation von Titanosteosyntheseplatten und -schrauben nach frontoorbitalem Advancement.

BACKGROUND: Perossoeus intracranial translocation or passive intracranial transmission of titanium osteosynthesis plates and screws in the growing skull following surgical craniosynostosis corrections, also referred to as the PIT effect, has been described in the literature since 1995. It is a phenomenon which has not received due attention until recently and is explained by appositional and resorptional remodeling processes in the growing skull. CASE REPORT AND DISCUSSION: An impressive case of the PIT effect with a total intracranial dislocation of titanium plates and screws is used to demonstrate the problems associated with this phenomenon and to discuss the few clinical case reports in the English-language literature. The obvious advantages of a resorbable material are pointed out; however, it is still uncertain as to whether the resorption process is fast enough to avoid the PIT effect if used clinically.

[Preliminary results of the use of resorbable plates and screws in craniofacial surgery]. / Resorbierbare Platten und Schrauben in der kraniofazialen Chirurgie. Vorläufige Ergebnisse.

In ten patients with craniosynostoses resorbable plates and screws (Lactosorb) consisting of poly-L-lactic acid (82%) and poly-glycolic acid (18%) were used to stabilize the segments after frontoorbital advancement. As our experience increased, an exact adaptation of the plates and simple handling proved to be possible. The plates were stable enough to retain a favorable functional and aesthetic result after redraping the soft tissue envelope. In one patient with Chotzen's syndrome the intended use of the resorbable material was abandoned: the thin osseous structures did not offer enough primary stability to the high pitch of the screws. During an observation period of up to 21 months no infection, exposure, instability or dislocation was observed. The clinical use of the resorbable material in frontoorbital advancement proved to be a stable method of segment fixation if the bone was of sufficient thickness. These promising preliminary results will have to observed in a larger group and over a longer period of time.

Primary leiomyosarcoma of the spinal leptomeninges.

A case of leiomyosarcoma of the spinal leptomeninges is presented, with clinical, radiological, light microscopic and immunohistochemical data. The probable origin of the tumor from a pluripotent mesenchymal cell is discussed.

Spinal extradural angiolipoma: case report and literature review.

A case report of a 12-year-old child with a spinal extradural angiolipoma is presented. The tumor was totally removed and a good recovery was obtained. In a review of 43 previous cases, the clinical, radiological, and histological features of the tumor are discussed. It is stressed that spinal angiolipomas and spinal lipomas have to be considered as two different clinicopathological entities in order to ensure adequate treatment and prognosis.

[Intracerebral gliofibroma]. / Intrazerebrales Gliofibrom.

A 14-month-old girl had three epileptiform attacks in the course of 6 months, each consisting of rhythmic movements of the right arm and right hand of 5 minutes' duration, followed by a 15-minute period of weakness. There were otherwise no abnormal neurological signs. Prenatal and perinatal development had been uneventful and the mother was healthy. Computed tomography showed a tumour in the left frontoparietal region. Surgery revealed an intracerebral tumour 7 cm in diameter with two large cysts; it was not sharply demarcated from the brain parenchyma, had no connection with the dura and was not infiltrating the ventricular system. The tumour was completely removed and at follow-up 18 months later there was no evidence of recurrence. Histological and immunohistochemical investigations showed that the tumour consisted of closely interwoven astrocytes and fibroblasts, two different cell types the latter of which does not normally occur in the brain. Exact immunohistochemical analysis of the components of a tumour is important because, unlike pure glial tumours, gliofibromas have a good prognosis after complete resections.