Moyamoya phenomenon after radiation for optic glioma.

The role of radiotherapy in the management of patients with optic pathway glioma is controversial. In a series of patients with optic pathway glioma treated at The Hospital for Sick Children in Toronto, five children were encountered who developed moyamoya phenomenon after radiotherapy. A retrospective review of the medical records was undertaken in order to assess the relationship between optic pathway glioma, neurofibromatosis type 1 (NF1), radiation therapy, and moyamoya disease. Forty-seven patients with optic pathway glioma were operated on at The Hospital for Sick Children between 1971 and 1990. The moyamoya phenomenon did not occur in any of the 19 patients not receiving radiotherapy. Among the 28 patients who received radiotherapy, five developed moyamoya disease (two of 23 without NF1 and three of five with NF1). There was a statistically significant relationship between radiotherapy and moyamoya disease when the analysis was stratified according to the presence of NF1 (Mantel-Haensel chi-squared test 15.23, p < 0.01). The high incidence of moyamoya disease (three of five cases, or 60%) in patients with NF1 who have undergone radiotherapy suggests a synergistic relationship that should be considered when formulating a treatment plan for NF1 patients with optic pathway glioma.

[Single craniotomy by trephining and closed-circuit external drainage for the treatment of chronic subdural hematoma]. / Craneotomía única por trepanación y drenaje externo a circuito cerrado para el tratamiento del hematoma subdural crónico.

Chronic subdural hematoma is one of the most frequent pathological entities in the adult. Therapeutic approaches have ranged from craniotomy with excision of the membrane to close external drainage placed, under local anesthesia, at the bedside. The authors report the results of treatment of twelve (12) patients by craniotomy with placement of a closed external drainage for the gradual emptying of the chronic subdural hematoma.