[The treatment of cerebral abscesses in children--the clinical experiences of neurosurgical clinic of PMMH in Lodz]. / Postepowanie kliniczne w leczeniu ropni u dzieci--doswiadczenia Kliniki Neurochirurgii ICZMP w Lodzi.

In our study we made attempt to assess which clinical criteria are essential for choosing optimal treatment for children suffering from cerebral abscesses. We observed the clinical results obtained at our Department from treatment of infections of the central nervous system (CNS) in children and analysed them with respect to applied therapy and clinical conditions. Between 1990 to 2000, 45 children aged 3 days to 15 years (mean 1.34 years, standard deviation 3.23 years) with infections of the CNS were treated at our Department. Within this group, 26 patients were diagnosed with cerebral abscesses, 1 with epidural empyema, 3 with subdural empyema and 15 with pyocephalus. 42 patients were operated. In 3 patients a conservative treatment was introduced at the moment when the abscesses were in the initial stage of organisation; in each case after a complete cycle of antibiotic therapy a regression of lesion was noted. The most frequently performed--in 19 patients--surgical procedure was the radical excision of the abscess by craniotomy. In 2 cases a re-operation was necessary. The highest rate of re-operations was noted in the group of children treated by external drainage; within this group of 18 patients only one 3-month-old girl did not require an additional surgical intervention. Neuroendoscopic techniques were used in 7 patients with compound hydrocephalus. Out of 45 treated children, 3 died from encephalitis, the primary reason being the infection of the ventriculo-peritoneal shunt. All children were assessed according to the Glasgow Outcome Scale and the results were significantly worse in those under 3 years in age. We suggest that in children above 3 years of age with mature abscesses of the central nervous system an operative evacuation of the abscesses by craniotomy should be performed.

[Clinical application of proton magnetic resonance spectroscopy for differential diagnosis of pediatric posterior fossa tumors]. / Zastosowanie Spektroskopii Protonowej Rezonansu Magnetycznego w diagnostyce róznicowej nowotworów tylnego dolu czaszki u dzieci.

We report here on a correlation between proton magnetic resonance spectroscopy (MRS) spectra obtained in children with posterior fossa tumors and tumor histology and grading. Twenty-six children (age 1-16) were investigated before surgery by using single-voxel proton MRS. All examination were performed on a 1.5 T MR scanner by using single-voxel (8 cm3) with PRESS sequence (TR 1600 ms, TE 270 ms, NEX 256). Spectra of N-acetylaspartate (NAA), choline containing compounds (Cho), creatine and phosphocreatine (Cr) and lactate (Lac) were evaluated. Absolute concentrations of the metabolites were measured and their ratios were calculated. Correlation between these and tumor histology and grading were then determined. Concentration of Cho and Lac, and Cho/NAA ratio were the major statistically significant parameters for discrimination between benign (WHO grade I and II) and malignant tumors (WHO grade III and IV), in particular between pilocytic astrocytomas and medulloblastomas. Discrimination between individual histological types within malignant and benign tumor groups was not possible. Proton MRS of pediatric posterior fossa tumors seems to be helpful in prediction of tumor grading and histology. Specific character of the examination requires establishing of the individual standards for every MR scanner.

Proton magnetic resonance spectroscopy of primary pediatric brain tumors: neuropathological correlation.

Forty-five children with primary brain tumors were evaluated by in vivo proton magnetic resonance spectroscopy (MRS) with the aim of detecting correlations between the obtained spectra and tumor malignancy and histology. All investigations were performed using a 1.5 T MR scanner (Picker) with point-resolved spectroscopic (PRESS) sequence (TR 1600 ms, TE 270 ms, NEX 256). Spectra were analyzed for N-acetylaspartate (NAA), choline containing-compounds (Cho), creatine and phosphocreatine (Cr) and lactate (Lac). The Cho/NAA ratio was the most useful parameter for differentiating between normal brain, benign and malignant tumors as well as discriminating the three main groups of pediatric brain tumors namely pilocytic astrocytoma, ependymoma and medulloblastoma. Proton MRS appears to be an important noninvasive technique in the differential diagnosis of pediatric brain tumors.

[Effect of partial kyphectomy on the improvement of the results of reconstructive surgery in open meningomyelocele]. / Wplyw czesciowej kifektomii na poprawe wyników operacji rekonstukcyjnej otwartej przepukliny rdzeniowej.

The authors present the results of reconstructive surgery on an open myelomeningocele in the lumbar region, the defect being accompanied by a large skin defect and the vertebrae malformed in form of bone hump. During the surgery two vertebral bodies were removed from the top of the hump, resulting in a proper closure of the myelomeningocele.

[Transfontanellar USG examination using a color Doppler method in the diagnosis and differentiation of vascular changes in the CNS (preliminary report)]. / Badanie USG przezciemiaczkowe z zastosowaniem kolorowego Dopplera w diagnostyce i róznicowaniu zmian naczyniowych OUN (doniesienie wstepne).

In the light of own experiences the diagnostic possibilities are presented of using Doppler ultrasonography with transfontanellar projection in the diagnosis and differentiation of vascular changes. Colour Doppler USG makes possible recording and measurement of blood flow in the vessels and may be specially useful in cases of central nervous lesions. The paper is supplemented with a videographic record of Galen's vein aneurysm imaged by Doppler USG.