Neurosurgical intervention in a haemophilic child with a subdural and intracerebral haematoma.

A case of a 3-year-old boy with severe haemophilia A who had a successful neurosurgical drainage of a combined spontaneous left temporal subdural and intra-parenchimal haematoma is reported. Surgical intervention was required because of clinical worsening during conservative treatment with dexamethasone and factor VIII (FVIII) replacement therapy. Continuous FVIII infusion was given before, during and after the procedure. There were no surgical complications and neurological examination remains intact. Neurosurgical interventions may be reserved for special, high-risk cases, as the one presented.

Selective posterior rhizotomy: experience of 30 cases.

The increasing interest in selective posterior rhizotomy for reduction of spasticity in children with cerebral palsy and other neurological disorders comes from the selectivity that this procedure has achieved with intraoperative electromyographic monitoring. Thirty patients were operated on between April 1989 and October 1991. Spasticity was of cerebral origin in 27 cases and secondary to spinal cord lesion in 3 others. A reduction in the abnormally high muscle tone was observed in all cases, mainly in the lower extremities, but also, to a lesser degree, in the upper extremities. All patients showed functional improvements that depended on the individual preoperative condition. Even severely disabled patients with quadriplegia and intellectual impairment, whose spasticity interfered with their daily care, had a significantly improved quality of life after rhizotomy. These patients became much looser, with better swallowing and less drooling, and were much more easily managed by their caretakers. Preliminary results with follow-up from 1 to 30 months indicates that selective posterior rhizotomy is a safe procedure which contributes to significant functional improvement in spastic patients.

Choroid plexus papillomas of the III ventricle in childhood. Their diagnosis and surgical management.

Ten infants and children with choroid plexus papilloma of the III ventricle are presented. Hydrocephalus of various degrees was present in all patients, and seven patients had bilateral ventriculoperitoneal shunts prior to craniotomy. All patients were investigated with computed tomography and angiography. Tumor was resected through the transfrontal-transventricular approach in nine and through a transcallosal approach in one. One patient died intraoperatively due to an uncontrollable hemorrhage from a subependymal vein at its point of entry into the homolateral internal cerebral vein, and another died shortly after surgery due to hypothalamic trauma. The remaining eight patients are alive without recurrence over a minimum follow-up period of 3 years; three have mental retardation and seizure disorder. Despite this tumor's deep location and vascularity and occurrence in infancy, choroid plexus papillomas of the III ventricle can be successfully resected. Appropriate care for hydrocephalus and intra- and postoperative management are important.

Microsurgical anatomy of the transcallosal approach to the ventricular system, pineal region and basal ganglia.

Vascular and neoplastic lesions of the lateral and III ventricles, the pineal region, or the basal ganglia affect highly critical areas. For surgical treatment of these lesions, the interhemispheric, transcallosal approach was studied in our laboratory in an attempt to evaluate the surgical procedure. The advantages and disadvantages are described in comparison with those for other approaches in the same regions. To this end, we dissected 20 anatomical specimens interhemispherically using the surgical microscope (with a magnification of 6 x to 25 x); the specimens were fixed for 6-8 weeks in formaldehyde 10%). In each specimen the corpus callosum was exposed and then sectioned to a length of 2 to 2.5 cm over its anterior, middle, and posterior thirds. The anatomy of the lateral and III ventricles and of the pineal region was explored; the arrangement configuration of the anterior cerebral arteries and their branches was also evaluated, as were the thalamostriate and other subependymal veins, the internal cerebral veins, the choroid plexus, the trigone, and the septum pellucidum.

Congenital dermal sinuses, dermoid and epidermoid cysts of the posterior fossa.

Dermal sinuses are abnormal communications between the skin and deeper tissues. Seven cases are presented of occipital dermal sinuses associated with dermoid or epidermoid cysts of the posterior fossa. The cysts were interdural, subdural and intracerebellar. Although they are benign lesions, there is a high incidence of complications, especially infections such as bacterial or aseptic meningitis and cerebellar abscess. The clinical features, radiological and tomographical characteristics, and the relationship to meningeal structures, dural sinuses and cerebellar parenchyma are described.

Giant arteriovenous aneurysm of the posterior fossa in a three-month-old infant.

A 3-month-old female infant presented a 20-day history of drowsiness and maturing deterioration. The neurological exam showed peripheric facial palsy on the right side and a brachiocrural hemiparesis on the left. A brain scan revealed a lesion of avascular content in the posterior fossa. The computed tomography scan showed hydrocephalus and a high-density lesion, nonenhanced after introduction of the contrast agent, compatible with a clot at posterior fossa level. Likewise, after contrast new images appeared which had not been seen previously, considered as afferent and efferent vascular elements to the lesion. The cerebral angiography showed an avascular lesion in the cerebellar vermis with important hypertrophy of arterial and venous elements, although no steal phenomena of neighbouring areas was evident. These findings, and the absence of cardiac failure, suggested the diagnosis, confirmed by surgery, of giant clotted arteriovenous malformation. The patient has done well postoperatively.

Spinal tumors and hydrocephalus.

Spinal tumors associated with hydrocephalus is a rare condition. The clinical, radiological and pathological features of 6 such cases are reported and correlated with those already published. Hyperproteinorrhachia and arachnoiditis, with basal or cortical blockage of the cerebrospinal fluid pathways have been consistently found and the subsequent hydrocephalus seems to be unrelated to the level, location or the pathology of the spinal lesion.

Hidrocefalia en la infancia: consideraciones de interes para el pediatra. / Hydrocephalus in childhood: considerations fo interest for the pediatrician

Durante un periodo de un ano fueron estudiados 103 pacientes con hidrocefalia, 55 del sexo masculino y 48 del femenino, cuyas edades oscilaron entre recien nacidos y los doce anos. Se ha evidenciado la importancia que presentan, para el pronostico de la enfermedad, un perimetro cefalico dentro de los limites normales o solo ligeramente aumentado y un sistema ventricular leve o moderadamente dilatado. La tomografia computada ha resultado el metodo diagnostico de eleccion, por ser incruento y eficaz. Se destaca la utilidad de la gentamicina parenteral en el periodo pre y posoperatorio inmediato, asi como su uso local intraoperatorio en la profilaxis de la colonizacion bacteriana del sistema valvular

Hidrocefalia en la infancia: consideraciones de interes para el pediatra. / Hydrocephalus in childhood: considerations fo interest for the pediatrician

Durante un periodo de un ano fueron estudiados 103 pacientes con hidrocefalia, 55 del sexo masculino y 48 del femenino, cuyas edades oscilaron entre recien nacidos y los doce anos. Se ha evidenciado la importancia que presentan, para el pronostico de la enfermedad, un perimetro cefalico dentro de los limites normales o solo ligeramente aumentado y un sistema ventricular leve o moderadamente dilatado. La tomografia computada ha resultado el metodo diagnostico de eleccion, por ser incruento y eficaz. Se destaca la utilidad de la gentamicina parenteral en el periodo pre y posoperatorio inmediato, asi como su uso local intraoperatorio en la profilaxis de la colonizacion bacteriana del sistema valvular