Sagittal craniosynostosis associated with midline cephalhematoma or vice versa, case report and a review of the literature.

INTRODUCTION: Sagittal craniosynostosis associated with midline cephalhematoma is a rare finding. Despite the controversy regarding its etiopathogenesis, this condition represents a clear indication for surgery. CASE REPORT: We present a case of a 10-week-old boy with an ossified midline vertex cephalhematoma and sagittal craniosynostosis. The child underwent a cephalhematoma excision and minimally invasive non-endoscopic narrow vertex craniectomy, with calvarial vault remodeling followed by 2 weeks use of a cranial orthosis. On 5-month follow-up, mesocephaly was achieved. CONCLUSION: Our case is well documented with native CT, 3D CT, intraoperative pictures, and 3D head scan imaging. We described our minimally invasive non-endoscopic technique that led to a rapid cranial vault remodeling with reduction of cranial orthosis need. A review of literature focused on surgical techniques is included.

Knockout of Atg5 delays the maturation and reduces the survival of adult-generated neurons in the hippocampus.

Autophagy is an evolutionarily conserved lysosomal degradation pathway that plays important roles in cell maintenance, expansion and differentiation. Removal of genes essential for autophagy from embryonic neural stem and precursor cells reduces the survival and inhibits neuronal differentiation of adult-generated neurons. No study has modified autophagy within the adult precursor cells, leaving the cell-autonomous role of autophagy in adult neurogenesis unknown. Here we demonstrate that autophagic flux exists in the adult dividing progenitor cells and their progeny in the dentate gyrus. To investigate the role of autophagy in adult hippocampal neurogenesis, we genetically deleted Autophagy-related gene 5 (Atg5) that reduced autophagic flux and the survival of the progeny of dividing progenitor cells. This significant reduction in survival of adult-generated neurons is accompanied by a delay in neuronal maturation, including a transient reduction in spine density in the absence of a change in differentiation. The delay in cell maturation and loss of progeny of the Atg5-null cells was not present in mice that lacked the essential pro-apoptotic protein Bax (Bcl-2-associated X protein), suggesting that Atg5-deficient cells die through a Bax-dependent mechanism. In addition, there was a loss of Atg5-null cells following exposure to running, suggesting that Atg5 is required for running-induced increases in neurogenesis. These findings highlight the cell-autonomous requirement of Atg5 in the survival of adult-generated neurons.

Selective posterior rhizotomy in the treatment of cerebral palsy, first experience in Czech Republic.

BACKGROUND: Selective posterior rhizotomy (SPR) is a surgical treatment of spasticity in patients with cerebral palsy (CP). STARTING POINT: We present the first experience with SPR in Czech Republic. MATERIAL AND METHODS: 14 patients with severe spasticity were indicated for SPR during the period of 2 years (2001-2002). The indication criteria were severe spasticity with clonus, more or less symmetric impairment of lower extremities and increased H/M ratio in preoperative electromyography. SPR was performed in 13 cases, in one patient only the revision and intradural neurolysis of caudal roots was done. In all patients we used osteoplastic laminotomy L2-S1. The intraoperative EMG monitoring with selection of rootlets with abnormal response was performed. Preoperative and postoperative number of spasms, passive range of joint movements, Ashworth scale, Peacock grade and level of functional independence were assessed. The comparison of H/M ratio on EMG before and after surgery was performed. RESULTS: An evident improvement in all tested parameters was noted. The per-operative course in all cases was uneventful. Till now, no persistent complications have been observed. CONCLUSION: SPR improves functional ability in a selected group of CP patients. Our findings regarding clinical outcomes are in agreement with those of other authors. In our experience the extrapyramidal symptoms may not be an absolute contraindication of SPR. (Tab. 5, Fig. 3, Ref. 10.).