Occult filum terminale syndrome.

Thirty-two pediatric patients presenting with symptoms of urinary dysfunction, stool incontinence and/or severe back and/or leg pain are described. In patients with urological dysfunction, urodynamic testing was consistent with a neurogenic etiology. Imaging studies demonstrated the tip of the conus medullaris to lie above the L2 vertebral body, and the filum terminale to be of normal diameter ( < 2 mm) in all patients. A diagnosis of an occult filum terminale syndrome was made based on clinical presentation in the absence of associated imaging abnormalities and section of the filum terminale was performed. Postoperatively, the majority of patients (97%) experienced significant ( > 50%) relief of their symptoms. The management of these patients is discussed.

Functional assessment following selective posterior rhizotomy in spastic cerebral palsy.

This study used the Pediatric Evaluation of Disability Inventory as a functional assessment tool for children with spastic cerebral palsy undergoing selective posterior rhizotomy. Sixteen patients were followed for 3-12 months following surgery. Improvement in self-care, mobility, and social functional skills were found. Overall, the patients required less caregiver assistance and needed fewer modifications for self-care. The results suggest that selective posterior rhizotomy improves the quality of life in children with spastic cerebral palsy.

Evaluation of the Pelorus Stereotactic Surgical System for CT-guided stereotactic brain biopsy.

The Pelorus Stereotactic Surgical System is a relatively new, commercially available device that can be used to perform computed tomography (CT)-guided stereotactic brain biopsy. It has been promoted as being a relatively simple and inexpensive system that is more rapid, less cumbersome, and generally easier to use than conventional stereotactic frames. In this paper, we describe the Pelorus System, and report on its diagnostic accuracy and associated morbidity, based on our experience with 49 consecutive patients in two institutions. Patients ranging from 7 months to 85 years of age had CT-guided stereotactic biopsy, primarily for diagnosis of lesions deep within the cerebral hemispheres. Two transfrontal biopsies of the lateral pons were also done. Satisfactory tissue for histologic diagnosis was obtained in 42 of 49 patients (86%). In this series, there were two deaths in the immediate postoperative period, unrelated to the use of the Pelorus System. One patient suffered a transient neurologic deficit, which resolved over a period of 3 days. Although the Pelorus System has some limitations, we found it easy to use, well-tolerated by patients, and useful for performing CT-guided stereotactic biopsy.

Peripheral hearing loss following head trauma in children.

The purpose of this prospective study was to determine the incidence and type of hearing loss occurring in children who suffered head injuries. Fifty children admitted to the neurosurgical service after sustaining head trauma were studied. Neurologic, otologic, and audiologic evaluations were performed. Diagnostic studies included skull roentgenograms and computerized tomography scans. A 32% incidence of conductive hearing loss and a 16% incidence of high-frequency sensorineural hearing loss was found in this group. All patients with temporal bone fractures had conductive hearing losses, but the presence of a skull vault fracture did not correlate with the presence, type, or degree of hearing loss. In addition, there was no correlation between either cause of injury, loss of consciousness, or Glasgow Coma Scale scores and the presence, type, or degree of hearing loss. There was a significant incidence of both sensorineural and conductive hearing loss in this series of patients, which indicates that close audiologic and otologic follow-up is necessary for all head injury patients.

The role of functional dorsal rhizotomy for the treatment of children with spastic cerebral palsy.

Functional dorsal rhizotomy is now a frequently used procedure in the treatment of spastic cerebral palsy. Appropriate candidate selection is imperative for good results to be achieved. The pathophysiology of spasticity and candidate selection criteria are discussed.

Infratentorial ependymomas in childhood: prognostic factors and treatment.

The prognostic factors and survival data were analyzed for 35 children (aged under 16 years at diagnosis) with childhood infatentorial ependymomas treated surgically at The Hospital for Sick Children in Toronto during the years 1970 to 1987. Tumor histology was reviewed individually and grouped into three categories (Categories I to III) for survival analysis. An overall 5-year survival rate of 44.6% was obtained after the exclusion of perioperative mortality. Factors associated with an improved 5-year survival rate were: total tumor removal, noninvasive tumors, Category I histology, age greater than 6 years, and absent physical signs of parenchymal invasion or lower cranial nerve involvement. The 5-year survival rate was lower when associated with Category III histology, brain-stem or cranial nerve signs, age less than 2 years, tumor invasion and/or cranial nerve involvement, and subtotal tumor removal. Clinical evidence of spinal metastases was found to be uncommon (3.1%). Surgical excision followed by radiation therapy was the primary mode of treatment for these tumors. Different approaches regarding the volume of radiotherapy to be delivered and the use of adjuvant chemotherapy are discussed.

Effect of subarachnoid hemorrhage on endothelium-dependent vasodilation.

The effect of subarachnoid hemorrhage (SAH) on endothelium-dependent vasodilation of the isolated rabbit basilar artery was examined using an isometric tension recording method. The SAH was induced by injecting 5 ml of fresh arterial blood into the cisterna magna. Sixty-two rabbits were separated into four groups according to the timing of sacrifice: control rabbits, and operated rabbits sacrificed on Days 2, 4, and 6 after SAH. Acetylcholine (ACh) (10(-7) M to 10(-4) M) and adenosine triphosphate (ATP) (10(-7) M to 10(-4) M) were used to evoke dose-dependent vasodilation of isolated arterial rings previously contracted by 10(-6) M serotonin (5-HT). There were no significant differences in the vasodilatory response to ACh among these four groups. Relaxation to approximately 84% of the initial contractile tone occurred with 10(-4) M ACh. On the other hand, the vasodilatory response to ATP was suppressed in the animals sacrificed 2 days after SAH; the relaxation of this group was approximately 52% at 10(-4) M ATP, compared to a relaxation of 87% observed in the other groups of animals. One of the major causes of the impairment of endothelium-dependent vasodilation seems to be an inhibition of the production of endothelium-derived relaxing factor by endothelial cells. After the relaxation studies, the dose-response curves for 5-HT were obtained. Serotonin caused significantly more contraction in the animals sacrificed 2 days after SAH than in the other groups. The present experiments suggest that impairment of the endothelium-dependent vasodilation following SAH, together with the potentiation of the contractile response to vasoactive agents in cerebral arteries, may play an important role in the pathogenesis of vasospasm.