Relationship of CSF shunting and IQ in children with myelomeningocele: a retrospective analysis.

This paper reviews 75 infants with myelomeningocele treated either at birth or from an early age at Rainbow Babies and Children's Hospital, for whom complete records and psychometric testing (IQ) are available (including complete summaries from referring hospitals). Three groups are compared: (1) infants without complications who were shunted for hydrocephalus (n = 41); (2) infants with complications who were shunted (n = 16), and (3) infants who were not shunted (n = 18). Complications were defined as ventriculitis (positive CSF cultures with elevated protein, depressed glucose and inflammatory cells), anoxia, poorly controlled hydrocephalus or other CNS anomalies such as porencephaly. The mean IQ of infants who were not shunted was 104, of those shunted without complications it was 91, and of those shunted who had complications it was 70. These IQ differences were significant at p less than 0.01, and were not explained by differences in spinal lesion levels.

Clinical and pathological study of dysplastic gangliocytoma. Case report.

A case of dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease) is reported. Computerized tomography revealed a nonenhancing mass lesion surrounded by areas of calcification. Surgical excision resulted in complete resolution of the patient's symptoms. The histological findings support the concept that this tumor represents a congenital abnormality in granule-cell migration and is not a true neoplasm.

Late complications of carotid ligation in the treatment of intracranial aneurysms.

The results in 57 consecutive patients treated with carotid ligation for an intracranial aneurysm were analyzed to define the risks of late complications. The average age for the group was 46 years. Eighty percent of the aneurysms were located on the internal carotid artery (ICA). The acute morbidity and mortality of the treatment and the natural history of the disease was 29%. Twenty-four patients were discharged with a common carotid artery (CCA) ligation, and 21 patients with an ICA ligation. Three patients from each ligation group could not be located for review. The follow-up period for the 21 patients with CCA ligation ranged from 1 to 15 years, with an average of 8.4 years, and for the 18 patients with ICA ligation it ranged from 2 to 19.5 years, with an average of 12.5 years. Excluding deaths from unrelated causes, five of the 21 patients with CCA ligation developed a late complication. Two patients had a transient ischemic attack (TIA). Two patients had a subarachnoid hemorrhage (SAH), one of which was fatal and was preceded by a TIA. Two patients developed monocular blindness. None of the patients had a stroke. Excluding deaths from unrelated causes, five of the 18 patients with ICA ligation developed a late complication. One patient had a fatal SAH. Three patients had a TIA, two of which were followed by a stroke. One patient had a stroke in the cerebral hemisphere contralateral to the side of the carotid ligation.

Needle biopsy of tumors in the region of the third ventricle.

Twenty-six patients underwent needle biopsy of tumors in the area of the third ventricle. Operative mortality was zero, and the diagnosis was established in 23 of the 26 patients. There was no permanent neurological deterioration in any of the patients. Needle biopsy yields diagnostic information with small risk, and is particularly helpful in the posterior portion of the third ventricle where tumors are likely to be quite radiosensitive.

Diphtheroid infections of cerebrospinal fluid shunts. The changing pattern of shunt infection in Cleveland.

In the process of trying to decrease infection rates, gentamicin has been used to irrigate shunt systems at the time of surgery. The infection rate did not change, but the epidemiology of infecting organisms changed from Staphylococcus epidermidis to diphtheroids. These indolent and sometimes asymptomatic infections can progress to cause systemic disease with nephritis, peritonitis, or blocked shunts, and are difficult to detect. Laboratory values of cerebrospinal fluid and blood may not be helpful, but prolonged culture incubation on anaerobic media will subsequently yield the organism. Systemic and intraventricular antibiotics may rid the system of diphtheroids and avoid morbidity of shunt revision if the infection is found before systemic disease occurs.

Excision of intramedullary arteriovenous malformation using intraoperative spinal cord monitoring.

We are presenting a patient whose intramedullary cervical arteriovenous malformation was successfully excised. The importance of monitoring somatosensory cortical evoked responses secondary to peripheral nerve stimulation is stressed.

The acute abdomen in patients with ventriculoperitoneal shunts.

A rationale for management of the patient with an acute adbomen and a ventriculoperitoneal shunt is presented in relation to eight patients. In two patients peritonitis was due to perforation of an abdominal viscus, not shunt related, and six were due to infections of ventriculoperitoneal shunts. Resolution of abdominal symptomatology occurs within six hours after the distal end of the shunt catheter is removed from the abdomen and placed in a drainage bottle. In four of these six, infection was limited to the peritoneal end of the catheter. The ventricular fluid was sterile.

Reversal of seven-year old visual field defect with extracranial-intracranial arterial anastomosis.

A variety of neurologic deficits has been reversed following extracranial-intracranial arterial anastomoses. We are presenting an unusual case of complete resolution of a documented seven-year-old defect in the right homonymous visual fields following anastomosis of the superficial temporal artery and the angular branch of the middle cerebral artery.

Acquired spontaneous, nontraumatic normal-pressure cerebrospinal fluid fistulas originating from the middle fossa.

Five cases of spontaneous cerebrospinal fluid (CSF) fistulas originating from the middle fossa are described, including one patient with an "empty" sella. It is suggested that acquired meningocele and meningoencephalocele progress to become CSF fistulas. The normal anatomical and physiological factors which give rise to acquired bone/dural/arachnoid dehiscences are discussed and illustrated.

Electrospinogram and spinal and cortical evoked potentials in experimental spinal cord trauma.

Studies in 28 traumatized cats showed the following acute changes after spinal cord compression in the cord segment below the trauma: 1) increase in size of the spinal cord evoked potential; 2) increase in size of the electrospinogram; and 3) increase in frequency of the electrospinogram.

Alterations in ventricular fluid pressure during ketamine anesthesia in hydrocephalic children.

We studies ventricular fluid pressure changes in 26 hydrocephalic children following administration of ketamine. The increase in VFP previously found with intravenously administered ketamine was compared with changes after ketamine given intramuscularly, and the possible alteration of this increase with sedative premedicants was studies. Changing the route of administration did not change the time to peak VFP changes or the duration of pressure elevation. There was no demonstrable alteration of the increase in VFP by premedication with secobarbital, dorperidol, or diazepam in clinical dosage. We feel that acute rises of VFP may affect areas of marginal cerebral blood flow and may increase the risk of herniation of brain tissue.