Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
-
Review Case Reports
Unilateral occipital hyperhidrosis following Chiari I decompression: case report and a review of the literature.
Paroxysmal unilateral cephalic hyperhidrosis is a rare disorder of the autonomic nervous system. ⋯ To our knowledge, hyperhidrosis of the occiput has not been previously reported in a patient with Chiari I malformation with an associated syringomyelia.
-
Comparative Study Clinical Trial
Intraoperative MRI for interventional neurosurgical procedures and tumor resection control in children.
Despite the introduction of neuronavigational systems, radical tumor removal is still problematic in many neurosurgical procedures. Thus, direct intraoperative imaging for tumor resection control was implemented with an intraoperative magnetic resonance imaging (ioMRI) scanner installed in the operating room. Whereas most procedures with ioMRI were carried out in adults, we summarize 7 years of experience using ioMRI in children for interventional neurosurgical procedures or for tumor resection control. ⋯ IoMRI using the open magnetom is suitable for detecting residual tumor tissue, can compensate for the phenomenon of brain shift using a new intraopertive 3D dataset for extended tumor resection, and is capable of monitoring interventional neurosurgical procedures. By using ioMRI for tumor resection control, the degree of tumor resection could be significantly improved.
-
FEATURES OF TEMOZOLOMIDE: Temozolomide (TMZ) belongs to the imidazotetrazine class and it is a DNA-methylating agent that has a good antitumor activity. Despite of dacarbazine, TMZ is spontaneously converted into its active metabolite 5-(3-methyltriazen-l-yl)imidazole-4-carboxamide at physiologic pH, so it is not required in enzymatic demethylation in the liver. TMZ is able to cross the blood brain barrier and is stable at gastric acid pH so it has almost 100% oral bioavailability and is rapidly absorbed after it is taken orally. ⋯ In spite of the poor activity of TMZ against pediatric brain tumors, the use of the drug in combination with other compounds should be evaluated in phases I and II clinical trials. Moreover, the evaluation of the methylation status of the O6-methylguanine DNA methyltransferase promoter in glioblastoma biopsy specimens could be assayed as a predictive factor of TMZ efficacy.
-
Comparative Study Clinical Trial
Role of intraoperative neurophysiology in primary surgery for obstetrical brachial plexus palsy (OBPP).
Management of conducting neuroma-in-continuity in primary surgery for obstetrical brachial plexus palsy (OBPP) is still discussed controversially. We present our experience with intraoperative neurophysiological recordings in the management of lesions in continuity in OBPP. ⋯ Intraoperative neurophysiological recordings face certain difficulties when used in small children with OBPP. Due to overoptimistic assessment of prognosis after intraoperative CNAP recordings and motor stimulation, the functional results after neurolysis of conducting neuroma-in-continuity are disappointing. Resection of neuroma-in-continuity, conducting or not, offers the best opportunity for maximal functional recovery of the compromised upper limb in OBPP. The role of intraoperative neurophysiological techniques should be confined to the diagnosis of root avulsions.
-
Comparative Study Clinical Trial
Lumbar hyperlodosis in cerebral palsy: anatomic analysis and surgical strategy for correction.
We report our experience of five cases in adolescents with spastic quadriplegia who had primarily sagittal plane deformity with hyperlordosis of the lumbar spine, an uncommon condition in cerebral palsy spinal deformity. ⋯ Hyperlordosis was reduced by 26 to 48 degrees , and the horizontal sacrum was corrected by 15 to 35 degrees , which enabled the patients to sit comfortably.