Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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The advancement of magnetic resonance (MR) imaging technology has revealed that intracranial venous anomalies, such as vertical embryonic positioning of the straight sinus (VEP of SS), are associated with atretic parietal cephaloceles. However, the precise anatomical relationships among the venous anomalies, superior sagittal sinus (SSS), cistern, and cephalocele have not been demonstrated. We compared the imaging features of conventional MR images and high-resolution 3-dimensional (3-D) MR images, such as Fourier-transformation-constructive interference in steady-state (CISS) images and T2-weighted reversed (T2R) images obtained on a 3-T MR machine. ⋯ Detailed findings of the venous anomalies on 3-D MR images provide clues to the diagnosis of atretic cephalocele.
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Obesity is a major concern in children treated for craniopharyngioma and is caused by hypothalamic damage. The role of aggressive surgical removal has been questioned, leading some authors to recommend a minimalist approach. In order to test this hypothesis, we decided to study obesity in craniopharyngioma and the factors related to it. ⋯ Our results suggest that obesity results from hypothalamic lesions caused by the tumor rather than by surgery. The postoperative weight gain appears to result from the continued impact of preoperative hypothalamic damage. The high rate of tumor recurrence in children, with the risk of additional damage to the hypothalamus, incites us to recommend total resection whenever it appears safe during initial surgery.
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Meningiomas are relatively uncommon in childhood. They represent 1% to 2% of all intracranial tumours of infancy and childhood and 1.5% to 1.8% of all intracranial meningiomas. Occasionally, meningiomas may develop without dural attachment. Clear cell meningioma is a histological distinctive uncommon variant of meningioma that may behave aggressively with local recurrence and progression as well as cerebrospinal fluid-borne metastasis. Meningiomas near the craniocervical junction represent challenging tumours, requiring special considerations because of the vicinity of the medulla oblongata, the lower cranial nerves and the vertebral artery. ⋯ In this study, the authors present a rare case of posterior fossa clear cell meningioma without dural attachment in a child with severe brainstem and cervical spinal cord displacement and discuss the clinical and radiological features as well as treatment considerations.
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The aim of this study is to assess the changes of brain tissue oxygen levels in children during the first 24 h following head injury and its correlation with changes of intracranial pressure and clinical outcome. ⋯ In children with head injury, rise in ICP may be accompanied by fall in PbtO(2). However, low brain oxygen levels during the first 24 h following head injury may not correlate necessarily with poor outcome.
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An alternative approach to the burr hole technique for endoscopic third ventriculostomy (ETV) in babes, the minicraniotomy, is described. It is easily performed and allows to close the dura mater and restore the bone integrity. Since 2002, it is the approach to ETV in babes with open fontanel in our service. ⋯ Analyzing 41 surgeries, the technique did not interfere with the safety and efficacy of the procedure. No cerebrospinal fluid leak occurred. The minicraniotomy seems to be appropriate and advantageous to that age.