Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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A clinical analysis of 95 patients with posterior fossa tumors treated in the Department of Neurosurgery of the Medical University in Gdansk over a period of 16 years (1979-1995) is presented. The following preoperative factors were studied: localization, size and suspected type of tumor, size of the ventricular system, and presence or absence of the "halo" symptom. The indications for ventricular drainage (Fisher) versus V-P shunting as a preliminary treatment are discussed. Finally, the advantages of each of these procedures are emphasized.
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Intra-operative anaphylaxis is of particular concern in neurosurgery. Not only is there an increased risk of major anaphylaxis, but the frequent placement of patients in the prone or sitting position may make resuscitation difficult. We describe two cases of per-operative anaphylaxis during neurosurgery and the techniques used in the successful management and investigation of these patients.
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A 14-year-old boy presented acutely with occipital headache, nausea and vomiting. MRI showed obstructive hydrocephalus and marked bilateral cerebellar swelling with increased signal on T2-weighted imaging. Following treatment with oral corticosteroids, the clinical and radiological signs resolved. The clinical course and radiological appearances were consistent with cerebellitis associated with a significant mass effect and hydrocephalus.
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Chemotherapy has an important role in the modern treatment of children with medulloblastoma (MB). In patients at high risk, intense chemotherapy should improve the survival rate. ⋯ Chemotherapy is also necessary to prevent or treat systemic dissemination. The optimal timing of chemotherapy is a focus of contemporary research.
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Comparative Study
Tumors of the orbit. Pitfalls of the surgical approach in 37 children with orbital tumor.
The authors review their experience with 37 children with orbital tumors, summarizing their surgical techniques, the indications applied, and the pitfalls of each surgical approach. Tumors located in the retro-ocular or intraorbital space were surgically excised through a transcranial approach (28 cases), while for tumors in other sites lateral orbitotomy (5 cases), medial orbitotomy (1 case) and biopsy (3 cases) were performed. A transcranial approach was used for tumors with intracranial extension and for those located in the orbital apex and deep medial orbital compartment. ⋯ A medial orbitotomy was used for tumors located medial to the optic nerve. Outcomes of the surgical intervention varied, depending on the pathology, location and extent of the individual tumors. To obtain optimal exposure and minimize functional deficits, the pitfalls of surgical approaches to orbital tumors are discussed.