Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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A critical analysis of functional and morphological aspects of Apert and Crouzon syndromes is presented, with reference to the papers presented in this session of the Consensus Conference on Craniosynostoses. Targets and limits of surgical correction are also discussed.
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Cerebrospinal fluid shunt failure remains a common and at times overwhelming problem in pediatric patients with hydrocephalus. Two new shunt valve designs, the Orbis-Sigma (Cordis Corporation, Miami, Florida) and the Delta valve (PS Medical, Goletta, California), have flow/pressure characteristics dramatically different from those of standard differential pressure valves which have been used for over three decades. Both new designs reduce the siphoning effect in the upright position, and have been reported to reduce shunt failure rates in uncontrolled series, allegedly due to reduction in shunt overdrainage. ⋯ For this reason a randomized trial is required to determine efficacy, and a standard differential pressure valve is required as the control design. A significant reduction in early shunt failure would dramatically improve the morbidity and mortality of pediatric hydrocephalic patients, as well as providing substantial savings to the health care system. Failure to determine any difference would focus attention on other issues surrounding shunt surgery, such as patient characteristics or surgical technique.
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Fifty-eight children who underwent anatomical, functional, or modified anatomical hemispherectomy for intractable seizures from 1986 to 1995 were evaluated for seizure control, motor function, and complications. Age at surgery ranged from 0.3 to 17.3 years (median 2.8 years). Twenty-seven anatomical, 27 functional, and 4 modified anatomical hemispherectomies were performed. ⋯ Motor function of the preoperatively hemiparetic extremities was improved or unchanged postoperatively in 38/50 (76%) of the patients. Complications included one intraoperative death, one late death from shunt obstruction managed elsewhere, late postoperative seizure breakthrough requiring reoperation and further disconnection in 5/27 functional hemispherectomy patients, mild cerebrospinal fluid infections in 3/27 anatomical hemispherectomy patients, and hydrocephalus requiring shunting in 3/27 functional hemispherectomy patients. A review of the literature and comparison of techniques is presented.
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Unusual morphological findings were encountered in a high cervical meningomyelocele sac of a neonate. Magnetic resonance imaging revealed a massive liquid-filled sac traversed by a linear structure. The spinal cord was seen to be located normally within the spinal canal. ⋯ The whole of this cord, along with the meningomyelocele sac, was excised. Histological analysis confirmed that this spinal cord-like structure consisted of glial tissue with an ependymal-lined cavity. The excised sac was lined by neural tissue.