Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Case Reports
Corpus callosum section in the treatment of intractable seizures in the Sturge-Weber syndrome.
The Sturge-Weber syndrome includes unilateral cerebral cortical angiomatosis, which often leads to progressive cerebral dysfunction and epileptic seizures that are medically difficult to control. Cerebral resections and hemispherectomy have been successfully performed in the past in intractable epileptic cases. ⋯ Cessation of generalized epilepsy was achieved in both cases. Corpus callosotomy is presented as a less destructive and safer procedure in dealing with intractable seizures in the Sturge-Weber syndrome.
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The treatment results of 21 (1972-1982) patients with craniopharyngioma are reported who were treated either by surgery alone or by surgery and radiation therapy. The authors reviewed 14 patients (67%) who were less than 18 years of age at the time of surgery. The eradication was thought to be total in 7 children and subtotal in 7. ⋯ All of the children suffered postoperative hormonal deficiencies. The results of this study indicate that total and subtotal removal followed by RT is an acceptable treatment for craniopharyngioma. Endocrine-deficient children, if treated properly, do well in terms of survival.
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In a 16-month period, 31 children underwent outpatient operations for a variety of neurosurgical problems. None of the patients experienced any anesthetic complications. ⋯ A saving of at least 49.5% in hospital charges was produced when surgery was performed in the outpatient surgical facility, and a 19.8% reduction in costs was achieved when the main hospital operating suite was used on an outpatient basis. Neurosurgical procedures can be safely and inexpensively performed on an outpatient basis, even in children.
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A retrospective analysis of the infantile acute subdural hematoma was made with special reference to its pathogenesis. In 11 of 15 cases, the hematomas were bilateral or a contralateral subdural fluid collection was present. In 7 of 11 patients who underwent operation the collection was bloody fluid and/or clotted blood. ⋯ In only 1 patient with unilateral hematoma was clotted blood present without subdural membrane. The thickest collection of clotted blood was in the parasagittal region. It is postulated that in most cases hemorrhage occurs after minor head injury, from the bridging veins near the superior sagittal sinus, into a pre-existing subdural fluid collection such as chronic subdural hematoma or subdural effusion with cranio-cerebral disproportion, and that infants without intracranial disproportion are unlikely to have acute subdural hematoma caused by minor head injury.
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Randomized Controlled Trial Clinical Trial
Prospective randomized cooperative medulloblastoma trial (MED 84) of the International Society of Paediatric Oncology (SIOP) and of the (German) Society of Paediatric Oncology (GPO).
This international, prospective, randomised therapeutic study is based on previous, separate studies of the two societies. The study asks two principal questions: Is it possible to improve the results of therapy by inserting, between surgery and post-operative irradiation, an intensive course of chemotherapy consisting of vincristine, procarbazine and methotrexate, followed by citrovorum factor rescue? In "low risk" patients (i.e. those with macroscopically "complete" resection and absence of metastases at diagnosis), can the radiotherapy to CNS areas outside the primary tumour site be reduced by 10 Gy with the aim of reducing late sequelae of irradiation but without compromising survival results? The study also aims at standardising diagnostic methods, neurosurgical procedure and radiotherapeutic technique employed in this tumour. For statistical reasons, results can only be disclosed after the end of the recruitment phase. It is intended to include approximately 350 patients in the study, which is planned to continue until the end of 1988.