Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Biography Historical Article
Holoprosencephaly in Mexico: first reported autopsy case by Dr. Agustín Arellano.
Holoprosencephaly with cyclocephaly is an early disturbance of organogenesis and has been classified as a severe brain malformation starting in 1755 by Eller in Germany, then in 1822 by Etienne Geoffroy de Saint-Hilaire in France, and finally in 1828 by Tiedemann in Germany. In 1839, Dr. Arellano published in Mexico a necropsy case of holoprosencephaly. This was the fourth publication worldwide on this kind of pathological alteration. Furthermore, in reference to diaphragmatic herniation, Arellano's paper is the fourth world report, having appeared 9 years before Bochdalek's publication. We have not found any other report that appeared before 1839 in the Americas on this particular malformation, and we consider that Arellano's paper was the first of its kind on the American continent. ⋯ As is well known, the publications of this Mexican medical researcher were, for his time, at the level of those of the most developed countries. It is also important to know that the medical journal where Arellano's work was published, the "Periódico de la Academia de Medicina de Mégico(sic)," founded and directed by Dr. Manuel Carpio in 1836, is the direct forerunner of the present Gaceta Médica de México, the oldest currently published journal in the Americas.
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Lesions located in the retroclival area and at the level of the cranio-vertebral junction are typically approached through a variety of anterior, antero-lateral and postero-lateral skull-based approach, either alone or in combination. The aim of this anatomical study was to demonstrate the possibility of an endoscopic endonasal approach to the clivus and cranio-vertebral junction. ⋯ The endoscopic endonasal approach to the clivus and cranio-vertebral junction could be a valid alternative for surgical treatment of anterior lesions of these regions. Adequate endoscopic skill, lab training on cadavers and dedicated tools are required for clinical applications of the approach.
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The necessity of surgical treatment of the arachnoid cyst in general and posterior fossa arachnoid cyst (PFAC) in particular is sometimes controversial. Surgery is warranted in symptomatic patients. In this study, we evaluated our experience throughout 27 years in the management of patients with PFAC. ⋯ The relatively good results using marsupialization or endoscopic cisternostomy as surgical procedure and the high incidence of shunt malfunction buttresses our use of both operations as a first-line surgery at present. Surgical procedure that does not include shunting decreases the ratio of recurrent operation because this kind of complication develops over time and should be consider as a second-line procedure.
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Vascular lesions with an intraosseus nidus involving the skull base are uncommon and challenging [Gianoli GJ, Amedee RG Vascular malformation of the sphenoid sinus. Ear Nose Throat J. 70:373-375;(1991), Malik GM, Mahmood A, Mehta BA Dural arteriovenous malformation of the skull base with intraosseous vascular nidus. Report of two cases. J. Neurosurg 81:620-623;(1994)]. We present a pediatric patient, with a life-threatening arteriovenous malformation (AVM) of the sphenoid sinus, clivus, and ventral skull base, who failed routine multimodality management of AVMs. An entirely transsphenoidal fully endoscopic resection was used to resect this ventral cranial base AVM with an intraosseus nidus located in the clivus. ⋯ Technological advances in endoscopic surgery and image guidance are now allowing for purely endoscopic surgical treatment of previously unresectable lesions with acceptable morbidity. We report the successful and safe resection of a ventral cranial base AVM via a fully endoscopic approach. This paper reports the first AVM with a purely intraosseus nidus of the ventral skull base and demonstrates the ability to deal with complex ventral skull base lesions using a fully endoscopic transsphenoidal technique.
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Traumatic epidural hematoma (EDH) represents a rare head injury complication in infants. Its diagnosis can be quite challenging because its clinical presentation is usually subtle and nonspecific. In our current communication, we present our data regarding the presentation of infants with EDH, their management, and their long-term outcome. ⋯ EDH in infants represents a life-threatening complication of head injury, which requires early identification and prompt surgical or conservative management depending on the patient's clinical condition, size of EDH, and presence of midline structure shift on head CT scan. Mortality and long-term morbidity are low with early diagnosis and prompt treatment.