Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Repair of myelomeningoceles larger than 5 cm in diameter is not easy. We describe a simple technique. ⋯ This simple technique is appropriate for the closure of large myelomeningoceles and does not need more extensive and complex procedures.
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We report a case of congenital intracranial cavernous angioma, which was initially found at a gestational age of 34 weeks in utero as a mass lesion associated with hydrocephalus. After birth, the patient was treated for hydrocephalus first by external drainage and then by ventricular peritoneal shunt. The natural course of the mass lesion was observed until the age of 8 months when the histopathological diagnosis confirmed the cavernous angioma after tissue was obtained by surgery. CT scans repeated monthly during this period demonstrated that the angioma continuously decreased in size. There was no evidence of hemorrhage in the angioma on serial CT scans. The histopathology revealed thrombosis of cavernous vessels with hyaloid changes in the angioma. ⋯ The mechanisms of the decreasing size of the cavernous angioma have often been discussed in relation to spontaneous hemorrhages and resolution. The present case suggests a mechanism in which the spontaneous formation of a thrombus might be the dominant factor for the decrease in size. Thrombus formation may result from low perfusion due to the large size of the angioma.
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A case of accumulation of CSF into the brain parenchyma simulating a brain tumor, secondary to an obstructed ventriculoperitoneal shunt, is presented. Until now, only seven cases of this rare complication have been described. ⋯ The mistake in the diagnosis was due to the clinical symptoms and to the MR images.
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Growing skull fractures and other enlarging skull defects are rare postoperative occurrences. We report here on a 10-month-old girl who presented with an enlarging burr hole and pseudomeningocele after an endoscopic third ventriculocisternostomy. ⋯ Growing skull fractures or other enlarging bone defects may occur after burr hole placement, particularly in infants who require larger access sites for endoscopy.
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Case Reports
Split cord malformation and situs inversus totalis: case report and review of the literature.
Situs inversus is a rare condition of visceral transposition in which the spinal axis is rarely affected. ⋯ Recent compelling evidence from animal models and human case reports has led to hypotheses that defects of the midline and laterality defects (e.g., situs inversus) are etiologically related. Confirmation from additional case reports of situs inversus and split cord malformation could prove useful in determining a genetic locus for split cord malformations or implicating various chemical agents that are known to produce situs inversus as potential causative factors in the production of split cord malformations.