Pediatric neurosurgery
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Pediatric neurosurgery · Jul 1997
Case ReportsEffect on ambulation of continuous intrathecal baclofen infusion.
Intrathecal baclofen (ITB) infusion has been shown to be an effective treatment for spasticity secondary to both cerebral palsy and spinal cord injury. Its effect on the ambulatory status of individuals with cerebral spasticity, however, has not previously been addressed. We reviewed the effect of ITB on functional ambulation in 24 patients who were ambulatory to some extent, either with or without assistive devices. ⋯ ITB allows for improved ambulation in a certain subset of patients with lower extremity spasticity. It is not contraindicated in patients who rely upon their spasticity for support during ambulation. ITB infusion allows for baclofen dosage titration to balance between extensor tone for support and suppression of hyperactive reflexes which may impede normal locomotion.
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Pediatric neurosurgery · Jul 1997
Resection of fourth ventricle tumors without splitting the vermis: the cerebellomedullary fissure approach.
Standard surgical practice for excision of fourth ventricle tumors entails splitting the inferior vermis, but incision of the vermis and lateral retraction on the dentate nuclei and their outflow tracts have been implicated in the development of the so-called 'cerebellar mutism syndrome'. We describe a surgical approach in which the cerebellar vermis is preserved. ⋯ The cerebellomedullary fissure approach yields exposure comparable to what can be achieved by splitting the vermis and may minimize the risk of neurological complications.