Pediatric neurosurgery
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Pediatric neurosurgery · Nov 1997
Normal diameter of filum terminale in children: in vivo measurement.
The hallmarks of tethered cord syndrome are a low-lying conus medullaris and a thick filum terminale. In diagnosing the tethered cord syndrome, the thick filum terminale is often defined as that greater than 2 mm in diameter. The cutoff of 2 mm in diameter was derived from myelographic measurements a few decades ago, and the true normal diameter of the filum terminale diameter in children or adults remains unknown. ⋯ The diameter of the filum at 10 and 15 mm caudal to the conus was 1,211 +/- 209 and 1,163 +/- 245 microm (mean +/- SD), respectively. In all children except one, the conus medullaris ended above the L2 level. The data indicate that filum terminales greater than 2 mm in diameter in children are abnormally thick.
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Pediatric neurosurgery · Aug 1997
Case ReportsChronic childhood hydrocephalus associated with cavernous angioma compressing the superior sagittal sinus.
We report an autopsy case of a boy who, following drowning at the age of 15 years, was found to have severe occult hydrocephalus and a cavernous angioma compressing the lumen of the superior sagittal sinus. We speculate that the cause of hydrocephalus was increased intrasinus pressure with impaired drainage of cerebrospinal fluid.
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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.
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Pediatric neurosurgery · May 1997
Intracranial neurological injuries associated with orbital fracture.
We attempted to define the central nervous system (CNS) concomitants of various types of orbital fractures in children by reviewing the records of 95 inpatients with admission diagnoses including orbital fracture who presented to the Children's National Medical Center from 1987 through 1994. Patients were divided into three age groups: group I: 0-5 years; group II: 6-12 years; group III: older than 12 years. Orbital fractures were classified by location: roof alone (A); orbital roof plus another orbital wall (B), and orbital fractures sparing the roof (C). ⋯ Seven of the patients with intracranial injury required emergent neurosurgical procedures. Younger children with maxillofacial injury sparing the orbital roof appear more likely to have coexisting intracranial injury, as reflected by CT findings and GCS on admission, than their older cohorts with similar injuries. Fracture of more than one orbital wall greatly increases risk of concurrent intracranial injury in all age groups.