Pediatric neurosurgery
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Pediatric neurosurgery · Oct 1996
Treatment of high-risk medulloblastoma and other primitive neuroectodermal tumors with reduced dose craniospinal radiation therapy and multi-agent nitrosourea-based chemotherapy.
To investigate toxicity, and progression-free survival (PFS) of children and adults with newly diagnosed medulloblastoma, pineoblastoma, and other primitive neuroectodermal tumors (PNET) with a combined modality regimen of radiation therapy and adjuvant nitrosourea-based chemotherapy. ⋯ The results using this therapy in high-risk groups of patients does not offer any improvement over results reported in other recent studies. The reason for these results may be due to the lowered craniospinal radiation dose.
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Pediatric neurosurgery · Sep 1996
Case ReportsIntestinal obstruction caused by extraperitoneal cerebrospinal fluid collection.
External compression caused by a massive extraperitoneal cerebrospinal fluid collection lead to intestinal obstruction in a 3-year-old child who had previously had a ventriculoperitoneal shunt for treatment of hydrocephalus. Radiological findings and ways of preventing this situation are discussed. A useful diagnostic radiological sign, the "coiling sign', indicating shunt misplacement at the peritoneal level, is also described.
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Pediatric neurosurgery · Jun 1996
The prognostic value of the Glasgow Coma Scale, hypoxia and computerised tomography in outcome prediction of pediatric head injury.
The outcome of 151 children less than 15 years of age and admitted within 24 h of head injury was studied in relation to clinical and computed tomography (CT) scan features. Thirty one (20.5%) had a poor outcome (24 died, 6 were severely disabled at 6 months after injury and 1 was in a persistent vegetative state) while 120 (79.5%) had a good outcome (89 recovered well and 31 were moderately disabled). Factors associated with a poor outcome were Glasgow Coma Scale (GCS) score 24 h following injury, presence of hypoxia on admission and CT scan features of subarachnoid haemorrhage, diffuse axonal injury and brain swelling. ⋯ The prognostic value of GCS scores < 8 was enhanced two-to fourfold by the presence of hypoxia. The additional presence of the CT scan features mentioned above markedly increased the probability of a poor outcome to > 0.8, modified only by the presence of GCS scores > 12. Correct predictions were made in 90.1% of patients, indicating that it is possible to estimate the severity of a patient's injury based on a small subset of clinical and radiological criteria that are readily available.
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Pediatric neurosurgery · Jan 1996
Seizure outcome in children treated for arteriovenous malformations using gamma knife radiosurgery.
Seizures are the second most common presenting symptom of arteriovenous malformations (AVMs) in children. Although radiosurgery has been found to be a safe and effective alternative treatment, the outcome of seizure control in children after radiosurgery for AVMs is unknown. Between 1987 and 1994, 72 children under the age of 18 years were treated with gamma knife radiosurgery for AVMs at our institution. ⋯ Two of the 72 patients (3%) developed seizures after treatment and remain on medication. Seizure outcome was not associated with the location or complete obliteration of the lesion. We conclude that stereotactic radiosurgery, as a non-invasive alternative, is associated with a good outcome for the AVM as well as AVM-related seizures in children.
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Pediatric neurosurgery · Jan 1995
Use of subdural grids and strip electrodes to identify a seizure focus in children.
For patients with intractable seizures, the best surgical outcome is achieved following precise localization of the seizure focus. Scalp EEG monitoring may be insufficient and chronic subdural invasive EEG monitoring has therefore been advocated. At Children's Hospital in Boston, 31 children had chronic subdural monitoring from January 1990 through June 1994. ⋯ During monitoring, cortical stimulations were performed to localize speech and somatosensory areas. There was only one complication, a subdural hematoma in a patient who had had previous surgery. Chronic subdural EEG monitoring is helpful in precisely localizing seizure foci in pediatric patients; it also allows motor and speech mapping and appears to be a safe modality in children.