The incidence of dumbbell tumors among spinal neoplasms is between 10% and 15%. Approximately 1% ... more The incidence of dumbbell tumors among spinal neoplasms is between 10% and 15%. Approximately 1% of neoplasms located at or near the spinal cord are ganglioneuromas. Ganglioneuromas are rare, slow-growing, benign tumors arising from sympathetic ganglia. The cases of two children with spinal dumbbell ganglioneuroma are presented. The tumors were totally resected by combined surgery in both patients. The patients are neurologically intact 5 and 4 years respectively after surgery.
Double-compartment hydrocephalus, a rare shunt complication, is caused by occlusion of the aquedu... more Double-compartment hydrocephalus, a rare shunt complication, is caused by occlusion of the aqueduct and the fourth ventricular outlets after shunting of the lateral ventricles. Dilation of the fourth ventricle causes brainstem dysfunction and cerebellar signs. A case of doublecompartment hydrocephalus presenting with opisthotonus is presented, and the relevant literature is reviewed.
Primary tumours of the meninges with a relatively high tendency for malignant behaviour are uncom... more Primary tumours of the meninges with a relatively high tendency for malignant behaviour are uncommon in childhood. This study concerns 18 cases of meningeal tumours in children under the age of 16, of which 13 were meningiomas and five were other tumours arising in the meninges. Meningiomas showed a preponderance in females as in adult series, and the majority were supratentorial in localisation. The percentage of meningeal tumours and meningiomas among all brain tumours in our centre were 3.72% and 2.69%, respectively. Four out of 13 meningiomas were fibroblastic, four were transitional , one was meningothelial, two were psammomatous and two were papillary meningiomas. Seven (38.8%) out of 18 tumours showed anaplastic features, including two papillary meningiomas, two hemangiopericytomas , one mesenchymal chondrosarcoma, one pleomorphic sarcoma and one anaplastic meningeal tumour. Papillary meningiomas with hemangiopericytoma-like solid areas were seen frequently in our cases (15.3%). Meningoangiomatosis was associated with two meningeal tumours. MIB 1 (Ki-67) labelling indices (Lis) ranged between 0% and 13,6% (mean 1.83%) in benign. and between 1% and 20% (mean 7.2%) in malignant tumour, including papillary meningiomas. Mean MIB-I Lis were 5.61 % and 1.14% in non-recurrent and recurrent cases, respectively. MIB-I Lis showed significant differences between benign and malignant meningeal tumours but no significant correlation either with prognosis or recurrence.
Brain involvement in hydatid disease occurs in 1 to 2% of all Echinococcus granulosus infections.... more Brain involvement in hydatid disease occurs in 1 to 2% of all Echinococcus granulosus infections. Fifty to 75% of intracranial hydatid cysts are seen in children. This study included 19 children who underwent surgery for intracranial hydatid cysts between January 1979 and September 1992. There were 12 boys and 7 girls, ages 3 to 16 years (mean, 8.1 yr). Headache and vomiting were the predominant symptoms. Papilledema was present in 16 patients, and 2 patients had secondary optic atrophy. A round, cystic lesion without perifocal edema and rim enhancement was detected on the computed tomographic scans of 13 patients. The cystic lesions with rim enhancement and perifocal edema were noted on the computed tomographic scans of 3 patients. Of these three patients, two subsequently had a recurrence. Total removal of the cyst without rupture was achieved in 12 patients. Only a 3-year-old boy in whom the cyst ruptured at surgery died. Seven patients in whom either the hydatid cyst ruptured at surgery or there was systemic hydatid disease received mebendazole therapy. Mebendazole seems to be effective in hydatid disease. Cerebral hydatid cysts should be removed in toto without rupture. The preoperative diagnosis is very important in planning surgery. When a cystic lesion is detected on computed tomographic scan, hydatid disease should be taken into consideration in countries where hydatid disease is endemic.
Object.The authors reviewed and analyzed information on 74 patients with split spinal cord malfor... more Object.The authors reviewed and analyzed information on 74 patients with split spinal cord malformations (SSCMs) treated between January 1, 1980 and December 31, 1996 at their institution with the aim of defining and classifying the malformations according to the method of Pang, et al.Methods.Computerized tomography myelography was superior to other radiological tools in defining the type of SSCM. There were 46 girls (62%) and 28 boys (38%) ranging in age from less than 1 day to 12 years (mean 33.08 months). The mean age (43.2 months) of the patients who exhibited neurological deficits and orthopedic deformities was significantly older than those (8.2 months) without deficits (p = 0.003). Fifty-two patients had a single Type I and 18 patients a single Type II SSCM; four patients had composite SSCMs. Sixty-two patients had at least one associated spinal lesion that could lead to spinal cord tethering. After surgery, the majority of the patients remained stable and clinical improvemen...
We designed this study to elucidate the associated occult spinal lesions in patients with simple ... more We designed this study to elucidate the associated occult spinal lesions in patients with simple dorsal meningocele. Methods: The study population was comprised of two groups. Group I comprised newly diagnosed patients with dorsal spinal meningocele, and group II comprised patients who had had surgery for meningocele and presented with progressive neurological deficits. Magnetic resonance imaging (MRI) scans of the whole spinal column were done. The associated spinal cord malformations were also treated at the same operation. There were 14 boys and 8 girls, with an age range from birth to 4 years (mean 3.9 months), in group I. Of 20 patients (90%) with associated spinal lesions, 6 had more than one lesion, excluding hydromyelia. Group II was made up of 6 patients who had been previously operated on for a meningocele and who presented with tethered cord syndrome. These were 4 boys and 2 girls, who ranged in age from 4 to 10 years (mean 6 years). Results: The level of the conus terminalis was lower than L3 in all patients. The other findings on MRI, besides low conus, were as follows: tight filum, split cord malformation, epidermoid, dorsal lipoma and hydromyelia. Conclusions: Meningocele frequently camouflages a second, occult, spinal lesion. MRI of the whole spinal column should be performed. An intradural exploration performed with a microneurosurgical technique is needed to detect the fibrous bands that may lead to spinal cord tethering and to release the entrapped nerve roots. The other associated spinal anomalies should be operated on during the same operation.
Objects: Subduroperitoneal (SP) shunts have been widely used in the management of pediatric subdu... more Objects: Subduroperitoneal (SP) shunts have been widely used in the management of pediatric subdural fluid collections. Methods: We retrospectively reviewed the complications of SP shunting in 73 boys and 24 girls, who ranged in age from 1 to 180 months (median 7 months). Subdural fluid collection was bilateral in 75 and unilateral in 22 patients. The most common complication was shunt obstruction (13 patients). Shunt migration was seen in 8 patients. Migration occurred only with unishunts without a reservoir and with peritoneal catheters. However, the shunts with a reservoir or flushing valve led to skin necrosis in 4 patients (P=0.003). Unilateral drainage though bilateral collections were present, infection, bowel perforation, and ileus occurred in 5, 4, 1 and 1 patients respectively. Conclusions: These SP shunt complications, some of which are avoidable, should be kept in mind.
Secondary malignant neoplasms (SMN) in CNS tumor survivors has become problem of increasing conce... more Secondary malignant neoplasms (SMN) in CNS tumor survivors has become problem of increasing concern over the last 20 years. These tumors usually occur in a different site from the primary brain tumor several years after treatment. We report secondary cranial malignant neoplasms in three patients who were treated with irradiation and chemotherapy for their primary brain tumors. The first case is a male survivor of an orbital rhabdomyosarcoma who developed a meningioma 8 years later. The other two cases are female survivors of ependymomas who were irradiated at the age of 3 and developed secondary gliomas 8 and 17 years after therapy respectively. Patients carry a risk of developing SMNs many years later since irradiation is still an important part of the treatment. An SMN may have a benign course, as in meningioma, or be a dilemma for the patient, as in glioblastoma.
Abstraet Forty-four consecutive patients with brain abscesses, aged between 1 month and 16 years,... more Abstraet Forty-four consecutive patients with brain abscesses, aged between 1 month and 16 years, were reviewed. The cause of abscess was meningitis in 36% of the cases, otitis in 27%, head injury in 16%, congenital heart disease in 9%, other in 5%, and undetected in 5%. Thirty patients had a single abscess and 12 had multiple abscesses. Multiloculated abscess was present in 2. Total excision was accomplished in 22 patients. Three patients underwent needle aspiration. Drainage of the abscess was performed in 13. Secondary excision was needed in 5 patients. One patient was treated nonsurgically. Streptococci, staphylococci and Proteus mirabilis were the microorganisms recovered in cultures. Overall mortality was 20% (9 patients). Mortality was significantly higher in patients under 2 years of age than in those older. Of 15 patients who were comatose at the time of admission, 6 died. Etiology, diagnostic method, and treatment modalities were not found to be significant factors in terms of predicting mortality.
One hundred forty-six consecutive patients operated on for extradural h e m a t o m a (EDH) from ... more One hundred forty-six consecutive patients operated on for extradural h e m a t o m a (EDH) from 1979 through 1991 were analyzed. This series included patients from both before and after the advent of computed tomography (CT). There were 102 boys and 44 girls, aged 1-16 years. All patients underwent plain skull X-radiography. CT scans were obtained in 72 cases and angiography was performed in 10. Thirty patients with E D H did not have skull fractures. Falls were predominant among the modes of injury. Thirty-seven percent of patients had a lucid interval. The overall mortality was 10%. The mortality rates in the CT and plain X-ray groups were 6% and 16% respectively. There was only one death in patients who did not have a lucid interval. The Glasgow C o m a Scale scores of all patients who died in this series were less than 8. We concluded that mydriasis, comatose state at the time of operation, and a lucid interval are ominous signs in the prediction of outcome.
There is no consensus on the management of infantile chronic subdural collections. Subdural tappi... more There is no consensus on the management of infantile chronic subdural collections. Subdural tapping, craniotomy and removal of membranes, and shunting from the subdural space have all been used. We performed continuous external subdural drainage (CESD) as a step prior to subdural-peritoneal shunt placement in the management of infantile chronic subdural fluid collections. Alum-bar drainage set was used for CESD. The catheter was placed in the subdural space through the anterior fontanel with a Touhy needle. This percutaneous technique seems an easy and safe method for CESD in infants with chronic subdural collections.
Frontoethmoidal encephaloceles are congenital malformations that cause complex deformities in the... more Frontoethmoidal encephaloceles are congenital malformations that cause complex deformities in the frontal, orbital, and nasal regions. As the term implies, with frontoethmoidal encephaloceles, intracranial material has herniated through the dural and skull defect. In this report, 21 patients with frontoethmoidal encephalocele operated by a craniofacial team are presented, and accompanying anomalies, results, and complications are discussed.
Stab wounds of the skull are uncommon. They are usually accidental in children. An apparently tri... more Stab wounds of the skull are uncommon. They are usually accidental in children. An apparently trivial wound may cause death due to vascular damage or infection. A 5-year-old boy presented with a nail in the left intraorbital region. He fell with a nail in his hand five hours prior to hospital admission. Computed tomographic scans displayed the nail penetrating the cranium through the left orbital roof and extending towards the left anterior clinoid process. The nail was removed under general anesthesia in the operating room. Meningitis developed two days after the removal of the penetrating object and responded well to antibiotics. The pertinent literature was reviewed.
Mutism is not a common condition following cerebellar damage. Mutism following posterior cranial ... more Mutism is not a common condition following cerebellar damage. Mutism following posterior cranial fossa surgery was first reported by Rekate et al. and Yonemasu in 1985. Since then, many case reports of mutism have appeared in the English literature. Very few cases developed mutism following brain stem surgery. Although mutism has been described in patients with head injury, only one case of mutism caused by a cerebellar injury has been reported, to our knowledge. We report on two patients in which the cerebellar mutism following a radical excision of an exophytic brain stem glioma and cerebellar injury developed. We reviewed the relevant literature and discussed the mechanism of cerebellar mutism.
... Clinical Neurology and Neurosurgery 97 (1995) 317-320 Clinical Neurology and Neurosurgery Cas... more ... Clinical Neurology and Neurosurgery 97 (1995) 317-320 Clinical Neurology and Neurosurgery Case report A case of Rathke's cleft cyst presenting with diabetes insipidus Yusuf Er~ahina ... [13] Rout, D., Das, L., Rao, VR ... [18] Oka, H., Kawano, N., Suwa, T., Yada, K., Kan, S. and ...
Cerebral hydatidosis account for approximately 1-2% of patients with hydatid disease. Fifty perce... more Cerebral hydatidosis account for approximately 1-2% of patients with hydatid disease. Fifty percent to 75% of intracranial hydatid cysts are seen in children. The cerebral hydatid cysts are usually single and located in the watershed of the middle cerebral artery. To our knowledge, no case of hydatid cyst in the thalamic location has been reported. A 4-year-old boy presented with the left sided weakness. A right thalamic hydatid cyst without rim enhancement and perifocal oedema was detected on the computed tomographic (CT) scan. He was put on albendazole, but headache, nausea and vomiting developed and hemiparesis got worse in the following two weeks. The non-contrast repeat CT showed the pericystic oedema. The rim enhancement and pericystic oedema were also present on magnetic resonance imaging scans. The right thalamic hydatid cyst was removed via the transcallosal approach. The cyst aspiration and intracystic injection of hypertonic saline were performed before the cyst removal. Leakage of the cyst fluid was conceivably the cause of the development of rim enhancement and pericystic oedema. Patients receiving albendazole for the treatment of cerebral hydatid cysts should be closely followed. The surgery is still the choice of treatment in cerebral hybrid cysts, in our opinion.
Two different approaches to fenestration, endoscopic and microsurgical, are in use for Sylvian ar... more Two different approaches to fenestration, endoscopic and microsurgical, are in use for Sylvian arachnoid cysts (SACs), the most frequent among intracranial arachnoid cysts. We presented the clinical data and compared our results, with regard to technique and clinical success, with either microsurgical or neuroendoscopic fenestration of SACs. Twenty-nine patients who subjected to cysto-cisternostomy by the same team, using either of the two methods, were studied retrospectively. Thirteen patients underwent microsurgery, and 16 had endoscopic cysto-cisternostomy. No reoperation was needed in either of these groups, i.e., full clinical and radiological success was achieved in both. The complication rate was 23% in the microsurgery patients and 47% in the endoscopic surgery group, with no statistically significant difference. No relevant differences between the two methods are seen either in the published data or in our results. Adding our results to the published data, both techniques were reviewed in a discussion of the one that allows a better controlled or safer fenestration. We conclude that endoscopic fenestration of SACs is not superior to microsurgical cyst fenestration, and the latter seems safer.
The incidence of dumbbell tumors among spinal neoplasms is between 10% and 15%. Approximately 1% ... more The incidence of dumbbell tumors among spinal neoplasms is between 10% and 15%. Approximately 1% of neoplasms located at or near the spinal cord are ganglioneuromas. Ganglioneuromas are rare, slow-growing, benign tumors arising from sympathetic ganglia. The cases of two children with spinal dumbbell ganglioneuroma are presented. The tumors were totally resected by combined surgery in both patients. The patients are neurologically intact 5 and 4 years respectively after surgery.
Double-compartment hydrocephalus, a rare shunt complication, is caused by occlusion of the aquedu... more Double-compartment hydrocephalus, a rare shunt complication, is caused by occlusion of the aqueduct and the fourth ventricular outlets after shunting of the lateral ventricles. Dilation of the fourth ventricle causes brainstem dysfunction and cerebellar signs. A case of doublecompartment hydrocephalus presenting with opisthotonus is presented, and the relevant literature is reviewed.
Primary tumours of the meninges with a relatively high tendency for malignant behaviour are uncom... more Primary tumours of the meninges with a relatively high tendency for malignant behaviour are uncommon in childhood. This study concerns 18 cases of meningeal tumours in children under the age of 16, of which 13 were meningiomas and five were other tumours arising in the meninges. Meningiomas showed a preponderance in females as in adult series, and the majority were supratentorial in localisation. The percentage of meningeal tumours and meningiomas among all brain tumours in our centre were 3.72% and 2.69%, respectively. Four out of 13 meningiomas were fibroblastic, four were transitional , one was meningothelial, two were psammomatous and two were papillary meningiomas. Seven (38.8%) out of 18 tumours showed anaplastic features, including two papillary meningiomas, two hemangiopericytomas , one mesenchymal chondrosarcoma, one pleomorphic sarcoma and one anaplastic meningeal tumour. Papillary meningiomas with hemangiopericytoma-like solid areas were seen frequently in our cases (15.3%). Meningoangiomatosis was associated with two meningeal tumours. MIB 1 (Ki-67) labelling indices (Lis) ranged between 0% and 13,6% (mean 1.83%) in benign. and between 1% and 20% (mean 7.2%) in malignant tumour, including papillary meningiomas. Mean MIB-I Lis were 5.61 % and 1.14% in non-recurrent and recurrent cases, respectively. MIB-I Lis showed significant differences between benign and malignant meningeal tumours but no significant correlation either with prognosis or recurrence.
Brain involvement in hydatid disease occurs in 1 to 2% of all Echinococcus granulosus infections.... more Brain involvement in hydatid disease occurs in 1 to 2% of all Echinococcus granulosus infections. Fifty to 75% of intracranial hydatid cysts are seen in children. This study included 19 children who underwent surgery for intracranial hydatid cysts between January 1979 and September 1992. There were 12 boys and 7 girls, ages 3 to 16 years (mean, 8.1 yr). Headache and vomiting were the predominant symptoms. Papilledema was present in 16 patients, and 2 patients had secondary optic atrophy. A round, cystic lesion without perifocal edema and rim enhancement was detected on the computed tomographic scans of 13 patients. The cystic lesions with rim enhancement and perifocal edema were noted on the computed tomographic scans of 3 patients. Of these three patients, two subsequently had a recurrence. Total removal of the cyst without rupture was achieved in 12 patients. Only a 3-year-old boy in whom the cyst ruptured at surgery died. Seven patients in whom either the hydatid cyst ruptured at surgery or there was systemic hydatid disease received mebendazole therapy. Mebendazole seems to be effective in hydatid disease. Cerebral hydatid cysts should be removed in toto without rupture. The preoperative diagnosis is very important in planning surgery. When a cystic lesion is detected on computed tomographic scan, hydatid disease should be taken into consideration in countries where hydatid disease is endemic.
Object.The authors reviewed and analyzed information on 74 patients with split spinal cord malfor... more Object.The authors reviewed and analyzed information on 74 patients with split spinal cord malformations (SSCMs) treated between January 1, 1980 and December 31, 1996 at their institution with the aim of defining and classifying the malformations according to the method of Pang, et al.Methods.Computerized tomography myelography was superior to other radiological tools in defining the type of SSCM. There were 46 girls (62%) and 28 boys (38%) ranging in age from less than 1 day to 12 years (mean 33.08 months). The mean age (43.2 months) of the patients who exhibited neurological deficits and orthopedic deformities was significantly older than those (8.2 months) without deficits (p = 0.003). Fifty-two patients had a single Type I and 18 patients a single Type II SSCM; four patients had composite SSCMs. Sixty-two patients had at least one associated spinal lesion that could lead to spinal cord tethering. After surgery, the majority of the patients remained stable and clinical improvemen...
We designed this study to elucidate the associated occult spinal lesions in patients with simple ... more We designed this study to elucidate the associated occult spinal lesions in patients with simple dorsal meningocele. Methods: The study population was comprised of two groups. Group I comprised newly diagnosed patients with dorsal spinal meningocele, and group II comprised patients who had had surgery for meningocele and presented with progressive neurological deficits. Magnetic resonance imaging (MRI) scans of the whole spinal column were done. The associated spinal cord malformations were also treated at the same operation. There were 14 boys and 8 girls, with an age range from birth to 4 years (mean 3.9 months), in group I. Of 20 patients (90%) with associated spinal lesions, 6 had more than one lesion, excluding hydromyelia. Group II was made up of 6 patients who had been previously operated on for a meningocele and who presented with tethered cord syndrome. These were 4 boys and 2 girls, who ranged in age from 4 to 10 years (mean 6 years). Results: The level of the conus terminalis was lower than L3 in all patients. The other findings on MRI, besides low conus, were as follows: tight filum, split cord malformation, epidermoid, dorsal lipoma and hydromyelia. Conclusions: Meningocele frequently camouflages a second, occult, spinal lesion. MRI of the whole spinal column should be performed. An intradural exploration performed with a microneurosurgical technique is needed to detect the fibrous bands that may lead to spinal cord tethering and to release the entrapped nerve roots. The other associated spinal anomalies should be operated on during the same operation.
Objects: Subduroperitoneal (SP) shunts have been widely used in the management of pediatric subdu... more Objects: Subduroperitoneal (SP) shunts have been widely used in the management of pediatric subdural fluid collections. Methods: We retrospectively reviewed the complications of SP shunting in 73 boys and 24 girls, who ranged in age from 1 to 180 months (median 7 months). Subdural fluid collection was bilateral in 75 and unilateral in 22 patients. The most common complication was shunt obstruction (13 patients). Shunt migration was seen in 8 patients. Migration occurred only with unishunts without a reservoir and with peritoneal catheters. However, the shunts with a reservoir or flushing valve led to skin necrosis in 4 patients (P=0.003). Unilateral drainage though bilateral collections were present, infection, bowel perforation, and ileus occurred in 5, 4, 1 and 1 patients respectively. Conclusions: These SP shunt complications, some of which are avoidable, should be kept in mind.
Secondary malignant neoplasms (SMN) in CNS tumor survivors has become problem of increasing conce... more Secondary malignant neoplasms (SMN) in CNS tumor survivors has become problem of increasing concern over the last 20 years. These tumors usually occur in a different site from the primary brain tumor several years after treatment. We report secondary cranial malignant neoplasms in three patients who were treated with irradiation and chemotherapy for their primary brain tumors. The first case is a male survivor of an orbital rhabdomyosarcoma who developed a meningioma 8 years later. The other two cases are female survivors of ependymomas who were irradiated at the age of 3 and developed secondary gliomas 8 and 17 years after therapy respectively. Patients carry a risk of developing SMNs many years later since irradiation is still an important part of the treatment. An SMN may have a benign course, as in meningioma, or be a dilemma for the patient, as in glioblastoma.
Abstraet Forty-four consecutive patients with brain abscesses, aged between 1 month and 16 years,... more Abstraet Forty-four consecutive patients with brain abscesses, aged between 1 month and 16 years, were reviewed. The cause of abscess was meningitis in 36% of the cases, otitis in 27%, head injury in 16%, congenital heart disease in 9%, other in 5%, and undetected in 5%. Thirty patients had a single abscess and 12 had multiple abscesses. Multiloculated abscess was present in 2. Total excision was accomplished in 22 patients. Three patients underwent needle aspiration. Drainage of the abscess was performed in 13. Secondary excision was needed in 5 patients. One patient was treated nonsurgically. Streptococci, staphylococci and Proteus mirabilis were the microorganisms recovered in cultures. Overall mortality was 20% (9 patients). Mortality was significantly higher in patients under 2 years of age than in those older. Of 15 patients who were comatose at the time of admission, 6 died. Etiology, diagnostic method, and treatment modalities were not found to be significant factors in terms of predicting mortality.
One hundred forty-six consecutive patients operated on for extradural h e m a t o m a (EDH) from ... more One hundred forty-six consecutive patients operated on for extradural h e m a t o m a (EDH) from 1979 through 1991 were analyzed. This series included patients from both before and after the advent of computed tomography (CT). There were 102 boys and 44 girls, aged 1-16 years. All patients underwent plain skull X-radiography. CT scans were obtained in 72 cases and angiography was performed in 10. Thirty patients with E D H did not have skull fractures. Falls were predominant among the modes of injury. Thirty-seven percent of patients had a lucid interval. The overall mortality was 10%. The mortality rates in the CT and plain X-ray groups were 6% and 16% respectively. There was only one death in patients who did not have a lucid interval. The Glasgow C o m a Scale scores of all patients who died in this series were less than 8. We concluded that mydriasis, comatose state at the time of operation, and a lucid interval are ominous signs in the prediction of outcome.
There is no consensus on the management of infantile chronic subdural collections. Subdural tappi... more There is no consensus on the management of infantile chronic subdural collections. Subdural tapping, craniotomy and removal of membranes, and shunting from the subdural space have all been used. We performed continuous external subdural drainage (CESD) as a step prior to subdural-peritoneal shunt placement in the management of infantile chronic subdural fluid collections. Alum-bar drainage set was used for CESD. The catheter was placed in the subdural space through the anterior fontanel with a Touhy needle. This percutaneous technique seems an easy and safe method for CESD in infants with chronic subdural collections.
Frontoethmoidal encephaloceles are congenital malformations that cause complex deformities in the... more Frontoethmoidal encephaloceles are congenital malformations that cause complex deformities in the frontal, orbital, and nasal regions. As the term implies, with frontoethmoidal encephaloceles, intracranial material has herniated through the dural and skull defect. In this report, 21 patients with frontoethmoidal encephalocele operated by a craniofacial team are presented, and accompanying anomalies, results, and complications are discussed.
Stab wounds of the skull are uncommon. They are usually accidental in children. An apparently tri... more Stab wounds of the skull are uncommon. They are usually accidental in children. An apparently trivial wound may cause death due to vascular damage or infection. A 5-year-old boy presented with a nail in the left intraorbital region. He fell with a nail in his hand five hours prior to hospital admission. Computed tomographic scans displayed the nail penetrating the cranium through the left orbital roof and extending towards the left anterior clinoid process. The nail was removed under general anesthesia in the operating room. Meningitis developed two days after the removal of the penetrating object and responded well to antibiotics. The pertinent literature was reviewed.
Mutism is not a common condition following cerebellar damage. Mutism following posterior cranial ... more Mutism is not a common condition following cerebellar damage. Mutism following posterior cranial fossa surgery was first reported by Rekate et al. and Yonemasu in 1985. Since then, many case reports of mutism have appeared in the English literature. Very few cases developed mutism following brain stem surgery. Although mutism has been described in patients with head injury, only one case of mutism caused by a cerebellar injury has been reported, to our knowledge. We report on two patients in which the cerebellar mutism following a radical excision of an exophytic brain stem glioma and cerebellar injury developed. We reviewed the relevant literature and discussed the mechanism of cerebellar mutism.
... Clinical Neurology and Neurosurgery 97 (1995) 317-320 Clinical Neurology and Neurosurgery Cas... more ... Clinical Neurology and Neurosurgery 97 (1995) 317-320 Clinical Neurology and Neurosurgery Case report A case of Rathke's cleft cyst presenting with diabetes insipidus Yusuf Er~ahina ... [13] Rout, D., Das, L., Rao, VR ... [18] Oka, H., Kawano, N., Suwa, T., Yada, K., Kan, S. and ...
Cerebral hydatidosis account for approximately 1-2% of patients with hydatid disease. Fifty perce... more Cerebral hydatidosis account for approximately 1-2% of patients with hydatid disease. Fifty percent to 75% of intracranial hydatid cysts are seen in children. The cerebral hydatid cysts are usually single and located in the watershed of the middle cerebral artery. To our knowledge, no case of hydatid cyst in the thalamic location has been reported. A 4-year-old boy presented with the left sided weakness. A right thalamic hydatid cyst without rim enhancement and perifocal oedema was detected on the computed tomographic (CT) scan. He was put on albendazole, but headache, nausea and vomiting developed and hemiparesis got worse in the following two weeks. The non-contrast repeat CT showed the pericystic oedema. The rim enhancement and pericystic oedema were also present on magnetic resonance imaging scans. The right thalamic hydatid cyst was removed via the transcallosal approach. The cyst aspiration and intracystic injection of hypertonic saline were performed before the cyst removal. Leakage of the cyst fluid was conceivably the cause of the development of rim enhancement and pericystic oedema. Patients receiving albendazole for the treatment of cerebral hydatid cysts should be closely followed. The surgery is still the choice of treatment in cerebral hybrid cysts, in our opinion.
Two different approaches to fenestration, endoscopic and microsurgical, are in use for Sylvian ar... more Two different approaches to fenestration, endoscopic and microsurgical, are in use for Sylvian arachnoid cysts (SACs), the most frequent among intracranial arachnoid cysts. We presented the clinical data and compared our results, with regard to technique and clinical success, with either microsurgical or neuroendoscopic fenestration of SACs. Twenty-nine patients who subjected to cysto-cisternostomy by the same team, using either of the two methods, were studied retrospectively. Thirteen patients underwent microsurgery, and 16 had endoscopic cysto-cisternostomy. No reoperation was needed in either of these groups, i.e., full clinical and radiological success was achieved in both. The complication rate was 23% in the microsurgery patients and 47% in the endoscopic surgery group, with no statistically significant difference. No relevant differences between the two methods are seen either in the published data or in our results. Adding our results to the published data, both techniques were reviewed in a discussion of the one that allows a better controlled or safer fenestration. We conclude that endoscopic fenestration of SACs is not superior to microsurgical cyst fenestration, and the latter seems safer.
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