Awni Musharbash

Image-Guided, Frameless Stereotactic Sectioning of the Corpus callosum in Children with Intractable Epilepsy

Corpus callosotomy is an effective neurosurgical procedure for children with intractable atonic or drop attack seizures. While this procedure has not changed significantly over the past three decades, some technical issues remain to be resolved. These include the intraoperative determination of the extent of the callosotomy, the need to stage the procedure, as well as side of approach of craniotomy. We report our 8-year experience with corpus callosotomy using a frameless stereotactic image-guided system (ISG Viewing Wand®). Seventeen children with atonic seizures underwent sectioning of the corpus callosum. The mean patient age was 10.5 years. Six children underwent complete callosotomy while 11 underwent resection of the anterior two-thirds. MRI 3D reconstruction of the sagittal sinus and draining cerebral veins was undertaken in all cases. The side of the craniotomy was determined on the basis of favorability of the draining veins with respect to the extent of the callosotomy. The extent of the callosotomy was determined by intraoperative feedback using the ISG Viewing Wand®. Nine of 11 patients in the partial callosotomy group and 4 of 6 patients in the complete callosotomy group showed significant improvement in atonic seizures. We conclude that the use of frameless stereotaxy can function as an important adjunct in the planning and conduction of successful sectioning of the corpus callosum in children with intractable seizures.

Closing the survival gap

Successful twinning initiatives have been reported in childhood leukemia. Pediatric neuro‐oncology requires a complex multidisciplinary approach and the feasibility of similar twinning programs is unknown. Twinning between King Hussein Cancer Center in Amman and the Hospital for Sick Children in Toronto started with e‐mail communications, and subsequently included monthly videoconferences and exchanges between institutions. The outcome of 35 newly diagnosed medulloblastoma patients (22 high‐risk and 13 average‐risk) treated during this period is reported. The 3‐year overall survival for average risk and high‐risk patients was 100 and 81%, respectively. This experience suggests that twinning may facilitate the implementation of multidisciplinary neuro‐oncology programs in low‐income countries. Videoconferencing allows interactive exchanges with a significant learning impact.

Carpal Tunnel Syndrome in a 28-Month-Old Child

We report a 28-month-old male child, known to have Maroteaux-Lamy syndrome (mucopolysaccharidosis type VI), who presented with inconsistent right hand discomfort. Clinical suspicion of right carpal tunnel syndrome was confirmed by nerve conduction and electromyographic studies, and a decompressive procedure was done with uneventful recovery. Carpal tunnel syndrome in mucopolysaccharidosis patients should be suspected, diagnosed and treated early for better outcome.

Mondini Malformation Associated With Diastematomyelia and Presenting With Recurrent Meningitis

The authors report the case of 5-year-old girl who presented with 4 episodes of recurrent meningitis. Her initial workup revealed a lumbosacral dermoid sinus associated with diastematomyelia and a tethered cord. Therefore, a surgical repair to correct the anomaly was performed. However, another episode of meningitis occurred after surgery, and a subsequent temporal bone scan revealed the presence of left Mondini dysplasia. To the authors’ knowledge, this is the first report of Mondini dysplasia in association with diastematomyelia.

Intra-axial dermoid tumor mimicking pilocytic astrocytoma

Dear Editor: We read with interest the paper by Pant and Joshi [1] in which they reported a case of cerebellar intra-axial dermoid cyst as an unusual location. They also reviewed the literature and found five cases of dermoid cyst with intraaxial location, including one with a cerebellar location. We like to add that we had seen a case of cerebellar dermoid cyst in our hospital. Our patient was a girl who presented to us as a case of recurrent meningitis with four episodes of meningitis since Childs Nerv Syst (2009) 25:395–396 DOI 10.1007/s00381-008-0796-0

Video-Teleconferencing in Pediatric Neuro-Oncology: Ten Years of Experience

Purpose The management of central nervous system tumors is challenging in low- and middle-income countries. Little is known about applicability of twinning initiatives with high-income countries in neuro-oncology. In 2004, a monthly neuro-oncology video-teleconference program was started between King Hussein Cancer Center (Amman, Jordan) and the Hospital for Sick Children (Toronto, Ontario, Canada). More than 100 conferences were held and > 400 cases were discussed. The aim of this work was to assess the sustainability of such an initiative and the evolution of the impact over time. Methods We divided the duration in to three eras according to the initial 2 to 3 years of work of three consecutive oncologists in charge of the neuro-oncology program at King Hussein Cancer Center. We retrospectively reviewed the written minutes and compared the preconference suggested plans with the postconference recommendations. Impact of changes on the patient care was recorded. Results Thirty-three sets of written minutes (covering 161 cases) in the middle era and 32 sets of written minutes (covering 122 cases) in the last era were compared with the initial experience (20 meetings, 72 cases). Running costs of these conferences has dropped from

Nonclosure of the Peritoneum at Shunt Insertion

360/h to <

Ataxia-Telangiectasia Complicated by Craniopharyngioma - A New Observation

40/h. Important concepts were introduced, such as multidisciplinary teamwork, second-look surgery, and early referral. Suggestions for plan changes have decreased from 44% to 30% and 24% in the respective consecutive eras. Most recommendations involved alternative intervention modalities or pathology review. Most of these recommendations were followed. Conclusion Video-teleconferencing in neuro-oncology is feasible and sustainable. With time, team experience is built while the percentage and the type of treatment modifications change. Commitment and motivation helped maintain this initiative rather than availability of financial resources. Improvement in patients’ care was achieved, in particular, with the implementation of a multidisciplinary team and the continuous effort to implement recommendations.

Descriptive epidemiological analysis, MRI signals intensity and histopathological correlations of meningiomas

To evaluate the nonclosure of the peritoneum during insertion of the distal end of a ventriculoperitoneal shunt in the peritoneal cavity, 43 patients in whom a ventriculoperitoneal shunt was inserted using laparotomy with nonclosure of the peritoneum for insertion of the distal catheter were reviewed. No morbidity occurred during a follow-up period of 3–9 months. We think that nonclosure of the peritoneum is safe in shunt surgery, but needs to be evaluated in further studies.