Donald D. Matson

Orthopaedic Aspects of Intraspinal Tumors in Infants and Children

1. A consecutive series of 115 intraspinal tumors in infants and children, treated between 1933 and 1963 at the Childrens Hospital Medical Center, Boston, is presented. About one-half of the tumors were treated during the first four years of life; these included congenital cysts, dermoid and teratoid tumors, and many neuroblastomata. Intramedullary gliomata were encountered in children of all ages. Neurofibromata and meningiomata, which are so common in adults, were rarely seen in these children. 2. The clinical picture, laboratory findings, and differential diagnosis are discussed. The importance of early diagnosis and treatment before the development of extensive neuromuscular damage is stressed. This is most important, because many of these lesions are benign and grow very slowly. 3. Whenever an intraspinal tumor in a child is suspected, adequate investigation is imperative including (a) repeated careful motor, reflex, and sensory examination and evaluation of sphincter function; (b) examination of cerebrospinal-fluid dynamics and protein content by lumbar puncture; (c) careful examination of roentgenograms of the entire spine; and (d) myelography whenever any abnormality in the foregoing studies is detected. 4. Treatment and results are presented. Forty-seven of the 115 patients died less than eight years after operation. One patient died fifteen years and another twenty-four years following surgery. Of the sixty-six patients still alive, fifty-eight were recently examined by the authors. The length of follow-up ranged from one to thirty years, with an average of twelve years. 5. Postoperatively, 83 per cent of all patients required orthopaedic care because of musculoskeletal abnormality. Experiences with orthopaedic management of paralytic deformities of the extremities and spine are presented. Scoliosis occurred in thirty-six patients and kyphosis in thirty patients. The importance of postoperative support to the spine in growing children with intraspinal tumors is emphasized. This is especially true when laminectomy is extensive, when there is associated muscle weakness, and after irradiation of the spine. Orthopaedic surgical treatment is indicated only when one is sure that the disease process is not progressive and that the pattern of paralysis is not changing. 6. It is hoped that this presentation will alert all physicians to the possibility of spinal-cord tumor whenever a child is found to have torticollis, scoliosis, unexplained limp, weakness of an extremity, sphincter disturbance, or an obscure pain in the trunk or art extremity. It is further hoped that with earlier diagnosis of the frequently benign slowly growing intraspinal tumors of childhood, much irreversible damage to the spinal cord can be prevented. Expert neurosurgical treatment of these tumors must be supplemented by immediate and continued orthopaedic management to minimize the occurrence and severity of fixed deformities of the spine and extremities.

Cortisone and ACTH as an Adjunct to the Surgery of Craniopharyngiomas

THE surgical management of craniopharyngiomas, whether radical or conservative, has always been hazardous. Gordy, Peet and Kahn1 reported a series of 51 cases in which the operative mortality was 4...

Neurological abnormalities in achondroplastic children

The neurological manifestations of achondroplasia are reviewed. Enlargement of the head accompanied by mild dilatation of the ventricles is usually present with no other clinical evidence of increased intracranial pressure. Head growth curves parallel the normal slope, although at higher values. Significant hydrocephalus when it occurs is probably due to obstruction of cerebrospinal fluid pathways at the level of the foramen magnum and is usually associated with other neurological signs related to cord compression at this level. Mental retardation may be inferred mistakenly in infancy and early childhood because of delayed acquisition of motor skills.

Collections of Subdural Fluid complicating Meningitis due to Haemophilus influenzae (Type B). A Preliminary Report.

THE incidence of recovery from acute bacterial meningitis has risen sharply since the introduction of modern antibiotic therapy. With this rise various untoward sequelae have become evident in pati...

Benign intracranial tumors of childhood.

THERE is a widespread impression among the pediatric and general medical profession, and perhaps among the lay public as well, that virtually all intracranial tumors in early childhood present a ho...

Early Neurolysis in the Treatment of Injury of the Peripheral Nerves Due to Faulty Injection of Antibiotics

THE modern treatment of all types of infectious disease by repeated intramuscular administration of antibiotics has resulted in an increased incidence of injuries of the peripheral nerves due to im...

Normal and pathological intracranical anatomy revealed by two‐dimensional echoencephalography

THE DESIRABILITY of developing a reliable method of visualizing the intracranial contents which does not involve operating upon or injecting anything into a patient is obvious. Intensity-modulated ultrasonic scanning of the brain through the intact skull has been employed at the Children’s Hospital Medical Center and the Peter Bent Brigham Hospital for the past two years with interesting and promising results. The first 98 patients studied were discussed briefly and the basic principles of the method were described in a previous publication.1 The purpose of the present report is to analyze in more detail certain selected ultrasonic scans based on increasing experience and to illustrate to a wider audience the usefulness of this procedure in outlining normal and abnormal intracranial structures.

Neurosurgical Procedures in the Treatment of Neoplastic Disease

WITH increasing use of new and more radical procedures for surgical palliation, with the increasing effectiveness of radiotherapy and chemotherapy in delaying, if not eliminating, the terminal onsl...

The treatment of hydrocephalus.

An endoscopic third ventriculostomy (ETV) is a surgical procedure in which an opening is created in the floor of the third ventricle using an endoscope. The ETV diverts CSF from the third ventricle to the subarachnoid space, where it can be absorbed in the usual way. Very occasionally, an ETV is combined with removal of some choroid plexus (tissue which produces CSF) in order to reduce the amount of CSF produced.

Neurological procedures for the treatment of pain in advanced cancer

The increasing use of new drugs and more radical surgical and radiological procedures for palliation of patients with cancer and the diminishing fre quency of intercurrent infection as a cause of death have resulted in a steady increase in the number of these pa tients living for longer periods. Ac cordingly, there is increased need for physicians to treat the pain and suffer ing that so frequently accompany ad vanced cancer. The causes of pain and suffering in patients with malignant neoplasms are many and accurate assessment often requires the greatest clinical experi ence and judgment on the part of the physician. To understand problems of pain it is essential to know not only the type and extent of disease and its ana tomic relation to pain-sensitive struc tures, but also something of the previ ous medical, social and spiritual back ground of the patient. Many patients know that they have incurable cancer; some of them have adjusted themselves to that knowledge, and others have