J. Esparza

Outcome in children with severe head injuries

We present a series of 56 children who suffered severe head injuries, with a Glasgow Coma Score (GCS) of less than 8. The cases were classified according to the type of morphologic lesion on computed tomography (CT) scan. Intracranial pressure (ICP) was monitored in all children in this series. A protocol that included artificial ventilation and other measures of treatment for intracranial hypertension was applied. Results were analyzed according to age, type of lesion, and ICP. The usefulness of the ICP recording and of obtaining a correct classification of lesions using the CT scan is emphasized.

Symptomatic Subependymoma: Report of Four New Cases Studied with Computed Tomography and Review of the Literature

The authors describe four cases of subependymoma studied with computed tomography (CT) and review 18 previously reported cases in an attempt to define the most characteristic CT presentation of this rare, benign tumor. Subependymoma usually appears as an isodense, or even hypodense, intraventricular tumor on plain CT scan and shows minimal or no enhancement in postcontrast studies. Differential diagnosis between subependymoma and the more malignant true ependymoma is difficult, particularly when the tumor occurs in the posterior fossa. Recognition of subependymoma should prompt the surgeon to attempt radical tumor removal because it can be achieved without sacrificing contiguous tissue and carries a good prognosis.

Intraventricular cavernoma in pediatric age

Abstract Introduction. Cavernomas rarely occur in the ventricular system. Only 10 pediatric cases out of 46 well-documented cases have been published. Case report. We report the case of an 11-year-old girl operated on for a voluminous cavernoma at the ventricular trigone which was diagnosed after absence seizures. Conclusion. Interestingly, the case we report showed a hypointense rim on T2-weighted magnetic resonance images which has not been a common finding in the cases previously reported.

Endoscopic-assisted osteotomies for the treatment of craniosynostosis

IntroductionThe development of multidisciplinar units for Craniofacial Surgery has led to better postoperative results and a considerable decrease in morbidity in the treatment of complex craniofacial patients.Materials and methodsStandard correction of craniosynostosis involves calvarial remodeling, often considerable blood losses that need to be replaced and lengthy hospital stay. The use of minimally invasive techniques for the correction of some of these malformations are widespread and allows the surgeon to minimize the incidence of complications by means of a decreased surgical time, blood salvage, and shortening of postoperative hospitalization in comparison to conventional craniofacial techniques.Discussion and conclusionSimple and milder craniosynostosis are best approached by endoscopy-assisted osteotomies and render the best results. Extended procedures other than simple suturectomies have been described for more severe patients. Different osteotomies resembling standard fronto-orbital have been developed for the correction, and the use of postoperative cranial orthesis may improve the final cosmetic appearance. Thus, endoscopic-assisted procedures differ from the simple strategy of single suture resection that rendered insufficient results in the past, and different approaches can be tailored to solve these cases in patients in the setting of a case-to-case bases.

Focal cerebral involvement by neurobrucellosis: pathological and MRI findings

Central nervous system involvement by brucellosis is infrequent and usually presents as acute meningoencephalitis. Neurobrucellosis presenting as a focal brain mass has rarely been demonstrated on imaging studies. We describe the imaging and pathologic findings in a child affected by neurobrucellosis with focal cortico-subcortical involvement.

Operative treatment of the anterior synostotic plagiocephaly: analysis of 45 cases.

Abstract An operative series of 45 patients with anterior synostotic plagiocephaly is analyzed. In the cases of six children it was not possible to visualize synostosis of the cranial sutures on plain X-ray films or three-dimensional CT. Primary procedures were performed at an average age of 14 months with an average postoperative follow-up of 47.5 months. Children were operated on either with lateral canthal advancement (5 cases), unilateral orbital advancement with “tongue in groove” (12 cases), or bilateral orbital advancement (28 cases). Excellent results were obtained in 33/45 patients, while 8/45 children required secondary minor revisions. Of the three different surgical techniques, the results achieved by the bilateral approach were considered better than those attained with the unilateral techniques. Osteotomies of the nasal bones are recommended in the cases of older children with severe nasal deviation associated with dislocation of the nasoethmoidal complex.

Extradural hemorrhage in the posterior fossa in neonates

The case of a neonate with an extradural hemorrhage in the left posterior fossa, the result of trauma at birth, is reported. The routine axial transverse CT scan did not detect the exact preoperative location of the clots in the extradural space of the posterior fossa. Good recovery was achieved following the operation.

Giant Hypothalamic Hamartoma Operated through Subfrontal Approach with Orbitary Rim Osteotomy

Introduction: Hypothalamic hamartomas are associated with precocious puberty, gelastic seizures and severe refractory epilepsy. Treatment options include surgical resection, radiofrequency and radiosurgery. Case Report: A 7-month-old girl presented with gelastic seizures and developmental delay related to a giant hypothalamic hamartoma. The patient was operated through a subfrontal approach. Intraoperatively the lesion appeared intimately adherent to the right internal carotid artery. Seizure control was improved after tumoral decompression. Conclusions: Treatment of giant hypothalamic hamartomas should always include surgical resection, given the mass effect over surrounding vital structures. Subfrontal approach with orbitary rim osteotomy provides a wide exposure with minimal frontal lobe retraction. Close adherence of hypothalamic hamartoma to vascular structures may be present, requiring careful surgical manipulation.

Arteriovenous malformation of the spinal cord in the neonate.

A newborn baby boy with a high-flow arteriovenous malformation (AVM) of the dorsal spinal cord is reported. The baby was born paraplegic. The myelogram suggested an increased vasculature, showing irregular worm-like radiolucent lesions of the dorsal spinal cord. Spinal angiography showed a huge arteriovenous angioma of the dorsal spinal cord with an intra-spinal aneurysmal sac. The vascular supply was decreased after two embolizations. This was followed by complete surgical resection of the aneurysmal sac.

Purely intramedullary spinal cord primitive neuroectodermal tumor: case report and review of the literature

INTRODUCTION Primitive neuroectodermal tumors (PNETs) are malign neoplasms of the central nervous system which mainly locate in cerebellum (medulloblastoma). Primary intraspinal PNETs are rare. Within this group, we have found ten cases of purely intramedullary PNETs (IPNETs). In this report, we describe a new IPNET case and review the literature about these infrequent intramedullary tumors. CASE REPORT A 17 month-old boy showed progressive decrease of motion in his lower extremities. Spine magnetic resonance imaging revealed an intramedullary expansive lesion from T3 to T10. A near-total removal was performed. The pathological diagnosis was PNET. Subsequent chemotherapy was recommended. Six months after operation, holocord progression has occurred. CONCLUSION IPNETs are uncommon tumors affecting children and young adults. They are characterized by recurrence, progression or intracranial dissemination. Outcome is dismal: most patients die within two years in spite of surgical resection followed by radiotherapy and chemotherapy.