Keizo Sakamoto

Intracranial tumors in the first year of life

Among 100 childhood brain tumors treated at Kobe Childrens Hospital from May 1970 to June 1985, 18 of the children presented with symptoms during the first year of life. This paper analyzes these 18 cases. Supratentorial tumors (78%) were more common than infratentorial ones, and 67% of all the tumors were located in the central neural axis. Initial symptoms were cranial enlargement (56%), vomiting (17%), cranial deformity (11%), blepharoptosis, respiratory distress, and ataxia. Histological diagnosis of the tumors was as follows: teratoma (3 cases), medulloblastoma (3), glioblastoma (2), astrocytoma (2), ependymoma (2), craniopharyngioma (1), choroid plexus papilloma (1), hamartoma (1), lipoma (1), melanotic progonoma (1), and an undetermined type, probably medulloblastoma (1). Seventeen of the patients underwent craniotomy for tumor resection (4 total, 4 subtotal and 7 partial removal, and 2 biopsies). Additional therapeutic methods used separately and in various combinations included ventriculoperitoneal shunt, subduralperitoneal shunt, ventricular drainage, radiotherapy and chemotherapy. Nine patients died (average 98 days) after surgery. Of the 9 survivors, 6 are still alive after more than 5 years. Five of the 6 are mentally retarded and 4 are physically handicapped to some degree.

Infantile subdural fluid collection: diagnosis and postoperative course

The authors reviewed 47 cases of infantile subdural fluid collection with regard to diagnosis and postoperative course after placement of a subdural-peritoneal shunt. CT scan with contrast enhancement proved to be an important diagnostic modality, showing vessels in the subarachnoid space as high-density spots. Utilizing this technique, we were able to differentiate the following varieties of fluid collection: (1) subdural fluid collection, in which enhancing vessels were seen on the brain surfae, (2) subarachnoid fluid collection, in which vessels were on the inner table of the cranium, and (3) coexistence of subdural and subarachnoid fluid collections, in which vessels were between the inner table of the cranium and the brain surface. The postoperative course of subdural fluid collection was characterized as follows: (1) the subdural fluid collection decreased first, with increased subarachnoid fluid collection; (2) the subarachnoid fluid collection remained after the disappearance of subdural fluid collection; and (3) the brain expanded again later. Subdural fluid collection disappeared about 1 month after the shunt operation, which could lead occlusion of the shunt system. Postoperative enlargement of the subarachnoid space was an early indicator of the efficacy of the subduralperitoneal shunt.

A Neonatal Huge Subependymal Giant Cell Astrocytoma

We report a neonate with a huge subependymal giant cell astrocytoma associated with tuberous sclerosis, with atypical magnetic resonance imaging findings. The neonatal subependymal giant cell astrocytoma is rare, and we discuss the difficulty in its diagnosis and treatment.

Traumatic cervical syringomyelia related to birth injury

A rare case of cervical syringomyelia related to breech delivery is reported. The initial diagnosis was bilateral brachial plexus palsy due to birth injury, which was revealed by magnetic resonance imaging (MRI) to be traumatic syringomyelia. The usefulness of MRI in the early diagnosis of cervical cord birth injury, especially in differentiating between brachial plexus palsy due to birth injury and spinal cord trauma due to birth injury in infancy, is emphasized.

Arteriovenous malformation of the spinal cord in a 17-month-old child

A case of arteriovenous malformation (AVM) of the cervical spinal cord occurring in a 17-month-old girl is reported. The initial symptom was quadriplegia of abrupt onset. Bilateral vertebral angiography disclosed 6 feeding arteries and a large draining vein. Complete obstruction of the blood supply to the AVM was confirmed angiographically, following cauterization and section of feeders via an anterior approach. Two years after the operation, the patient can sit and move all extremities with residual slight right hemiparesis. This report is the first operative case of cervical cord AVM in a child under 2 years of age.

Dermoid cyst within an upper thoracic meningocele

A case of dermoid cyst within an upper thoracic meningocele is reported. The incidental feature of this combination is extremely rare. As upper thoracic meningocele is often associated with other spinal and intracranial abnormalities, close observation and radiologic evaluation of the craniospinal axis are necessary to obtain an exact diagnosis and to achieve an appropriate treatment.

Isolated Fourth Ventricle: Review of seven cases

Seven cases of isolated fourth ventricle (IFV) are reported. They presented with an enlarged fourth ventricle on CT scans following V-P shunting for hydrocephalus. These cases are reviewed in respect to their etiology, clinical course and management. The IFV can be considered as a reversible state with a “disproportionately large communicating hydrocephalus.” Reopening of the aqueduct is commonly observed in the IFV. Spontaneous involution can be expected in asymptomatic cases. (Shoni no Noshinkei 13:103–108, 1988)

“Skull punch” for craniotomy in neonates and infants

We have designed a new instrument that we have called a “skull punch,” which is useful and safe for making a burr hole for a purely osteoplastic craniotomy in neonates and infants. The instrument is described in detail.