Kenneth Shapiro

Spinal Cord Seeding from Cerebellar Astrocytomas

Three juvenile patients with cerebellar astrocytomas which have seeded the spinal subarachnoid space are presented. Histologic verification of the similarity between the posterior fossa tumor and its spinal implant was obtained in two of the three patients. The cerebellar tumors in all cases have been benign (grade I),and the behavior, other than their seeding has also been indolent. Review of pertinent literature discloses no similar experience with cerebellar astrocytomas. Aggressive therapy is advocated for the rare patient with subarachnoid seeding from this benign lesion.

The Time Course of Brain Tissue Pressure and Local CBF in Vasogenic Edema

Our results for tissue pressure show: 1. Resting brain tissue pressure is above atmospheric pressure and equal to cerebrospinal fluid pressure. 2. The ventricular fluid pressure provides a reasonable estimate (± 10 mm Hg) of the maximum brain tissue pressure. 3. Excluding impaction, the maximum brain tissue pressure gradients developed are transient, less than 10 mm Hg, and dissipate within 2 h. 4. With impaction, the brain tissue pressure tends to equilibrate with the compartmental CSF pressure.

Vasoactive intestinal peptide in cerebrospinal fluid

Immunoreactive vasoactive intestinal peptide (VIP) was measured in lumbar and ventricular cerebrospinal fluid (CSF) from patients with various neurological disorders and in 2 hour aliquots of cisternal fluid removed continuously from rhesus monkeys. Although most of the VIP in concentrated pools of human ventricular fluid and of monkey cisternal fluid co-eluted with synthetic porcine VIP28 on a column of Sephadex G-25 superfine, there was evidence that smaller immunoreactive fragments were also present. A circadian pattern of CSF VIP concentration was observed in 2 of the 3 monkeys studied, with highest levels occurring at night and lowest during the day. Ventricular fluid VIP levels were highest in hydrocephalic children and lowest in patients with multiple sclerosis or epilepsy, while VIP was not detectable in ventricular fluid from patients in coma following a severe head injury. There were no significant differences in VIP concentrations in CSF from patients with dystonia. Parkinsons disease, or Alzheimers disease, suggesting that VIP containing neurons are not affected in these disorders. Lumbar fluid VIP levels were low in patients undergoing aneurysm surgery. Since VIP is a potent vasodilator, these findings may have important implications in relation to the development of vasospasm following subarachnoid hemorrhage.

Intracranial Meningiomas of Infancy, Childhood and Adolescence

The authors add 9 cases of pediatric meningiomas to 112 previously published cases and review clinical findings. Characteristic clinical and radiologic features are discussed in an attempt to identify

A role for endoscopy in the placement of ventriculoperitoneal shunts

Compartmentalization of the lateral ventricle may prevent adequate functioning of ventriculoperitoneal shunts. We recently treated a patient with postinfectious hydrocephalus who required bilateral shunts. In addition, the left ventricle was shown to contain a large noncommunicating cyst. Prior to placement of the shunt, ventriculoscopy was performed and a channel established surgically between the cyst and the remainder of the ventricular system. Application of this new interventional technique may be indicated in complicated cases of compartmentalized hydrocephalus.

Decreased ventricular fluid norepinephrine metabolite in childhood‐onset dystonia

3-methoxy-4-hydroxyphenylglycol (MHPG), the primary brain metabolite of norepinephrine (NE), was measured in ventricular fluid from 51 patients with dystonia, other movement disorders, or hydrocephalus. The dystonic patients were divided into three categories: childhood-onset form with early limb dystonia and rapid progression to generalized symptoms, more localized and benign adult-onset dystonia, and symptomatic dystonia. Patients with the childhood form had significantly lower ventricular fluid MHPG levels (8.7 ± 0.6 ng per milliliter) than other dystonic patients (11.4 ± 1 ng per milliliter), age-matched controls with neurologic disease (11.7 ± 1.1 ng per milliliter), or other movement disorders (11.8 ± 0.7 ng per milliliter). Decreased ventricular fluid MHPG levels suggest a possible abnormality of brain NE function in childhood dystonia.

Venous Malformation Mimicking a Posterior Fossa Tumor in a Young Child

Symptomatic venous malformations are uncommon at any age. They are extremely rare in the first decade of life. We describe a 3.5-year-old child with a cerebellar venous malformation presenting with a subacute course mimicking the more common posterior fossa tumors. The childs symptoms were due to a posterior fossa hemorrhage; she subsequently did well. The clinical, CT, angiographic, and pathologic features are described. Venous malformations should be included in the differential diagnosis of young children with evidence of posterior fossa disease.

Hydrocephalic Edema: Accessory CSF Absorption or Passive Response to Ventricular Enlargement

Protein poor fluid has been found in the periventricular white matter surrounding hydrocephalic ventricles. Some have coined the term, hydrocephalic edema (2, 10) to describe this finding and cited it as evidence for an accessory pathway for the absorption of CSF in hydrocephalus (8). In other settings, such as vasogenic cerebral edema, evidence has been accumulated to show that transcerebral migration of fluid as a mechanism for “clearing” edema is first associated with the establishment and then dissipation of gradients of increased water content of the white matter (6). If the periventricular edema associated with the hydrocephalic process represented a similar mechanism for clearance of fluid, one would expect to see migration of this fluid and then dissipation of the gradients as ventricular enlargement progressed. Since earlier studies examining water content in hydrocephalus were limited to models of compensated hydrocephalus (5, 8), the following studies were performed to document the temporal changes in the water content and to correlate white matter water content with morphologic changes in progressive hydrocephalus.

Independence of Compliance and CSF Hydrodynamics as an Explanation for Volume Preservation in the Neural Axis

Historically, investigations of CSF hydrodynamics preceded studies of pressure volume relationships within the neural axis. As techniques were developed to describe the two concomitantly, a greater understanding of the interaction between CSF hydrodynamics and neural axis pressure volume relationships has been achieved, but has been limited to acute studies