Muñoz Mj

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.

Post-traumatic diffuse brain swelling: isolated or associated with cerebral axonal injury

Eighteen children with severe head injuries and diffuse brain swelling were studied. They were separated into two groups based on the computed tomography (CT) findings. Seven patients had small ventricles in the normal location and small or absent cisterns. Eleven had these signs plus small deep-seated intraparenchymal hemorrhagic foci and/or intraventricular hemorrhage. Patients in the first group were in relatively good neurological condition; their intracranial pressure was easily controlled and all had a favourable outcome. On contrast, children in the second group had a more severe clinical presentation, frequently had uncontrollable intracranial hypertension, and more than 50% died.

Cranial sonographic evaluation in children with meningomyelocele

Over a period of 5 years, 25 children between 1 day and 26 months of age were prospectively evaluated because of the presence of meningomyeloceles. Cranial sonography was used to ascertain the types of associated cranial alterations. Twenty-three children (92%) presented signs of Chiari II malformation. In only two (8%) were the ultrasonographic results normal. The abnormalities detected were classified as alterations of the ventricular system, extraventricular alterations, and associated findings. The most frequent alteration of the ventricular system was the “batwing” configuration of the frontal horns, which appeared in 22 children (88%). Among the extraventricular alterations, 23 children (92%) had a downward displaced cerebellum, obliterated basal cisterns and low positioning of the tentorium cerebelli. Associated findings were a polymicrogyria in 1 case and intracranial hemorrhage in 2. The 23 children with Chiari II malformation were followed up clinically and sonographically. Our findings were similar to those of other published series. In spite of the introduction of magnetic resonance imaging, we consider cranial sonography to be an inexpensive and convenient method of evaluating the existence of Chiari II malformation in the child with meningomyelocele and of following up its evolution after shunt procedures.

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.

Hamartoma of the suprasellar cistern in a 5-year-old girl.

Abstract A 5-year-old girl with precocious puberty secondary to a suprasellar hamartoma is presented. Magnetic resonance imaging (MRI) revealed a lesion without attachment to the tuber cinereum or the mamillary bodies. Total resection of the tumour was performed.