Norio Kobayashi

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.

A Neonatal Huge Subependymal Giant Cell Astrocytoma: Case Report

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.

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.

Lipomas in the corpus callosum and the forehead, associated with a frontal bone defect

This report concerns a case of lipomas in the corpus callosum, possibly both lateral ventricles, and the forehead, which were associated with a defect in the frontal bone. It is thought that the lipoma originated in the interhemispheric fissure and extended to the forehead by at least the second month of gestation. It interfered with the development of the corpus callosum, and the collagenous capsule of the lipoma remained till birth. It caused a defect in the frontal bone in the midline, in spite of the development of both frontal bones.

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.

Reduction Cranioplasty for Congenital Hydrocephalus

Reduction cranioplasty for congenital hydrocephalus with enormous head size was performed in four patients. We employed two techniques. One was reduction cranioplasty with subdural hematoma membrane excision. The other was reduction cranioplasty and V-P shunt performed in one stage to prevent the occurrence of subdural hematoma in neonates and young infants. The operative techniques used are described in detail. To prevent subdural hematoma as a postoperative sequel of V-P shunt we recommend the latter technique for the treatment of congenital hydrocephalus with enormous head size.

Approximation of the Split Brain Surface in an Infant with Schizencephaly and Multiple Brain Anomalies

The authors reported an infant with schizencephaly and multiple brain anomalies. The schizencephaly was treated by approximating the two surfaces of the brain defect with intermittent sutures, which we called “cerebrorrhaphy.”

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)