SUMMARY Cranial ultrasonography was used in the initial evaluation of 40 infants with macrocrania. Three of the infants had normal findings. The other 37 had evidence of various types of abnormality: intraventricular obstructive hydrocephalus, external hydrocephalus, arrested hydrocephalus with atrophy, or mild ventriculomegaly. All the infants were given neurological and developmental examinations at the time of presentation and were followed up for one year. Sonograms and head‐circumference and intracranial pressure measurements were done at intervals, according to the initial ultrasound findings and the clinical status of the children. Neurodevelopmental outcome was related to the type of abnormality. The majority of children with external hydrocephalus were neurodevelopmentally normal at follow‐up. In contrast, those with obstructive or arrested hydrocephalus had unfavourable outcomes, which may be related to the significant perinatal insult causing the hydrocephalus. CT confirmation was available for 16 of the infants. RÉSUMÉ Echographies craniennes dans l'évaluation de macrocéphalie chez le nourrisson L'échographie cranienne fut utilisée dans l'évaluation initiale de 40 nourrissons avec macrocéphalie. Les données cliniques étaient normales dans trois cas. Dans les 37 autres cas, il existait des types variés d'anomalies: hydrocéphalie intraventriculaire non communicante, hydrocéphalie périphérique, hydrocéphalie stabilisée avec atrophie, ou ventriculomégalie modérée. Tous les nourrissons bénéficiérent d'examens neurologiques et développementaux au moment de l'évaluation initiale et furent suivis durant un an. Des échographies, mesures du tour de tête et de la pression intracranienne furent effectuées régulièrement, en fonction des données de l'échographie initiale et de l'état clinique des enfants. Le devenir neuro‐développemental fut relié au type d'anomalies. La majorité des enfants avec hydrocéphalie périphérique eurent un développement neurologique normal au suivi. En revanche, le devenir ne fut pas favorable pour les hydrocéphalies non communicantes ou stabilisées, ce qui pourrait être reliè aux dommages périnataux marqués ayant provoqué l'hydrocéphalie. Une confirmation par scanners existait pour 16 des nourrissons. ZUSAMMENFASSUNG Cranielle Ultrasonographie zur Beurteilung der Makrokranie im Kindesalter Bei 40 Kindern mit Makrokranie wurde zur ersten Beurteilung die cranielle Ultrasonographie durchgeführt. Drei der Kinder hatten normale Befunde. Die anderen 37 hatten verschiedene abnorme Befunde: intraventrikulären, obstruktiven Hydrocephalus, externen Hydrocephalus, zum Stillstand gekommener Hydrocephalus mit Atrophie oder leichte Ventrikulomegalie. Alle Kinder wurden bei der Aufnahme genau neurologisch und im Hinblick auf ihre Entwicklung untersucht und über ein Jahr kontrolliert. Je nach anfänglichem Ultraschallbefund und klinischem Zustand der Kinder wurden in Intervallen Sonogramme und Messungen des Kopfumfangs und des intracraniellen Druckes vorgenommen. Der Endbefund der neurologischen Entwickl...
An intradural, intramedullary lipoma originating within the cervicothoracic cord with significant extension into the posterior fossa is reported. The lipoma was found incidentally by CT scan at the infant’s age of 2 days. Follow-up studies by CT and MRI were performed on several occasions. Because of hydrocephalus, VP shunting was performed. After shunting and shunt revisions, surgery of lipoma was performed at the age of 2 years. Posterior fossa craniectomy and laminectomy from C1 to T4 revealed a lipoma, which was maximally reduced. Six months after surgery, the child was well and showed good recovery.
This is a rare case of concomitant bihemispheric cerebral ganglioglioma and hemangioma in an 18-month-old child. There were two identical processes; a combination of ganglioglioma and hemangioma was located in the parieto-occipital region of both cerebral hemispheres. The child underwent diagnostic computed tomographic and magnetic resonance imaging examinations for seizures and right-sided facial palsy, which showed the bilateral presence of parieto-occipital, oval, well-demarcated, subcortically located processes. A biparieto-occipital craniotomy was carried out and two well-demarcated abnormalities were observed and both were removed in toto. Two years after the operation, the boy had normal psychomotor development and remained free from seizures with no therapy required. Repeat magnetic resonance imaging showed no tumor recurrence. Gangliogliomas are relatively uncommon tumors in childhood, located in the supratentorial compartment and usually associated with seizures. Histopathologic and immunohistochemical analysis of the two processes found in our patient showed them to be a ganglioglioma and a hemangioma, confirming the dysontogenetic origin of these alterations and the association between malformations and tumor growth. The combination of ganglioglioma and hemangioma, especially bilateral presentation of two such identical processes in a young child, is very rare and was not found in the recent literature.
A nine-weeks-old infant with haemophilia A developed an intracerebral haematoma. Intracranial operation and removal of the haematoma were performed safely under the cover of highly potent AHF cryoprecipitate. Computerized tomography of the brain is very useful for neurosurgical care of the haemophiliac patients as a noninvasive and atraumatic method of examination. The literature of intracranial operations in infants with haemophilia A under the age of one year is reviewed.
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