The authors have presented 81 children with intraspinal tumors, all less than 16 years of age. The clinical features indicated that gait disturbance, pain, and sphincter disturbance are the most prominent complaints. Reflex changes, paralysis, and sensory impairment are the most frequent physical findings. Cerebrospinal fluid protein was recorded in 47 patients and was abnormal in 34. Spine radiography was abnormal in 58% of the patients. Seventy of the patients had myelography, and it was diagnostic in 67. Surgery was performed on 79 patients, with a 2.5% operative mortality (30 days postsurgery). Of the 49 patients who are alive, 91.5% are able to walk. Mean follow-up period was 8.5 years. The authors document the benign course of the intramedullary astrocytomas and suggest an approach to their treatment. They encourage an aggressive approach to metastatic intraspinal tumors. The latrogenic origin of some epidermoid tumors is noted. The importance of early diagnosis and treatment of the intraspinal tumors in children is emphasized.
Thirteen infants with compartmentalization of the lateral ventricles diagnosed by air encephalography, computerized tomography, or autopsy are reported. In each case, the body of one or both lateral ventricles was completely divided by a membrane posterior to the foramen of Monro. Recognition of this entity is important from both therapeutic and prognostic standpoints.
Four cases of cerebrospinal fluid (CSF) ascites secondary to ventriculoperitoneal shunting are described. It is possible to differentiate CSF ascites from a CSF-filled pseudocyst by the characteristic bowel gas pattern on films of the abdomen and by the presence of shifting dullness. Two of the patients had active shunt infections, and had ascitic fluid with a protein level greater than 3 gm% and a white blood cell (WBC) count greater than 1000/cu mm. Both were treated successfully with antibiotics and removal of the shunt from the peritoneum. Two other patients had no evidence of infection, protein levels of less than 2 gm%, and WBC count less than 100 cu mm. These disorders resolved spontaneously. A review of 18 cases reported in the literature shows that the etiology of CSF ascites in the absence of shunt infection is multifactorial, and no features are consistently present in all cases. Ascites without infection may resolve spontaneously without surgical intervention.
Chiari III malformations are extremely rare hindbrain malformations that are associated with a high early mortality rate, or severe neurologic deficits in the survivors. The preferred treatment is early operative closure and CSF shunting. We report a case of a newborn infant with a Chiari III malformation with displacement of the brainstem and cerebellum into the cervical encephalocele which precluded immediate operative closure of the defect. Instead, a ventriculoperitoneal shunt was placed and the patient was followed with serial imaging studies. The child survived. The shunt allowed the brainstem and cerebellum to regress into the cervical spinal canal as the dilated cerebral aqueduct and fourth ventricle decompressed. A delayed closure of the cervical encephalocele was performed at 30 months of age. Cerebrospinal fluid diversion with delayed closure may be an option for large lesions.
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