Despite intervention in childhood and adequate cerebrospinal fluid diversion the prognosis for independent living into adulthood remains poor. All patients have elements of cognitive impairment. Structural brain abnormalities may be more important determinants of cognitive outcome than shunt malfunction.
Malignant perip heral nerv e shea th tumors of the nos e and paranasal sinuses are extreme ly uncomm on. We report the case ofa 65-y ear-old woman who presented with a rapid emergence of "nasal polyps " that comp letely obstructed her nasalpassag es. Six years earliet; she hadbeen asse ssed else where f or nasal polyps. A t presentation, the patient exhibited grosspolypo sis, with lesionsprotrudingfrom both nostrils. Histology confirmed a diagnosis ofa malignant periph eralnerve sheath tumor: This case demonstrates that symp toms ofnasal obstruction are not always secondary to simp le causes. We discuss the clinical pi cture ofnasal and paranasalmalignant p eriph eralnerve shea th tumor; its pathology, and its treatm ent.
This systematic review has shown that there are no prospective randomised studies of antimicrobial treatment options for paediatric neurosurgical patients in the last 20 years, and larger prospective studies are urgently required for this serious infection. There is some limited case series showing the benefits of certain antimicrobials such as vancomycin and ceftriaxone, but a larger case series or randomised controlled trial is required, particularly to establish the benefit, if any, of additional intraventricular antimicrobials.
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