Cases reported "Meningomyelocele"

Filter by keywords:



Filtering documents. Please wait...

1/27. Successful therapy in a child with a congenital peripheral medulloepithelioma and disruption of hindquarter development.

    PURPOSE: Medulloepithelioma is an embryonal multipotential neuroepithelial tumor with a striking potential for divergent differentiation. It is usually intraocular or intracerebral and associated with a good prognosis only if completely surgically excised. Data regarding therapy in children with incompletely resected tumors are limited. PATIENT AND methods: A girl was born with a large, peripheral, congenital medulloepithelioma associated with complete absence of the left hindquarter and anus. Plain film, ultrasonography, and magnetic resonance imaging demonstrated complete absence of the left kidney and hemipelvis. A subtotal resection of the mass and reconstruction of the tumor-related anatomical defects were performed. RESULTS: Pathologic examination showed neuroglia and pseudostratified neuroectoderm diagnostic of medulloepithelioma. She was treated with multiagent chemotherapy including vincristine, cisplatin, cyclophosphamide, carboplatin, and etoposide. She is now 50 months of age and developing normally without recurrent disease. CONCLUSIONS: A child with an incompletely resected congenital peripheral medulloepithelioma who has experienced long-term disease-free survival after treatment with chemotherapy is described. This report supports a role for adjuvant chemotherapy in the treatment of children with peripheral medulloepithelioma.
- - - - - - - - - -
ranking = 1
keywords = cerebral
(Clic here for more details about this article)

2/27. The Chiari II malformation: lesions discovered within the fourth ventricle.

    Structural lesions associated with the Chiari II malformation have been identified within the fourth ventricle in 8 patients. During the 42-month period encompassing the operations of the 7 patients treated surgically, only 9 other patients were explored without the discovery of some associated structural lesion. The patients ranged in age from 2 to 26 years. The following lesions were identified: glial or arachnoidal cysts (3 patients), glial or choroidal nodules (3 patients) and subependymoma (2 patients). These lesions were all situated in the roof of the fourth ventricle adjacent to or interspersed with the choroid plexus. Only the cystic lesions were identified by preoperative imaging. In only 1 case did the associated lesion, a 2-cm cyst, seem to contribute to the patient's clinical presentation. Structural lesions of the fourth ventricle associated with the Chiari II malformation are common in patients who are submitted to decompression. These lesions may be dysplasias of developmental origin, or they may be reactive lesions related to chronic compression and ischemia. They do not necessarily required biopsy or excision.
- - - - - - - - - -
ranking = 266.84999088422
keywords = ventricle
(Clic here for more details about this article)

3/27. The Chiari/hydrosyringomyelia complex presenting in adults with myelomeningocoele: an indication for early intervention.

    OBJECTIVE: To determine how adults with myelomeningocoele who develop the Chiari/hydrosyringomyelia complex present, and to determine if surgical intervention influences outcome in these patients. methods: A chart review of the 220 patients who attend a clinic for adults with spina bifida and hydrocephalus (CASBAH), and follow-up of the five cases with myelomeningocoele who had surgical intervention for associated symptomatic Chiari/hydrosyringomyelia complex. RESULTS: Bilateral upper limb weakness and wasting were the commonest presenting symptoms (four patients). Sensory disturbance (three patients) was also common, dysphagia (one) and ataxia (one) occurring less often. The median time to surgical intervention was 36 months. Two patients had a shunting procedure performed in isolation, two foramen magnum decompression in addition to a shunting procedure and one a foramen magnum decompression. Surgical intervention did not completely reverse problems attributed to the Chiari/hydrosyringomyelia complex in any of the cases. One patient died post-operatively. Of the four who survived one had some improvement in function post-operatively, two remained static and one had further mild deterioration. CONCLUSION: All adults with myelomeningocoele should be questioned about changes in upper limb function for early detection of Chiari/hydrosyringomyelia complex. Our results suggest that early intervention is needed if further deterioration is to be avoided, and to improve the chances of neurological and functional recovery.
- - - - - - - - - -
ranking = 18.915225756997
keywords = foramen
(Clic here for more details about this article)

4/27. gait analysis in myelomeningocele: possibilities and applications.

    gait analysis with a fully integrated laboratory is a relatively new instrument in the armamentarium of the pediatric orthopedic surgeon. The introduction of it has been especially successful in neuromuscular pathology and, particularly, in cerebral palsy. In spina bifida, however, it also enhances substantially the possibilities of detailed analysis of the locomotion problem. It is, furthermore, a very useful instrument in evaluating treatment and in follow-up. With a few examples, this paper tries to show the possibilities and advantages of a gait laboratory in the evaluation of patients with ambulatory spina bifida.
- - - - - - - - - -
ranking = 1
keywords = cerebral
(Clic here for more details about this article)

5/27. Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes.

    STUDY DESIGN: A retrospective case-control study evaluating risk factors for infection, causative organisms, and results of treatment in patients with cerebral palsy or myelomeningocele who underwent fusion for scoliosis was performed. OBJECTIVES: To identify risk factors for infection, and to characterize the infections in terms of infecting organisms and response to treatment. SUMMARY OF BACKGROUND DATA: No previous studies have analyzed risk factors or causative organisms, nor have they indicated results of treatment for infections in this group of patients. methods: After a 10-year retrospective review of 210 surgically treated patients, deep wound infections developed in 16 patients with myelomeningocele and 9 patients with cerebral palsy. These patients were studied extensively for possible risk factors, along with 50 uninfected patients matched for age, diagnosis, and year of surgery. Statistical testing was performed to identify risk factors. The courses of the infections were characterized in terms of organisms isolated and response to treatment. Treatment was performed in a stepwise fashion and classified in terms of the most successful step: debridement and closure, granulation over rods, or instrumentation removal. RESULTS: Of the 10 risk factors tested, 2 were found to be significant: degree of cognitive impairment and use of allograft. Findings showed that 52% of the infections were polymicrobial. Gram-negative organisms were isolated as commonly as gram-positive organisms. The most common organisms were coagulase-negative staphylococcus, enterobacter, enterococcus, and escherichia coli.- debridement and closure were successful in 11 of 25 patients with deep wound infection. Of the 14 patients with infection not resolved by serial debridements and closure, 2 were managed successfully by allowing the wound to granulate over rods, and 7 required rod removal for persistent wound drainage. There were three symptomatic pseudarthroses. Infections resulting from gram-positive organisms were most often managed successfully with debridement and closure (P = 0.012). CONCLUSIONS: patients with cerebral palsy or myelomeningocele who have severe cognitive impairment, and those who received allograft may be at increased risk for infection. Infections are more often polymicrobial and caused by gram-negative organisms than is typical for elective orthopedic procedures. This suggests an enteric source. Treatment with debridement and closure was not always successful. patients in whom infection develops are then at increased risk for pseudarthrosis.
- - - - - - - - - -
ranking = 3
keywords = cerebral
(Clic here for more details about this article)

6/27. Clinical features in patients requiring reoperation after failed endoscopic procedures for hydrocephalus.

    The aim of this study was to clarify the clinical features of patients at risk of secondary obstruction following endoscopic fenestration. Clinical notes and endoscopic findings for 15 patients treated with endoscopic procedures were retrospectively reviewed. Endoscopic third ventriculostomy (ETV) was performed as initial treatment in 4 patients with non-communicating hydrocephalus, including a neonate with myelomeningocele, and as an alternative to shunt revision in 4 patients. Two patients with non-communicating hydrocephalus caused by tumor or arachnoid cyst were also managed with third ventriculostomy. Four patients with loculated hydrocephalus underwent endoscopic septostomy. A child with an isolated fourth ventricle was treated with endoscopic aqueductoplasty. Of the 15 patients undergoing endoscopic procedure, 4 required reoperation. Of the 10 patients treated with ETV, only the neonate with myelomeningocele required a ventriculoperitoneal shunt because of failure of the initial procedure. Of the 4 patients treated with endoscopic septostomy, 2 children with loculated hydrocephalus following intraventricular hemorrhage (IVH) underwent a second septostomy. In a patient with an isolated fourth ventricle following posthemorrhagic hydrocephalus, recurrence was noted 8 months after the initial procedure. He underwent a second procedure using a stent implanted into the aqueduct to maintain CSF circulation. Sufficient stomal size or implantation of a stent may be required in the under-2-year age group with hydrocephalus accompanied by IVH and associated with myelomeningocele, in whom the risk of secondary obstruction may be high.
- - - - - - - - - -
ranking = 76.242854538348
keywords = ventricle
(Clic here for more details about this article)

7/27. Endovascular management of ventricular catheter-induced anterior cerebral artery false aneurysm: technical case report.

    OBJECTIVE AND IMPORTANCE: We describe the case of a 3.3-kg infant who developed an anterior cerebral artery pseudoaneurysm after ventricular catheter placement. The lesion was treated with endovascular vessel sacrifice. CLINICAL PRESENTATION: A 3.3-kg infant with a myelomeningocele underwent repair and ventricular catheter insertion for hydrocephalus. During shunt insertion, intracerebral arterial bleeding was encountered. Subsequent arteriography demonstrated an anterior cerebral artery pseudoaneurysm. TECHNIQUE: Via a transfemoral artery approach, the aneurysm and feeding vessel were catheterized with a microcatheter and wire. The aneurysm and vessel were then sacrificed with detachable platinum coils. CONCLUSION: Arterial injury is uncommon after ventricular catheter placement. When it does occur, however, an unstable pseudoaneurysm may form. Endovascular techniques can be used to remedy this problem, thus at times obviating the need for a standard craniotomy, which can be particularly difficult in a newborn.
- - - - - - - - - -
ranking = 7
keywords = cerebral
(Clic here for more details about this article)

8/27. Contrast-induced central nervous system toxicity after radiographic evaluation of the lower urinary tract in myelodysplastic patients with ventriculoperitoneal shunts.

    Routine urological evaluation of children with myelomeningocele helps to identify those at risk for upper urinary tract deterioration. We report on 2 patients with ventriculoperitoneal shunts who had intraperitoneal rupture of the bladder. Reflux of contrast media via or around the ventriculoperitoneal shunt into the cerebral ventricles occurred in both patients, resulting in severe neurological insult.
- - - - - - - - - -
ranking = 39.121427269174
keywords = ventricle, cerebral
(Clic here for more details about this article)

9/27. Shunt-related craniocerebral disproportion: treatment with cranial vault expanding procedures.

    Two patients with intracranial arachnoid cysts, one with myelomeningocele-hydrocephalus and the other with a subdural fluid collection, were given a cerebrospinal (CSF) extracranial shunt. All four patients developed features of CSF overdrainage following shunting and were treated by cranial vault expanding procedures. Before undergoing decompressive craniotomy, the patients were treated by a variety of procedures, including changing of obstructed ventricular catheters (n=4), insertion or upgrading of programmable valves (n=3), and foramen magnum decompression (n=1). Clinical manifestations of these four patients were attributed to craniocerebral disproportion caused by chronic and progressive skull changes due to dampening of the CSF pulse pressure, which is necessary for maintaining normal cranial growth. On the basis of our previous experience with expanding craniotomies in cases of minimal forms of craniosynostosis, we treated these patients with bilateral parietal craniotomies, with satisfactory results. In conclusion, biparietal decompressive craniotomy constitutes a useful and safe procedure for relieving the clinical manifestations of some CSF overdrainage syndromes, especially in cases with slit-ventricle syndrome and craniocerebral disproportion that prove to be refractory to simpler management procedures.
- - - - - - - - - -
ranking = 53.579040147673
keywords = ventricle, foramen, cerebral
(Clic here for more details about this article)

10/27. Chiari type II malformation: a case report and review of literature.

    INTRODUCTION: Herniation of cerebellar vermis through the foramen magnum, internal hydrocephaly and spina bifida cystica are the major signs of Chiari type II malformation. spina bifida cystica (1 in 2000 neonates) is very often the first clinical manifestation of the disease. AIM: To discuss the pathomorphology, clinical picture and possible treatment of this underestimated malformation. patients AND methods: Lumbosacral spina bifida aperta and flaccid paraplegia of the lower limbs were found in a female newborn. Later on, pneumonia and evidence of markedly expressed internal hydrocephaly were found. At 48 days of age, surgical correction of the meningocele was undertaken. There was a sudden heart and respiratory arrest at the end of surgery but in spite of the cardiopulmonary resuscitation the infant died 24 hours later. RESULTS: Postmortem pathological examination revealed expressed internal hydrocephaly, small posterior fossa, herniation of vermis and atrophic medulla oblongata; presence of these signs verified the Chiari type II malformation. It is very difficult to diagnose this malformation antemortem without magnetic resonance imaging. Brainstem dysfunction is the most common cause of death in children under 2 years of age with Chiari type II malformation. Its clinical manifestation can be episodic and poorly expressed. CONCLUSIONS: A thorough understanding of this entity (clinical and pathomorphological manifestations) and magnetic resonance imaging are mandatory for the malformation to be diagnosed. Early recognition of symptoms of brainstem compression and a subsequent surgical decompression can decrease the high mortality rate among children with Chiari type II malformation.
- - - - - - - - - -
ranking = 9.4576128784985
keywords = foramen
(Clic here for more details about this article)
| Next ->


Leave a message about 'Meningomyelocele'


We do not evaluate or guarantee the accuracy of any content in this site. Click here for the full disclaimer.