[Results of combined treatment of cerebellar medulloblastomas in children with chemotherapy preceding radiotherapy]. / Wyniki leczenia skojarzonego rdzeniaka mózku u dzieci z zastosowaniem chemioterapii przed rozpoczeciem naswietlan.

153 patients presenting with medulloblastoma between 1980-1992 were treated at the Department of Pediatric Neurosurgery, Child's Health Centre in Warszawa. This group was studied retrospectively and assessed for clinical presentation, histology, treatment regimen and survival. 44 cases treated between 1980 and 1986 underwent surgical resection, postoperative staging evaluation, and craniospinal irradiation, additionally patients assigned to "high risk" group received post-irradiation chemotherapy. Beginning 1986-86 patients with "standard risk" medulloblastoma were treated with preirradiation--"sandwich" chemotherapy consisting of either procarbazine, vincristine and CCNU or "eight drugs a day", followed by megavoltage irradiation, while "high risk" group received also postirradiation chemotherapy. The 5-year actuarial survival rate for all patients was 43%. There were no statistically significant differences in 5-year survival rate between the group treated with preirradiation chemotherapy--52%, and without--54%. The presented group was studied to identify variables of prognostic significance. The extent of disease at the time of diagnosis, as measured by M staging criteria was significantly associated with outcome. The extent of tumour resection, histological subtype of the tumour, postoperative complications, T-staging, and age did not influence the prognosis in the present study.

[Indications for shunting in children with tumours of posterior fossa]. / Wskazania do leczenia zastawkowego dzieci z nowotworami tylnego dolu czaszkowego.

Between 1980-1987 in the Neurosurgery Department we treated 113 patients with cerebellar astrocytoma, 52 children with medulloblastoma and 30 patients with ependymoma. Before operation shunting was used in 10 patients and after operation in 15 patients, generally shunting was necessary in 22% patients with cerebellar astrocytoma. In cases of medulloblastoma before operation shunting was used in 6 children and after in 15 patients, generally shunting was necessary in 21 (40%) patients. In cases of ependymomas shunting was used in 6 patients before operation and 5 cases after operation, generally shunting was necessary in 11 (36%) patients.

[Mutism after surgeries with removal of posterior cranial fossa neoplasms]. / Mutyzm po operacjach usuniecia nowotworów tylnego dolu czaszkowego u dzieci. Opis dwóch przypadków.

The authors report two cases of mutism after posterior fossa surgery in children aged 3.5 and 5 years. In the first hours after the operation the children spoke. Various hypotheses are advanced for explaining of this speech disorder.

Cerebrospinal compensation in hydrocephalic children.

One hundred and fifteen cases of hydrocephalus in children were analysed. Cerebrospinal compensatory reserve was assessed by a computerized, constant rate, lumbar infusion test. Head circumference and ventricular size were measured and a psychometric examination carried out. A classification of hydrocephalus based on resting cerebrospinal fluid pressure (CSFP) and resistance to cerebrospinal fluid outflow (RCSF) was introduced. Parameters of compensatory reserve were compared in atrophy (low CSFP, low RCSF), normal-pressure hydrocephalus (low CSFP, increased RCSF), non-communicating hydrocephalus (high CSFP, low RCSF) and acute hydrocephalus (high CSFP and increased RCSF). Significant differences were found between the factors describing compensatory ability in these groups. Sixty-two patients could be classified on the basis of resting CSFP and RCSF. Differentiation between the types of hydrocephalus was shown to be more accurate when all variables measured during the pressure-volume test were considered. The patterns of the time courses of CSFP during rate infusion tests in the different types of hydrocephalus are presented.

[Lateral ventricle choroid plexus papillomas in infants]. / Brodawczaki splotu naczyniówkowego komór bocznych mózgu u niemowlat.

Choroid plexus papillomas are rare intracranial tumours occurring most frequently in children. In the period 1983-1988 in the neurosurgery department 10 infants were treated for choroid plexus papillomas. Their age was from 4 weeks to 12 months. The diagnosis was based on the results of ultrasonography and CT. Eight patients had shunts implanted for hydrocephalus. In most cases the histological examination demonstrated benign tumours. Radical removal of the lesion was done in 90% of cases, but, despite this, remote results were satisfactory in only 40% of cases.

[Treatment of cerebral vein aneurysms in children]. / Leczenie tetniaków zyly Galena u dzieci.

Aneurysms of the vein of Galen are very rare vascular anomalies found mainly in newborns and infants. In the years 1982-1989 five children with these aneurysms were treated. Their age was from 6 weeks to 16 months, all were males. The diagnosis was based on computed tomography (initial examination) and cerebral angiography. Two cases with hydrocephalus were treated with valves. The main procedure was clipping of supplying vessels. One child died during diagnostic procedures. The results in four operated on patients are good.

[Indications for the shunt treatment of children with cerebellar astrocytoma]. / Wskazania do leczenia zastawkowego dzieci z gwiazdziakami mózdzku.

In the years 1980-1987 the number of children aged from 11 months to 15 years treated for cerebellar astrocytoma was 113, the mean age was 5.4 years. Shunt insertion preceding the main surgical treatment was done in 10 cases (9%). After the operation shunt was necessary in 15 cases, that is 15% of cases not undergoing shunt insertion before the operation. In all, shunting was necessary in 22% of patients with cerebellar astrocytoma. In the conclusions the authors suggest indications to shunting in various age groups in cases of cerebellar astrocytoma.

[Characteristics of intracranial volume-pressure relationship in hydrocephalic children with reference to age]. / Charakterystyka wewnatrzczaszkowych stosunków objetosciowo-cisnieniowych u dzieci z wodoglowiem, z uwzglednieniem czynnika wieku.

The purpose of the study was establishing of the effect of child's age, and thus the biomechanical properties of cranial coverings, on the parameters characterizing the intracranial space in the infusion test. The results of the infusion tests performed as a supplementary diagnostic examination in 59 cases of infantile hydrocephalus were subjected to statistical analysis. The studied material and the methods used for its processing no significant differences were found in the mean values of the biomechanical parameters of intracranial space were found between the group of younger children (aged up to 2 years) and older children (over 2 years). This finding may be important in the interpretation of the results of the infusion test, since it was not found that the biomechanical properties of the cranial coverings had any significant effect on the results of this test.

Overpressure radionuclide cisternography and metrizamide computed tomographic cisternography in the detection of intermittent rhinoliquorrheas in children.

The authors present their clinical observations on 25 children treated because of cerebrospinal fluid leakage. In an attempt to improve the detection of rhinorrhea, overpressure radionuclide cisternography (ORNC), combined with the placement of nasal pledgets, was employed in 20 cases. In 16 cases, metrizamide computed tomographic cisternography (MCTC) was performed. In 11 children both types of investigations were done. ORNC was performed as follows: after placing pledgets in each side of the nasopharynx, a lumbar puncture was done and opening, resting CSF pressure was continuously monitored. 99mTc-DTPA (1 ml, 0.5-3.0 mCi) was injected intrathecally and infusion of artificial CSF followed. MCTC was done 1 h after instillation of 5 ml of metrizamide. The rhinorrhea was diagnosed in 14 cases (all cases were verified through operation). In one case with negative ORNC, rhinorrhea was observed 1 week after examination and in the other 4 days after an additional head tap. In the group of MCTC, four results were true-positive, seven true-negative, and five false-negative. Concerning the group of ORNC and MCTC, four cases were false-negative with MCTC, but true-positive in ORNC. In seven cases EEG was performed immediately before and after ORNC and no changes were observed. There were no adverse effects following either type of investigation. In conclusion, the authors state that ORNC seems to be more sensitive in comparison to MCTC in diagnosis of intermittent rhinorrhea. MCTC, however, may be useful for precisely locating the CSF leakage.

[Results of the treatment of children with brain neoplasms. I. Survival of children and cause of death]. / Wyniki leczenia dzieci z nowotworami mózgu. Czesc I. Przezywalnosc dzieci i przyczyny smierci.

In a group of 146 children aged from 8 months to 16 years treated for brain neoplasms the authors analysed the therapeutic results. Excluding the so called operative losses the survival over 4 years was obtained in one-fourth of patients with medulloblastoma, in over one-third of those with ependymoma, one-half of astrocytoma cases, and over one-third of children with other neoplasms. The authors estimate positively the therapeutic methods used (operation, radiotherapy and chemotherapy by Bloom's schedule) and see the possibility of increasing the survival rate by improvement in the diagnosis of brain tumours in children and by optimalization of treatment, especially in its early period, for reducing the number of operative losses.

Analysis of CSF dynamics by computerized pressure-elastance resorption test in hydrocephalic children. Indications for surgery.

Since 1982, 23 hydrocephalic children have been studied for compensatory mechanisms of the cerebrospinal fluid system. The authors describe the method and results of a computerized pressure-elastance resorption test (CPERT), a spinal steady-state infusion test, in hydrocephalic children. Computerized analysis of the P/V and AMP/P curve provides valuable data that precisely describe the degree of disturbances of CSF dynamics. The following parameters were quantitatively determined: out-flow resistance, opening pressure, elastance, elasticity, reference pressure and optimum (break-point) pressure. It is concluded that the described test allows the differential diagnosis of chronic hydrocephalus in children. The value of optimum pressure (analysis of AMP-P relation) gives precise indications for surgery and the selection of a valve system with adequate opening pressure. In some cases, the CPERT test can be used instead of continuous ICP monitoring.

Angiographic evaluation of conjoined twins.

Two sets of conjoined twins were studied by angiocardiography and cerebral angiography. Conjoined heart was demonstrated in the thoracopagus twins and surgical separation was impossible. Cerebral angiography disclosed the separate circulations in craniopagus twins and surgical separation was performed.