Image guided excision of a ruptured feeding artery "pedicle aneurysm" associated with an arteriovenous malformation in a child: case report.

Excision of a ruptured aneurysm located at a lenticulostriate feeding artery associated with an arteriovenous malformation was performed using image guided neuronavigation in an 8-year-old child. The management of this lesion, which is rare in childhood, demonstrates the potential of combining frameless stereotaxy for precise target approach with conventional open microneurosurgery to minimize morbidity. Because of the unavoidable shifting of the brain that occurs during surgery, a catheter pointing towards the dome of the aneurysm was placed using image guidance prior to insertion of spatulae.

Treatment of infantile spasms with high-dosage vitamin B6.

High-dose vitamin B6 (pyridoxine-HCl, 300 mg/kg/day orally) was introduced as the initial treatment of recently manifested infantile spasms in 17 children (13 symptomatic cases with identified brain lesion and 4 cryptogenic cases). 5 of 17 children (2 cryptogenic, 2 with severe pre/perinatal brain damage and one with Sturge-Weber syndrome) were classified as responders to high-dose vitamin B6. In all 5 cases the response to vitamin B6 occurred within the first 2 weeks of treatment and within 4 weeks all patients were free of seizures. Two patients developed other seizures (partial seizures, etiologically unclear blinking attacks), but no relapse of infantile spasms was observed among the five responders to vitamin B6. No serious adverse reactions were noted. Side effects were mainly gastrointestinal symptoms, which were reversible after reduction of the dosage. Considering the life-threatening side effects of treatment with ACTH/corticosteroids or valproate, a controlled clinical trial with high-dose vitamin B6 would appear justified to either prove or disprove efficacy.

[Radiotherapeutic results in the treatment of craniopharyngioma]. / Strahlentherapeutische Ergebnisse bei der Behandlung von Kraniopharyngeomen.

From 1974 to 1985, twelve patients (seven children and five adults) with craniopharyngioma received megavoltage external beam radiation therapy at the University of Heidelberg. All patients had biopsy proven diagnosis. Nine patients received irradiation after incomplete surgical removal. Three patients were irradiated primarily because of inoperability. In all cases irradiation was applied by a rotation technique with 42 MeV photons. A mean dose of 52.2 Gy (ranged from 46 to 60 Gy) was administered at 2.0 Gy per fraction. In one case radiotherapy was broken off on account of the development of a hypoglycemic coma of unknown genesis. The mean follow-up period amounts nine years up to now. Local tumor control was achieved in nine patients. Two deaths occurred from tumor progression, after temporary improvement. In all cases no radiation related neurological, ophthalmological or endocrine side effects were observed.