Cerebral aspergillosis in children. Report of three cases.

Between March and December of 1997, 3 cases of infantile cerebral aspergillosis appeared in our hospital. All patients presented some kind of immunosuppression associated with clinical findings of intracranial hypertension. After surgery, all cases were histopathologically confirmed and had positive cultures of Aspergillus. The first case was a patient with a history of subtotal resection of supratentorial ependymoma which presented a new enhancing mass on a control CT scan. Brain tumor recidiva was suspected, although, an Aspergillus granuloma was encountered on the tumor bed. Both other cases were found in patients who underwent transplantation: one presented multiple cerebral lesions after a renal transplant, and the other, after a bone marrow transplant, developed a rhinocerebral aspergillosis. The discussion was focused on the clinical findings, images and treatment of this cerebral infectious disease.

Patología infecciosa pseudotumoral del sistema nervioso central en la infancia / Infections mimicking central nervous system (CNS) tumors in children

Las infecciones del sistema nervioso central(SNC)pueden presentarse como lesiones ocupantes seudotumorales con efecto de masa,principalmente en pacientes inmunosuprimidos,pudiendo ser la primera manifestación de la enfermedad.La mayoría de los casos publicados corresponden a adultos especialmente dentro de la población HIV.En un contexto clínico adecuado,lesiones de tipo tumoral en las neuroimágenes,deben plantear el diagnóstico diferencial con patología infecciosa.Nuestro objetivo es describir los hallazgos clínicos y de neuroimágenes de 16 pacientes con infecciones intracraneanas a forma seudotumoral que requieren cirugía con presunción diagnóstica de lesión neoplásica.En nuestra serie de 1.0005 lesiones expansivas intracraneales neuroquirúrgicas,excluyendo inmunosuprimidos,trasplantados y HIV conocidos(con riesgo potencial de absceso cerebral)se diagnosticaron en 16 biopsias cerebrales(1,6 por ciento)Infecciones por protozoarios(enfermedad de Chagas:2,toxoplasmosis:3,uno de ellos asociado a Mycobacterium avium intracellulare,amebas de via libre:2)cestodes(Cysticercus cellulosae:2,quiste hidiatídico Echinococcus granulosus:4 y tuberculomas:3.En casos clínicos estudiados y seleccionados algunas observaciones pueden ayudar a evitar procedimientos invasivos del SNC así como modificar la táctica y técnica quirúrgica

Extratemporal epilepsy in children: candidate selection and surgical treatment.

From June 1988 to June 1998, 60 children with extratemporal epilepsies (EE), most of whom were symptomatic, underwent surgery. All patients were studied by means of CT scanning, MRI and scalp EEG. Video-telemetry was used in 40 cases. Intracranial electrodes were placed in 10. Intraoperative ECoG was used in the 35 children who underwent resective procedures and in the 25 in whom disconnection was performed. Surgical procedures were as follows: 24 lesionectomies, 25 disconnecting procedures, 7 polectomies and/or lobectomies, 3 corticectomies and 1 anatomical hemispherectomy. After at least 1 year's follow-up in 48 children, to date 38 are in Engel class I, 7 in class II, 1 in class III and 2 in class IV. That is to say, in 46 of the 48, surgical outcomes ranges from very good to at least worthwhile, as reflected in their classification in Engel class III.

Lateral ventricle tumors in children: a series of 54 cases.

A series of 54 patients with lateral ventricle tumors diagnosed and surgically treated from 1988 to 1998 was reviewed. Neoplasms invading ventricles and originating beyond their walls were excluded. There were 35 male and 19 female patients. Their ages ranged from 15 days to 20 years, and two frequency peaks were observed, one at 2 and one at 11 years. The most frequent signs and symptoms were attributed to increased intracranial pressure. The 54 patients included 41 who developed hydrocephalus, but only 15 of these required shunting. The trigonal region and frontal horn were the most common sites of origin. Surgery was planned with due consideration for the localization of the tumor, its presumptive histology, its main feeding vessels, the parenchymal functionality, and the presence or absence of hydrocephalus. The most frequent tumor types were subependymal giant cell astrocytoma, choroid plexus tumors, ependymoma, and astrocytoma. The most common complications were intraventricular hemorrhage, cortical collapse, subdural collection and seizures. To conclude, tumors located within the lateral ventricles are often very voluminous and are predominantly benign, and the treatment of choice is total resection. In the case of malignancy, postsurgical radiotherapy and/or chemotherapy should be given.

Thalamic tumors in children.

Thalamic tumors (TT) merit individual analysis and must not be confused with tumors that, while involving the entire thalamus have a different origin. We analyzed 26 patients who fulfilled our criteria of having "strictly" TT. We examined incidence, clinical features, histology, response to treatment (mainly surgery), recurrence rate, mortality and prognosis. We considered that histology and surgical treatment were the most important items related to prognosis. Low-grade tumors (LGT) had a good prognosis, while anaplastic tumors (AT) had a discouraging one; nevertheless both must be operated on. We believe that total removal of LGT is curative and total removal of AT, even if it is not curative, can extend survival by some months. Radiotherapy and chemotherapy seemed to be of little value in our series of TT.

Treatment of cloverleaf skull syndrome.

Up to a few years ago, patients with cloverleaf skull deformity underwent partial surgery to relieve intracranial hypertension with poor functional and aesthetic results, often leading to relapses and reoperations, both in our own experience and in that of other authors. As of 1990, however, we started to use the technique described by Persing et al. to resolve the complex cloverleaf malformation in a single definitive procedure. Five patients, whose ages ranged from 2 months to 5 years, achieved satisfactory results both as regards relief from intracranial hypertension and preservation of visual acuity, and from the aesthetic viewpoint. Surgical approaches and their modifications are described.

Complications in paediatric craniopharyngioma treatment.

Forty-eight consecutive children treated for craniopharyngioma at the Juan P. Garrahan National Paediatric Hospital (Buenos Aires, Argentina) from 1988 to 1994 are described. Complications of patients undergoing total resection alone and those undergoing subtotal or partial resection plus radiotherapy were compared. Survival time and quality of life proved more satisfactory in the former group, as there were no recurrences. In contrast, among the latter patients, 53% suffered relapses. Endocrinological complications were similar in the two groups. Postsurgical subdural haematomas were quite frequent and eight patients required treatment for intracranial hypertension. Vascular complications, though less common, led to high morbidity and mortality. There was a considerable incidence of shunt malfunction (80%), arguing against placement of a preoperative shunt, which tended besides to foster postsurgical subdural haematomas.

Dysembryoplastic neuroepithelial tumor: morphological, immunocytochemical, and deoxyribonucleic acid analyses in a pediatric series.

Overtreatment by radiotherapy and/or chemotherapy for central nervous system tumors in infancy and childhood may be deleterious, so the recognition of surgically curable clinicopathological entities is mandatory. The dysembryoplastic neuroepithelial tumor is a complex multinodular lesion consisting of glial nodules, associated with a specific glioneuronal element and/or with focal cortical dysplasia, and occurring in young patients presenting with intractable, mostly complex partial, seizures without neurological deterioration. We report on 14 patients; 9 were from a series of 600 pediatric patients with intracranial central nervous system tumors studied at a single institution from 1988 to 1993, and 5 were referred from other pediatric hospitals. Six tumors were frontal, six were temporal, one was parietal, and one was occipitoparietal. Computed tomographic scans disclosed hypodense lesions with cystic appearances in 4 patients and slight focal postcontrast enhancements in only 2 patients, whereas magnetic resonance imaging, available for 7 of 14 patients, showed hypointense lesions in T1-weighted images and hyperintense lesions in T2-weighted images. Deformities of the overlying cranium were also observed in five patients. The age range at the time of surgery (excluding a 20-year-old male patient who underwent surgery at the main pediatric hospital) was 2.6 to 13 years, with a mean of 6.68 years. The male to female patient ratio was 10:4, and the duration of symptoms was 0.2 to 6 years.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of the level of endemic tuberculosis in a survey of Banqui (Central African Republic)]. / Evaluation du niveau d'endémie tuberculeuse par enquête tuberculinique dans la ville de Bangui (République Centrafricaine).

A cluster sample survey on tuberculosis has been carried out in Bangui in February 1988. The bimodal distribution of the diameters of IDR on children aged between 5 to 9, gives evidence of a circulation of some non typical mycobacteriae and enables to fix the limit of positivity at 14 mm. The prevalence rate of the tuberculotic infection is 7.9 +/- 1.7% in the surveyed children population at school. The annual risk of infection is evaluated at 1.09% that ranks the Centrafrican Republic in the countries with a low prevalence rate.

Evaluation of the efficacy of a low-passage bovine rotavirus (strain WC3) vaccine in children in Central Africa.

The safety and efficacy of a WC3 rotavirus vaccine was evaluated in a double-blind placebo-controlled trial involving 472 children in Bangui (Central African Republic). Each child received two doses of either placebo (235 children) or vaccine (237 children) at a 1-month interval, the first dose being given at 3 months of age. During the follow-up survey 9 months after the first dose, 117 rotavirus diarrhoeas were observed, 59 in the placebo group, 58 in the vaccinated group. The only positive effect of the vaccine was a significantly higher proportion of mild rotavirus diarrhoeal episodes in the vaccinated group than in the placebo group. Of the children in the vaccinated group, 60% had a positive immune response to WC3 rotavirus when tested by plaque reduction seroneutralization.

Delayed posttraumatic intracranial lesions in children.

Three patients with delayed posttraumatic intracranial hematoma (2 intracerebral and 1 extradural) are described, together with a review of the literature on possible etiologies. Close monitoring of the patient with craniocerebral trauma is essential to avoid a fatal outcome and to repeat neuroradiological studies when warranted.

Choroid plexus papillomas of the III ventricle in childhood. Their diagnosis and surgical management.

Ten infants and children with choroid plexus papilloma of the III ventricle are presented. Hydrocephalus of various degrees was present in all patients, and seven patients had bilateral ventriculoperitoneal shunts prior to craniotomy. All patients were investigated with computed tomography and angiography. Tumor was resected through the transfrontal-transventricular approach in nine and through a transcallosal approach in one. One patient died intraoperatively due to an uncontrollable hemorrhage from a subependymal vein at its point of entry into the homolateral internal cerebral vein, and another died shortly after surgery due to hypothalamic trauma. The remaining eight patients are alive without recurrence over a minimum follow-up period of 3 years; three have mental retardation and seizure disorder. Despite this tumor's deep location and vascularity and occurrence in infancy, choroid plexus papillomas of the III ventricle can be successfully resected. Appropriate care for hydrocephalus and intra- and postoperative management are important.

A cohort study of enteric campylobacter infection in children from birth to two years in Bangui (Central African Republic).

A cohort of 111 children from Bangui, Central African Republic, was followed for enteric campylobacter infection from birth until the age of 2 years. Stools were examined at each episode of diarrhoea, and bi-weekly up to the age of 6 months irrespective of the presence of diarrhoea. 349 episodes of diarrhoeal illness were recorded (1.6 per child-year). Campylobacters were isolated from 41 (11.7%) of the 349 episodes, but in half of them another enteric pathogen was also isolated. Campylobacters were statistically associated with diarrhoea only before the age of 6 months. Bi-weekly sampling up to this age detected 75 infections (1.3 per child-year), yet only 12 (16%) were associated with diarrhoea. Campylobacter coli was isolated slightly more often (51%) than C jejuni (49%); biotyping and serogrouping showed that no strain was especially associated with disease. Fewer children who had campylobacter infection before the age of 6 months suffered campylobacter diarrhoea between 6 and 24 months of age than those who did not, but the difference did not reach statistical significance. A significantly higher rate of isolation was found in the homes of infected children (human and animal contacts) than of non-infected children. Campylobacter infections were statistically associated with the presence of live poultry and the lack of piped water in homes.

Prospective longitudinal study of rotavirus infections in children from birth to two years of age in Central Africa.

A cohort of 111 children born in Bangui (Central African Republic) was followed from birth to two years of age for rotavirus infections by biweekly stool investigations until six months of age, as well as at each diarrhoeic episode. Thirty-eight children (34.2%) exhibited at least one rotavirus infection by the age of 6 months. Thirty children (27%) presented with rotavirus-associated diarrhoea before 2 years of age. Until the children reached the age of 12 months, rotavirus was identified significantly more frequently in diarrhoeic stools than in non-diarrhoeic stools (p less than 0.001). A low diversity of characterized rotavirus strains was found; only two electrophoretypes were identified, and 91% of the strains belonged to subgroup II, serotype 1, with no special strain identified in newborns. A total of 38 children had a rotavirus infection before the age of six months, while 73 did not: only 2.6% of the first group had diarrhoea associated with rotavirus between 6 and 24 months, versus 20.5% in the second group (p less than 0.05). In two-thirds of the cases of infection, the presence of rotavirus in stools was detected only once; repetitive isolations were more frequent in diarrhoeic than in asymptomatic infections. The isolation rate of rotavirus in the general populations was found to be very low (0.2%).

Intracranial neoplasms during the first year of life.

During a 7-year period, from January 1976 to December 1982, 470 brain tumors were treated at the Hospital de Niños Ricardo Gutierrez in Buenos Aires, 40 of which occurred in infants under 1 years of age. Diagnosis was at best tentative because most cases were referred on account of symptoms and nonspecific signs, e.g., macrocephaly, vomiting, and altered behavior. The supratentorial location was predominant over the infratentorial, with a ratio of 4:1. Craniotomies with resection of tumor were performed on all but four infants. Optic chiasm pilocytic astrocytoma, superficial brain astrocytoma, and choroid plexus papilloma were the most common histologic types. Thirty-three infants (80%) were found to have hydrocephalus complicating the brain tumor, but only 15 of them were shunted, because 4 infants died, and in 14, hydrocephalus remitted after the operation. After 2-9 years of postoperative observation, 16 infants (40%) live tumor-free and have normal neurological examinations, 5 (12%) suffer moderate deficits, and 19 (48%) have died.

Congenital dermal sinuses, dermoid and epidermoid cysts of the posterior fossa.

Dermal sinuses are abnormal communications between the skin and deeper tissues. Seven cases are presented of occipital dermal sinuses associated with dermoid or epidermoid cysts of the posterior fossa. The cysts were interdural, subdural and intracerebellar. Although they are benign lesions, there is a high incidence of complications, especially infections such as bacterial or aseptic meningitis and cerebellar abscess. The clinical features, radiological and tomographical characteristics, and the relationship to meningeal structures, dural sinuses and cerebellar parenchyma are described.