Extremely rare occurrence of multiple cranial fasciitis: A case report.

Cranial fasciitis (CF) is a rare, rapidly growing, benign fibroproliferative lesion of the skull in the pediatric population. It is characterized by benign mesenchymal proliferation of spindle cells arranged as short, intersecting loose fascicles within a fibromyxoid stroma, and mostly appears as a single mass. A surgical excision with clear surgical margins is definitively curative for CF. Up to date only two cases with multiple CF have been reported in the literature. In this report, we describe a 1-year-old girl with multiple locations of CF, as the first case to be reported in the Turkish population. The radiological and morphological findings of our case were comparable with the observations of the two previous reports in the literature. Histopathological examination remains to be the gold-standard for differential diagnosis of CF, as the treatment of this lesion differs from other malignancies of the skull in the pediatric population.

Effectiveness of multiple endoscopic fenestrations for the treatment of Sylvian fissure arachnoid cysts: a multicenter study.

PURPOSE: Arachnoid cysts are usually asymptomatic lesions. However, they can sometimes cause intracranial hypertension, headache, seizures, focal neurological deficits, and bleeding. The most commonly used surgical techniques are microsurgical cyst fenestration/excision/drainage, cyst shunting, and endoscopic procedures. We aimed to investigate the success of different surgical techniques. METHODS: Between 2000 and 2021, patients with Sylvan fissure arachnoid cysts who received treatment via an endoscopic approach chosen as the first-line treatment in three centers were enrolled. All case notes and radiological studies were evaluated retrospectively. RESULTS: The study included 131 (female, n = 28; male, n = 103) patients with a mean age of 87.04 ± 66.76 (range, 0-216) months. Of the patients, 25 had Galassi type II left-sided arachnoid cysts, 33 had Galassi type II right-sided arachnoid cysts, 40 had Galassi type III left-sided arachnoid cysts, and 32 had Galassi type III right-sided arachnoid cysts. No difference was found between patients who underwent single and multiple fenestrations in terms of Galassi type, side, clinical outcome, and cyst size (p > 0.05). On the contrary, the rate of additional surgical intervention was lower in patients with multiple fenestrations than in those with single fenestration (36.10% vs. 5.30%; p < 0.001). CONCLUSION: Endoscopic fenestration of Sylvian fissure arachnoid cysts is a good alternative to open surgery or cystoperitoneal shunting, and the number of fenestrations made during this surgery decreases the need for a second surgical procedure.

Repeat endoscopic third ventriculostomy success rate according to ventriculostoma closure patterns in children.

PURPOSE: This study aimed to examine the success rate of repeat endoscopic third ventriculostomy (redo-ETV) according to pattern of ventriculostoma closure based on observations in 97 paediatric redo-ETV patients. METHODS: Clinical data and intraoperative video recordings of 97 paediatric hydrocephalus patients who underwent redo-ETV due to ventriculostoma closure at two institutions were retrospectively analysed. We excluded patients with a history of intraventricular haemorrhage, cerebrospinal fluid (CSF) infection or CSF shunt surgery and those with incompletely penetrated membranes during the initial ETV. RESULTS: Verification of ventriculostoma closure was confirmed with cine phase-contrast magnetic resonance imaging and classified into 3 types: type 1, total closure of the ventriculostoma by gliosis or scar tissue that results in a non-translucent/opaque third ventricle floor; type 2, narrowing/closure of the ventriculostoma by newly formed translucent/semi-transparent membranes; and type 3, presence of a patent ventriculostoma orifice with CSF flow blockage by newly formed reactive membranes or arachnoidal webs in the basal cisterns. The overall success rate of redo-ETV was 37.1%. The success rates of redo-ETV according to closure type were 25% for type 1, 43.6% for type 2 and 38.2% for type 3. The frequency of type 1 ventriculostoma closure was significantly higher in patients with myelomeningocele-related hydrocephalus. CONCLUSION: For patients with ventriculostoma closure after ETV, reopening of the stoma can be performed. Our findings regarding the frequencies of ventriculostoma closure types and the success rate of redo-ETV in paediatric patients according to ventriculostoma closure type are preliminary and should be verified by future studies.

Flow ventricular catheters for shunted hydrocephalus: initial clinical results.

BACKGROUND: The non-homogenous flow of the cerebrospinal fluid within the ventricular catheter is one of the causative factors in shunt obstructions during the treatment of hydrocephalus. Previously, we studied the flow in ventricular catheters under the steady and pulsatile boundary conditions by means of computational fluid dynamics (CFD) in three-dimensional paradigms. Subsequently, several catheter designs with homogeneous flow patterns were developed out of which one prototype was chosen after a validation study. OBJECTIVE: To test the effectiveness of the flow ventricular catheter in a prospective, multicenter, comparative study. METHODS: Eligible centers were three pediatric hospitals: two with sole adult practice and one a mixed pediatric-adult. Standard silicone material was used to develop a parametric catheter model with homogenous flow characteristics. The flow catheters were inserted in pediatric (n = 30) and adult (n = 10) patients with all types of hydrocephalus. Simultaneously, regular ventricular catheters were inserted in another 43 control patients in the participating centers. Catheter positioning was standardized according to the Schaumann and Thomale classification. RESULTS: All ventricular catheters had a cephalad grade I or II positioning, and caudally, its extension had a peritoneal location. Programmable valves were utilized in 70% and antisiphon devices in 20% of the cases. Regular differential pressure valves were utilized in the remaining. No case of flow catheter obstruction was identified during a mean follow-up period of 2 years at the time of this writing. There were four catheter obstructions in the control cohort, all pediatric cases, during the first year. Shunt infections occurred in two cases in the control group, while there was one recurrent case of adult ventriculitis in the flow catheter group. CONCLUSIONS: This prototype model represents the next generation of ventricular catheters with a homogeneous flow pattern. The flow catheter can be inserted safely in hydrocephalic patients, and this preliminary prospective comparative study showed a possible obstruction-free functionality.

Endonasal endoscopic management of the craniopharyngeal canal meningoencephalocele using a nasoseptal flap in a 6-month-old infant.

Endonasal endoscopic approach (EEA) has become a routine and effective method for the management of large skull base defects in adults and increasingly in older pediatric populations despite their challenging narrow transnasal corridors. To our knowledge, this is the first report in the literature of a large craniopharyngeal canal (CC) meningoencephalocele in a 6-month-old infant managed purely through EEA, also by utilizing a pedicled nasoseptal flap (PNF).

Aggressive osteoblastoma of the cervical spine and resultant complication due to swollen oxidized regenerated cellulose: A case report.

Background: Osteoblastomas, although rare, are benign primary bone tumors, with cervical spine involvement being exceptionally uncommon. Late diagnosis, especially in aggressive cases, can lead to surgical challenges. Oxidized regenerated cellulose (ORC) used for hemostasis may result in complications if left in the surgical field. Case Description: An 8-year-old female presented with six months of intractable neck pain accompanied by swelling, hindering proximal right upper extremity evaluation. Motor strength was intact distally, with normal reflexes and no hypoesthesia. Imaging revealed a C4-5 facet joint lesion necessitating surgery. Intraoperative hemorrhage prompted ORC application, which led to postoperative arm pain and C5-6 radiculopathy. Subsequent surgery alleviated these symptoms. Conclusion: Osteoblastomas, despite their benign classification, may exhibit aggressive characteristics, warranting en-bloc resection. Cervical spine osteoblastomas, due to their vascular nature and proximity to vital structures, complicate surgical interventions. ORC, a commonly used hemostatic agent, may induce compression complications, and early intervention is critical for patient recovery. This case underscores the intricacies of managing aggressive osteoblastomas in the cervical spine and highlights potential ORC-related complications. Surgeons must exercise caution when using ORC and consider postoperative risks. Prompt intervention and meticulous planning are paramount for favorable outcomes in such cases.

Success Rate of Repeat Endoscopic Third Ventriculostomy Procedure According to the Ventriculostomy Orifice Closure Patterns: A Single Institutional Series of 74 Patients.

AIM: To analyze the success rates of repeat endoscopic third ventriculostomy (re-ETV) procedure according to ventriculostomy orifice closure types in patients who have undergone a second neuroendoscopic surgery for non-communicating hydrocephalus. MATERIAL AND METHODS: The study included 74 patients who underwent re-ETV procedure due to dysfunctional ventriculostomy orifice. Ventriculostomy closure patterns are classified into three types: Type-1 is defined as the complete closure of the orifice with non-transparent gliosis or scar tissue. Type-2 represents the closure or narrowing of the orifice by newly formed translucent membranes. Type-3 pattern is defined as the blockage of CSF flow due to newly formed reactive membranes in the basal cisterns, with an intact ventriculostomy orifice. RESULTS: The frequency of the ventriculostomy closure patterns was found as follows. Type-1: 17 cases (22.97%); Type-2: 30 cases (40.54%); and Type-3: 27 cases (36.48%). The success rate of the re-ETV procedure according to closure types was 23.52% in Type-1 cases, 46.66% in Type-2 cases, and 37.03% in Type-3 cases. A significantly higher rate of Type-1 closure pattern was observed in the myelomeningocele associated hydrocephalus cases (p < 0.01). CONCLUSION: In cases where ETV failure occurs, an endoscopic exploration with reopening of the ventriculostomy orifice is a preferable treatment option. Therefore, identifying patients who may benefit from the re-ETV procedure is essential. Type-1 closure pattern was observed to have a higher frequency in cases where hydrocephalus was associated with myelomeningocele, and the success rate of re-ETV seems to be lower in those cases.

Intradural Spinal Arachnoid Cysts in Children: A Collective Experience of 2 Centers.

BACKGROUND: Pediatric intradural spinal arachnoid cysts are rare and can cause spinal cord or nerve root compression. Spinal arachnoid cysts can cause pain, motor/sensory neurological impairments, gait disturbances, spasticity, and bladder problems depending on their location. This study discusses the clinical aspects, management, surgical nuances, and postoperative clinical outcomes of symptomatic congenital intradural spinal arachnoid cysts, which are rarely seen in the pediatric population. METHODS: Our study involves a retrospective evaluation of 8 pediatric patients who underwent surgery for spinal intradural arachnoid cysts at the Department of Neurosurgery, Kocaeli University School of Medicine, and the Department of Neurosurgery, Selros University School of Medicine. The demographic data of all patients, preoperative/postoperative clinical findings, surgical procedures, surgical complications, and radiological imaging were evaluated. RESULTS: The average age of the patients was 8.7 uated. surgicrange:1-17).The female to male ratio was 4:4. The most common complaint was weakness in the lower extremities (87.5%). Urinary problems (50%) and sensory disturbances (50%) were less frequently observed. All patients had dorsal localization of the cysts. Cyst excision was performed in 7 out of 8 patients, and cyst fenestration was performed in 1 patient. Postoperatively, 7 patients showed complete symptom resolution, while one patient had partial improvement. CONCLUSIONS: The success of surgical treatment depends on cyst location, neural tissue compression, and duration of symptoms. Complete removal or fenestration is determined by cyst location and accessibility. Intracystic shunts may be used in certain cases. Timely diagnosis and surgical intervention are crucial for improving neurological function in these rare cases.

Success of pure neuroendoscopic technique in the treatment of Sylvian arachnoid cysts in children.

INTRODUCTION: Neuroendoscopic approaches to Sylvian arachnoid cysts (SACs) constitute an alternative treatment option to craniotomy for fenestration and shunting procedures. In this study, the authors discuss their experience on pure neuroendoscopic technique in the treatment of SACs in children. RESULTS: The results of treatment of 20 children (range of age, between 7 months and 17 years) with Galassi type II (n, 5) or III (n, 15) SACs who were subjected to pure neuroendoscopic fenestration procedure were presented. It was possible to perform the cystocisternostomy endoscopically in all children with several stomies. The site of the opening was between the optic nerve and the carotid artery in 19, between the carotid artery and the oculomotor nerve in 17, and below the oculomotor nerve in 7. The stomies were enlarged in all cases using the double balloon. Three of the cases required repetition of the operation and two cases required "cystoperitoneal shunt" implantation. There was one minor complication in a patient who had an asymptomatic postoperative subdural effusion, which resolved spontaneously. Of the 18 cases, in which the neuroendoscopic procedures succeeded, 10 showed a reduction in cyst size. The mean follow-up period was 53 months. DISCUSSION: Our results suggest that "pure neuroendoscopic" approach can be used safely in the management of SACs in children. We recommend at least two fenestration sites for an effective marsupialization of the cyst within the basal cisterns. In pediatric cases, the use of a small diameter rigid endoscope allows to reach safely the planned target areas.

Role of interpeduncular and prepontine cistern cerebrospinal fluid flow measurements in prediction of endoscopic third ventriculostomy success in pediatric triventricular hydrocephalus.

AIM: The aim of the present study was to evaluate the correlation of the clinical success of the endoscopic third ventriculostomy (ETV) procedure with the measurements of cerebrospinal fluid (CSF) flow through the interpeduncular and prepontine cisterns in pediatric triventricular hydrocephalus. METHODS: 51 children (age range: 25-201 months; mean: 55.3 months) with primary aqueductal stenosis who have been treated with ETV were included in the study. All patients were analyzed by conventional and cine magnetic resonance imaging (MRI) before and after endoscopic treatment. Both the stroke volume and the flow velocity of CSF in the interpeduncular and prepontine cisterns were evaluated. The MRI findings were correlated with clinical outcome. Simple descriptive and independent t tests were used for statistical analyses, and receiver operating characteristic curve analysis was used for the cutoff value of the 'flow index' (FI). RESULTS: Among the 51 patients, 37 patients (72.5%) responded to ETV clinically during long-term follow-up. A further analysis was made for the prediction of who would respond to ETV, using the formula (stroke volume of prepontine cistern/stroke volume of interpeduncular cistern) ×100, which was defined as the FI. Early postoperative FI values of over 40% were significantly correlated with ETV success. CONCLUSION: Our results suggest that ETV success can be predicted by the ratio of early CSF stroke volume values of the interpeduncular and prepontine cisterns.

Early Endoscopic Ventricular Irrigation for the Treatment of Neonatal Posthemorrhagic Hydrocephalus: A Feasible Treatment Option or Not? A Multicenter Study.

AIM: Neonatal intraventricular hemorrhage (IVH) usually results in posthemorrhagic hydrocephalus (PHH). This multicenter study describes the approach of early neuroendoscopic ventricular irrigation for the treatment of IVH/PHH and compares the results with the cases that have been initially treated only with conventional temporary cerebrospinal fluid (CSF) diversion techniques. MATERIAL AND METHODS: The data of 74 neonatal PHH cases, that have been treated at three pediatric neurosurgery centers, were retrospectively analyzed. 23 neonates with PHH underwent early endoscopic ventricular irrigation (Group-A). 29 neonates were initially treated with conventional methods (Group-B). 22 neonates underwent ventriculosubgaleal shunt placement (Group-C). Complications, shunt dependency rates, incidence of multiloculated hydrocephalus and incidence of CSF infection were evaluated and compared retrospectively. RESULTS: Group-A, Group-B and Group-C cases did not differ significantly regarding gestational age and birth weight. In Group-A, 60.8% of the patients required a later shunt insertion, as compared with 93.1% of the cases in Group-B and 77.2% of the cases in Group-C. Group-A patients were also associated with significantly fewer CSF infections as well as significantly lower incidence for multiloculated hydrocephalus development as compared with Group-B and Group-C. CONCLUSION: Early removal of intraventricular blood degradation products and residual hematoma via neuroendoscopic ventricular irrigation is feasible and safe for the treatment of PHH in neonates with IVH. Neuroendoscopic technique seems to offer significantly lower shunt rates and fewer complications such as infection and development of multiloculated hydrocephalus in those cases.

Does Shunt Selection Affect the Rate of Early Shunt Complications in Neonatal Myelomeningocele-Associated Hydrocephalus? A Multi-Center Study.

AIM: To evaluate the effect of shunt selection on the rate of shunt revision due to early shunt complications in neonatal myelomeningocele-associated hydrocephalus. MATERIAL AND METHODS: The data of 157 neonatal myelomeningocele cases in three pediatric neurosurgery centers (Ankara University, Kocaeli University, Selcuk University) who underwent shunt surgery at the time of myelomeningocele repair between 2000 and 2014 were retrospectively analyzed. Clinical features of the patients, shunt types, and early shunt complications within the first three months were recorded. The patients were classified according to several features of the shunt systems, such as the valve type, valve size/contour and catheter type. RESULTS: Of all patients, 71 (45.2%) underwent early shunt revision surgery due to various complications. Mechanical complications were the most frequent cause of shunt failure, followed by infection. There was no significant difference among the valve types. Also, no significant difference was observed among the catheter types. Only valve contour/size (contoured regular/ultra-small/burr-hole/ cylindrical/neonatal) seemed to significantly affect the rate of early complications. The patients with neonatal-design valves or ultrasmall valves had significantly less complications, such as poor wound-healing, wound-dehiscence, cerebrospinal fluid leak or shunt exposure. The infection rate secondary to these complications was found to be lower. CONCLUSION: Myelomeningocele patients with prominent hydrocephalus frequently have a friable skin, due to reduced macrocrania-related subcutaneous tissues. Small-sized (neonatal-design or ultra-small) valves may significantly reduce the early shunt complication rate among this population.

Third Ventricle Floor Variations and Abnormalities in Myelomeningocele-Associated Hydrocephalus: Our Experience with 455 Endoscopic Third Ventriculostomy Procedures.

AIM: To evaluate the incidence of anatomical variations and abnormalities of the third ventricle floor encountered during the endoscopic third ventriculostomy (ETV) procedure in myelomeningocele-associated hydrocephalus (MAH) cases. MATERIAL AND METHODS: A retrospective analysis was performed on 455 pediatric MAH cases that had been treated with ETV. This case series consisted of the patients who were initially treated with ETV and also those who were treated with ETV for the management of cerebrospinal fluid shunt dysfunction. Variations and anomalies of the third ventricle floor were determined by reviewing the video records of the ETV procedures. RESULTS: The analysis of the data revealed that the rate of the MAH cases with variations and abnormalities of the third ventricle floor was 41.1%. The most common anatomical features were "thick and prominent massa intermedia" (37.1%) and "narrow tuber cinereum" (33.1%). CONCLUSION: This study documents the most common anatomical variations and abnormalities of the third ventricle floor in cases with MAH. Various anatomical situations and specific ventricular configuration of MAH cases may add an operative factor of difficulty which should be well recognized by the neurosurgeon who plans and executes an ETV procedure in this patient population.

Double myelomeningocele in a neonate: Case report and review of the literature.

The presence of myelomeningocele at multiple levels along the spinal column is extremely rare. There are only a few cases of double myelomeningocele reported in the literature. We report the case of a newborn male who had two myelomeningoceles with one at the cervical level and the other at the lumbar level. This unusual case report as well as a review of the literature is presented.

Lumbar teratoma presenting intradural and extramedullary extension in a neonate.

BACKGROUND CONTEXT: The association of teratomas and spinal malformations such as spina bifida, partial sacral agenesis, hemivertebrae, and diastematomyelia has been described in the literature. Reported cases, however, are mainly presacral or sacrococcygeal with an extremely rare presentation of intradural extension. PURPOSE: A case of lumbar teratoma with an intradural extension and extramedullary component and the clinical outcome following surgical treatment are reported. STUDY DESIGN/SETTING: To our knowledge, among the reported teratoma cases with an intradural extension and extramedullary component, our case has a distinguishing feature regarding the involvement of the lumbar spine. It is also the first case, showing no neurological deficit during the postoperative period. METHODS: A full-term, female infant presented with a 30 x 30 x 10 mm lumbar mass covered with normal skin. The mass contained an irregular, bone-like, hard and mobile material accompanying cystic components. Magnetic resonance imaging revealed a total closure defect of the first and second lumbar laminae and a subcutaneous mass with intradural extension. The lesion was found to penetrate the dural sac through an extended exposure from T12 to L3. There was no firm attachment of the intradural, extramedullary component of the lesion. Total removal of the tumor was achieved. RESULTS: The patient was discharged on day 7 without any neurological deficit or sign of hydrocephalus. The pathological examination showed a benign teratoma containing mature cartilage, muscle, adipose tissue, and glandular tissue. Follow-up at 2 years showed no recurrence or neurological deficit and a normal sphincter tone. Urodynamic evaluation was within normal limits. CONCLUSION: Accompanying a spinal dysraphic state, the mature teratoma in our case may support the idea of a tumor actually arising from a dysraphism and growing outward to produce the mass.

Surgical technique and outcome in cervical and thoracic myelomeningocoele surgery.

Cervical and thoracic myelomeningocoeles differ from common lumbosacral myelomeningocoeles in many respects. We review the surgical technique and outcome achieved for a series of six infants who underwent surgery for cervical or thoracic myelomeningocoele. Five patients, who had intradural exploration and microsurgical untethering of the spinal cord, were neurologically stable on follow-up. The other patient, who had a simple subcutaneous resection of the sac without release of the intradural tethering bands, was re-operated on 16 months later, with progressive neurological symptoms due to cord tethering. Following re-exploration and microsurgical untethering of the spinal cord, the neurological deficits significantly improved. We suggest that the surgical technique in these lesions should include careful intradural exploration and microsurgical release of the spinal cord by meticulous resection of all tethering bands. This enables postoperative neurological improvement and possible prevention of future neurological deficits due to cord tethering.

Fatal giant pediatric intracranial cavernous angioma.

Cavernous angioma is a benign vascular lesion that may occur in the central nervous system. The symptoms of raised intracranial pressure or consciousness alteration are usually related to acute hemorrhage. A previously healthy four-year-old girl was admitted with sudden loss of consciousness, vomiting and clonic seizures. Her Glasgow coma score (GCS) was 7 at presentation (5 m 1v 1e). Anisocoria and mydriasis were present on the right. Computerized tomography revealed a giant spherical, hyperdense intraaxial left frontoparietal lesion. The findings of surrounding vasogenic edema and compression of the adjacent lateral ventricle were seen on computerized tomography (CT). She was taken to operation and the mass was grossly excised. The GCS remained unchanged. A diagnosis of brain death was made. A cavernous hemangioma was diagnosed with pathologic examination. In conclusion, a cavernous angioma may occasionally follow a rapid and fatal course by causing gross hemorrhage in the pediatric age group. Early recognition by CT or magnetic resonance imaging (MRI) and prompt surgical evacuation are necessary.