Cranial and ventricular size following shunting or endoscopic third ventriculostomy (ETV) in infants with aqueductal stenosis: further insights from the International Infant Hydrocephalus Study (IIHS).

PURPOSE: The craniometrics of head circumference (HC) and ventricular size are part of the clinical assessment of infants with hydrocephalus and are often utilized in conjunction with other clinical and radiological parameters to determine the success of treatment. We aimed to assess the effect of endoscopic third ventriculostomy (ETV) and shunting on craniometric measurements during the follow-up of a cohort of infants with symptomatic triventricular hydrocephalus secondary to aqueductal stenosis. METHODS: We performed a post hoc analysis of data from the International Infant Hydrocephalus Study (IIHS)-a prospective, multicenter study of infants (< 24 months old) with hydrocephalus from aqueductal stenosis who were treated with either an ETV or shunt. During various stages of a 5-year follow-up period, the following craniometrics were measured: HC, HC centile, HC z-score, and frontal-occipital horn ratio (FOR). Data were compared in an analysis of covariance, adjusting for baseline variables including age at surgery and sex. RESULTS: Of 158 enrolled patients, 115 underwent an ETV, while 43 received a shunt. Both procedures led to improvements in the mean HC centile position and z-score, a trend which continued until the 5-year assessment point. A similar trend was noted for FOR which was measured at 12 months and 3 years following initial treatment. Although the values were consistently higher for ETV compared with shunt, the differences in HC value, centile, and z-score were not significant. ETV was associated with a significantly higher FOR compared with shunting at 12 months (0.52 vs 0.44; p = 0.002) and 3 years (0.46 vs 0.38; p = 0.03) of follow-up. CONCLUSION: ETV and shunting led to improvements in HC centile, z-score, and FOR measurements during long-term follow-up of infants with hydrocephalus secondary to aqueductal stenosis. Head size did not significantly differ between the treatment groups during follow-up, however ventricle size was greater in those undergoing ETV when measured at 1 and 3 years following treatment.

The components of shoulder and elbow movements as goals of primary reconstructive operation in obstetric brachial plexus lesions.

Most of the cases of obstetric brachial plexus lesions (OBPL) show satisfactory improvement with conservative management, but in about 25% some surgical treatment is indicated. The present paper analyzes the effects of primary reconstructive surgeries in aspect of achieving delineated intraoperatively goals. Children operated before the age of 18 months with follow-up period longer than 1 year were selected. Therapeutic goals established during the operation were identified by analysis of initial clinical status and operative protocols. The elementary movement components in shoulder and elbow joints were classified by assessing range of motion, score in Active Movement Scale and modified British Medical Research Council scale of muscle strength. The effect was considered satisfactory when some antigravity movement was possible, and good when strength exceeded M3 or antigravity movement exceeded half of range of passive movement. In 13 of 19 patients most of established goals were achieved at good level, in 2 at satisfactory level. Remaining 4 patients showed improvement only in some aspects of extremity function. In 2 patients improvement in some movements was accompanied by worsening of other movements. The analysis of results separated into individual components of movements showed that goals were achieved in most of the cases, simultaneously clearly indicating which damaged structures failed to provide satisfactory function despite being addressed intraoperatively. The good results were obtained mainly by regeneration through grafts implanted after resection of neuroma in continuity, which proves that this technique is safe in spite of unavoidable temporary regression of function postoperatively.

Correlation of facial nerve paresis and histopathological type of vestibular schwannoma.

The objective of the study was to evaluate the dependence of facial nerve paresis, as a symptom of cerebellopontine angle tumour, on the histopathological subtype of vestibular schwannoma, diagnosed from a post-operative histopathological examination. We retrospectively analysed 91 surgically treated patients with vestibular schwannoma. We studied the histopathological subtype and the preoperative condition of the facial nerve. The following WHO 2000 subtypes were distinguished: neurinoma cellular (51 cases), neurinoma conventional (23 cases), neurinoma ancient (11 cases), (other types: 2 neurofibroma and 2 ganglioneuroma). We analysed the dependence of facial nerve paresis on the histological subtype of tumours and their sizes. The analysis was based on the traditional classification: Antoni A (11 cases), Antoni B (12 cases) Antoni A/B (23 cases) and Antoni B/A (40 cases). 30 patients (30%) in the analysed group had paresis of the facial nerve preoperatively. Preoperative facial paresis occurred frequently in subtypes "cellular" and Antoni B, and rarely in subtypes conventional and Antoni A and B/A. In the small tumour cases (up to 20 mm), facial nerve paresis occurred frequently in subtypes cellular and conventional, as well as in Antoni A and A/B.

Stereotactic methods in interdisciplinary diagnosis and treatment of posterior fossa tumours.

For over 2 years, we have had access to latest generation apparatus and software for planning and stereotactic treatment as well as for x-rays treatment. Until now, we have carried out over 100 procedures. These included 52 stereotactic biopsies of neoplasms, some of them located within the structures of the posterior fossa. In this report, we have discussed the possibilities and effectiveness of diagnosis and treatment of tumours located in different structures, including posterior cave. In the study, we used stereotactic methods. We have described biopsies of the following tumours: cerebellar hemisphere tumour (diagnosed as "metastatic atypic planoepitheliale carcinoma" in a patient with coexisting orbit lymphoma), a bifocal lesion (located in cerebellar hemisphere and cerebellar peduncle, diagnosed as pilocytic astrocytoma of WHO malignancy grade II/III), and lesion (located in the pons, diagnosed as pilocytic astrocytoma WHO grade II).

[Multimodal intraoperative electrophysiological monitoring during cerebellopontine angle tumor surgery. Benefit or loss?]. / Wielomodalne sródoperacyjne monitorowanie elektrofizjologiczne w trakcie operacji guzów kata mostowo-mózdzkowego. Zysk czy strata?

In the Neurosurgery Department, Silesian University School of Medicine, continuous monitoring of selected neurophysiological functions of the central and peripheral nervous system was introduced in 1998 as a routine procedure in cerebellopontine angle surgery and some other operations performed in the petroclival region. Such benefits from this method as increased patient safety, availability of information about dynamic changes in the monitored structures, and the possibility of cranial nerves localization using stimulation in the operating area, are quite obvious. The paper presents results of a detailed statistical analysis of the amount of time required for preparation and for operating in 174 cerebellopontine angle tumor surgeries performed in the years 1986-2002 with (group M) and without (group BM, before the year 1998) intraoperative monitoring. Subgroups distinguished according to the histological type of tumor were evaluated. Out of 95 procedures performed in group M, 57 were operations of acoustic neurinoma cases, 15 meningiomas, 8 cases of epidermal cyst, and 15 other growth processes in the cerebellopontine angle region. Among 79 operations in group BM, there were 57 cases of acoustic neurinoma, 4 cases of meningioma, 8 cases of epidermal cyst, and 10 of other types of neoplastic growth. In group M as compared to group BM the pre-op. preparation time was found to be significantly longer in cases of the VIII-th nerve neurinoma, and of other tumors. No statistically significant differences in the amount of operating time in were found between any of the subgroups. Both radicality of tumor removal and facial nerve status have clearly improved since intraoperative monitoring was introduced.

[Endoscopic ventriculostomy of the third ventricle in adults. Own experience]. / Wentrikulostomia endoskopowa komory III u doroslych. Doswiadczenia wlasne.

Only few reports can be found on endoscopic third ventriculostomy (ETV) in the Polish literature, and the majority of other reports concern paediatric or mixed population. This has induced the authors to report their experience with ETV in adults, reporting the results and discussing the usefulness and effectiveness of this procedure, causes of complications and failure. ETV was carried out in 20 patients aged over 18 years in a two-year period, beginning in 1999. In 13 cases (64%) the cause was external compression of CSF system by tumour leading to hydrocephalus. In 3 cases aqueduct stenosis was producing hydrocephalus, in 3 cases arachnoid cyst, perisellar or situated in posterior part of the third ventricle, was the cause, and in one case colloidal cyst of the third ventricle. The outcome were analysed according to clinical and radiological criteria finding that the ETV was successful in 90% of cases by clinical criteria, and in 88% by radiological criteria. Only unimportant clinical complications were reported without major consequences. It is concluded that ETV is a very useful method for hydrocephalus treatment in adults, especially if caused by blockade of CSF pathways by tumour or arachnoid cysts in the vicinity of the third ventricle.