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2006| January-June | Volume 1 | Issue 1
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Medulloblastoma in children: Prognostic factors and predictors of outcome
Girish Menon, S Nair, T Muthurethinam, K Krishnakumar, RN Bhattacharya
January-June 2006, 1(1):16-20
To determine the relative contributions of clinical, radiological and histopatholgical predictors of survival in children with medulloblastoma (MB) and to compare it with their adult counterparts.
Materials and Methods:
Retrospective case record analyses of 79 children (<16 y) operated after Jan. 1990, who have completed at least 5 y of follow-up. The following variables were assessed by bivariate analysis: age, CT scan location of the lesion, brainstem invasion, extent of excision, histological subtype. Statistical analysis was performed using Chi-square test, Fischers test and Student's
Near-total to total excision could be achieved in 59 (74.6%) cases. Twenty-three patients (29.11%) required CSF diversion procedures. Histopathology revealed features of classical medulloblastoma in 63.2%, thermoplastic variant in 11% and glial differentiation in 25.3% of cases. Postoperative mutism was seen in 14 (17.72%) patients. All patients received adjuvant therapy. On follow-up, 34 patients were found to have posterior fossa recurrence and four patients were re-operated. An additional 17% of patients were found to have either spinal or supratentorial metastasis on follow-up. The overall 5-year recurrence-free survival rate was 19 (24.05%). Mortality was recorded in 23 patients and nearly 29 patients who were severely disabled on follow-up were referred to terminal care centres.
In spite of recent advances in management, children with medulloblastoma still carry a poor prognosis. We observed poor outcome in children below 7 y of age. Vermian location had a better outcome in adults but not in children. Desmoplastic variant was observed to be a significant prognostic factor in paediatric, group while brain stem invasion carried poor prognosis for both.
Suprasellar arachnoid cyst with bobble-head doll movements: A management option
Vikram Muthusubramanian, Anil Pande, Madhabushi Chakravarthy Vasudevan, Ramamurthi Ravi
January-June 2006, 1(1):24-26
The authors describe their experience with endoscopic ventriculo-cysto-cisternostomy and placement of cisterno-cysto-venticulo peritoneal shunt for suprasellar arachnoid cyst for a child with bobble head doll movements. The abnormal head movements improved and follow up imaging showed reduction in the cyst and ventricular size. The benefits of minimally invasive endoscopic ventriculocystocisternostomy with endoscopic guided placement of cisterno-cysto-ventriculo peritoneal shunt is been discussed.
Cerebellar glioblastoma multiforme presenting as a cerebellopontine angle mass
Anupam Jindal, Awadhesh Kumar Jaiswal, Sushila Jaiswal, Paritosh Pandey, Ashok Kumar Mahapatra, Mehar Chand Sharma
January-June 2006, 1(1):21-23
Cerebellar glioblastoma multiforme (GBM) is a highly malignant brain tumour, which is exceedingly rare and such tumour presenting as cerebellopontine angle (CPA) mass is even rarer. We here discuss the case of a 15-year-old girl who had cerebellar GBM presenting as CPA mass that resembled meningioma on CT scan and was managed successfully with minimal problems.
Paediatric intracranial aneurysms
AA Wani, S Behari, RN Sahu, AK Jaiswal, VK Jain
January-June 2006, 1(1):11-15
Intracranial aneurysms in childhood account for 1-2% of intracranial aneurysms., These aneurysms have unique characteristics that make them different from those in adults. These differences are evident in their epidemiology, location, clinical spectrum, association with trauma and infection, complications and outcome.
Primer on pediatric intracranial ependymomas
January-June 2006, 1(1):5-10
Aims and Objectives:
To review the clinical features and current understanding of the biology and management of pediatric ependymoma, critically analysing the different treatment modalities.
Materials and Methods:
The MEDLINE database, bibliographies of selected articles, and current English-language texts on the subject were reviewed. A Pubmed search was made with keywords pediatric, intracranial, ependymoma, surgery, chemotherapy, and radiotherapy. Most recent articles and also significant older articles having all above said words were selected and their results were compared in detail.
Almost all articles stress the complete or near total resection of the tumor at first surgery followed by radiotherapy in patients older than 3 years of age and chemotherapy in younger children. Conformal radiation therapy (CRT) is a technique which has promising results.
Local tumor control is single most important prognostic factor. This is best achieved through gross total tumor resection wherever possible. Radiotherapy should be offered to all patients (>3-years age) with focused dose (CRT) to tumor bed. Chemotherapy with the current agents does not appear to hold much promise. However, it may be useful in the context of providing the surgeon with an opportunity to do further surgery on a tumor that is less vascularized.
Acute carotid artery injury
Suresh K Sankhla
January-June 2006, 1(1):27-30
A case of acute carotid artery injury with unusual presentation is described. Although the clinical and radiographic examinations were in favor of a large cerebral infarction, the initial angiogram in this patient failed to demonstrate any intracranial or extracranial vascular injury. A subsequent angiogram, however, demonstrated a pseudoaneurysm of the left common carotid artery which was treated surgically. He made an excellent recovery in his neurological functions postoperatively.
Germinoma of fourth ventricle: A case report and review of literature
Anand B Kakani, Vikram S Karmarkar, Chandrashekhar E Deopujari, Rajan M Shah, Nadir E Bharucha, Girish Muzumdar
January-June 2006, 1(1):33-35
Coiling of ventriculo-peritoneal shunt in the subdural space: A possible etiology
Sil Kaushik, Sandip Chatterjee
January-June 2006, 1(1):31-32
Migration of ventriculo-peritoneal shunt into the subdural space is a reported but rare complication. We report a case of migration and coiling of both ends of the shunt into the subdural space. We also hypothesize that coiling of the shunt tube during packaging predisposes to elastic recoil and tendency of such migration.
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January-June 2006, 1(1):3-4
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