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   2009| July-December  | Volume 4 | Issue 2  
    Online since October 29, 2009

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Meningiomas in children: A study of 18 cases
Nirav Mehta, Sanat Bhagwati, Geeta Parulekar
July-December 2009, 4(2):61-65
DOI:10.4103/1817-1745.57322  PMID:21887184
Background : Intracranial meningiomas are rare tumors in children accounting for 0.4-4.6% of all primary brain tumors in the age group of 0-18 years. Objective : To retrospectively analyze the epidemiological profile, clinical features, radiological findings, type of excision, histopathological findings, and overall management profile of these patients. Materials and Methods : Eighteen consecutive cases of meningioma in patients under 18 years of age admitted and operated at our institute between the years 1974-2005 were included in this study. Results : The mean age of patient at presentation to our hospital was 12.81 years. The male to female ratio was 1.57:1. The median preoperative duration of symptoms was 1.2 years. An increased incidence was seen in patients with neurofibromatosis. Intraventricular and skull base locations were common. Total tumor excision was achieved in all cases. Conclusion : A higher incidence of atypical and aggressive meningiomas is seen in children. Children with complete resection and a typical benign histology have a good prognosis.
  11 6,118 546
Pediatric craniofacial surgery for craniosynostosis: Our experience and current concepts: Part -1
YN Anantheswar, NK Venkataramana
July-December 2009, 4(2):86-99
DOI:10.4103/1817-1745.57327  PMID:21887189
Craniostenosis is a disease characterized by untimely fusion of cranial sutures resulting in a variety of craniofacial deformities and neurological sequelae due to alteration in cranial volume and restriction of brain growth. This involves vault sutures predominantly, but cranial base is not immune. Association with a variety of syndromes makes the management decision complex. These children need careful evaluation by multiple specialists to have strategic treatment options. Parental counseling is an important and integral part of the treatment. Recent advancements in the surgical techniques and concept of team approach have significantly enhanced the safety and outcome of these children. We had an opportunity of treating 57 children with craniostenosis in the last 15 years at our craniofacial service. Out of them, 40 were nonsyndromic and 17 were syndromic variety. We describe our successful results along with individualized operative technical modifications adopted based on the current understanding of the disease.
  7 8,261 368
Anal extrusion of a ventriculo peritoneal shunt tube: Endoscopic removal
Sreedhar Vuyyuru, Sreenivas R Ravuri, Vamsidhar R Tandra, Manas K Panigrahi
July-December 2009, 4(2):124-126
DOI:10.4103/1817-1745.57342  PMID:21887196
We describe the extrusion of a ventriculo peritoneal shunt tube from the anus into a 6-year-old boy following the placement of a ventriculo peritoneal shunt for postoperative periventricular tumor-induced hydrocephalus. He was admitted with a complaint of extrusion of a tube through anus on and off during bowel evacuation. He was evaluated with an X-ray of the abdomen which was showing a coiled tube in descending and sigmoid colon, confirmed by sigmoidoscopy. The proximal end was exposed for external ventricular drainage and distal end was removed endoscopically. The patient was watched for peritonitis and managed conservatively. The proximal end of the tube was removed after 5 days of external ventricular drainage and after ruling out ventriculitis and meningitis. Bowel perforation by a ventriculo peritoneal tube is a rare complication. Diagnosis is often difficult and delayed. Most of the bowel perforation is seen in young patients.
  6 5,861 206
Adhesion molecule levels in serum and cerebrospinal fluid in children with bacterial meningitis and sepsis
Soad M Jaber, Enas A Hamed, Sherifa A Hamed
July-December 2009, 4(2):76-85
DOI:10.4103/1817-1745.57326  PMID:21887188
Background : Adhesion molecules play a role in leukocyte recruitment during central nervous system (CNS) inflammation. Aim: This study was designed to compare serum, cerebrospinal fluid (CSF) concentrations of adhesion molecules in children with meningitis and sepsis, and to evaluate their sources. Setting : This study was carried out at Pediatric Department, King Abdulaziz University Hospital from January 2007 to June 2008. Design: Serum and CSF samples were collected on admission from meningitis (n = 40), sepsis (n = 20) patients, and sera from controls (n = 20). Materials and Methods : Endothelial (E), leukocyte (L), platelet (P) selectins intercellular cell adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecules-1 (VCAM-1) were measured using ELISA. Statistics : ANOVA and Spearman's correlations were used. Adhesion molecules with albumin concentration were estimated in CSF/serum to calculate concentration quotients. Results : In meningitis, serum sE-, sL-, sP-selectins sICAM-1, sVCAM-1 levels were higher than controls. Compared to sepsis, serum sE-selectin, sL-selectin, sVCAM-1, CSF-sL-selectin, CSF-sVCAM-1, VCAM-1 ratio and index were higher, while serum sP-selectin was lower than meningitis. sE-selectin ratio, CSF sICAM-1 were higher in meningitis with positive than negative culture. The sE-selectin index was higher in meningitis with neurological complication than those without it. In meningitis, correlation was found between CSF protein and CSF white blood cell counts (WBCs), CSF sICAM-1, CSF sVCAM-1 and between CSF sE-selectin and CSF sICAM-1. Conclusions : This study supports the role of adhesion molecules especially sL-selectin, sVCAM-1 in meningitis and suggests further research to determine their use as biomarkers for meningitis and use of their antagonists as therapeutic for CNS inflammation. The presence of discrepancy of CSF/serum ratios for molecules of same molecular weight suggest intrathecal shedding in addition to diffusion through the blood-CSF barrier.
  6 3,927 233
Unusual complication of ventriculoperitoneal shunt surgery
Tarun Agarwal, Sanjay Pandey, Ashutosh Niranjan, Veenu Jain, Shashank Mishra, Vishal Agarwal
July-December 2009, 4(2):122-123
DOI:10.4103/1817-1745.57340  PMID:21887195
Ventricular shunts are commonly employed in the management of hydrocephalus, and numerous complications such as dissection or migration have been reported in the literature besides shunt malfunction. We present a case of the migration of the peritoneal catheter into the scrotum who attended at our institute. He was managed successfully, but subsequently developed intraabdominal cystic swelling for which he was reoperated.
  5 4,992 217
Dandy-Walker variant associated with bipolar affective disorder
Anand Lingeswaran, Deepak Barathi, Gyaneswahr Sharma
July-December 2009, 4(2):131-132
DOI:10.4103/1817-1745.57341  PMID:21887198
The Dandy-Walker malformation is a congenital brain malformation, typically involving the fourth ventricle and the cerebellum. To date, the Dandy-Walker syndrome has not been described in association with bipolar disorder type I mania, and therefore we briefly report the case of a Dandy-Walker variant associated with acute mania. A 10-year-old boy was brought by his mother to the outpatient clinic of the Department of Psychiatry of a tertiary care hospital, with symptoms of mania. The MRI brain of the patient showed a posterior fossa cystic lesion, a giant cisterna magna communicating with the fourth ventricle and mild hypoplasia of the cerebellar vermis, with the rest of the structures being normal and no signs of hydrocephalus. These findings showed that the patient had a Dandy-Walker variant. He responded partially to valproate and olanzepine, which controlled the acute manic symptoms in the ward.
  3 3,920 237
Therapeutic paradox in CNS tuberculosis
Geetanjali Jindal, Debabrat Ghosh
July-December 2009, 4(2):133-134
DOI:10.4103/1817-1745.57331  PMID:21887199
  3 2,482 193
Outcome of endoscopic third ventriculostomy and Chhabra shunt system in noncommunicating non-tumor childhood hydrocephalus
OE Idowu, LO Falope, AT Idowu
July-December 2009, 4(2):66-69
DOI:10.4103/1817-1745.57323  PMID:21887185
Background : Endoscopic third ventriculostomy (ETV) the main alternative to ventriculoperitoneal shunt (VPS) is just beginning to have a foothold in West Africa. It provides a great opportunity for a hydrocephalic child to be shunt free. The purpose of this paper is to compare outcome following ETV and VPS (using the cheap Chhabra shunt) in children with noncommunicating non-tumoral hydrocephalus in an environment where late presentation is the norm. Materials and Methods : Sixty-three pediatric patients (<6 years) with hydrocephalus who underwent a VPS or ETV at our hospital were included in this study. The study period was of 30 months (January 2006 till June 2008). Clinically successful outcome was defined as no event occurring during or after surgery that resulted in an alternate surgical procedure, or significant post-operative complication that includes death. All complications related to the procedures were also analyzed. Results : The outcome of surgical intervention was not significantly related to the gender, age of the patient at surgery, or type of surgery. The post-operative complication rate was similar in both groups. Conclusions : The clinical outcome of ETV is comparable to that of VPS, with the added benefit of no shunt-related problems; and being a short procedure, patient anesthesia and operation time, hospital stay, and cost are significantly reduced. We consider ETV to be the procedure of choice for the treatment of noncommunicating nontumoral hydrocephalus in the pediatric population.
  3 5,214 376
Pediatric craniofacial surgery for craniosynostosis: Our experience and current concepts: Parts -2
YN Anantheswar, NK Venkataramana
July-December 2009, 4(2):100-107
DOI:10.4103/1817-1745.57328  PMID:21887190
Craniostenosis associated with other syndromes poses several clinical and management challenges. Involvement of cranial, facial, and systemic defects with an underlying genetic abnormality needs comprehensive understanding, to plan appropriate and safe treatment modalities. Often, these children require staging involving several/multiple surgical procedures. Unsuccessful outcomes and retrusion of the deformities are common in comparison to the nonsyndromic variety. We present our experience in treating 17 children with syndromic craniostenosis with successful outcomes and minimal morbidity. We also describe the principles behind the staging. Technology adoption has improved the results as well as reduced the complications to an acceptable minimum.
  3 5,703 334
Infantile nonconvulsive status epilepticus caused by herpes encephalitis
Gulnar Sensoy, Tulin Revide Sayli, Alev Guven, Gozde Kanmaz
July-December 2009, 4(2):139-141
DOI:10.4103/1817-1745.57336  PMID:21887203
  2 2,338 157
Acute encephalopathy associated rotavirus gastroenteritis
Faruk Incecik, M Ozlem Herguner, Sakir Altunbasak, Huseyin Solgun
July-December 2009, 4(2):141-143
DOI:10.4103/1817-1745.57337  PMID:21887204
  1 3,227 227
Magnetic resonance imaging of bilateral mesial temporal sclerosis in chronic kernicterus
Virginia C Mendes, Fernando Costa, Antonia Silva, Maria Jose Rosas
July-December 2009, 4(2):120-121
DOI:10.4103/1817-1745.57339  PMID:21887194
Kernicterus is an encephalopathy resulting from the cerebral deposition of unconjugated bilirubin in the neonatal period. We report a case of kernicterus where MRI demonstrated bilateral symmetric high signal intensity and volume loss in the hippocampus in addition to globus pallidus and subthalamic nucleus hyperintensity onT2-weighted images. The authors believe that hippocampal sclerosis, plays a role in adding specificity to the imaging diagnosis of kernicterus.
  1 3,651 171
Candidal infections of ventriculoperitoneal shunts
VP Baradkar, M Mathur, A Sonavane, S Kumar
July-December 2009, 4(2):73-75
DOI:10.4103/1817-1745.57325  PMID:21887187
Although ventriculoperitoneal (VP) shunt infection is a common complication of shunt procedures, fungal infection is considered to be rare. In the present study, we performed retrospective analysis of six cases in which candida infection occurred. In all these six cases, VP shunt was performed in children for hydrocephalus and the onset of symptoms varied between seven days to one month after the surgical procedure was performed. The commonest clinical signs and symptoms were fever (100%), vomiting (100%), and altered sensorium (50%). The commonest isolate was Candida albicans (66.66%) followed by Candida parapsilosis and Candida glabrata in one case each. All the patients were successfully treated with Amphotericin B and there was no mortality recorded.
  1 3,360 225
Gluteal pseudophallus in a male child: A rare cutaneous marker of occult spinal dysraphism
Abdul Rashid Bhat, Tariq H Raina, Sajad Arif, Altaf R Kirmani, Mohammed Afzal Wani, Imtiyaz Naqash, AU Ramzan
July-December 2009, 4(2):127-130
DOI:10.4103/1817-1745.57343  PMID:21887197
Congenital midline paraspinal cutaneous markers have been practically linked to the location and nature of neural-tissue lesions. One of the most interesting congenital midline paraspinal cutaneous markers has been the human tail in the lumbosacral region, with underlying spinal dysraphism. Human tails have many shapes and sizes and are usually localized to the lumbosacral region. After a complete neurological examination, the MRI is the most sensitive diagnostic modality to reveal the underlying occult spinal dysraphic state. Surgical excision is aimed at untethering of the spinal cord in symptomatic children and for aesthetic reasons in asymptomatic patients. Here we report an asymptomatic male child with normal external genitilia, whose tail is attached to the gluteal region like an adult phallus and investigations revealed an underlying spinal dysraphic state.
  - 4,481 181
Glutaric aciduria type1: CT diagnosis
Santosh P.V Rai
July-December 2009, 4(2):143-143
DOI:10.4103/1817-1745.57338  PMID:21887205
  - 2,255 158
Exencephaly in a live, full term fetus
IV Renuka, R Sasank, S Indira Devi, M Vasundhara
July-December 2009, 4(2):134-136
DOI:10.4103/1817-1745.57332  PMID:21887200
  - 3,207 134
Congenital cystic eye with meningocele
Jagath Lal Gangadhar, Bhagavathullah Indiradevi, Venkatesh C Prabhakaran
July-December 2009, 4(2):136-138
DOI:10.4103/1817-1745.57334  PMID:21887201
  - 2,266 136
Kawasaki disease presenting atypically as meningoencephlitis
Parveen Bhardwaj, Ram Krishan Kaushal, Hemant Gupta
July-December 2009, 4(2):138-139
DOI:10.4103/1817-1745.57335  PMID:21887202
  - 2,311 159
Role of biplane digital subtraction angiography, and 3D rotational angiography in craniopagus twins: A case report, detailed pictorial evaluation, and review of literature
Lakshmi Sudha, Bhawna Dev, Ravindra Kamble, Santhosh Joseph
July-December 2009, 4(2):113-116
DOI:10.4103/1817-1745.57330  PMID:21887192
Cranially conjoined twins (craniopagus) are regarded as one of the rarest human malformations. Craniopagus represents 2 to 6% of conjoined twins and is the rarest type of disorder. A conventional angiogram with three dimensions is needed to confirm the exact extent of sharing of the arterial / venous tree. 3D angiography was first proposed by CORNELIUS and advanced into clinical practice by VOIGT in 1975. We present a case of craniopagus vertical type II twins, evaluated for cerebral circulation.
  - 3,232 144
Changes in the globus pallidus in chronic kernicterus
Umesh C Parashari, Ragini Singh, Rajesh Yadav, Pallavi Aga
July-December 2009, 4(2):117-119
DOI:10.4103/1817-1745.57333  PMID:21887193
The objective of the study was to establish the diagnosis of kernicterus as a cause of seizures and abnormal movements in a 1-year-old child. We performed an MRI of the brain of the child on our 1.5 T scanner. The MRI of the patient showed high signals on T2-weighted images in the globus pallidus bilaterally, with no evidence of mass effect. Because of an increased risk of hearing loss, the brain-stem evoked response examination was also performed. The brain-stem evoked response examination showed bilateral severe sensorineural hearing loss. The presence of isolated hyperintense signals in basal ganglia (globus pallidi) was very useful in the evaluation of the structural changes in posticteric bilirubin encephalopathy.
  - 4,599 247
Endoscopic third ventriculostomy
NK Venkataramana, Shailesh A.V Rao, Arun L Naik
July-December 2009, 4(2):108-112
DOI:10.4103/1817-1745.57329  PMID:21887191
  - 2,132 179
Effect of detethering on bladder function in children with myelomeningocele: Urodynamic evaluation
Ahmed S El - Hefnawy, Bassem S Wadie
July-December 2009, 4(2):70-72
DOI:10.4103/1817-1745.57324  PMID:21887186
Aim of Work : To study the effect of detethering of the cord on urodynamic changes in patients with myelomeningocele. Materials and Methods : We retrospectively reviewed the urodynamic data of 37 patients. In all of them myelomeningocele primary repair was carried out. The patients were divided into two groups: (1) those who underwent detethering of the cord and (2) those who did not. Neurourological examination, filling cystometry, assessment of bladder management, and fecal continence were studied in all patients. Results : Eleven (29.7%) out of 37 patients underwent detethering of the cord. The mean age at presentation was 10.1 ± 4 and 10.8 ± 7 years in groups 1 and 2, respectively (P 0.7). Nocturnal and diurnal enuresis was found in 45% of group 1, while it was found in 69% of group 2. Fecal soiling was detected in 18% in group 1 and in 38.5% in group 2. Mean bladder capacity was 210 ± 125 cc and 199 ± 120 cc for groups 1 and 2, respectively (P 0.8). Uninhibited detrusor contractions were noticed in nine patients (82%) of group 1 and in 21 patients (81%) of group 2. Delta det LPP was lower in group 1 (35 ± 19 cm H 2 O) than in group 2 (46 ± 40 cm H 2 0). Conclusion : Detethering of the cord had a positive impact on patients with myelomeningocele in terms of lowering of det LPP and accordingly decreasing the risk of upper tract deterioration.
  - 3,928 342
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