Successful conservative management of Gorham disease of the skull base and cervical spine.

Gorham's disease, also called massive osteolysis or vanishing bone disease, is an enigmatic condition caused by endothelial proliferation occurring in bone and soft tissue. Death is frequent when there is spinal or visceral involvement. We present a case of spinal and skull base Gorham's disease that was reversed by radiation therapy administered while the spine was supported by a halo vest.

Multilevel lumbar disc herniation in 12-year-old twins.

Herniation of a lumbar disc in the pediatric age group is rare. A 12-year-old female twin developed backache and left sciatica after a mild lifting injury. Magnetic resonance imaging of the spine showed multilevel lumbar disc herniation.

Therapy of giant intracranial aneurysms in the elderly.

A series of 13 elderly patients (eight female, five male) with giant intracranial aneurysms is presented. The mean age was 67.8 years, with a range of 57-81 years.

Management of hydrocephalus in ilio-omphalopagus conjoined twins.

One member of ilio-omphalopagus conjoined twins developed symptomatic hydrocephalus. Uneventful ventriculoperitoneal shunting improved the baby's condition. Technical aspects of the neurosurgical and anesthetic management in this case are discussed.

Intracranial arterial duplex Doppler waveform analysis in infants.

Duplex sonography of the brain was performed on 130 pediatric patients: 53 with normal brains, 22 with intracranial hemorrhage, 15 with hypoxic-ischemic encephalopathy, 29 with hydrocephalus requiring ventricular shunting, and 11 with ventriculomegaly without hemorrhage or shunting. Doppler arterial waveforms from the Circle of Willis showed increased pulsatility in 82% of patients with intracranial hemorrhage, 53% of patients with hypoxic-ischemic change, and in only 31% of patients with hydrocephalus requiring shunt and 36% of patients with ventriculomegaly without shunt or hemorrhage. Mean pulsatility was increased (p less than 0.

High activity iodine 125 endocurietherapy for recurrent skull base tumors.

Experience with endocurietherapy of skull base tumors is reviewed. We present our cases of recurrent pituitary hemangiopericytoma, radiation-induced recurrent meningioma, recurrent clival chordoma, recurrent nasopharyngeal cancer involving the cavernous sinus, and recurrent parotid carcinoma of the skull base which were all successfully retreated with high-activity 125iodine (I-125) permanent implantation.

Outpatient pediatric neurosurgery.

In a 16-month period, 31 children underwent outpatient operations for a variety of neurosurgical problems. None of the patients experienced any anesthetic complications. One patient was admitted for management of a surgical complication and was discharged uneventfully 4 days later.

Neurosurgical complications of pediatric orthotopic liver transplantation.

Liver transplantation is the only definitive treatment of end-stage liver disease. The University of Nebraska began its hepatic transplantation program in July 1985. Since that time, 43 children and 48 adults have undergone orthotopic liver transplantation (OLTx) with survival rates to date of 79.

Metameric capillary hemangioma producing complete myelographic block in an infant. Case report.

A variety of lesions of ectodermal, mesodermal, (rarely) endodermal, or mixed-cell layer origin involve the region of the conus medullaris. Some of these abnormalities produce cord tethering and others, such as lipoma, frequently present as masses. In the present case, an infant was discovered to have a lesion most closely resembling a capillary hemangioma involving the skin of the midline and right buttock, the deep soft tissues of the right buttock, the dura, and the conus medullaris.

Recurrent bacterial meningitis: coronal thin-section cranial computed tomography to delineate anatomic defects.

Three patients with histories of recurrent bacterial meningitis were previously examined with skull and sinus radiographs, routine cranial computed tomography, intrathecal radioisotope tracer studies, and immunologic evaluation. None of these studies were diagnostic. Pneumococcal vaccine and prophylactic penicillin therapy were ineffective in preventing recurrent episodes in two cases.

Aspergillus infections of the lumbar disc spaces. Report of three cases.

Three cases of lumbar vertebral interspace infection due to the Aspergillus fungus are presented. Two patients responded to vigorous surgical therapy in combination with prolonged administration of antifungal agents. The third patient died of complications related to the antibiotic therapy.

Ectopic immature renal tissue over the dorsum of lumbar and sacral area in two infants.

During reparative surgery for meningomyelocele of the lumbar area, a 7-week-old female infant was found to have a small, well-delineated, subcutaneous, renal blastema. A 3-month-old female infant was found to have immature renal tissue, consisting of glomeruli and tubules, in a soft tissue swelling dorsal to the sacrum. Neither of these patients showed neurologic or renal abnormalities.