Histopathologic and Spectrometric Evaluation of Bony Components of Synostotic Suture and Parietal Bone in Children with Sagittal Synostosis.

Aim: To understand the characterization of the ossification process both in the synostotic suture, and the adjacent parietal bone.

Material And Methods: The surgical procedure for the 28 patients diagnosed with sagittal synostosis consisted of removing the synostotic bone as a whole, if possible, "Barrel-Stave" relaxation osteotomies, and strip osteotomies to the parietal and temporal bones perpendicular to the synostotic suture. The synostotic (group I) and parietal (group II) bone segments are obtained during osteotomies.

Angiographic Angular Adjustment: Matching Angiographic Views and Surgical Findings to Estimate the Actual Arterial Anatomy in Surgery for Intracranial Aneurysm - Technical Note.

Aim: To describe a simple technique of angular adjustment of cerebral angiographic views that makes them similar to the surgical field under the operation microscope.

Material And Methods: The technique of angular adjustment consists of three steps: 1. Upside-down 180-degree rotation of the standard angiographic anterior-posterior view, 2.

Reattachment of the Temporalis Muscle After Frontoorbital Advancement in Craniosynostosis Surgery.

Craniosynostosis surgery may result in temporal hollowing occasionally. Overexpansion of the normal side and undergrowth of the affected side exacerbate the problem in unilateral cases (like unicoronal synostosis). Temporalis muscle lies in the temporal fossa, and it is usually severed or detached from its origin in order to reach the lateral aspect of the fronto-orbital bar.

Spontaneous Intracystic Haemorrhage of an Arachnoid Cyst Associated with a Subacute Subdural Haematoma: A Case Report and Literature Review.

Arachnoid cysts (ACs) are congenital malformations that may develop anywhere in the subarachnoid space along the cerebrospinal axis, but are mostly observed in the temporal fossa and Sylvian fissure, predominantly on the left side. ACs account for 1% of all intracranial space-occupying lesions. ACs are potential risk factors for subdural haematoma in all age groups following a traumatic head injury.

Successful Application of the Ventriculo-Gallbladder Shunt: A Salvage Procedure.

Ventriculo-gallblader shunt is very rarely used in the treatment of hydrocephalus. A 44-year-old male with ventriculoatrial shunt dysfunction was evaluated. His ventriculoatrial shunt was not working.

Spontaneous Resolution of a Sylvian Arachnoid Cyst in a Child: A Case Report.

We report the case of a 7-year-old boy with an incidentally diagnosed left sylvian arachnoid cyst. At a clinical follow-up of 2 years, cranial computed tomography scans found the cyst to be totally resolved. The mechanism of this rare spontaneous resolution of an arachnoid cyst is discussed.

Stepwise Removal of the Fused Midline Parietal Bone to Avoid Superior Sagittal Sinus Injury in Infants with Sagittal Synostosis.

This work describes a simple technique for the safe removal of the midline parietal bone with the synostotic sagittal suture in infants with sagittal synostosis to avoid dural tearing and bleeding from the superior sagittal sinus. The technique consists of stepwise removal of the midline parietal bone in three pieces instead of one piece, starting with the anterior one-third midline bone being safely freed from the underlying dural sinus and then transversely cut using a craniotome. The step is repeated twice for the middle and distal one-third of the bone respectively.

Children with Metopic Ridge.

Aim: The premature closure of the metopic suture results in metopic synostosis, also known as trigonocephaly. However, there is a group of children who have only a frontal metopic ridge, obvious with inspection and fingertip palpation, without the clinical features of trigonocephaly. This study aims to report a group of children with metopic ridge with a special emphasis on the definition and the diagnostic features.

Spontaneous Rhinorrhea mimicking sinusitis.

Spotaneous or non-traumatic cerebrospinal fluid rhinorrhea is an uncommon condition and may present a diagnostic challenge to clinicians. This condition is often being misdiagnosed for allergic rhintis or chronic sinusitis since the precipitating cause is not readily apperent in most patients. The mechanism of rhinorrhea is stil not completely clarified.

Choroid plexus carcinoma in adults: an extremely rare case.

Choroid plexus tumors are rare intraventricular papillary neoplasms derived from choroid plexus epithelium, which account for approximately 2% to 4% of intracranial tumors in children and 0.5% in adults. Almost all choroid plexus carcinomas are seen in children and are extremely rare in adults.

The effect of untethering on urologic symptoms and urodynamic parameters in children with primary tethered cord syndrome.

Objective: To evaluate urinary system symptoms (USSs) and urodynamic parameters (UPs) before and after untethering in children with primary tethered cord syndrome (pTCS).

Methods: USSs and UPs of patients undergoing untethering for pTCS during the period January 2008-July 2012 were evaluated preoperatively and at the postoperative third and 12th months. For analysis, patients were separated into 4 groups according to the presence of USSs: group 1, USSs preoperative positive and postoperative negative; group 2, USSs preoperative positive and postoperative positive; group 3, USSs preoperative negative and postoperative positive; group 4, USSs preoperative negative and postoperative negative.

Microsurgical training model for residents to approach to the orbit and the optic nerve in fresh cadaveric sheep cranium.

Background: Neurosurgery and ophthalmology residents need many years to improve microsurgical skills. Laboratory training models are very important for developing surgical skills before clinical application of microsurgery. A simple simulation model is needed for residents to learn how to handle microsurgical instruments and to perform safe dissection of intracranial or intraorbital nerves, vessels, and other structures.

Laboratory training in the retrosigmoid approach using cadaveric silicone injected cow brain.

Background: A neurosurgical laboratory training model is designed for trainees in microneurosurgery to learn to handle surgical microscopes and microneurosurgical instruments. The silicone injection of a fresh cadaveric cow cranium is an alternative to using a cadaveric human brain for becoming familiar with the cerebellopontine angle (CPA) via the retrosigmoid approach. To report an improved method for training in the CPA via the retrosigmoid approach, using a fresh cadaveric cow cranium injected with silicone.

A laboratory training model using fresh sheep spines for pedicular screw fixation.

Background: Laboratory training models are essential for developing and refining surgical skills prior to clinical application of spinal surgery. A simple simulation model is needed for young residents to learn how to handle instruments and to perform safe posterior lumbar approaches. Our aim is to present a practical laboratory model using a fresh sheep lumbar spine that simulates the pedicular screw fixation in spine surgery.

One-stage surgery through posterior approach-for L5-S1 spondyloptosis.

Grade 5 spondylolisthesis or spondyloptosis is a rare condition. Generally, the surgical management of spondyloptosis includes multi-staged procedures instead of one-staged procedures. One-stage treatment for spondyloptosis is very rare.

Paediatric ganglioglioma of the conus medullaris.

Gangliogliomas of the conus medullaris are very rare, with only 12 patients reported so far. We report a 6-year-old male who presented with a painless numbness of the left lower limb and with bladder dysfunction. MRI revealed an intramedullary lesion at the T11-T12 vertebral levels.

Primary cerebellopontine angle craniopharyngioma in a patient with Gardner syndrome.

Craniopharyngiomas usually involve the sella and suprasellar space. Ectopic craniopharyngiomas have rarely been reported at the cerebellopontine angle (CPA). We report a rare primary craniopharyngioma of the CPA without extension into the sellar region.

Validity of serum tau protein levels in pediatric patients with minor head trauma.

Background: The aim of this study was to investigate the relationship between intracranial injury and serum tau protein levels in pediatric patients with minor head trauma (MHT).

Methods: We included 60 pediatric patients with MHT (Glasgow Coma Scale [GCS], 14-15) and 28 control patients. The patients were divided into 3 groups as follows: those without (group 1) and with (group 2) intracranial lesions shown on cranial computed tomography (CCT) and the control group (group 3).

Indications for brain computed tomography and hospital admission in pediatric patients with minor head injury: how much can we rely upon clinical findings?

Objectives: The aim of this study was to describe the characteristics of patients with a minor head injury (MHI) who were admitted to a pediatric emergency unit and to identify the clinical signs and symptoms that most reliably predict the need for cranial computed tomography (CCT) and hospital admission following MHI.

Methods: All patients were retrospectively evaluated according to age, gender, details of injury, presenting symptoms, physical examination findings, radiological investigations ordered and results, length of stay, outcome of the injury and hospitalization rates.

Results: The factors affecting indications for computed tomography and hospitalization were retrospectively analyzed in 916 patients--585 males and 331 females, aged between 1 month and 15 years (mean: 5.

A laboratory training model in fresh cadaveric sheep brain for microneurosurgical dissection of cranial nerves in posterior fossa.

A neurosurgical laboratory training model is designed for residents of neurosurgery to handle surgical microscopes and microneurosurgical instruments. The material consists of a one-year-old fresh cadaveric sheep cranium. A four-step approach was designed to simulate microneurosurgical dissection along the posterior fossa cisterns, and to dissect cranial nerves emerging from the brain stem.

Intrasacral extradural arachnoid cysts.

Three patients presented with rare intrasacral extradural arachnoid cysts manifesting as sensory deficiencies and pain in the lower extremities. Magnetic resonance imaging with various sequences identified the cysts. Two patients underwent surgery via laminectomy of the sacrum for cyst exploration and disconnection of the cyst with the dural theca.

Giant subdural empyema in a child: a case report.

An unusual case of a giant (8 x 6 x 6 cm) frontoparietal SDE of Streptococcus pneumoniae in a 17-month-old child is reported. The initial diagnosis was made with emergency CT. The purulent material was removed via a frontoparietal craniotomy.

Simulation of surgery for craniosynostosis: a training model in a fresh cadaveric sheep cranium. Technical note.

The authors present a training model in sheep crania that allows residents in neurosurgery and plastic surgery to practice the frontoorbital remodeling procedure used in the surgical correction of simple craniosynostoses such as plagiocephaly, trigonocephaly, and brachiocephaly. The model comprises a three-step approach: subperiosteal and subperiorbital dissection; elevation of the bifrontal bone flap and the supraorbital bar; and finally, frontoorbital remodeling. The authors conclude that this training model, based on the use of cadaveric sheep crania, represents a fairly useful method to accustom trainees to the required surgical techniques and simulates well the steps of standard pediatric and adult craniofacial surgery for simple craniosynostosis.

Microneurosurgical training model in fresh cadaveric cow brain: a laboratory study simulating the approach to the circle of Willis.

Background: Residents of neurosurgery need many years to develop microneurosurgical skills, and laboratory training models are essential for developing and refining surgical skills before clinical application of microneurosurgery. A simple simulation model is needed for young residents to learn how to handle microneurosurgical instruments, and to perform safe dissection of intracranial vessels and nerves.

Methods: The material consists of a 2-year-old fresh cadaveric cow cranium.