Targeted studies as a learning tool in outcomes assessment.

Authors discuss the need for increased analytical skills in the current medical environment and suggest a method which combines the use of targeted studies and Internet communication as part of graduate medical education. Advantages of such a program include involvement of the private sector in clinical outcome studies, improvements in the design of clinical studies and publications and the early development of skills in interpreting and evaluating literature. A further goal would be the development of an understanding of the principles underlying, to the extent that it is possible, unbiased assessment of one's own clinical practices.

Sinus pericranii.

Sinus pericranii is an anomalous extracranial vascular malformation that is in continuity with the intracranial dural venous sinuses. Five case reports, three congenital and two traumatic, are described. Clinical management, including evaluation, diagnosis, and treatment, is discussed.

Intramedullary lesions of the pediatric spinal cord: correlation of findings from MR imaging, intraoperative sonography, surgery, and histologic study.

Findings of preoperative magnetic resonance (MR) imaging and radiologist-directed intraoperative sonography (IOS) were correlated with surgical and pathologic findings in 11 pediatric patients with intramedullary spinal cord lesions. There were seven gliomas and one each of primitive neuroectodermal tumor, venous vascular malformation, neuroenteric cyst, and active schistosomiasis. MR imaging provided discrete preoperative anatomic localization and excluded multicentric lesions but did not reliably distinguish between solid and cystic lesions.

The effectiveness of chemotherapy for treatment of high grade astrocytoma in children: results of a randomized trial. A report from the Childrens Cancer Study Group.

Fifty-eight patients with high-grade astrocytoma were treated by members of the Childrens Cancer Study Group in a prospective randomized trial designed to study the effectiveness of chemotherapy as an adjuvant to standard surgical treatment and radiotherapy. Following surgical therapy, patients were assigned randomly to radiotherapy with or without chemotherapy consisting of chloroethyl-cyclohexyl nitrosourea, vincristine, and prednisone. Treatment with chemotherapy prolonged survival and event-free survival.

Infections of CSF shunt and intracranial pressure monitoring devices.

Management of shunt infections varies, but externalization of shunt apparatus and the need for intraventricular antibiotics seem to have been rather uniformly adopted. No recent studies on EVD systems have been reported, largely because of the widespread use of alternatives such as the fiberoptic systems and the hollow subarachnoid bolt. Studies from the 1970s and personal experience with long-term monitoring in children with Reye's syndrome and head trauma indicate that it can be done safely with a low risk of infection.

Stereotactic decompression of a prepontine arachnoid cyst with resolution of precocious puberty.

A case of a prepontine (clival) arachnoid cyst is reported. The patient presented with isosexual precocious puberty. Treatment was initially with fenestration by suboccipital craniectomy, however, definitive treatment was via stereotactic transfrontal placement of a cystoperitoneal shunt.

Arnold-Chiari malformation in an infant with Kleeblattschadel: an acquired malformation?

A case of Arnold-Chiari malformation in an infant with Kleeblattschadel is reported. The author suggests that the malformation may be acquired on the basis of cephalocranial disproportion and may be a contributing factor in the development of hydrocephalus.

Spinal ultrasonography. Intraoperative and pediatric applications.

Ultrasonography has had limited usefulness in the diagnosis of diseases of the spine and spinal cord in older children and adults. However, its use intraoperatively in patients of all ages, and nonoperatively in infants and young children, is finding increased application. The authors, who perform and rely on spinal sonography in both clinical situations, present an overview of technique, normal anatomy, and selected pathologic entities based on their experience and the literature.

Symptomatic Chiari I malformation in childhood: a report of 7 cases.

The Chiari I malformation, once thought to be a disorder of clinical importance only in the teen years and beyond, is now recognized as being significant in the pediatric population as well. We have reviewed 7 cases of Chiari I malformation in children less than 12 years of age. Hydrosyringomyelia was often, but not invariably, an accompanying feature, and this in turn was associated with scoliosis and motor weakness.

Arnold-Chiari II malformation: intraoperative real-time US.

Nineteen cases in which high-resolution, intraoperative, real-time sonography was performed during decompression of an Arnold-Chiari II malformation were reviewed. The variations of the often complicated hindbrain anatomic features, well known from autopsy series, were shown in detail with intraoperative sonography. The extent of herniation of the cerebellar vermis, the medulla, and the fourth ventricle into the cervical spinal canal, as well as fourth ventricular dilatation, arachnoid cysts, and cervical hydromyelia, were also demonstrated sonographically.

Superior sagittal sinus thrombosis with infarction in sickle cell trait.

An adolescent female with sickle cell trait presented with acute neurologic deterioration during treatment for pseudotumor cerebri. Cranial computed tomography, initially normal, subsequently revealed multiple hemorrhagic infarctions. Suspected superior sagittal sinus thrombosis was confirmed by cerebral angiography.

Stereotaxic biopsy of intrinsic lesions of the brain stem.

Despite improved brain-stem imaging by magnetic resonance and high-resolution x-ray computerized tomography, definitive diagnosis and therapy of intrinsic lesions of the brain stem require histological verification. A stereotaxic approach to brain-stem lesions provides a high yield of positive histological diagnosis with a low incidence of morbidity. A series of 14 stereotaxic procedures performed on 12 patients with intrinsic lesions of the mesencephalon, pons, and medulla is reviewed.

Childhood cerebellopontine angle teratoma associated with congenital hydrocephalus.

A case of childhood teratoma in the cerebellopontine angle associated with shunted congenital hydrocephalus is presented. The need for detailed computed axial scanning with and without contrast in congenital hydrocephalus not associated with intraventricular hemorrhage or myelodysplasia is emphasized.