Biomedical subjects
Publications and source records attributed to A D Hockley.
The authors report their experience with anterior encephalocele, comprising 11 congenital and 11 traumatic cases. Unlike occipital encephaloceles, anterior lesions are usually associated with normal mental development. Surgery aims to restore normal anatomy with repair of the defective dura, bone and skin. Indications, surgical methods and outcome are discussed.
A 3.5 month old boy was diagnosed as having hydrocephalus secondary to an aneurysm of the vein of Galen. Cerebral angiography 2 1/2 years later showed the aneurysm to be completely occluded and CT demonstrated it to be thrombosed and completely calcified. Complete calcification of an aneurysm of the vein of Galen has only been described on two previous occasions and never in a child this young.
With an incidence of approximately 1 in 2,000 per head of population, most neurosurgeons are presented at times with the problem of craniosynostosis. This paper summarises the different clinical effects of different skull deformities, and describes the present state of the art with regard to surgical management.
A new and simple method for the operative treatment of atlanto-axial instability in children is described. The technique involves a metal rectangle wired in place between the occiput and cervical spine to act as an internal fixation device. Onlay bone grafts subsequently produce bony fusion. A synchronous decompression of the cervical canal can be performed and there is no need for complex or prolonged external fixation.
We describe a method for decompression and fusion of the occipitocervical junction in cases of atlantoaxial subluxation. Use of an implanted steel rectangle provides immediate rigid internal fixation, permitting early mobilization with minimal external support.
This case represents the youngest patient recorded with a jugular foramen schwannoma and the first report of the classic 'dumb-bell' configuration of this tumor in a child. The case illustrates the importance of excluding an intracranial component when these tumors present as a swelling in the neck.
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Shrinkage of a massive, highly invasive, longstanding (probably 40 years) prolactin-secreting pituitary tumour is described in which tumour volume was reduced by 40% 8 d after beginning bromocriptine treatment. After 4 months of treatment the tumour was only 11% of the pretreatment volume and by 8 months it was further reduced in size being confined to the pituitary fossa, which was partially empty. Reduction in tumour volume was accompanied by a gradual reduction in serum prolactin concentrations to normal values at 4 months. Between 4 and 18 months serum prolactin has remained normal on 5 mg of bromocriptine daily. Visual function improved within 48 h of starting bromocriptine and was almost normal by 6 d. CSF rhinorrhoea developed as the tumour shrank and was successfully managed with the relatively minor procedure of a diversionary lumbo-peritoneal shunt. Bromocriptine should be considered as the initial treatment of choice for massive invasive prolactinomas because of the significant risk of morbidity from neurosurgical treatment.
The methods and results of surgical management in 42 patients under 20 years of age with subdural empyema are described. Based on this experience and on a review of the literature, primary craniotomy with radical removal of pus has increasingly become the authors' preferred method of treatment, in addition to appropriate antibiotic treatment with survival figures of around 90% expected.
The case reported is of a 46-year-old woman who had congenital adrenal hyperplasia due to a 21-hydroxylase deficiency, and in whom there was the development of an ACTH secreting pituitary tumour. The patient was untreated with glucocorticoids until the age of 32 years when she presented with infertility. She next presented with amenorrhoea at the age of 44 years when she was found to have an enlarged pituitary fossa. Despite treatment with bromocriptine and adequate doses of dexamethasone, the tumour enlarged and required operative treatment 1 year later. Before and after operation, plasma ACTH levels were between 300 and 400 ng/l, immunocytochemistry showed staining for ACTH and other structurally related pro-opiocortin peptides but for no other hormones, and the tumour secreted large amounts of ACTH in vitro. The report of this case is to our knowledge the first account of a feedback tumour in congenital adrenal hyperplasia and provides yet another reason why patients with this condition should be treated, and good control achieved.
Specimens of material occluding ventricular catheters removed at shunt revision operations were studied by scanning electron microscopy. Immediate fixation allowed examination of human choroid plexus and ependyma which resembled living tissue.
Mesenchymal tumors arising from the dura in three newborn babies are described, with discussion of their clinical and pathological significance.
There has been little comment on the specific management of intracerebral bleeding occurring in patients suffering idiopathic thrombocytopenic purpura. The authors present the cases of four children with intracerebral hemorrhage due to this coagulation disturbance. A plan of management is described based on this experience; it includes immediate control of cerebral edema, emergency splenectomy, supportive care with platelet transfusions and corticosteroids, cerebral angiogtaphy, and a definitive neurosurgical procedure. If necessary, the radiological investigation and surgical therapy can be performed with a single general anesthetic. Three of the patients have survived without major neurological sequelae.
Metastatic mammary carcinoma invaded a spinal meningioma.
Results of proximal anterior cerebral artery occlusion are described in 68 patients with anterior communicating artery aneurysms. The procedure is found useful in the treatment of these aneurysms because of its technical simplicity and the low rates of mortality and morbidity achieved.
Two cases of unilateral proptosis associated with intracranial schwannomas in children are described. In both cases, tumour occupied both the orbit and middle cranial fossa, where in one case the intracranial component was extradural and in the other intracerebral. Possible sites of tumour origin are discussed.
Intra-operative anaphylaxis is of particular concern in neurosurgery. Not only is there an increased risk of major anaphylaxis, but the frequent placement of patients in the prone or sitting position may make resuscitation difficult. We describe two cases of per-operative anaphylaxis during neurosurgery and the techniques used in the successful management and investigation of these patients.
The hematology and oncology service at Birmingham Children's Hospital was established in the late 1960s and now is one of the largest in the United Kingdom. It provides comprehensive care for the entire range of childhood malignancies, coagulation disorders, and hemoglobinopathies and other hematological disorders, and undertakes bone marrow transplant and megatherapy/peripheral blood stem cell procedures. Research includes clinical trials of treatments of childhood cancers; molecular biology studies on leukemia, Hodgkin's disease, neuroblastoma, and sarconas; childhood cancer epidemiology, and geographical and racial incidence; and treatment of hemophilia and molecular investigation of coagulation disorders. These activities involve collaboration with local, national, and international research groups.