Biomedical subjects

Benjamin S Carson

Publications and source records attributed to Benjamin S Carson.

At least 19 recordsLinked to original sources

PubMed2006

The Strata programmable valve for shunt-dependent hydrocephalus: the pediatric experience at a single institution.

BACKGROUND AND OBJECTIVE: The Medtronic PS Medical Strata valve has pressure flow characteristics that are noninvasively adjusted with a magnetic tool. The objective of this study was to examine its efficacy during our initial experience with it in shunt-dependent children. MATERIALS AND METHODS: A retrospective review of 53 children with a median age of 2.0 years who had 61 Strata valves implanted. CONCLUSION: The Strata valve is efficacious in the treatment of shunt-dependant hydrocephalus in children. The 1-year shunt survival rate of 67.2% is comparable to that previously reported from a multicenter trial. Of the 30 therapeutically aimed adjustments during the study period, 16 (53.3%) resulted in improvement in abnormal signs or symptoms. Our data indicate that adjustments can be used to treat signs or symptoms of cerebrospinal fluid overdrainage or underdrainage, which may obviate the need for additional surgery.

Adolescent↗

PubMed2006

A novel brainstem tumor model: functional and histopathological characterization.

INTRODUCTION: Diffuse pontine gliomas remain a challenging and frustrating disease to treat. The survival rates for these high-grade brainstem tumors (BSTs) is dismal and optimal therapy has yet to be determined. The development of a satisfactory brainstem tumor model is necessary for testing new therapeutic paradigms that may prolong survival. MATERIALS AND METHODS: We report the surgical technique, functional testing, and histopathological features of a novel brainstem tumor model in rats. Female Fischer 344 rats (n=45) were randomized to receive an injection of either 3 microl of 9L gliosarcoma cells (100,000 cells, n=), 3 microl of F98 glioma cells (100,000 cells, n=10), or 3 microl of medium (Dulbecco's modified eagle medium) into the pontine tegmentum. Using a cannulated guide screw system, implanted in the skull of the animal, we injected each group at coordinates 1.4 mm right of the sagittal and 1.0 mm anterior of the lambdoid sutures, at a depth of 7.0 mm from the dura. The head was positioned 5 degrees from horizontal before injection. The rats were post-operatively evaluated for neurological deficits using an automated test. Kaplan-Meier curves were generated for survival and disease progression, and brains were processed postmortem for histopathology. RESULTS AND DISCUSSION: 9L and F98 tumor cells grew in 100% of animals injected and resulted in a statistically significant mean onset of hemiparesis of 16.5+/-0.56 days (P=0.001, log-rank test), compared to animals in the control group which lacked neurological deficits by day 60. The animals with tumor cells implanted demonstrated significant deterioration of function on the automated rod testing. Animals in the control group showed no functional or pathological signs of tumor. Progression to hemiparesis was consistent in all tumor-injected animals, with predictable onset of symptoms occurring approximately 17 days post-surgery. The histopathological characteristics of the 9L and F98 BSTs were comparable to those of aggressive human BSTs. CONCLUSION: The establishment of this animal tumor model will facilitate the testing of new therapeutic paradigms for the treatment of BSTs.

Animals↗

PubMed2006

Intracranial drug-delivery scaffolds: biocompatibility evaluation of sucrose acetate isobutyrate gels.

INTRODUCTION: Sucrose acetate isobutyrate (SAIB) is a water insoluble, biodegradable gel used for controlled-release oral and subcutaneous drug delivery. We investigated SAIB compatibility in the rat central nervous system (CNS) by implanting solutions of SAIB in adult and in neonatal brains. METHODS: 10-15 microL solutions of SAIB gels in 0-30% ethanol were injected into the cerebral cortex of adult Fischer 344 rats. Control animals were implanted with a 10 mg biodegradable poly anhydride copolymer of poly [bis (p-carboxyphenoxy) propane] anhydride and sebacic acid (PCPP:SA). Adult rats were evaluated for signs of pain and distress, including changes in posture, facial signs, and grooming behavior. 1-2 microL solutions of SAIB gels in 15% ethanol were injected into brains of 12-24 h-old rats. Neonatal rats were evaluated for survival. Adult and neonatal brains were examined by histopathology 3-48 days after implant. RESULTS: Gel implants produced elliptical compression of cortical tissue, cell loss, and inflammation. Cell loss appeared to be confined to the implantation wound and associated neuronal fields. In adult rats, neurophil compression, inflammation, and cell loss appeared similar with the 10-mg PCPP:SA implants and the 10-mg SAIB implants. There was no clinical evidence of pain or distress from SAIB implants. 1-2 microL implants of SAIB-15% ethanol had no effect on survival of neonatal animals. CONCLUSION: Brain implants of SAIB induce a mild to moderate inflammatory response and associated neuronal cell damage. The implants appeared to be biocompatible in adult and neonatal animals. These results suggest that further studies of SAIB as an injectable drug-delivery scaffold for CNS therapeutic agents are warranted.

Animals↗

PubMed2006

Postlaminectomy kyphosis in the skeletally immature achondroplast.

STUDY DESIGN: Retrospective review. OBJECTIVES: To determine the risk of postlaminectomy thoracolumbar kyphosis in skeletally immature achondroplasts and evaluate the need for concurrent fusion at multilevel decompression. SUMMARY OF BACKGROUND DATA: Spinal stenosis is a relatively common complication of achondroplasia. Although most achondroplasts do not develop symptomatic spinal stenosis until the third or fourth decades, some patients become symptomatic before skeletal maturity. While postlaminectomy kyphosis typically does not occur in the adult achondroplast, it is not known if it occurs in the skeletally immature achondroplast. METHODS: The charts and radiographs of 10 consecutive skeletally immature achondroplasts that underwent surgical treatment for symptomatic spinal stenosis during a 10-year period were retrospectively reviewed. The average age of the 6 male and 4 female patients at surgery was 9.2 years (range 6-16). All patients had preoperative lateral radiographs. Decompression consisted of multilevel (5-8) thoracolumbar laminectomies. More than 50% of each medial facet was preserved bilaterally to maintain spinal stability. RESULTS: Postlaminectomy thoracolumbar kyphoses developed in all 10 patients (100%). The postlaminectomy kyphoses ranged from 78 degrees to 135 degrees (mean 94 degrees ). All patients underwent spinal fusions with instrumentation, performed from 10 months to 2.6 years after the decompressions, to stabilize the kyphoses. CONCLUSIONS: Skeletally immature achondroplasts are at high risk for developing postlaminectomy thoracolumbar kyphoses. Therefore, concurrent spinal fusion is indicated in skeletally immature achondroplasts who undergo thoracolumbar laminectomies of at least 5 levels.

Achondroplasia↗

PubMed2006

PIK3CA gene mutations in pediatric and adult glioblastoma multiforme.

The phosphatidylinositol 3-kinases (PI3K) are a family of enzymes that relay important cellular growth control signals. Recently, a large-scale mutational analysis of eight PI3K and eight PI3K-like genes revealed somatic mutations in PIK3CA, which encodes the p110alpha catalytic subunit of class IA PI3K, in several types of cancer, including glioblastoma multiforme. In that report, 4 of 15 (27%) glioblastomas contained potentially oncogenic PIK3CA mutations. Subsequent studies, however, showed a significantly lower mutation rate ranging from 0% to 7%. Given this disparity and to address the relation of patient age to mutation frequency, we examined 10 exons of PIK3CA in 73 glioblastoma samples by PCR amplification followed by direct DNA sequencing. Overall, PIK3CA mutations were found in 11 (15%) samples, including several novel mutations. PIK3CA mutations were distributed in all sample types, with 18%, 9%, and 13% of primary tumors, xenografts, and cell lines containing mutations, respectively. Of the primary tumors, PIK3CA mutations were identified in 21% and 17% of pediatric and adult samples, respectively. No evidence of PIK3CA gene amplification was detected by quantitative real-time PCR in any of the samples. This study confirms that PIK3CA mutations occur in a significant number of human glioblastomas, further indicating that therapeutic targeting of this pathway in glioblastomas is of value. Moreover, this is the first study showing PIK3CA mutations in pediatric glioblastomas, thus providing a molecular target in this important pediatric malignancy.

Adolescent↗

PubMed2006

Cervicomedullary decompression for foramen magnum stenosis in achondroplasia.

OBJECT: Achondroplasia is the most common hereditary form of dwarfism, and is characterized by short stature, macrocephaly, and a myriad of skeletal abnormalities. In the pediatric population, stenosis and compression at the level of the cervicomedullary junction commonly occurs. The goal in this study was to assess the outcomes in children with achondroplasia who underwent cervicomedullary decompression. METHODS: Forty-three pediatric patients with heterozygous achondroplasia and foramen magnum stenosis underwent 45 cervicomedullary decompressions at the authors' institution over an 11-year period. After surgical decompression, complete resolution or partial improvement in the preoperative symptoms was observed in all patients. There were no deaths in the treated patients. The surgical morbidity rate was low and usually consisted of a cerebrospinal fluid (CSF) leak in patients in whom the dura mater had been opened (either intentionally or accidentally). This problem was successfully managed in all cases with local measures (wound oversewing) or CSF diversion. CONCLUSIONS: In this review the authors demonstrate that decompression of the cervicomedullary junction in the setting of achondroplasia may be accomplished safely with significant clinical benefit and minimal morbidity.

Achondroplasia↗

PubMed2006

Local infusion therapy in the monkey brainstem: technical considerations.

This chapter assesses the safety of freehand placement of an infusion catheter (outer diameter, 0.3 mm) in brainstems of cynomolgus monkeys (Macaca fascicularis) for local infusion therapy. A posterior midline approach through the cerebellum and roof of the fourth ventricle was used to implant catheters into a pontine target area. Computer tomography (CT), magnetic resonance imaging (MRI), and histology were used to examine the position of the implants. The freehand placement of a catheter resulted in approximately 5-mm variations in anterior-posterior and dorsal-ventral locations of the targeted implantation site. No evidence of morbidity from the surgery, or from the infusion process was present. In conclusion, small-diameter catheters for chronic drug infusions can be implanted safely into the brainstem, an eloquent region that has been considered surgically inoperable. Infusion systems may offer a minimally invasive, generally applicable tool to provide chronic therapy for central nervous system (CNS) lesions.

Animals↗

PubMed2005

A novel brainstem tumor model: guide screw technology with functional, radiological, and histopathological characterization.

OBJECT: Survival rates for high-grade brainstem tumors are approximately 10% and optimal therapy has yet to be determined. Development of a satisfactory brainstem tumor model is necessary for testing new therapeutic paradigms that may prolong survival. The authors report the technique, functional progression, radiological appearance, and histopathological features of a novel brainstem tumor model in rats. METHODS: Thirty female Fischer 344 rats were randomized (10 animals/group) to receive an injection of either 3 ml of 9L gliosarcoma cells (100,000 cells), 3 ml of F98 glioma cells (100,000 cells), or 3 ml of medium (Dulbecco modified Eagle medium) into the pontine tegmentum of the brainstem. Using a cannulated guide screw system implanted in the skull of the animal, rats in each group were injected at coordinates 1.4 mm to the right of the sagittal and 1 mm anterior to the lambdoid sutures, at a depth of 7 mm from the dura mater. The angle of the syringe during injection was anteflexed 5 degrees from the vertical. Postoperatively, the rats were evaluated for neurological deficits by using an automated rotarod test. High-resolution [18F]fluorodeoxyglucose-positron emission tomography (FDG-PET) fused with computerized tomography (CT) scans were acquired pre- and postoperatively through the onset of hemiparesis and correlated accordingly. Kaplan-Meier curves were generated for survival and disease progression, and brains were processed postmortem for histopathological investigation. The 9L and F98 tumor cells grew in 95% of the animals in which they were injected and resulted in a statistically significant mean onset of hemiparesis of 16.5 6 0.56 days (p = 0.001, log-rank test), compared with animals in the control group, which had no neurological deficits by Day 45. The FDG-PET studies coregistered with CT scans demonstrated space-occupying brainstem lesions, and this finding was confirmed by histological studies. Animals in the control group showed no functional, radiological, or pathological signs of tumor. CONCLUSIONS: Progression to hemiparesis was consistent in all tumor-injected animals, with predictable onset of symptoms occurring approximately 17 days postsurgery. The histopathological and radiological characteristics of the 9L and F98 brainstem tumors were comparable to those of aggressive primary human brainstem tumors. Establishment of this animal tumor model will facilitate the testing of new therapeutic paradigms for the treatment of these lesions.

Animals↗

PubMed2005

Experimental models of brainstem tumors: development of a neonatal rat model.

OBJECTIVE: Brainstem tumor models are required to advance the treatment for diffuse pontine gliomas in children. The feasibility of creating an experimental rodent model by inoculating newborn pups with tumor cells was examined. The study was performed to create an animal model for diffuse brainstem tumors. METHODS: Eighty-two Fischer rat pups aged 12-24 h were anesthetized by hypothermia. The brainstem was injected with saline to identify anatomical coordinates for subsequent tumor cell challenges. The newborn pups were then inoculated with F98 (n=30) or 9L (n=30) glioma cells. Animals were returned to their mother for nursing. Tumor growth was assessed by survival and histopathology. RESULTS: Twenty-one percent of the saline-treated animals (17 out of 82) and 5% of the tumor cell-challenged pups (3 out of 60) were eliminated by their mothers. Inoculations with 9L and F98 cells produced brainstem tumors in 83% (24 out of 29) and 93% of animals (26 out of 28) respectively that were evaluated. CONCLUSIONS: Our results demonstrate that neonatal rat models for brainstem tumors can be prepared using known injection coordinates and orthotopic cell lines. Decreasing rates of maternal removal during the course of the work suggests that the method involves a learning curve.

Animals↗

PubMed2005

Pilomyxoid astrocytoma of the spinal cord: report of three cases.

OBJECTIVE AND IMPORTANCE: Pilomyxoid astrocytoma (PMA) is a recently described, rare, circumscribed glioma similar to pilocytic astrocytoma. Despite its circumscribed nature, PMA implies a worse overall outcome than typical pilocytic astrocytoma. All PMAs reported to date involved the hypothalamic/chiasmatic region. Since these original reports, we have encountered three tumors in the spinal cord with histological features identical to those of PMA. CLINICAL PRESENTATION: We report three male pediatric patients. The first patient presented at age 6 with back pain and constipation. The second patient presented at age 8 with back pain and a bout of urinary incontinence. The third patient, a neonate, presented with respiratory failure and hypotonia. INTERVENTION: The first patient's cervical and thoracic neoplasm was treated with subtotal resection and multiple laminectomies and spinal fusion for recurrence. The second patient underwent gross total resection of his thoracic neoplasm. The neonate underwent laminectomy and biopsy of his holocord tumor. CONCLUSION: PMAs typically occur in the hypothalamic region and within the first 4 years of life. Tumors with identical histological features are being recognized outside this typical clinical setting. The cases presented in this report suggest that PMA can occur at a later age and can involve the spinal cord. We believe that increased recognition of these circumscribed gliomas will help to elucidate their nature and lead to better management decisions.

Astrocytoma↗

PubMed2005

Distal ventriculoperitoneal shunt failure caused by silicone allergy. Case report.

The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus. Although allergic reactions to the silicone in shunt hardware are very rare, the authors describe a case of silicone allergy causing multiple ventricular shunt revisions. A 24-year-old man, who had undergone multiple VP shunt revisions, presented with shunt malfunction caused by allergic reaction of the tissues surrounding the shunt tubing. The patient's existing silicone-based shunt was replaced with a new polyurethane system, including the proximal and distal catheters as well as the valve mechanism. Contrary to recommendations in previous studies of silicone shunt allergies, long-term immunosuppression was not initiated. The patient was followed up for more than 8 years without recurrence of an allergic reaction to the shunt. This outcome indicates that replacing the original silicone-based shunt system with a polyurethane-based system alone is sufficient in the treatment of a silicone shunt allergy.

Adult↗

PubMed2005

Infusion rates and drug distribution in brain tumor models in rats.

OBJECT: The aim of this study was to investigate the optimal delivery rates of chemotherapy for the treatment of central nervous system tumors and to determine whether local delivery can lower toxicity profiles and increase target concentrations of chemotherapy. METHODS: The authors used two brain tumor models in rats. Slow (1 microl/hour) and fast (10 microl/hour) pumps were used to deliver chemotherapy--carboplatin, doxorubicin, and a high-molecular-weight transferrin-doxorubicin conjugate to the brains of normal rats and rats previously injected with F98 or 9L rat brain tumor cells. Brains were cut in 1-mm sections rostral and caudal from the infusion point. Slices were analyzed for doxorubicin and platinum by fluorescence and atomic absorption, respectively. In the normal tissues, the volume of drug distribution is generally greater at the faster flow rate. In abnormal tissues, distribution is similar at slow and fast infusion rates for low-molecular-weight drugs and greater at slow rates for a high-molecular-weight targeted toxin. CONCLUSIONS: After local administration the distribution of chemotherapy appears to be significantly influenced by tumor metabolism. Additional studies are needed to determine the optimal delivery rates for the interaction of the drug with the targeted tumor.

Animals↗

PubMed2004

Flexible versus rigid catheters for chronic administration of exogenous agents into central nervous system tissues.

INTRODUCTION: Neuropharmacology studies depend on consistency in drug delivery. Drug infusions into central nervous system (CNS) tissues have been described as unreliable. Speculation has focused on infusion pumps as the source of variation. This report demonstrates that the catheter may be a source of variability. The inconsistency can be significantly reduced by a change in catheter design. METHODS: Normal and tumor cell-challenged (abnormal) brains of Fischer rats were infused with small and large molecular weight cytotoxic drugs via rigid and flexible catheters placed directly into the parenchyma. Coronal tissue sections rostral and caudal to the infusion point were analyzed for drug concentrations. Carboplatin, estimated through atomic absorption assays, and doxorubicin and transferrin-bound doxorubicin, measured by fluorescent spectroscopy, were mapped in serial sections at various distances from the infusion point. RESULTS: The expected drug distribution pattern approximates a bell-shaped curve with a maximum drug concentration near the infusion point and approximately equal, declining concentrations rostral and caudal to the infusion. This expected distribution was found in only 10 of the 17 normal brains and 15 of the 28 abnormal brains infused with a rigid catheter. In contrast, 10 of the 10 normal brains and 16 of the 16 abnormal rat brains infused with a flexible catheter had the expected distribution pattern. The distribution pattern was not associated with the molecular weight of the infused drug. CONCLUSION: Replacement of rigid infusion tubes with flexible tubing increases the reliability of local CNS drug infusions. Rigid catheters may allow backflow of the infused drug along the path of the catheters into the subdural space.

Animals↗

PubMed2004

Pilomyxoid astrocytoma: a review.

Pilomyxoid astrocytoma (PMA) is a recently described type of brain tumor. PMA shares similar features with pilocytic astrocytoma (PA), the most common central nervous system (CNS) tumor in the pediatric population, yet displays subtle histologic differences. Previous studies have shown PMA to behave more aggressively than PA, with shorter progression-free and overall survival as well as a higher rate of recurrence and CNS dissemination. These findings suggest that PMA may be a unique and distinct neoplasm. This review summarizes the histologic, clinical, and radiographic characteristics of PMA. In addition, the current treatment options and research endeavors involving this disease are described. Increased recognition of PMA within the medical community has the potential to affect the treatment and prognosis of pediatric low-grade astrocytomas.

Astrocytoma↗

PubMed2004

Living with achondroplasia: quality of life evaluation following cervico-medullary decompression.

Achondroplasia is the most common of the heritable skeletal dysplasias. Cervico-medullary compression is a frequently encountered and potentially lethal neurological complication. Cervico-medullary decompression (CMD) at the foramen magnum is often employed to relieve the pressure on the emerging cervical cord. Given the inherent risks associated with major surgery, there has been a substantial debate regarding the best criteria for CMD. Our objectives for this study are to explore the quality of life of patients who had undergone CMD, and to assess whether surgery is associated with mortality and increased long-term morbidity. A Medical Outcome Study 36-item Short Form General Health Survey designed to evaluate eight general health concepts as well as achondroplasia-related issues, was administered to patients assessed in the neurosurgery department in Johns Hopkins Hospital between 1977 and 1998. One hundred and sixty-seven patients were eligible for inclusion. Forty-three could not be contacted, and two refused consent. One hundred and twenty-two patients were assessed. Fifty-six (46%) individuals had CMD and 66 (54%) did not. There was 1 case of mortality in the CMD group and 12 cases in the non-CMD group. In the non-CMD group, all deaths, as far as we know, were unrelated to cervico-medullary compression. In this cohort of surviving patients (n = 109), the quality of life of the 55 (50.5%) who had undergone CMD is comparable to that of the 54 (49.5%) who did not have surgery, controlled for age and sex. CMD is indicated for patients with achondroplasia with significant symptomatic foramen magnum compression. It can be life saving. It can abolish profound central apnea that may cause sudden death and alleviate neurological complications associated with damage of the significantly compressed spinal cord. With regards to long-term outcome evaluation, the quality of life of individuals with achondroplasia who had CMD is similar to those age- and sex-matched patients who did not have this surgery. Moreover, CMD, with all its inherent surgical risks, does not appear to be associated with higher mortality or increased long-term morbidity.

Achondroplasia↗

PubMed2004

Proton magnetic resonance spectroscopic imaging in pediatric pilomyxoid astrocytoma.

OBJECTS: A pilomyxoid astrocytoma (PmA) is considered to be either a more aggressive variant of a pediatric pilocytic astrocytoma (PA) or a tumor of a separate entity. METHODS: We present two cases of pediatric optic-chiasmatic PmA. Proton magnetic resonance spectroscopic imaging (MRSI) of the PmA revealed decreased concentrations of total choline (Cho), creatine (Cr), and N-acetyl aspartate (NAA). In contrast, proton MR spectra of PAs showed elevated Cho and decreased Cr and NAA signals. CONCLUSION: Low metabolite concentrations in PmAs detected by MRSI may therefore help to distinguish PmAs from PAs preoperatively.

Aspartic Acid↗

PubMed2004

Long-term effects of carboplatin brainstem infusions on hearing thresholds in monkeys.

OBJECTIVE: To isolate the central auditory neurotoxicity of carboplatin from its well-established ototoxic effects. DESIGN: The "best-case scenario" of targeted drug delivery to brain cancer was simulated by infusing carboplatin directly into the brainstem of cynomolgus monkeys with chronically implanted catheters. Because this manner of drug administration produced low levels of carboplatin in spinal fluid and blood, it was assumed that resulting deficits were dictated by the central auditory neurotoxicity of platinum compounds and not peripheral ototoxic effects. The magnitude of this hearing loss was estimated by comparing the auditory brainstem response thresholds of treated monkeys with results from normal controls. SUBJECTS: Six adult male cynomolgus monkeys (Macaca fascicularis) weighing 4 to 6 kg (3 received carboplatin treatment and 3 served as normal controls). INTERVENTION: Brainstem infusions of carboplatin. RESULTS: The average threshold of carboplatin-treated monkeys was elevated 8.8 dB (SD = 7.3 dB) relative to normal controls 6 months after the termination of drug delivery and increased to 10.7 dB with less variation between subjects (SD = 5.6 dB) 1 year after drug treatment. Although small in magnitude, the hearing loss was statistically significant (P<.05). CONCLUSIONS: Brainstem infusions of carboplatin induced some degree of hearing impairment in all treated monkeys. These threshold elevations were modest compared with the ototoxic effects that have been reported after systemic doses of carboplatin. Our findings suggest that the neurotoxic sensitivity of cochlear hair cells is not shared by neurons in the central auditory pathways. As a result, methods for reducing the ototoxic effects of chemotherapy remain a viable strategy for preserving auditory function in patients with brain cancer.

Animals↗

PubMed2004

The cognitive outcome of hemispherectomy in 71 children.

PURPOSE: Long-term neuropsychological outcome was studied in 71 patients who underwent hemispherectomy for severe and intractable seizures at The Johns Hopkins Hospital between 1968 and 1997 and who agreed to participate. Seizures were due to cortical dysplasias (n = 27), Rasmussen syndrome (n = 37), or vascular malformations or strokes (n = 7). Both presurgical and follow-up results are available and reported for 53 patients. METHODS: Patients and caretakers were interviewed, and patients were administered standard measures of intelligence, receptive and expressive language, visual-motor skills, adaptive/developmental functioning, and behavior. RESULTS: Mean age at surgery was 7.2 years. At follow-up, on average 5.4 years after surgery, 65% are seizure free, 49% are medication free, and, of those responding, none rated quality of life as worse than before surgery. Mean IQ was in the 70s for Rasmussen and vascular patients and in the 30s for cortical dysplasia patients. Language and visual-motor skills were consistent with IQ. For Rasmussen patients only, language was significantly more impaired for left than for right hemispherectomy, both before surgery and at follow-up. Adaptive skills were mildly impaired, with greatest impairment in the physical domain. Cognitive measures typically changed little between surgery and follow-up, with IQ change <15 points for 34 of 53 patients; of the remainder, 11 declined and eight improved. Behavior was free of major problems, but social interactions and activities were limited. CONCLUSIONS: The most significant predictor of cognitive skills at follow-up was etiology, with dysplasia patients scoring lowest in intelligence and language but not in visual-motor skills. Regardless of etiology, most patients showed only moderate change in cognitive performance at follow-up.

Child↗