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Biomedical subjects

D D Cochrane

Publications and source records attributed to D D Cochrane.

At least 37 records · Page 2Linked to original sources
PubMed1996

Value of postoperative surveillance imaging in the management of children with some common brain tumors.

The rationale for obtaining surveillance computerized tomography (CT) scans or magnetic resonance (MR) images in pediatric patients with brain tumors is that early detection of recurrence may result in timely treatment and better outcome. The purpose of this study was to investigate the value of surveillance cranial images in a variety of common pediatric brain tumors managed at a tertiary care pediatric hospital. A retrospective chart review was performed of children with astrocytoma of the cerebral hemisphere, cerebellum, optic chiasm/hypothalamus, or thalamus; cerebellar or supratentorial high-grade glioma; supratentorial ganglioglioma; posterior fossa or supratentorial primitive neuroectodermal tumor (PNET); and posterior fossa ependymoma. Data were analyzed to determine the frequency with which recurrences were identified on a surveillance image and how the type of image at which recurrence was identified related to outcome. In 159 children, 17 of 44 recurrences were diagnosed by surveillance imaging. The percentage of recurrences identified by surveillance imaging was 64% for ependymoma, 50% for supratentorial PNET, 43% for optic/hypothalamic astrocytoma, and less than 30% for other tumors. The rate of diagnosis of recurrence per surveillance image varied from 0% to 11.8% for different tumor types. Only for ependymomas did there appear to be an improved outcome when recurrence was identified prior to symptoms. Our results indicate that, using the protocols outlined in this study, surveillance imaging was not valuable in identifying recurrence of cerebellar astrocytoma or supratentorial ganglioglioma during the study period, but was probably worthwhile in identifying recurrence of posterior fossa ependymoma and optic/hypothalamic astrocytoma and, possibly, medulloblastoma. Surveillance protocols could be made more effective by individualizing them for each type of tumor, based on current data on the patterns of recurrence.

Astrocytoma↗
PubMed1995

Radiographic imaging requirements following ventriculoperitoneal shunt procedures.

The requirements for radiographic imaging of the ventricles after a ventricular shunt procedure are not well defined. At British Columbia's Children's Hospital, the standard protocol included an ultrasound examination or CT scan at 6-8 weeks postoperatively, and a delayed CT scan at 6 months to 2 years, with additional scans only if the patient had symptoms of shunt malfunction. This study was performed to determine if the delayed scan could be omitted without compromising patient care. The study comprised 86 children with ventriculoperitoneal shunt operations, who had early CT scans or ultrasound examinations less than 20 weeks postoperatively, delayed postoperative CT scans between 20 weeks and 2 years, and who were asymptomatic at the time of these radiographic studies. In 39 of the 86 patients a change in ventricular size occurred between the early and delayed imaging studies, and in these patients the delayed scan was felt to be required. In patients in whom the early imaging study was done at more than 12 weeks postoperatively, and probably in patients with small ventricles preoperatively, there was no added information gained by doing a delayed scan. It is concluded that a radiographic examination of ventricular size at 12 weeks after a shunt operation may provide an adequate baseline study. If the early postoperative radiographic study is done less than 12 weeks after surgery, we would advise that in asymptomatic patients, with the exception of patients with very small ventricles preoperatively, a CT scan be repeated at a later date to obtain an appropriate baseline assessment of ventricular size for the future.

Adolescent↗
PubMed1995

Acute subdural hematoma associated with cerebral infarction in the full-term neonate.

Acute subdural hematomas in the full-term neonate are usually thought to be a manifestation of birth trauma. Most commonly, these hematomas are associated with a tentorial tear, and less frequently are secondary to damage to the occipital sinus accompanying occipital osteodiastasis, or to rupture of bridging superficial cerebral convexity veins. We report 6 cases of acute subdural hematoma associated with cerebral infarction (SDH/CI) in term neonates, an entity which has not been well-documented previously. This combination accounted for half the cases of neonatal acute subdural hematomas referred to a pediatric neurosurgical service. All children presented within 72 h of birth, usually after an uneventful delivery, and typically with seizures (5/6), apneic spells (3/6) and a full or bulging fontanel (5/6). Although the patients were referred to the neurosurgical servive for management of a convexity subdural hematoma, the CT scans showed a large associated cerebral infarct, which was hemorrhagic in 5 of the 6 cases, most commonly in the distribution of the middle cerebral artery. Craniotomy was performed in 4 patients, needle aspiration of the subdural hematoma in 1, and no surgical intervention in 1. The outcome in 3 patients, who have been followed for more than 1 year, has been good, with some mild focal neurologic deficits, but no seizure activity. The pathogenesis of this entity is unclear, but the acute subdural hematoma in these cases is probably secondary to the cerebral infarction. Recognition of SDH/CI as a specific entity in term neonates has significant management and possibly medicolegal implications.

Brain Damage, Chronic↗
PubMed1995

Cervical meningoceles and myelocystoceles: a unifying hypothesis.

The classification and embryogenesis of cystic cervical dysraphic lesions are discussed in the light of the authors' experience and review of the literature. It is felt that these lesions are best described as meningoceles or myelocystoceles, and the use of the term 'myelomeningocele' may be more confusing than clarifying. The authors hypothesize that the cervical meningocele and the myelocystocele are part of a spectrum of the same underlying developmental abnormality, namely limited dorsal myeloschisis, with the eventual abnormality depending on the presence or absence of associated hydromyelia.

Cervical Vertebrae↗
PubMed1995

Relationship of intraoperative electrophysiological criteria to outcome after selective functional posterior rhizotomy.

At British Columbia's Children's Hospital, the criteria used in selective functional posterior rhizotomy (SFPR) evolved in three distinct phases. In Phase 1 the electrophysiological criteria for abnormality included a low threshold to a single stimulation, a sustained response to 50-Hz stimulation, and spread outside the segmental level being stimulated. In Phase 2 the electrophysiological criteria were unchanged, but fewer L3-4 nerve roots were cut. In Phase 3, fewer L3-4 nerve roots were cut, as in Phase 2, but based on the results of posterior nerve root stimulation in nonspastic controls, the only electrophysiological criterion used was contralateral and suprasegmental spread. The present study examined the relationship between the criteria used in each phase and patient outcome. The records of 77 consecutive children who underwent SFPR and had a minimum follow-up period of 1 year were reviewed, comprising 25, 19, and 33 patients in Phases 1, 2, and 3, respectively. Outcome parameters included quantitative assessments of lower-limb spasticity and range of motion, and qualitative assessments of lower-limb function. In Phase 3, 52% of the nerve roots were cut, compared to 66% in Phases 1 and 2. In all three phases there was a significant decrease in lower-limb spasticity and an increase in range of movement, with the smallest decrease in spasticity in Phase 3. Over 90% of children in each phase improved with respect to lower-limb function, and excluding independent walkers and quadriplegics confined to a wheelchair, improvement in the level of ambulation occurred in 87.5%, 71.4%, and 73.7% of patients, in Phases 1, 2, and 3, respectively.

Adolescent↗
PubMed1994

The surgical and natural morbidity of aggressive resection for posterior fossa tumors in childhood.

The morbidity associated with gross total removal of pediatric posterior fossa tumors is well recognized although it is rarely isolated from other factors that comprise the management morbidity for these tumors. This study reviews (1) the operative and postoperative complications in 105 patients and (2) the neurological morbidity in a subset of 91 patients undergoing gross total removal of their tumor between 1982 and 1992. Gross total removal was achieved in 102 patients with a single procedure. Two patients with residual tumor underwent early repeat craniotomy for excision and 1 is being followed without repeat resection. Intra- and postoperative complications occurred in 33 patients and included hematoma requiring craniotomy (3), gastrointestinal hemorrhage (2), hydrocephalus requiring shunt placement (9), wound problems (4), and pseudomeningocele formation requiring additional treatment (5). Delayed onset hydrocephalus requiring shunting occurred in 2 patients and spinal deformity in 4 patients. Worsening of preoperative deficit (new cranial nerve palsies, worsening ataxia, bulbar dysfunction including apnea, mutism and seizures) occurred in 41% of patients operated on for primitive neuroectodermal tumors (PNET) (14/34), 53% of ependymomas (10/19), and 30% of astrocytomas (15/50). No patient who had a choroid plexus tumor was worsened by the procedure. Complete recovery of new postoperative deficits occurred in 14% of PNET (2/14), 50% of ependymoma (5/10) and 47% of astrocytoma (7/15), most often within 6 months of the procedure. Residual neurological morbidity, due to persistence of preoperative symptoms or due to deficits that occurred as the result of the surgical procedure, was assessed in a subgroup of 91 patients followed for an average of 48 months (2-147 months). This assessment did not include morbidity due to adjuvant therapy. Sixty-two percent of patients continued to exhibit abnormal cerebellar or bulbar signs. Forty-three percent of the total population exhibited limitation in function due to residual deficit. Only 38% of patients were both functionally normal and had a normal neurological examination at last follow-up.

Adolescent↗
PubMed1994

Prevention of postshunting ventricular asymmetry by transseptal placement of ventricular catheters. A randomized study.

Ventricular asymmetry is common after ventricular shunting, and occasionally isolation of the contralateral ventricle necessitates a second shunt. The following study was performed to determine whether contralateral placement of the ventricular catheter via ultrasound-guided perforation of the septum pellucidum would decrease the incidence of postshunting ventricular asymmetry which might predispose to symptomatic isolation of a lateral ventricle. Fifty-eight children with hydrocephalus and an open fontanel, who were having a ventriculo-peritoneal shunt via a parieto-occipital approach, were randomized to have the ventricular catheter tip placed into either the ipsilateral or the contralateral frontal horn. Ventricular asymmetry occurred in 23% of the patients with contralateral versus 54% with ipsilateral placement (chi 2 = 5.53; p = 0.019). In 7 patients with contralateral placement, in whom a special catheter with two sets of holes was used, such that holes were located in both ventricles, no shunt-related ventricular asymmetry occurred. In 2 children with ipsilateral placement, a second shunt was required for a symptomatic isolated lateral ventricle. Perforation of the septum pellucidum with placement of the ventricular catheter in the contralateral ventricle, using a specially designed catheter with two sets of holes, may decrease the incidence of postshunting ventricular asymmetry and symptomatic isolation of a lateral ventricle.

Cerebral Ventricles↗
PubMed1994

The validity of electrophysiological criteria used in selective functional posterior rhizotomy for treatment of spastic cerebral palsy.

Although selective functional posterior rhizotomy (SFPR) is an established procedure for the treatment of spasticity, the electrophysiological criteria used to define which posterior rootlets should be cut have not been standardized. The purpose of this study was to determine the validity of the intraoperative electrophysiological criteria used to select posterior rootlets for sectioning in SFPR. Intraoperative stimulation of posterior lumbosacral nerve roots and rootlets, using a 50-Hz stimulus at threshold intensity, was performed in five nonspastic children (controls) undergoing laminectomy for spinal cord untethering and in 32 spastic patients undergoing SFPR. Electromyographic responses were recorded in the upper and lower limbs, the neck, and the face. The pattern of sustained responses was assessed in detail in 17 additional patients who had previously undergone SFPR and in the five controls. Sustained responses with ipsilateral lower limb extrasegmental spread occurred in both spastic patients and the control group. Contralateral lower limb spread and suprasegmental spread to the upper limbs, neck, and face were found only in spastic children. Sustained responses with an incremental pattern were restricted to the spastic population and correlated well with the extent of contralateral and suprasegmental spread, whereas decremental patterns were not associated with contralateral spread. It is concluded that contralateral and suprasegmental spread into the upper limbs, neck, and face, and incremental responses are probably valid criteria of abnormality.

Adolescent↗
PubMed1993

Cytogenetic analysis of 109 pediatric central nervous system tumors.

Reports of cytogenetic abnormalities in pediatric central nervous system (CNS) tumors are important for collection and comparison of large numbers of karyotypes of primary CNS neoplasms to produce statistically significant correlations. We report cytogenetic results of 119 samples of pediatric CNS tumors from 109 patients. Tumors included 33 low-grade astrocytomas, 18 high-grade astrocytomas, 14 gangliogliomas, 13 ependymomas, 17 primitive neuroectodermal tumors (PNET), three choroid plexus papillomas and carcinomas, and a miscellaneous group of 20 rare primary CNS tumors and metastases. In each group, cytogenetic results were correlated with histologic subtype and survival. The study indicated specific chromosome abnormalities in different groups of tumors. Low-grade astrocytomas showed mostly numeric abnormalities with gains of chromosome 7, high-grade astrocytomas showed differences from karyotypic changes observed in adults in lacking double minutes (dmin) and monosomy 10. The ependymoma group showed the largest proportion of abnormal karyotypes with frequent involvement of chromosome 6 and 16. Chromosome 6 was the single most common abnormal chromosome in this study, closely followed by chromosomes 1 and 11. Pediatric CNS neoplasms differ from adult tumors cytogenetically as well as histologically and biologically.

Adolescent↗
PubMed1992

Laminotomy: a technical note.

In order to restore spinal integrity following posterior exposures of the spinal canal in children, we describe modifications of Raimondi's laminotomy technique. The use of a pneumatic dissecting tool with foot-plate to create a hinged osteoplastic laminotomy is described, as are techniques for securing the laminotomy flap in place at the end of the procedure.

Cervical Vertebrae↗
PubMed1992

Long-term outcome and complications of children born with meningomyelocele.

The long-term functional outcome of 101 children born with meningomyelocele between 1971 and 1981 was assessed, by a combination of retrospective chart review and follow-up assessments. The children had been managed at birth using a process of nonstandardized selection. Eighty-three of the 101 patients survived after a minimum follow-up of 8.6 years, for a mortality rate of 18%. Forty-four of 83 children (53%) were community ambulators, and this correlated well with the presence of intact quadriceps function. Forty-eight children (58%) attended normal school and were grade-appropriate. Sixty-two of 83 patients (75%) were socially continent of urine, and 71/83 (86%) were socially continent of stool. Hydrocephalus was present in 93 of the 101 children in the study, and 85 children were shunted. Half of the shunted children required a shunt revision in the first year of life, and thereafter the rate of revision decreased, so that after 2 years the risk of revision was approximately 10% per year.

Activities of Daily Living↗
PubMed1992

Observations on electrical stimulation of lumbosacral nerve roots in children with and without lower limb spasticity.

Selective functional posterior rhizotomy (SFPR) is a popular operation for the treatment of spasticity in children with cerebral palsy, but the physiologic basis of the procedure is poorly understood. As part of SFPR operations in 60 consecutive children, the responses to electrical stimulation of posterior lumbosacral roots and rootlets, and the corresponding anterior roots were studied. In addition, similar electrical stimulation of posterior roots was performed in four nonspastic "control" children. Sustained responses to 50 Hz stimulation, one of the criteria used to signify abnormality in the spastic children, was found frequently in the "control" children. Contralateral spread to the lower limb muscles and suprasegmental spread to the upper limbs, face, and neck were determined to be the most valid criteria which differentiated abnormal from normal responses. Stimulation of anterior nerve roots at 50 Hz caused sustained responses and ipsilateral lower limb spread, at a low threshold compared to that of corresponding posterior roots. The results of this study bring into question the validity of some of the criteria that are used to select abnormal posterior rootlets in the SFPR procedure, and suggest criteria that may be more valid based on findings in nonspastic children.

Child, Preschool↗
PubMed1992

Selective functional posterior rhizotomy for treatment of spastic cerebral palsy in children. Review of 50 consecutive cases.

Fifty consecutive children are described with spastic cerebral palsy treated with selective functional lumbar and sacral rhizotomy and followed for a minimum of 6 months. In all patients, spasticity improved postoperatively, but this was not necessarily accompanied by a functional improvement. Eighteen children who could not walk preoperatively were able to do so after rhizotomy. All 17 children who could walk preoperatively could do so following surgery, and in 15, gait was improved. Complications included transient urinary dysfunction in 4 children and sensory loss in 1. The operative procedure evolved with time: the technique of replacement laminotomy was refined; the electrophysiologic basis for selection of nerve rootlets changed after studies of nonspastic controls; smaller percentages of the L3 and L4 roots were sectioned in an attempt to prevent postoperative weakness of quadriceps, and there was a trend in the most recent patients to cut a smaller portion of all the posterior roots.

Adolescent↗
PubMed1992

Removal of adherent ventricular catheter.

The technique for freeing adherent ventricular catheters is described in which a Bugbee wire, insulated except for the tip, is used to deliver a monopolar coagulating current to the tissue adherent to the drainage holes of the catheter. This may have some advantage over the use of an uninsulated metal cannula for delivery of a unipolar diathermy cutting current. The technique described has permitted effective and safe removal of adherent ventricular catheters.

Catheters, Indwelling↗