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Biomedical subjects

J E Kalsbeck

Publications and source records attributed to J E Kalsbeck.

At least 19 recordsLinked to original sources
PubMed2001

Tumor-related epilepsy in children.

A 10-year retrospective review of 15 children with cerebral tumors and seizures was conducted to study the factors responsible for delay in the diagnosis of tumors and to assess outcome following surgery. Mean duration of seizures prior to surgery was 37 months. Ninety-three percent had no focal neurologic deficits. Head computed tomography was abnormal in 64%, whereas magnetic resonance imaging was abnormal in all patients. Electroencephalography showed focal abnormalities ipsilateral to the tumor in 73%. There was no surgical mortality. Eighty percent were seizure free or had rare seizures following surgery. Factors contributing to a delayed diagnosis of the brain tumor included a nonfocal neurologic examination and delay in obtaining an appropriate neuroimaging study. We believe that head magnetic resonance imaging should be the investigation of choice in partial epilepsies.

Adolescent↗
PubMed1999

Craniofacial correction of giant frontoethmoidal encephalomeningocele.

The surgical treatment of a very large anterior encephalocele in an infant is presented. Because of the large size of the encephalocele, a combined transfacial-transcranial approach was used for correction of the associated intracranial, cranioorbitonasal bone, and facial skin deformities.

Craniotomy↗
PubMed1998

Chiari III malformation treated with CSF diversion and delayed surgical closure.

Chiari III malformations are extremely rare hindbrain malformations that are associated with a high early mortality rate, or severe neurologic deficits in the survivors. The preferred treatment is early operative closure and CSF shunting. We report a case of a newborn infant with a Chiari III malformation with displacement of the brainstem and cerebellum into the cervical encephalocele which precluded immediate operative closure of the defect. Instead, a ventriculoperitoneal shunt was placed and the patient was followed with serial imaging studies. The child survived. The shunt allowed the brainstem and cerebellum to regress into the cervical spinal canal as the dilated cerebral aqueduct and fourth ventricle decompressed. A delayed closure of the cervical encephalocele was performed at 30 months of age. Cerebrospinal fluid diversion with delayed closure may be an option for large lesions.

Arnold-Chiari Malformation↗
PubMed1995

Cloacal exstrophy: the neurological implications.

Congenital anomalies commonly accompany the abdominal wall defects of cloacal exstrophy with an incidence as high as 100% in some series. The urological literature cites an incidence of vertebral and/or spinal cord anomalies in 75% of cases. We reviewed the records of the 17 patients with cloacal exstrophy treated at our institution since 1978. Abnormalities of the vertebral column or spinal cord were identified in 16 patients, including 11 of 12 (92%) fully evaluated by myelography, computerized tomography or magnetic resonance imaging of the lumbosacral spinal cord. Nine patients had a lipomeningocele and 4 had a lipomyelocystocele. Spinal exploration, repair and cord untethering were done in 11 patients of whom 2 subsequently underwent reoperation for re-tethering the cord. A total of 15 patients is ambulatory although 5 require lower extremity braces. The incidence of spinal cord or vertebral anomalies in our patients with cloacal exstrophy approaches 100%, which is higher than commonly cited in the urological literature. We recommend magnetic resonance imaging of the spinal cord as part of the initial evaluation of newborns with cloacal exstrophy. Lifelong attention to the risk of spinal cord tethering can optimize neurological outcome in affected individuals.

Abnormalities, Multiple↗
PubMed1994

Cranial reconstruction in osteogenesis imperfecta.

Although osteogenesis imperfecta (OI) is recognized as a cause of craniosynostosis, therapeutic endeavors have not been reported. We present an 8-month-old girl with type 3 OI, in whom bilateral occipital flattening, biparietal widening, and frontal narrowing were effectively managed with a combined surgical release and reconstruction and molding cap therapy. The quality of the calvarial bone in OI requires a modified approach to the conventional bone techniques commonly used in the correction of craniosynostosis deformities.

Craniosynostoses↗
PubMed1991

Orbital teratoma associated with trigonocephaly.

A rare case of congenital orbital teratoma that developed concurrently with the clinical findings of metopic sutural synostosis in an infant is presented. A cause-and-effect and/or embryologic relationship between these two cephalic malformations is possible, although coincidental occurrence is equally probable. The proximity of these congenital anomalies permitted complete resolution in a one-stage craniofacial procedure without alteration in the surgical technique.

Craniosynostoses↗
PubMed1990

Modifications in the surgical correction of trigonocephaly.

A modified technique for the surgical correction of trigonocephaly is presented. The technical modifications are designed both to increase the stability of fixation of the supraorbital bar and lateral canthal advancements and to increase interorbital distance and anterior cranial fossa volume when utilized in those patients who exhibit the full expression of trigonocephaly, including midline ridging, bifrontal recession, hypotelorbitism, shortened anterior cranial fossa, deficient projection of lateral orbit, and bitemporal narrowing. It is a modification of the supraorbital bar remodeling/advancement procedure as originally described by Marchac with the introduction of a nasofrontal osteotomy and superior osteotomy bone graft and midline miniplate fixation of the supraorbital bar to the nasofrontal junction. Its use in 20 patients has been favorable.

Bone Plates↗
PubMed1986

Radiologic manifestations of delayed radiation necrosis of the brain.

One of the most effective treatment modalities for tumors of the head and neck has been radiation therapy. In a small number of cases, delayed radiation necrosis of the brain is a dreaded and devastating complication of radiation therapy. The imaging studies (radionuclide brain scan, cerebral angiography, computed tomography and magnetic resonance imaging) in 12 cases of histologically proven, delayed radiation necrosis of the brain are analysed. While both computed tomography and magnetic resonance imaging can depict radiation necrosis with great sensitivity, however, the ability of these imaging techniques to differentiate between radiation necrosis and recurrent or residual brain tumor is low.

Adolescent↗
PubMed1984

Cerebrospinal fluid ascites complicating ventriculoperitoneal shunting. Report of four cases.

Four cases of cerebrospinal fluid (CSF) ascites secondary to ventriculoperitoneal shunting are described. It is possible to differentiate CSF ascites from a CSF-filled pseudocyst by the characteristic bowel gas pattern on films of the abdomen and by the presence of shifting dullness. Two of the patients had active shunt infections, and had ascitic fluid with a protein level greater than 3 gm% and a white blood cell (WBC) count greater than 1000/cu mm. Both were treated successfully with antibiotics and removal of the shunt from the peritoneum. Two other patients had no evidence of infection, protein levels of less than 2 gm%, and WBC count less than 100 cu mm. These disorders resolved spontaneously. A review of 18 cases reported in the literature shows that the etiology of CSF ascites in the absence of shunt infection is multifactorial, and no features are consistently present in all cases. Ascites without infection may resolve spontaneously without surgical intervention.

Adult↗
PubMed1983

Developmental outcome of very low birth weight infants requiring a ventriculo-peritoneal shunt.

All infants of less than 1,500 g birth weight who required a ventriculo-peritoneal shunt were followed for developmental problems over the 1st year of life. There were 19 infants; 2 died within the 1st postoperative week. At 1 year of age corrected for prematurity the mean Bayley Mental Developmental Index was 62 +/- 23.0, and the mean Psychomotor Developmental Index was 61 +/- 19. Only 2 infants attained scores greater than 85 on both scales, while an additional 2 infants attained a score of greater than 85 on one scale. It is concluded that ventriculo-peritoneal shunting procedures performed after progressive ventricular enlargement has taken place are not likely to result in normal development of the infant less than 1,500 g birth weight.

Cerebrospinal Fluid Shunts↗
PubMed1983

Postsurgical arachnoid cyst: report of two cases.

We present two cases that demonstrate the occurrence of symptomatic arachnoid cysts after craniotomy. Both patients presented 1 year postoperatively with generalized seizures as the only symptom. Focal or localizing neurological signs were not present. Both patients responded well to shunting procedures.

Adenoma, Chromophobe↗
PubMed1980

Compartmentalization of the cerebral ventricles as a sequela of neonatal meningitis.

Thirteen infants with compartmentalization of the lateral ventricles diagnosed by air encephalography, computerized tomography, or autopsy are reported. In each case, the body of one or both lateral ventricles was completely divided by a membrane posterior to the foramen of Monro. Recognition of this entity is important from both therapeutic and prognostic standpoints.

Brain Diseases↗
PubMed1979

Optic chiasmatic glioma in children.

We reviewed the records of 29 patients with optic nerve or chiasm glioma, or both, seen from 1955 to 1966. Sixteen patients were girls and 13 were boys. At the time of diagnosis, 14 patients were less than 2 years old. Optic atrophy was the most frequently seen physical finding, present in 26 of 29 patients. Twelve patients had diencephalic syndrome (41%). Proptosis was seen in eight. Eleven patients (38%) had associated neurofibromatosis. Pneumoencaphalogram was done on 26 patients and was abnormal in 23. The diagnosis was confirmed at surgery in 27 patients. All tumors were astrocytomas. Eighteen patients underwent radiotherapy. Surgery and radiotherapy were used as treatment for optic-chiasmatic glioma with diencephalic syndrome.

Age Factors↗
PubMed1979

Scoliosis and hydrocephalus in myelocele patients. The effects of ventricular shunting.

Developmental scoliosis is a common cause of increasing disability and deformity in long-term myelocele survivors, and is believed to result from a paralytic collapsing spine. The possible etiological role of compensated hydrocephalus and hydromyelia was assessed by determining the effect of ventricular shunting on 11 myelocele patients with developmental scoliosis. After successful shunting, one patient with a 47 degrees curve continued to deteriorate. Three cases with curves greater than 60 degrees were stabilized for short periods, but eventually required spinal fusion. Seven cases with curves less than 55 degrees were improved from a mean scoliosis of 29 degrees to 13 degrees during a 20-month follow-up period. Several patients had pre-existing shunts that were found to be non-functional on shuntogram. These findings suggest that the spinal complications of hydrocephalus may be more common than previously recognized in myelocele patients and that advanced developmental scoliosis may be avoided by early recognition and ventricular shunting.

Adolescent↗
PubMed1979

Intraspinal tumors in children. A review of 81 cases.

The authors have presented 81 children with intraspinal tumors, all less than 16 years of age. The clinical features indicated that gait disturbance, pain, and sphincter disturbance are the most prominent complaints. Reflex changes, paralysis, and sensory impairment are the most frequent physical findings. Cerebrospinal fluid protein was recorded in 47 patients and was abnormal in 34. Spine radiography was abnormal in 58% of the patients. Seventy of the patients had myelography, and it was diagnostic in 67. Surgery was performed on 79 patients, with a 2.5% operative mortality (30 days postsurgery). Of the 49 patients who are alive, 91.5% are able to walk. Mean follow-up period was 8.5 years. The authors document the benign course of the intramedullary astrocytomas and suggest an approach to their treatment. They encourage an aggressive approach to metastatic intraspinal tumors. The latrogenic origin of some epidermoid tumors is noted. The importance of early diagnosis and treatment of the intraspinal tumors in children is emphasized.

Adolescent↗
PubMed1978

An unusual late complication of Gasserian ganglion cecompression surgery. Case report.

The authors report an unusual complication following sugery for decompression of the Gasserian ganglion. Eight years postoperatively this patient developed a left temporal lobe granuloma caused by a piece of wood used to plug the foramen spinosum at surgery. The patient's clinical and radiological findings were suggestive of a glioma involving the temporal lobe.

Brain Diseases↗
PubMed1976

A histochemical investigation of catecholamines in spinal cord injury.

The catecholamine hypothesis of progressive spinal cord necrosis following mechanical trauma was investigated with the histofluorometric method. Forty-four adult mongrel dog were examined as control, L1 crush-injured, and crush-injured with prior T1 total transection groups. In crush injured dogs, catecholamines were present in a 1 cm length of white matter at the crush site, with the greatest accumulation in the deep lateral and ventral funiculi. Gray matter fluorescence was not enhanced. Prior transection did not abolish the intense accumulation of catecholamines at the site of the cord injury. We propose that the catecholamines accumulating at the cord injured site are not central in origin, but represent an uptake mechanism into white matter as a reflection of cord microperfusion.

Animals↗