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Biomedical subjects

M Caldarelli

Publications and source records attributed to M Caldarelli.

At least 55 records · Page 3Linked to original sources
PubMed1996

Surgical options in the treatment of interhemispheric arachnoid cysts.

BACKGROUND: Arachnoid cysts located within the interhemispheric fissure are a matter of discussion as to the surgical indication and the choice of the most appropriate surgical procedure. In fact, in spite of the large dimensions that they can reach, the clinical manifestations may remain subtle and apparently stable over the years. On the other hand, the larger utilization of prenatal ultrasound investigations has increased the number of lesions detected before they can provoke clinical manifestations. As far as surgery is concerned, two main options are available-an extrathecal shunting procedure or a direct approach to the lesion, with excision of its wall. METHODS: In this report, we analyze the results obtained in 25 children harboring an interhemispheric arachnoid cyst, surgically treated in the period 1978 to 1994. Mean age at diagnosis was 18.8 months (10 days to 15 years). RESULTS The main clinical manifestations included macrocrania, mild to moderate signs of increased intracranial pressure, cranial bulging, developmental delay, and neurologic signs. In 14 cases, the diagnosis had been obtained prenatally. The cyst was located in one hemicranium in 16 cases, whereas it was on the midline, with bilateral extension, in the remaining 9 cases; in the latter cases, variable degrees of callosal agenesis were also observed. All 25 children were operated on. In 16 of them, the treatment consisted of a craniotomy with wide excision of the cyst lining and marsupialization into the subarachnoid spaces of the midline (and/or into the ventricular system). In 6 children, the surgical procedure was a cystoperitoneal (CP) shunt. The last 3 children of our series underwent craniotomy and cyst excision after having been treated by means of a ventriculoperitoneal shunt. At follow-up examination, 17 children are normal, and the remaining 8 disclose mild to moderate psychomotor retardation. CONCLUSIONS: Although both craniotomy and CP shunt are associated with good results, the first surgical procedure offers the advantage of avoiding the insertion of a permanent cerebrospinal fluid shunt device and the known complications of this type of procedure.

Adolescent↗
PubMed1996

[Optic gliomas in the first year of life].

BACKGROUND: Optic gliomas are mainly observed in pediatric patients. Twenty-five percent of cases are diagnosed in the first year of life. Infants with optic gliomas must be considered distinctly from the rest of pediatric patients with this type of lesion, because of the more invasive nature of the tumour and a worse prognosis. Most authors think that surgical treatment of optic gliomas has to be limited to a diagnostic biopsy of the lesion and, in selected cases, to partial decompressive excision. Chemotherapy is useful in the control of the disease, particularly when combined with surgery. Radiotherapy has important secondary effects on the immature brain, and its use is restricted to patients who have reached the 2nd year of life. METHODS: We report our observations on 11 patients with optic gliomas diagnosed in the first year of life, and treated at the Section of Pediatric Neurosurgery of the Catholic University of Rome between 1980 and 1994. RESULTS: In 45.4% of cases the tumour involved the intracranial optic nerve, the optic chiasm, the optic tract and the thalamus. Nystagmus was the most frequent clinical sign, and it was observed in all cases. Signs of intracranial hypertension were observed in 72.6% of cases. We performed a partial decompressive excision of the tumour in 82% of patients. In 2 of these cases we have observed a spontaneous disappearance of the tumour residue and in 5 cases a prolonged time of survival. Mortality has been lower in our group of patients, compared with other authors' experience (36.4% vs 50-80%). Also morbidity has been lower. A severe neurological worsening was observed in two patients and a complete blindness in other two cases (18.1% vs 66.6-100%). CONCLUSIONS: We think that the lower morbidity and mortality observed in our patients can, at least in part, be ascribed to a more aggressive surgical treatment of the lesions.

Child↗
PubMed1995

Surgical treatment of late neurological deterioration in children with myelodysplasia.

Late deterioration of the neurological condition in patients operated on for myelomeningocele repair has been repeatedly reported in the literature. At the present time magnetic resonance imaging (MRI) allows one to recognize various pathological conditions which can be amenable to surgical correction in these patients, such as Chiari type II malformation, hydro/syringomyelia, decompensated hydrocephalus, and tethered spinal cord. The authors report their experience with 26 myelodysplastic children operated on for myelomeningocele repair in the early neonatal period, who exhibited late deterioration at variable time intervals from the first operation. The children were examined pre-operatively by means of MRI; the results were compared with those provided by MRI in 46 myelodysplastic children who underwent the investigation as a routine follow-up control. The MRI findings were subdivided into 4 main groups of increasing severity from 1 to 4; in some subjects, associated pathological conditions (Chiari II malformation, hydromyelia, etc.) were detected as well. Twenty-two out of the 26 patients with late neurological deterioration were operated on. Eleven of them (grades 2 to 4) underwent detethering of the fixed conus, with an improvement of their clinical picture from mild to good. On the other hand the remaining 11 subjects (grades 1 to 2) improved their condition following the correction of the associated abnormalities (malfunctioning CSF shunt: 5 cases; hydromyelia: 4 cases; symptomatic Chiari II malformation: 2 cases).

Child↗
PubMed1994

Spontaneous spinal epidural hematoma in toddlers: description of two cases and review of the literature.

The cases of two children under the age of two who presented with spontaneous spinal epidural hematoma (SSEDH) are reported. The patients were operated on soon after the diagnosis had been confirmed by magnetic resonance imaging examination. The present paper highlights the fact that in toddlers the diagnosis of SSEDH based on a mere clinical picture is particularly difficult, and that this pathology presents a good prognosis following the surgical treatment. The pertinent literature is reviewed.

Child, Preschool↗
PubMed1993

Surgical indication in children with congenital hemiparesis.

Nine children with perinatal occlusion of the middle cerebral artery, resulting in unilateral enlargement of one lateral cerebral ventricle associated with cortical atrophy and subcortical cavity formation, were operated on because of intractable epilepsy. All subjects exhibited mild to severe hemiparesis, localized in the right side of the body in six instances and in the left side in the three cases. All but one patient presented with some degree of psychomotor retardation. The surgical treatment consisted of the removal of the atrophic cerebral cortex. One child died after surgery because of disseminated intravascular coagulation. All the remaining eight children benefited from the operation, with a decrease in the hypertonia of the affected limbs and an improvement in dexterity and gait as well as in intellectual performance. Five patients could be considered seizure-free following the surgical treatment, and the remaining three experienced a significant reduction in the frequency of the seizures.

Atrophy↗
PubMed1992

[Spinal lipomas in childhood].

Spinal lipomas account for 5% of the tumors of the spinal cord, frequently present already at birth. Most commonly they are associated with forms of dysraphism, but lipomas without bony involvement are considered dysembriogenetic lesions too. Children with lipoma frequently have intact neurological functions, but may become symptomatic later on. Diagnosis is possible also in neurologically intact patients because of skin lesions or subcutaneous masses. Many surgeons suggest early surgery to prevent injury to neural structures from traction due to cord tethering; others prefer to wait for the rise of any symptom before considering surgery. However, neurological recovery after surgery is rarely observed, and, when present, is always partial; the primary goal of surgery is to stop the clinical progression through the detethering of the cord.

Child↗
PubMed1991

Early diagnosis and treatment of spinal dysraphism to prevent urinary incontinence.

Spinal dysraphism represents a very rare congenital anomaly of the spinal cord and cauda equina, often associated with cutaneous sacral lesions. This condition results in distorsion of neural tissue, possibly leading to vesical dysfunction and urinary incontinence. A series of 12 children with spinal dysraphism (4 lipomeningoceles with tethered cord, 3 tight filum terminale, 2 dermal sinuses, 2 arachnoid cysts, 1 anterior meningocele) observed during the last 6 years is presented. The patients are divided into two groups: group A includes 5 infants (age range 4 months-2 years) and group B 7 older children (4-12 years). All 7 patients of group B were referred for urinary incontinence as their chief complaint; only 1 had evidence of a skin lesion while 3 had a club foot. In group A, 4 had skin lesions (2 asymptomatic and 2 dermal sinuses referred after several episodes of meningitis) and the 5th child had a club foot. The diagnosis was made by myelo-CT scan in the earlier 4 and by magnetic resonance imaging in the more recent 8 cases. All 12 children were operated. In group B, the patients' urinary incontinence persisted but did not worsen (3 were stable and 4 had slightly improved); in group A, 2 were dry (follow-up greater than 2 years), 1 could not be accurately evaluated because he was less than 2 years of age, and the 2 who suffered from meningitis were incontinent. Early diagnosis and neurosurgical treatment of spinal dysraphism may prevent urinary incontinence. Accurate urodynamic, neurophysiologic, and neuroradiologic evaluation of children with severe voiding anomalies or club foot is recommended even if no lumbosacral cutaneous lesions are present.

Child↗
PubMed1990

[Intracranial tumors in the 1st year of life].

The introduction of the new diagnostic tools for neuroimaging has resulted in the early recognition of congenital brain tumors. In the present report we describe 39 children, in whom the diagnosis of an intracranial tumor has been obtained during the first 12 months of life. These patients represent 14.4% of a pediatric population of 271 children with brain tumors, observed in the same period of time (11 years) in the Neurosurgical Institute of the Catholic University of Rome. Most of the tumors were located within the supratentorial compartment. Midline tumors were common. Sixteen children underwent the total removal of the tumor. Four infants could not be operated either because their poor general condition or the extension of the tumor. In one case, treatment was refused by the parents. The remaining children underwent the partial removal of the tumor, which was followed by chemotherapy (malignant tumors) or by serial neuroradiological examination (benign tumors), with the aim of postponing radiotherapy at the end of 2 years of age at least. The total mortality (surgical deaths: 7 cases) and deaths during the follow-up period (11 cases) was 38.5%. Out of the 24 surviving children, 8 (20%) are normal: 7 (17%) exhibit only minimal neurosurgical deficits; 9 (22%) are seriously handicapped. One child has been lost for the follow-up observation.

Age Factors↗
PubMed1989

"Occult" hydrocephalus in children.

The authors describe 32 children between 2 and 15 years of age who had hydrocephalus that was only clinically manifest late in life. The clinical picture of these children did not suggest an obvious increase in intracranial pressure; instead, the presenting signs were rather nonspecific and included macrocrania, mild psychomotor retardation, unsteady gait, increased muscle tone and deep tendon reflexes in the lower limbs, impaired ocular movement, epilepsy, and endocrine dysfunction. Their histories suggest the possible causes of the ventricular dilation in about one third of the cases were: perinatal hemorrhage, leptomeningitis, neurofibromatosis, and untreated aneurysm of the great vein of Galen. In 20 patients, however, no positive anamnestic findings were reported. CT scan revealed triventricular dilation in more than half of the cases; tetraventricular dilation was present in 6 patients, and biventricular dilation in the remaining subjects. All children underwent CSF shunting, which resulted in complete recovery in all but 2 cases. The most frequently recorded surgical complication was post-operative subdural effusion (7 subjects), which required surgical treatment in only 2 cases.

Adolescent↗
PubMed1989

[Craniostenosis. Analysis of 161 cases surgically treated during the first year of life].

One hundred-sixty-one cases of children operated on for craniostenosis in the first year of life at the Neurosurgical Department of the Catholic University of Rome in the period 1982-1986 are presented. The average age at diagnosis was 6 months and at operation 7.4 months. The patients considered in the present study were subdivided into two groups according to the prevalent involvement of sagittal suture or of the anterior sutural group (coronal metopic, spheno-frontal and spheno-palatine sutures). In fact, these two groups differ considerably not only in the characteristics of the pathological process of early fusion of the cranial sutures, but also in the technique required for surgical correction. Four children with premature fusion of all cranial sutures are considered separately. Congenital malformations of the bone structures or changes in ocular motility were presented in 7.9% of 63 patients with sagittal craniostenosis and in 14.7% of the group with premature fusion of the anterior cranial sutures. Surgical correction (linear craniectomies extended to the cranial base for the group with sagittal craniostenosis, craniectomies with advancement of the supraorbital margin and rotation of the bone operculum for the group with anterior craniostenosis) proved satisfactory in the great majority of cases. Postoperative morbidity was particularly low. Apart from postsurgical anaemia which required blood transfusion on the third day in 15.5% of operated patients, the only complications were transitory hyperpyretic states observed in 6.2% of cases. Only one child died for reasons related to the surgical procedure. The low postoperative mortality (0.6% of cases) and the low percentage of bone pathology recurrence (7.4%) compared with the results of other series involving older children, seem to indicate that the early surgical correction of bone malformations does not bear additional risk for the patient, permitting at the same time normal functional development of the brain and a more gradual morphological remodelling of the skull.

Craniofacial Dysostosis↗
PubMed1988

The lumbar subarachnoid infusion test in infants.

The authors describe the results obtained with the lumbar subarachnoid infusion test in 75 infants with suspected abnormalities in the cerebrospinal fluid dynamics. On the basis of the results obtained, an algorithm is proposed that enables infants with normal intracranial responses during the test to be differentiated from those with defective cerebrospinal fluid absorption mechanisms.

Cerebrospinal Fluid↗
PubMed1984

Multiple spinal meningiomas in children.

A case of a girl with multiple spinal meningiomas, without evidence of neurofibromatosis, is described. The patient first underwent the complete removal of an intradural tumour at the lower lumbar level, at the age of eight year. A second intradural meningioma, located at the upper lumbar level, was surgically excised after a five year symptom-free period.

Adolescent↗
PubMed1982

Light microscopy and ultrastructural studies of Sturge-Weber disease.

Different degrees of cerebral calcifications together with encephalofacial angiomatosis and seizure disorders characterize the Sturge-Weber syndrome. According to the observations reported in the literature, calcium deposits may be found in the wall of cerebral vessels, in the perivascular tissue and rarely within the neurons. Corresponding to the variety of localizations, the interpretation of the phenomenon remains obscure. Most theories postulate the role of a vascular factory and of a mesenchymal factor. Ultramicroscopic studies of the specimens obtained in 2 children with the Sturge-Weber Syndrome provided the following findings. A mucopolysaccharidic substance constitutes the substratum for the deposition of calcium. Small amounts of this substance and calcium deposits may be detected within the connective tissue of cerebral vessels precociously; later on, while increasing in size and calcium concentration, they obviously migrate to outside the vessels. Successively, the calcium deposits seem to localize around the blood vessels, In our opinion, these observations stress the role of a primitive vascular factor; consequently, anoxia, necrosis of cerebral tissues, and variation in the calcium ion concentration would act only as secondary factors.

Angiomatosis↗
PubMed1981

A technique for evaluation of CSF shunt patency using telethermography.

Sixty-two operated hydrocephalic children have been tested in order to evaluate the functioning of CSF shunt using a telethermographic technique. The obtained results indicate that the thermal transfer due to CSF flow within the shunt may be utilized for detecting the patency of the inserted CSF shunt.

Adolescent↗
PubMed1981

Infratentorial arachnoid cysts in children.

8 Children surgically treated for posterior fossa arachnoid cyst are described. In all the cases an enlarging head was the presenting sign; intracranial hypertension was evident in 6 patients; 2 children were clinically regarded as being affected by 'arrested' hydrocephalus. Preoperative subarachnoid lumbar infusion tests (8 cases) and prolonged intraventricular CSF pressure recordings (2 cases) demonstrated abnormal CSF dynamics in 6 cases. Ultramicroscopic examinations of the cyst wall (4 cases) suggest alterations in the anatomical arrangement of the arachnoid membrane, which supports the hypothesis of maldevelopment as the origin of the lesion.

Arachnoid↗
PubMed1980

Effects of artificially induced increases in intracranial pressure on epileptic activity.

The effects of induced increases in intracranial pressure (ICP) on epileptic activity following topical application of penicillin on the cerebral cortex or dorsal hippocampus were investigated in rabbits. Enhanced basal epileptic activity was brought about by the rise in the ICP, obtained with repeated lumbar infusions of saline. In some animals, this increased activity was already evident during the test, while in others it became obvious only at the end of the procedure. When induced, the increased epileptic activity could persist even after the ICP had returned to within normal limits.

Animals↗