✓ The authors report the case of a 3-year-old girl with a Chiari malformation Type I (CM-I) and concomitant fatty terminal filum. This child was examined prior to the onset of CM-I as well as after, and the authors present magnetic resonance (MR) images documenting that the malformation was acquired as the child grew in height. This case contributes to the literature describing an acquired CM-I associated with a fatty filum and is the first published account to include MR imaging obtained before and after the onset of the malformation.
Taylor J. Abel, Abhineet Chowdhary, Patrik Gabikian, Richard G. Ellenbogen and Anthony M. Avellino
Timothy J. Hatlen, David B. Shurtleff, John D. Loeser, Jeffrey G. Ojemann, Anthony M. Avellino and Richard G. Ellenbogen
Programmable valves (PVs) for shunting CSF have increasingly replaced nonprogrammable valves (NPVs). There have been only a few longer-term studies (≥ 5 years) conducted that have compared the effectiveness of NPVs with that of PVs for children with hydrocephalus, and only 1 study has reported NPVs as being favorable over PVs. The objective of this retrospective study was to compare the long-term survival of these 2 types of shunt valves.
The authors collected data for all patients who underwent CSF shunt insertion or revision between January 1, 2000, and December 31, 2008. Patients underwent follow-up for a minimum of 2 years postoperatively. Statistical analyses were done using chi-square, Kaplan-Meier survival curve, and multivariate analyses.
A total of 616 valves were implanted, of which 313 were PVs and 303 were NPVs. Of these, 253 were original shunt implantations and 363 were revisions. The proportion of 5-year survival for NPVs (45.8%) was significantly higher than that for PVs (19.8%) (p = 0.0005, log-rank). The NPVs that survived longer than 6 months also survived through the 5th year better than the PVs (p = 0.0001).
The authors' data suggest that NPVs survive longer than PVs in children, but there is a need for prospective, case-control studies to confirm these data.
Samuel R. Browd, Jacob Zauberman, Mahesh Karandikar, Jeffery G. Ojemann, Anthony M. Avellino and Richard G. Ellenbogen
The authors report their experience with a novel flexible fiber capable of transmitting CO2 laser energy during spinal cord tumor resection and detethering.
A fiber optic system capable of transmitting CO2 laser energy was used in the detethering of the spinal cord in 3 cases. The first case involved a 9-year-old girl with a terminal lipoma. The second case was an 11-month-old boy with a thoracic intramedullary dermoid and dermal sinus tract. The third case involved a 13-year-old girl suffering from a tethered spinal cord subsequent to a previously repaired myelomeningocele.
In all 3 cases, the new fiber CO2 laser technology allowed the surgeon to perform microsurgical dissection while sparing adjacent neurovascular structures without time-consuming setup. The system was easy to implement, more ergonomic than previous technologies, and safe. The CO2 laser provided the ability to cut and coagulate while sparing adjacent tissue because of minimal energy dispersion and ease of use, without the articulating arms involved in the prior generation of lasers.
Using a flexible fiber to conduct CO2 laser energy allows accurate microneurosurgical dissection and renders this instrument a high-precision and ergonomic surgical tool in the setting of spinal cord detethering.
Case report and review of the literature
Ali H. Mesiwala, John D. Kuratani, Anthony M. Avellino, Theodore S. Roberts, Marcio A. Sotero and Richard G. Ellenbogen
✓ The issue of whether seizures can arise in the cerebellum remains controversial. The authors present the first known case of focal subcortical epilepsy with secondary generalization thought to arise from a dysplastic lesion within the cerebellum. A newborn infant presented with daily episodes of left eye blinking, stereotyped extremity movements, postural arching, and intermittent altered consciousness lasting less than 1 minute. These episodes began on his 1st day of life and progressively increased in frequency to more than 100 events per day. Antiepileptic medications had no effect, and interictal and ictal scalp electroencephalography (EEG) recordings demonstrated bilateral electrical abnormalities. Magnetic resonance imaging revealed a mass in the left cerebellar hemisphere, and ictal and interictal single-photon emission computerized tomography revealed a focal perfusion abnormality in the region of the cerebellar mass. The patient subsequently underwent intraoperative EEG monitoring with cortical scalp electrodes and cerebellar depth electrodes. Intraoperative EEG recordings revealed focal seizure discharges that arose in the region of the cerebellar mass and influenced electrographic activity in both cerebral hemispheres. Resection of this mass and the left cerebellar hemisphere led to complete resolution of the patient's seizures and normalization of the scalp EEG readings. Neuropathological findings in this mass were consistent with ganglioglioma. A review of the literature on the cerebellar origins of epilepsy is included.