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Stanley L. Barnwell and Michael S. B. Edwards

meningitis, which resolved after antibiotic therapy. The fistula healed spontaneously. The patient did well until the summer of 1983, when he developed a slowly progressive gait abnormality and occasional back pain. There was no bowel or bladder dysfunction. He was admitted to the Pediatric Neurosurgery Service for evaluation of these symptoms on March 12, 1984. He had been taking no medications. Examination The second through 12th cranial nerves were normal. Motor tone, bulk, and strength were normal in both arms. Sensory testing to pinprick, light touch

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James E. Boggan, Catherine Bolger and Michael S. B. Edwards

E arly investigations of photoradiation therapy by Diamond, et al. , 6 in the rat 9L gliosarcoma brain-tumor model showed that treatment with hematoporphyrin and light produced a significant cytotoxic effect on subcutaneous tumors in vivo and on cultured tumor cells in vitro , but had little or no effect on intracerebral tumors. Hematoporphyrin derivative (HPD), however, has been reported to have greater uptake in tumors than does hematoporphyrin, 4, 14 and therefore may be a more effective photosensitizer. The use of HPD and laser light as an adjunct in

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Ali K. Choucair, Victor A. Levin, Philip H. Gutin, Richard L. Davis, Pamela Silver, Michael S. B. Edwards and Charles B. Wilson

S ince the phenomenon of multiple gliomas was first described by Gowers in 1896, 4 it has been the subject of many reviews. 1, 2, 5, 8, 10 Multiple lesions occur in 6% to 10% of patients with gliomas; 1 the percentage of patients who have metastasis to the spinal cord is unknown. The records of patients who had an initial diagnosis of glioma and who received postoperative radiation therapy and chemotherapy at the Neuro-Oncology Service of University of California, San Francisco, were reviewed. The objectives were to estimate the percentage of patients who

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Michael S. B. Edwards, William M. Wara, Samuel F. Ciricillo and A. James Barkovich

B rain-stem gliomas account for 10% to 20% of all central nervous system tumors in children and adolescents. Most are anaplastic and infiltrative tumors 3, 9, 18 that respond initially to radiation therapy but a large proportion recur within 18 months, producing both relentless brain-stem dysfunction and death. 7, 19, 25 The 5-year survival rate varies from 5% to 43%. 2, 4, 8, 11, 14, 15, 17, 18, 25 The classic presentation in the pediatric population is with rapid onset of bilateral brain-stem dysfunction, including multiple cranial nerve palsies and long

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William G. Obana, Philip H. Cogen, Richard L. Davis and Michael S. B. Edwards

failure to thrive, and neurological examination showed reduced visual acuity and vertical nystagmus in the left eye. First Admission Axial computerized tomography (CT) scans revealed a solid, 3 × 3 × 3-cm contrast-enhancing mass in the hypothalamic region. He later underwent bifrontal craniotomy and subtotal resection of the lesion. The tumor was found to be filling the entire suprasellar region and extending into the left optic nerve canal. Medical therapy for panhypopituitarism was initiated at that time. Pathological examination of the resected tissue showed

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Surgical treatment of syringomyelia

Favorable results with syringoperitoneal shunting

Nicholas M. Barbaro, Charles B. Wilson, Philip H. Gutin and Michael S. B. Edwards

(SP) shunting. 24 Even though satisfactory results have been reported for most of these procedures, some authors have been critical of these results. 32, 34 We reviewed the clinical findings, radiological evaluation, and operative therapy of 39 patients with syringomyelia treated at the University of California, San Francisco, from 1970 to 1982. The radiological evaluation and operative therapy evolved considerably during that period. A new SP shunt was used in 15 patients and has become the primary treatment for syringomyelia at this institution. In this report

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Michael S. B. Edwards, William M. Wara, Raul C. Urtasun, Michael Prados, Victor A. Levin, Dorcas Fulton, Charles B. Wilson, John Hannigan and Pamela Silver

great clarity. In 1969 he wrote, “To our knowledge, X-ray therapy has never cured a brain stem glioma. … Indeed, should any patient with a clinical diagnosis of brain stem glioma still be alive as long as 18 months after diagnosis, with or without X-ray treatment, reinvestigation and probably surgical exploration is indicated as some other lesion is probably present.” Despite this dismal assessment, in recent years various authors have reported that radiation therapy may control tumor growth and may reverse neurological dysfunction caused by brain-stem glioma in 75

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Corey Raffel, Michael S. B. Edwards, Richard L. Davis and Arthur R. Ablin

R adiation therapy is an established cause of secondary neoplasia in the central nervous system (CNS). 26 Both benign and malignant tumors can develop after cranial irradiation. Benign postirradiation tumors, of which meningiomas are the most common, have a relatively long latency period, 16 defined as the interval from the start of radiation therapy to clinical recognition of the tumor, whereas postirradiation sarcomas develop after a shorter latency. 5 Reports of glial neoplasms after radiation therapy are rare. We present the unusual case of a child who

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Isabelle M. Germano, Michael S. B. Edwards, Richard L. Davis and Davide Schiffer

%). The duration of symptoms varied from a few weeks to more than 10 years. A predisposing factor was identified in five cases: two patients had received radiation therapy for another central nervous system tumor, and three had neurofibromatosis. Neuroimaging Findings Preoperative magnetic resonance (MR) imaging suggested the diagnosis of meningioma in the three cases in which it was performed ( Fig. 1 ). On T 1 -weighted MR images, the tumors were hypo- or isointense; on T 2 -weighted images, they were hyper- or isointense. Surrounding edema was best seen on T

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group of patients whose lesions conformed to what Horten and Rubinstein 1 classified as “cerebral neuroblastoma,” yet the tumors behaved differently from other highly cellular cerebral tumors. These patients responded more favorably to therapy and had a distinctly better prognosis than those with primitive neural tumors that did not belong under the classification of cerebral neuroblastoma. References 1. Horten BC , Rubinstein LJ : Primary cerebral neuroblastoma. A clinicopathological study of 35 cases. Brain 99 : 735 – 756