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Biomedical subjects

C Di Rocco

Publications and source records attributed to C Di Rocco.

At least 109 records · Page 6Linked to original sources
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↗
PubMed1994

[Surgical treatment of epileptogenic hemimegalencephaly].

Thirteen children affected by hemimegalencephaly were observed in the Pediatric Section of the Institute of Neurosurgery of the Catholic University of Rome in the last six years. Nine of them were operated because of an intractable epilepsy. Seven were males and 2 females; the age at operation ranged between 7 months and 11 years (mean: three years and five months); the follow-up period varied between 1 and 6 years (mean 3 years and 10 months). All the patients had a clinical history of daily epileptic seizures not responsive to medical treatment; all of them presented with severely delayed psychomotor development. At neurological examination, six children showed a motor deficit of variable severity contralateral to the affected hemisphere and two patients a severe tetraparesis. The remaining child did not present with motor deficit. In all the cases the diagnosis had been obtained by CT scan and MRI. One of the cerebral hemispheres was abnormally enlarged with associated dilation of the lateral cerebral ventricle. The cortical architecture was obviously deranged with several areas of heterotopia of the gray substance suggesting an alteration of the neuronal cell migration. All the children underwent an extrathalamocaudato hemispherectomy. A post-operative ventriculo-peritoneal shunt was required in two cases. There were neither operative, nor late deaths. A dramatic reduction in the frequency and severity of epileptic seizures was observed in all but one of the patients of the series.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain↗
PubMed1994

Spinal epidural meningiomas in childhood: a case report.

A case of a girl affected by an extradural spinal meningioma is described. This lesion is rare in childhood, and the prognosis may be not favorable. In our case a complete removal of the neoplasm with exeresis of the involved dura resulted in a very good clinical and radiological recovery.

Adolescent↗
PubMed1993

The identification and the education of a pediatric neurosurgeon at an international level.

Although the field of application of pediatric neurosurgery is easily identified by the age criterion as well as the specific illnesses of children, the "pediatric neurosurgeon" is still fairly undefined. In fact, the evolution of the process by which the pediatric neurosurgeon is identified is quite different in the various countries, depending on the cultural environment, the socioeconomic level and the age distribution of the population. In North America, in recent years there has been activity aimed at obtaining full independence for pediatric neurosurgery. On the other hand, as a result of inertia, academic tradition and the health care system, Europe only appears to be willing to recognize this subspecialty culturally and to oppose its actual independence from general neurosurgery.

Career Choice↗
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↗
PubMed1993

Intracranial tumours in the first year of life. A report on 51 cases.

The authors report on 51 infants with intracranial tumours treated in an eleven-year period; these infants represent 13% of the total population of children with intracranial tumours who have been operated on in the same institution during the same period of time. Males (28 cases) were slightly more frequent. Astrocytomas (17 cases), medulloblastomas (12 cases), and ependymal tumours (5 cases) were the commonest histologic types. Signs and symptoms of increased intracranial pressure were by far the most frequent clinical manifestations, followed by seizure disorders. Thirty tumours were localized within the supratentorial, and 21 within the subtentorial compartment. The parasellar region (10 cases) and the lateral cerebral ventricles (8 cases) for the supratentorial tumours, the inferior cerebellar vermis and fourth ventricle (13 cases) for the infratentorial tumours appeared to be the preferred topographic locations. Craniotomies were carried out in 44 infants, with a total or radical removal of the tumour in 19 cases, a subtotal removal in 6 cases, and a partial removal in 17 cases. In 3 cases only a biopsy procedure was performed. Twenty-nine of these patients required an ancillary procedure such as CSF shunting. Three subjects underwent a biopsy procedure and 1 infant the insertion of a CSF shunting device only. Surgery was not performed in 5 cases. Overall, there were two surgical deaths. Two infants died before any surgical treatment could be performed. Radiation therapy was administered to 9 patients when they had reached three years of age. Chemotherapy was given to 21 infants, according to various chemotherapeutic protocols. During the postoperative period 20 deaths (39%) were recorded. Two patients were lost to follow-up. From 1 to 10 years after the operation, 29 patients are still alive, 14 of them (28%) with a normal psychomotor development, 10 (20%) with some neurological or mental deficits, and 5 (10%) with severe psychomotor retardation. There was no apparent correlation in this series between late outcomes and the histological type of the tumour.

Astrocytoma↗
PubMed1993

Epilepsy and low grade gliomas in pediatric neurosurgery.

A series of 33 children affected by low grade gliomas and epilepsy is reported. Seizures are often the only symptom of these patients; intracranial hypertension and focal neurological signs may be present too. All children were operated on; tumor removal was performed in 21 cases, tumor removal associated with corticectomy and/or lobectomy was performed in 12 patients. The treatment of epilepsy has been more effective in the first group of patients with only lesionectomy than in the second one, in which neoplasm removal was coupled with nervous system tissue asportation.

Adolescent↗
PubMed1993

[Hypersecretive congenital hydrocephalus due to choroid plexus villous hypertrophy associated with controlateral papilloma].

The authors present a case of a nine month-old baby with hypersecretive congenital hydrocephalus. The CSF overproduction was the result of a rare abnormality of the choroid plexus, a villous hypertrophy of the right ventricular choroid plexus and a left ventricular plexus papilloma. Surgical removal of the plexus papilloma and the plexectomy of the hypertrophic ventricular structure did not ameliorate the hydrocephalus, which has been controlled after a biventricular-peritoneal shunt. The physiopathological relationship between hydrocephalus and choroid plexus abnormalities are reported. The importance of an early diagnosis and treatment is stressed. Both hydrocephalus and choroid plexus pathology may represent a cause of psychomotor delay, for the little patient the effects of which is investigated in this paper.

Cerebral Angiography↗
PubMed1992

Cerebrospinal fluid pharmacokinetics of carboplatin in children with brain tumors.

The pharmacokinetics of carboplatin in cerebrospinal fluid (CSF) and plasma was studied in five children with brain tumors (four medulloblastomas and one ependimoblastoma) who underwent preirradiation treatment with carboplatin. Carboplatin pharmacokinetics was studied following the administration of 600 mg/m2 as a 1-h infusion. Four children were treated a few weeks after surgery, whereas one child with an unresectable tumor was treated prior to surgery. All patients had a ventricular-peritoneal CSF shunt connected to a subcutaneous reservoir. Total platinum and free carboplatin were measured. The mean AUC values for free carboplatin in CSF and plasma were 2.29 +/- 1.20 and 8.18 +/- 1.27 mg ml-1 min, respectively. The mean ratio of CSF AUC to plasma AUC was 0.28 (range, 0.17-0.46). Both plasma peak levels and AUC values showed limited interpatient variability. On the other hand, carboplatin levels in CSF showed substantial interpatient variability, with a greater than 5-fold difference in peak levels and a 3-fold difference in AUC values being recorded. The interpatient difference in CSF pharmacokinetics may have been related at least in part to the different anatomical alterations induced by the surgical procedures or by the presence of a large tumor mass. In the four evaluable patients exhibiting macroscopic residual tumor, we observed one complete remission (CR) and two partial remissions (PR) following two cycles that consisted of two doses of 600 mg/m2 carboplatin given on 2 consecutive days (total dose, 1200 mg/m2) and were separated by a 1-month interval. These results may give some indication as to the optimal dose and schedule for carboplatin administration in the treatment of primitive neuroectodermic tumors (PNET).

Brain Neoplasms↗
PubMed1992

Fibrous dysplasia of the skull in children.

Early diagnosis of skull fibrous dysplasia in children is relatively easy, based on a history of painless progressive bony bulging. The therapeutic approach is still controversial, due to the benignity of the lesion. However, the clinical course may be unpredictable, with sudden appearance of symptoms, some of which can be important and irreversible. In pediatric patients, the possibility that an early surgical correction might positively interfere with the natural history of the lesion has to be evaluated by taking into account the obvious difficulties that will be encountered in reconstructing the skull after a wide excision of the pathologic bone. In the present report, we describe our personal experience on the surgical treatment of 9 children, ranging in age between 7 and 14 years. The patients were subdivided into two groups, according to the localization and extent of the disease. Patients in group 1 presented an involvement of the hair-covered cranium and/or the fronto-orbital region. Group 2 patients presented with a multizonal involvement of the skull, including the central cranial base (pterygoid, sphenoid, petrous and mastoid bone). The different surgical options, chosen for the two groups of patients, are discussed, together with the technical methodologies utilized, the cosmetic results and the long-term follow-up.

Adolescent↗
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↗
PubMed1992

[Non-tumoral neonatal hydrocephalus. Results of surgical treatment in the first month of life].

Two hundred eight patients with non-tumoral congenital hydrocephalus underwent CSF shunting below the age of one month. Ultrasonography was the most frequently utilized tool; hydrocephalus was recognized during pregnancy in 52% of the cases. Hydrocephalus was associated with myelomeningocele in 97 infants; in 38 subjects ventricular dilation was secondary to aqueductal stenosis. Post-hemorrhagic and post-infective hydrocephalus accounted for only 20 and 13 cases respectively. At the follow-up observation, a normal psychomotor development was recorded in 67.3% of the cases. Seventeen patients died. CSF infection was the most common cause of death (41%); in 6 patients the exitus was determined by the natural evolution of congenital associated malformations. Shunt revision did not influence the morbidity and the mortality significantly. On the other hand, CSF infections appeared to influence the prognosis negatively. In our experience, the prognosis of hydrocephalus operated on in the first month of life does not differ from that of hydrocephalus operated on late in life.

Cerebrospinal Fluid Shunts↗
PubMed1991

Intracranial tumors of the first year of life. A cooperative survey of the 1986-1987 Education Committee of the ISPN.

The introduction of new diagnostic tools for neuroimaging has resulted in the early recognition of congenital brain tumors. In the present report the authors describe an International Multicenter Series of 886 children with brain tumor, in whom the diagnosis was obtained during the first 12 months of life. Most of the tumors were located within the supratentorial compartment. In spite of a relatively high operative mortality, surgery still appears to be the more effective therapy. Radiotherapy in this age group is of little value due to the vulnerability of the infantile brain. At the present time, the use of chemotherapy is still controversial.

Brain Neoplasms↗
PubMed1990

"C" trigonocephaly syndrome: clinical variability and possibility of surgical treatment.

We report on 3 new cases of C trigonocephaly syndrome. In addition to the findings characteristic of this condition, one of the patients also had a large omphalocele. This patient was referred from a suburban hospital with a diagnosis of Down syndrome, stressing the fact that C syndrome is still under-recognized and underdiagnosed. Another patient was diagnosed at birth and immediately submitted to craniosynostectomy. A second operation was performed 7 months later resulting in normal brain growth and close to normal psychomotor development at 3 years, in contrast to the third patient, who was not treated surgically and was severely retarded at 4 years.

Abnormalities, Multiple↗
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↗
PubMed1990

[The congenital cervical dermal sinus. A clinical case report and review of the literature].

Congenital dermal sinus represents a dysraphic state of the central nervous system. It can show up throughout a defect of the midline, of both the skull and the spine. Usually, the malformation presents a fistulous tract, connecting the skin with the underlying tissues (hypoderm, paraspinal muscles, vertebrae and, in some cases, also the dura mater and spinal cord). The incidence of the malformation is quite low, 1:2,500 births; the cervical and dorsal locations represent the less common region. The malformation can remain undetected at the clinical examination because of the scarce cutaneous stigmata. Usually, it is revealed by repeated episodes of meningeal infection, due to the free communication between the inner dural space and the nervous structure and the external space, allowed by the open cutaneous tract. The case of a cervical dermal sinus tract, observed and successfully treated in a 10-months-old female child prompted us to this study and to review of the cases reported in the literature.

Female↗