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Biomedical subjects

F Epstein

Publications and source records attributed to F Epstein.

100 records · Page 6Linked to original sources
PubMedDate not supplied

Surgical indication and technical considerations in the management of benign brain stem gliomas.

The treatment of brain stem gliomas has evolved over the last few decades, reflecting advances in imaging (MR), microsurgical techniques and biological understanding. The aim of this chapter is to provide a preoperative classification for intrinsic brain stem lesions that will predict histopathology and biological behavior from the clinical syndrome and the MR appearance. Such a classification system may help selecting children with brain stem tumors that can benefit from surgery. Technical considerations, potential surgical complications, and the ways to avoid them are discussed.

Brain Neoplasms↗
PubMedDate not supplied

Total vertex craniectomy for the treatment of scaphocephaly.

Sutural stripping, morcellation, subtotal craniectomy, and even subtemporal decompression, have been employed in the treatment of sagittal synostosis. This report describes a further modification of past techniques, the total vertex craniectomy. This procedure, employed in 9 patients, has achieved uniformly excellent cosmetic results.

Craniotomy↗
PubMedDate not supplied

Pediatric posterior fossa tumors: hazards of the "preoperative" shunt.

Many neurosurgeons recommend a "preoperative" shunt for children with posterior fossa tumors. It has been reported that the definitive surgery is simplified and the postoperative course is more benign as a result of the cerebrospinal fluid diversion. The present report documents complications as a result of upward herniation and hemorrhage within the tumor after shunt placement. On the basis of this experience, we conclude that a shunt is potentially hazardous and should be restricted to that selected group of patients who are acutely ill from increased intracranial pressure that is refractory to temporizing pharmacological management.

Adolescent↗
PubMedDate not supplied

Chronic headache in the shunt-dependent adolescent with nearly normal ventricular volume: diagnosis and treatment.

The shunt-dependent adolescent will occasionally manifest shunt malfunction by intermittent or chronic headache without any obvious signs of increased intracranial pressure (ICP). A small percentage of these patients will have nearly normal ventricular volume, making the diagnosis and treatment difficult. The authors present a comprehensive approach to this problem that uses computerized axial tomography (CT), ICP monitoring, positive contrast or isotope shunt scan, shunt revision, subtemporal craniectomy, or medical management as the individual situation dictates. The CT scan identifies patients with nearly normal ventricular volume. ICP monitoring then determines whether there is shunt malfunction. The shunt scan aids in localization of the malfunction. For distal obstruction, a simple revision is performed. When proximal shunt malfunction occurs, either subtemporal craniectomy or revision is carried out. It has been documented that occasionally ICP is episodically increased in the absence of shunt malfunction. This is secondary to abnormal brain compliance, and subtemporal craniectomy alone or in conjunction with corticosteroids is curative. This comprehensive approach is designed to provide a method for recognizing and treating intermittently increased ICP in the shunt-dependent child.

Adolescent↗
PubMedDate not supplied

Dense cystic craniopharyngiomas.

Characteristic computed tomographic (CT) findings of craniopharyngioma include calcification, contrast enhancement, and cyst formation. Sharp margins associated with a hypodense centrum usually characterize the CT appearance of a cystic tumor. The appearance of "dense" cysts in craniopharyngiomas has not been emphasized. Four cases of craniopharyngiomas with isodense to hyperdense cysts are reported. Comparative biochemical and in vitro CT analysis of cyst aspirates taken from these lesions demonstrate that high intracystic protein concentration accounts for the greater part of the hyperdensity. Various mechanisms for intracystic protein accumulation are discussed. Lesion characteristics, and not necessarily attenuation coefficients, are stressed in differentiating "dense" cystic from solid craniopharyngiomas.

Adolescent↗