Pediatric Neurosurgery by David M. Frim, N. Gupta

By David M. Frim, N. Gupta

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Callosal agenesis. (transaxial T2-WI) 2 Figure 45. Polymicrogyria. Abnormal morphology of gyri in both frontal lobes. Excessive fine irregularity of cortex, consistent with dense polymicrogyria, mimicking pachygyria. (transaxial T2-WI) Figure 46. Closed-lip schizencephaly. Cleft along left frontal lobe, extending to left lateral ventricle, lined with gray matter.

Children affected by brain tumors have clinical presentations that vary with patient’s age and location and growth rate of the mass. Infants can present with vomiting or lethargy, cranial nerve or motor dysfunction, or an enlarging head size due to hydrocephalus. Older children can present with positional headaches, nausea and vomiting, confusion, seizures, cranial nerve or motor deficits, or ataxia. Tumors in the sellar, supra-sellar or hypothalamic region can lead to diabetes insipidus, growth failure, amenorrhea or precocious puberty by disrupting the hypothalamic-pituitary axis.

Figure 26. Ganglioglioma of the temporal lobe in a teenager presenting with seizures. (transaxial TI-WI with contrast) 42 Pediatric Neurosurgery 2 Figure 27. Large, left, hemispheric, irregular, heterogeneous, dense, enhancing PNET with cystic components and punctate calcifications. (CT, FLAIR, T1-WI with contrast) Along hypothalamic stalk between floor of third ventricle and pituitary gland Usually suprasellar; large tumors can extend beyond suprasellar area Involve stalk and extend into hypothalamus Hypothalamus and infundibulum Enlarged infundibulum Enhancement Tuber cinereum of hypothalamus, between mammillary bodies Craniopharyngioma Germinoma Granulomatous disease (TB and sarcoid) Hypothalamic hamartoma ↑ = increased; ↓ = decreased; NF1 = neurofibromatosis type 1; SI = signal intensity Well-defined oval mass Isodense and isointense to gray matter No enhancement Well-defined, slightly heterogeneous mass Iso- or hyperdense ↓T1 and mixed T2 SI Enhancement Multicystic, suprasellar, enhancing mass with calcification Rarely intrasellar Variable T1 and ↑T2 SI Lobulated hypodense solid mass ↓T1 and ↑T2 SI Variable enhancement If large, can be heterogeneous Hypothalamus and/or optic chiasm Imaging Appearance Location Tumor Type Astrocytoma Table 11.

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