Paediatric Neurosurgery Cases

Congenital anomalies of the brain and spinal cord represent the most common paediatric neurosurgical diseases. These types of anomalies have a great impact on the parents' psychological life.

A 6-month infant had onset of encephalitis since 2 weeks old, after that there was gradual swelling of his head. Brain CT scan revealed enlarged ventricles with large cyst occupying left occipital region. Fluid aspiration from the lateral ventricle and cystic cavity for complete analysis to ensure there is no more infection. Surgical intervention was done with connection of both lateral ventricle and occipital cyst by Y-shaped connector to peritoneal cavity to decrease intracranial pressure.

A 2-day-old infant with congenital lumbosacral meningomyelocele. Operated with total excision of the sac and dural repair.

A 21-month-old child had recurrent vomiting with chest infection resistant to medications for months. Brain CT scan showed hydrocephaly with a big cyst at the posterior fossa of her head (Dandy Walker syndrome). Operation was done with insertion of medium pressure device to the lateral ventricle connected by Y-shape connector to the posterior fossa cyst. After surgery she is very well and vomiting disappeared.

A 14-day-old child had congenital dorsal meningomyelocele. Operated on 2-3-07 with total excision of the sac and dural repair.

A 10-year-old male had congenital encephalocele with hydrocephaly, ventriculoperitoneal shunt inserted since the 1st year of his life. Presented to Al-Imran clinic, with 4 months history of headache and repeated vomiting. During examination, he had a small mass in the back of his head with bilateral papilloedema. Brain CT scan revealed hydrocephaly. Operation was done on 18-2-07 with total excision of encephalocele, insertion of new shunt and removal of the old one. During postoperative day, the patient was very well with no more headache and vomiting.

A 2-day-old infant had congenital occipital encephalocele. Operated on 10-2-07 with total excision of the sac and dural repair.

An 8-year-old child with congenital hydrocephaly had ventriculoperitoneal shunting done since the third month of his life. A mass developed in the way of his shunt for one week. Surgery was done and showed infected shunt with pus collection in the mass with consequent removal of the shunt at 16-1-07. On the first postoperative day, he developed repeated vomiting. Brain CT scan revealed intraventricular haemorrhage, urgent external ventricular shunt with heavy antibiotics cover to prevent meningitis. After 8 days, left frontal ventriculoperitoneal shunt was done. He improved gradually and discharged home very well.

A 12-year-old male presented as scalp mass at right temporal area. Brain CT scan revealed a bony erosion with soft tissue swelling. Surgical total excision with removal of unhealthy bony margin. Histopathology result showed a histiocytosis mass.

A 12-year-old child had headache and vomiting especially at morning for 14 days. On examination, she had bilateral papilledema with left facial palsy. Brain CT and MRI scanning showed dilated brain ventricles with no posterior fossa tumor. Ventriculoperitoneal shunt was done. Postoperatively she was free from any headache and vomiting and discharged home.

A 7-month-old child had repeated vomiting. Treated as gastroenteritis but not improved. Brain CT scan revealed hydrocephaly. Surgical intervention with ventriculoperitoneal shunt was done. She was very well postoperatively.

A 2-month infant had slow deterioration of consciousness with difficulty feeding. When she reached hospital, she was unconscious with dilated right pupil and left-sided paralysis. Brain CT scan showed massive right intracerebral hematoma. Urgent craniotomy was done on 16-8-06 to evacuate the hematoma. Within the 1st postoperative week, she returned to her normal breast feeding and the pupil size became normally reacting to light but still she was unable to move the right eyeball (oculomotor palsy). At the end of 1st month, she became very active child with normal movement for both eyes.