Pediatric Neurosurgery

Question 1

Positional plagiocephaly

Answer 1

Head has parallelogram shape (contralateral occipital bossing) + ear is anterior on symptomatic side.

Question 2

Sagittal synostosis

Answer 2

-Frontal/occipital bossing
-Palpable sagittal ridge
-Reduced biparietal diameter
-No orbit or midface abnormalities

Question 3

What is the incidence of shunt infection after initial procedure? And after initial shunt infection?

Answer 3

Approximately 8 to 10% after initial procedure and up to 25% after initial shunt infection

Question 4

What maneuvers have shown benefit in reducing shunt infection?

Answer 4

Peri operative antibiotic
Double gloving
Short duration of surgery
Reduce mechanical manipulation of the hardware
Antibiotic-impregnated shunt catheters

Question 5

What is fronto-occipital Horn ratio (FOHR)?

Answer 5

It is a measure used to classify the ventricular size, which is consists of the division of the average of maximum width of the frontal and occipital horns by the lateral diameter of the skull.

The normal value is considered more than 0.37.

FOHR < 0.2 is the reference value to define slit ventricles.

Question 6

What is the incidence of the spinal metastasis in medulloblastoma?

Answer 6

50%

Question 7

What genetic syndrome start associated with medulloblastoma?

Answer 7

-Nevoid basal cell carcinoma syndrome.
-Turcot’s syndrome A
-Li-Fraumeni syndrome
-Rubinstein-Taybi syndrome

Question 8

What the cellular origin of medulloblastoma?

Answer 8

-WNT tumors arise from WNT expressing cells in the lower rhombic lip.
-SSH tumors arise from SHH modulated cerebellar cortex.
-Group 3 and 4 origin is not clear.

Question 9

Different locations of medulloblastoma

Answer 9

-WNT-activated tumors typically localized to the cerebellar peduncle/ CPA cistern.
-SSH-activated tumors within the cerebellar hemisphere
-group 3 and 4 are localized within the fourth ventricle