Among the pediatric brain tumors, medulloblastoma (MB) is the most common solid variety and entirely occur in the posterior fossa with tendency to seed into CSF spaces. Despite innovations in technological developments and understanding of tumor biology, modern imaging facilities, advances in surgical practices, and newer chemotherapeutic and radiation techniques, this malignant type of tumor continues to be a formidable entity. Even though, the outcome in terms of survival rate is better than any time before, the overall result is still disappointing. With advances in management strategy, chances of survival with good quality of life have been amplified, where newer targeted therapies and rehabilitation plays an immense role. While the adverse effects of surgery and adjuvant therapies are still on play, researchers are trying ceaselessly to minimize those to give maximum wellbeing to these unfortunate children.
Part of the book: Brain Tumors
Chiari malformation (CM) and its management are long debated enigmas for neurosurgeons. Many surgical procedures have been innovated and are in practice for this perplexing and daunting entity to give the patients a satisfactory remedy. But, a unanimously accepted surgical procedure is still lacking to achieve gratifying result. We tried to develop a novel technique, which we call the “stealth cranioplasty (SCP),” to help the adult Chiari malformation type 1 (CM1) patients. In this chapter, the philosophy behind developing the technique of “stealth cranioplasty” by reconstruction of posterior fossa (PF) by cranioplasty with pre-shaped titanium mesh is described. Different stages, difficulties, and modifications of the journey toward the present day status are also elaborated graphically.
Part of the book: Neurosurgical Procedures
Chiari malformations (CM) are a set of enigmatic congenital anomalies, owing to their complex pathology, varied presentations and management dilemma. Because of the daunting nature of this disease, a universal definitive treatment protocol is yet to be established. Diverse surgical procedures are in practice with various philosophies, aiming to resolve different sections of the pathologies of this disorder, either singly or in combination. However, outcomes are quite variable. Though not a well-recognized and commonly practiced paradigm of managing CM, different techniques of cranioplasty for CM has been described by many authors with variable rates of success. Cranioplasty for Chiari has been found to be helpful in different circumstances with the objective to address different predicaments. Initially, it has been exercised as one of the modalities to manage some particular situations, mostly in cases to solve complications following surgery. Now in some centers, different types of methods of cranioplasty are practiced routinely to treat particular set of Chiari patients with specifically set criteria and some have shown success in those certain scenarios. In this chapter, different methods of cranioplasty for Chiari malformation by different authors, strategies behind the techniques and their results are described in brief. “Stealth cranioplasty”, a technique devised by our team is also portrayed.
Part of the book: Neurosurgical Procedures