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Background: Several surgical techniques have been described for correction of scaphocephaly. Recent advances in the field of craniofacial surgery have allowed more extensive operative procedures for the treatment of cranial vault anomalies. In general the aim of surgical treatment is to prevent early refusion of the parietal bones after the sagittal craniectomy associated with the widening of the biparietal diameter. In children older than 6 months these procedures may result unsatisfactory providing only a partial correction of the malformation. Therefore operative techniques of total cranial vault reshaping are reported in the literature., Methods: We performed a surgical procedure of biparietal widening and occipital remolding in eight 3 month old infants with a marked deformation of the occipital prominence from sagittal synostosis., Results: This technique has provided excellent cosmetic results with an immediate correction of the parieto-occipital malformation. There have not been intraoperative complications and the postoperative course was uneventful., Conclusions: The occipital remolding is useful in young infants with a marked skull deformity; this technique will produce immediate restoration of an esthetically pleasing cranial shape and a more satisfactory cosmetic result compared to less extensive procedures.

Background: Extradural hematomas are rate complications of head injures in children often resulting from minor head traumas. Therefore the management of these ordinary traumas remains controversy since in many asymptomatic cases the intracranial bleeding is detected only by CT scan., Methods: During the study period between January 1991 and September 1995 sixty-one patients ranging in age from 5 months to 12 years were operated on for epidural hematomas. They represent about the 3% of all patients admitted for head injury in the same period in our Division. According to the age, children were divided in three groups (G1, G2, G3). Males predominate over females in each group of age. The mechanism of injury, the clinical findings, the neurological assessment on admission, the site of hematoma and the presence of skull fracture were examined in order to identify clinical and diagnostic parameters predicting developing intracranial complications., Results: The most common cause of head trauma was accidental falls in children under 5 years of age. Otherwise bicycle, pedestrian and car accidents are the main type of injury in older patients. A skull fracture was identified in 49 cases with a homogeneous distribution among the groups of age. Recurrent vomiting was found in about 70% of cases. A loss of consciousness was frequently reported (78%) in older children. Outcome mainly depended on Glasgow or Children Coma Score on admission. In our series the overall mortality rate was 4.9%., Conclusions: Our data according with the literature suggest that localized skull traumas, suspected fractures, a loss of consciousness after trauma and recurrent vomiting can be recommended as indications for intracranial complications.

The occurrence of intracranial aneurysm in the pediatric population is a rare phenomenon. A case of giant aneurysm of the intracavernous carotid artery in a child is reported. Clinicoradiological findings are presented and the surgical procedure is illustrated. Authors stress the value of monitoring the cerebral collateral blood flow before and during the operation.

Cerebral cavernous angiomas are congenital malformations usually presenting with symptomatic hemorrhages or seizures. The advent of MRI has allowed to detect asymptomatic, "cryptic" brain cavernomas. They can occur in a sporadic, isolated form and in a familial form characterized by multiple lesions. Surgical treatment is recommended by most authors in symptomatic cases when the lesion is isolated and readily accessible. Treatment is more controversial when the vascular malformation is located in critical brain region. On the other hand the increased risk of rebleeding after a prior hemorrhage and the decreased effectiveness of lesionectomy in patients with a long seizure history could lead to perform an early surgical excision also for cavernous angiomas located in those areas. We report three cases of symptomatic cerebral cavernomas located in critical areas, in children. In all cases the surgical removal of the lesions was successfully performed. The two cases presented with seizures are seizure-free in spite of the interruption of the antiepileptic therapy. The patient presented with neurological deficit due to intraparenchymal hemorrhage progressively recovered his motor function. Our experience seems to confirm the value of surgical removal regardless of where the cavernoma is located.

Pathogenesis of craniosynostosis is poorly understood. Several different factors (primary fusion of a cranial vault suture, abnormal tensile forces acting on the cranial sutures, genetic control, fetal constraint) may be responsible for the malformation. Trigonocephaly is a relatively rare form of cranial malformation ranging from 5 to 20% of all the craniosynostotic syndromes. This form of craniosynostosis may be simple not associated with other cerebral defects or complex, associated with arhinencephaly and hypoplasia of frontal lobes; three gradations of malformation (marked, mild, incomplete) may be considered. A case of trigonocephaly associated with anterior basal meningocele is reported. The operative treatment and radiological findings are described. The pathogenetic role of the basal meningocele to determine the premature sutural fusion through tensile forces transmitted by abnormal dural attachments is evaluated.

Intramedullary arteriovenous malformations are rare in childhood. Yasargil reports only two cases in children under ten years of age out of a total of forty-one cases of AVM operated on between 1967 and 1983 in which microsurgical techniques were used. The early symptoms of these lesions are those due to intramedullary or subarachnoid haemorrhage with neurological deficit, pain and/or weakness or numbness of one or more limbs. We report the case of an intramedullary haematoma due to arteriovenous malformation within the medulla oblongata in a three year old child admitted for cervical pain and right arm hypostenia. The CT scan and MRI showed an intramedullary expansive lesion with associated internal haematoma between C1-C7 level. Because of the rapid clinical deterioration upon the onset of right hemiparesis we procedeed to empty the intramedullary haematoma and to remove the intrabulbar AVM. A swift improvement of neurological deficit was observed along with a total regression of the symptomatology in a month's time. The excellent results reported in this case, very likely the only case in the literature occurring in a very small child at this spinal cord level, are mostly due to the early surgical treatment and to the exact information that MRI provided.

Two cases of craniosynostosis treated with the new titanium micro system for the skeletal fixation are described. Mechanical and physical characteristics of the system (biocompatibility, high strength, malleability, possibility of adequate stabilization) are discussed. Aesthetic and functional outcomes are evaluated.