Background: The advantages of the distraction procedure for craniosynostosis reported thus far are osteogenesis, absence of initial fixation materials, and simultaneous skin expansion, which enable sufficient bone movement. These advantages provide benefits to the patient including a less invasive procedure, fewer relapses, and more stable results. On the other hand, the disadvantages include a prolonged treatment period and the need for secondary surgical intervention. The most tangible disadvantage is the limitation in morphological correction resulting from the unidirectional internal types of devices. In order to solve these problems that diminish the advantages of the distraction procedure, we have designed a new distraction system, the MCDO system^[○!R]. Methods: From 2003 to 2007, a selected group of 23 patients with syndromic and nonsyndromic craniosynostosis were treated using the MCDO system. The mean patient age was 27 months (9 to 75 months). Follow-up was 18 to 78 months (median: 58.5 months). Results: The postoperative clinical course was uneventful in all cases. There were no cases of meningitis, liquid fistula, or extradural hematoma during distraction. The mean volume of blood transfused was 18.0ml/kg (0 to 54.7ml/kg) body weight. There was minor pin-track infection at the site of the anchor pins in 13 patients, which healed with ordinary conservative treatment and shampooing. The planned distraction program was completed in all cases. The mean duration of distraction was 10 days (7 to 13 days), and the consolidation period was 27.5 days (19 to 35 days). The mean duration of frame fitting was 38.5 days (30 to 54 days). Traction pin and anchor pin loosening occurred in 28/204 (13.7%) and 23/130 (17.7%) among all patients. The morphological results in all patients were satisfactory. Slight bony bumps formed between the distracted bone pieces; however, they disappeared within 6 months by formation of bone between the gaps. Conclusion: The MCDO system allows the contouring of any kind of skull deformity according to the concept of distraction osteogenesis. The distraction method with the MCDO system offered numerous advantages over not only the distraction method with unidirectional internal devices, but also conventional cranioplasty for patients 9 months of age or older, patients with craniosynostosis, and for patients requiring secondary surgery.

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Surgery for pediatric spinal lipoma consists of resection of the lipoma and untethering of the spinal cord. Partial or subtotal resection of the lipoma has been a main stream surgical procedure for pediatric spinal lipoma for functional preservation of the spinal cord (standard procedure). On the other hand, near total resection of the spinal lipoma along the fusion line between the lipoma and spinal cord is newly emerging as a radical procedure. In this paper, the author describes both procedures briefly. More attention was paid to the radical procedure, which could achieve gross total resection of the lipoma, and thus could be more beneficial in preventing postoperative re-tethering of the spinal cord. The radical resection procedure is more technically demanding and the use of intraoperative neurophysiology is strongly recommended. In addition, it was suggested that a combination of both procedures could bring optimal surgical results in cases of complex spinal lipoma.

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Hypothalamic hamartomas (HHs) are classified into two types, parahypothalamic type and intrahypothalamic type, by the degree of hypothalamic involvement as seen on MRI. This categorization has contributed to the accurate prediction of their prognosis and to improved treatment strategies. HH patients with medically intractable seizures are now treated with surgery that targets the HH per se, e.g. HH removal, disconnection from the hypothalamus, stereotactic irradiation, and radiofrequency lesioning. Although surgical intervention carries risks, the total eradication or disconnection of the lesion leads to the cessation or reduction of seizures and improves the cognitive and behavioral status of these patients. Recent reports on stereotactic radiofrequency lesioning and the transcallosal interfornicial approach showed promising results for seizure control. Precocious puberty in HH patients is safely controlled by long-acting gonadotropin-releasing hormone agonists. The accumulation of knowledge regarding the pathogenesis of symptoms and the development of safe, effective treatment modalities may lead to earlier intervention in young HH patients and prevent the decline in their cognitive abilities and quality of life.

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Following the introduction of neuroendoscopy, the treatment of hydrocephalus and intracranial cysts to establish physiological cerebrospinal fluid circulation by analyzing cerebrospinal fluid dynamics has become possible. Also in the treatment of brain tumors, as minimally invasive preferential management has taken preference, pathological diagnosis by neuroendoscopy and subsequent multimodal treatment have been performed. This article cannot discuss all of the new treatment strategies available using neuroendoscopy. Therefore, we review the latest literature on a new treatment strategy using neuroendoscopy for hydrocephalus after intraventricular haemorrhage in prematurity, third ventriculostomy for Chiari malformation type I associated with hydrocephalus, and a new neuroendoscopic approach for the third ventricle, and lastly, introduce our minimally invasive surgery for sagittal craniosynostosis.

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Epilepsy is the most common neurologic disorder in childhood. In cases where a reasonable trial of several antiepileptic medications fails to provide adequate seizure control, neurosurgical options include both diagnostic techniques as well as innovative treatments. For that reason, pediatric neurosurgeons often involve themselves early in the evaluation and management of these children. Although full seizure control may be impossible, improved neurologic development and avoidance of injuries from ictal events may be worthy, alternative outcomes. Recently developed techniques in neuromodulation, like vagal nerve stimulation and deep brain stimulation, provide potential improved seizure control for those patients who would be unlikely to benefit from resective surgery for cure.

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The clinical condition of childhood epilepsy largely differs from that of adult-onset epilepsy. Epilepsy is caused by widespread brain lesions or complicated clinical conditions, thus requiring extensive knowledge about the disease for its diagnosis. Prognosis of childhood epilepsy is highly variable: some patients heal naturally; some cases cause suspension or regression of growth; and some cases are complicated with severe progressive psychosomatic disorders. Operability of childhood epilepsy also differs from that of adult epilepsy. In particular, mesial temporal lobe epilepsy comprises only 10% of all the operated cases of childhood epilepsy, whereas cortical dysgenesis widely scattered over the exterior area of the temporal lobe and relatively rare clinical conditions unique to childhood are more common. Resection of epilepsy lesions is considered to be a surgical option if the lesions are well localized. However, resection of widespread lesions or palliative surgical treatment is also commonly performed. It is highly desirable to determine operability by individually reviewing special conditions occurring during childhood. For example, the influence of epilepsy's attack on the brain and mental condition, and the compensation ability of the damaged brain function caused by surgical complications, during the growth process should be considered.

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The aim of the study was to determine how a persons' quality of life (QOL) changes before and after a brain check-up examination. The authors assessed health-related QOL in 203 examinees using the MOS Short Form 36-Item Health Survey (SF-36^[○!R]) over 1 month before examination. For 57 examinees, the QOL quantified by SF-36^[○!R] was compared before, 3 months, and 1 year after the examination. The examinees' mean scores for each of the eight domains of SF-36^[○!R] were lower than that of a Japanese reference population because over 60% of them were suffering from headache or dizziness. The QOL level improved at 3 months and 1 year after the examination if they knew of no serious brain disease in themselves. Asymptomatic events such as minor stroke or vascular stenosis also did not affect QOL. However, in case of a confirmed diagnosis of unruptured aneurysm, the examinees' QOL declined, especially in terms of physical and mental daily activities and this state of low mental activity lasted 1 year after the examination. The present study indicates both merits and demerits of brain check-ups in a persons' QOL; the diagnosis of a cerebral aneurysm may have a certain psychological impact during at least 1 year, although the majority of other asymptomatic brain disorders give satisfactory QOL. We expect that, despite the results of a brain check-up, people should be more positively prepared for, understand and utilize properly the variety of health information available to keep their good health and QOL.

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OBJECT: Spontaneous lumbar epidural lipomatosis (SEL) is a rare condition, and few reports have discussed its diagnostic imaging. To evaluate its clinical features, diagnosis and treatment, we report four new cases of surgically treated SEL. METHODS: Morphological findings of epidural fat were evaluated by magnetic resonance imaging (MRI), myelography and CT-scan. In addition, body mass index (BMI), involved vertebral levels, and pre- and post-operative Japanese Orthopaedic Association (JOA) score were analyzed to examine characteristic of SEL. RESULTS: The average age of four patients was 65.3 years (range 58〜78 years). All patients were male. The average duration of symptoms were 35.0 months, and all cases presented neurogenic intermittent claudication. Three patients also had other lumbar disease. Y-sign was shown on MRI and CTM in all cases. Dynamic myelography was especially useful for making a diagnosis in one case. As for the treatment, fat de-bulking and a partial laminectomy were performed on all patients. Re-operation (foraminotomy) was performed seven months later in one patient. The average post-surgery recovery rate was 37.0% by JOA score. CONCLUSIONS: SEL is often accompanied with other lumbar degenerative disease. MRI, CTM findings, and myelography were useful in the diagnosis of SEL. When SEL presents progressive neurologic symptoms, surgical decompression is considered effective for symptomatic improvement.

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