Journal of neurosurgery. Pediatrics
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J Neurosurg Pediatr · Nov 2009
Comparative StudyComparison of accidental and nonaccidental traumatic brain injuries in infants and toddlers: demographics, neurosurgical interventions, and outcomes.
Nonaccidental trauma has become a leading cause of death in infants and toddlers. Compared with children suffering from accidental trauma, many children with nonaccidental trauma present with injuries requiring neurosurgical management and operative interventions. ⋯ Infant and toddler victims of NAT have significantly worse injuries and outcomes than those whose trauma was accidental. In the authors' experience, however, with aggressive intervention, many of these patients can make significant neurological improvements at subsequent follow-up visits.
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J Neurosurg Pediatr · Nov 2009
Embolization of a giant pediatric, posttraumatic, skull base internal carotid artery aneurysm with a liquid embolic agent.
Many treatments for posttraumatic, skull base aneurysms have been described. Eight months after an all-terrain-vehicle accident, this 12-year-old girl presented with right-side Horner syndrome caused by a 33 x 19-mm internal carotid artery aneurysm at the C-1 level. We chose to treat the aneurysm with a new liquid embolic agent for wide-necked, side-wall aneurysms (Onyx HD 500). ⋯ Follow-up angiography revealed durable aneurysm occlusion after 1 year. The cost of Onyx was less than the cost of coils required for coil embolization of similarly sized intracranial aneurysms at our institution. Liquid embolic agents can provide a safe, efficacious, and cost-effective approach to treatment of select giant, posttraumatic, skull base aneurysms in pediatric patients.
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J Neurosurg Pediatr · Nov 2009
Infections related to intrathecal baclofen therapy in children and adults: frequency and risk factors.
The purpose of this study was to determine the frequency of infection and to identify risk factors for infection in connection with the implantation of an intrathecal baclofen (ITB) pump. ⋯ The rate of infection is significantly higher in children undergoing ITB pump implantation than it is in adults. Screening trials applying the Albright method fail to reduce the frequency of infection subsequent to pump implantation. The presence of a PEG tube has the greatest significance as a predictor of infection.
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J Neurosurg Pediatr · Nov 2009
Application of intraoperative high-field magnetic resonance imaging in pediatric neurosurgery.
Over the past decade, the use of intraoperative MR (iMR) imaging in the pediatric neurosurgical population has become increasingly accepted as an innovative and important neurosurgical tool. The authors summarize their experience using a mobile 1.5-T iMR imaging unit with integrated neuronavigation with the goal of identifying procedures and/or pathologies in which the application of this technology changed the course of surgery or modified the operative strategy. ⋯ The application of iMR imaging in the pediatric neurosurgical population allows, at minimum, the opportunity to perform less invasive surgical exposures. Its potential is greatest when its high-quality imaging ability is coupled with its superior neuronavigation capabilities, which permits tracking of the extent of resection of intracranial tumors and, to a lesser extent, other lesions during the surgical procedure.
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J Neurosurg Pediatr · Nov 2009
Pressure autoregulation, intracranial pressure, and brain tissue oxygenation in children with severe traumatic brain injury.
Cerebral pressure autoregulation is an important neuroprotective mechanism that stabilizes cerebral blood flow when blood pressure (BP) changes. In this study the authors examined the association between autoregulation and clinical factors, BP, intracranial pressure (ICP), brain tissue oxygen tension (PbtO(2)), and outcome after pediatric severe traumatic brain injury (TBI). In particular we examined how the status of autoregulation influenced the effect of BP changes on ICP and PbtO(2). ⋯ These data demonstrate the influence of the strength of autoregulation on the response of ICP and PbtO(2) to BP changes and the variability of this response between individuals. The findings suggest that autoregulation testing may assist clinical decision-making in pediatric severe TBI and help better define optimal BP or cerebral perfusion pressure targets for individual patients.