Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Symptom recurrence remains a problem for some patients after surgical decompression for Chiari I malformation. We set out to identify variables at presentation that could identify subgroups most likely to experience incomplete symptom relief after hindbrain decompression for Chiari I malformation. ⋯ In our experience, recurrence of mild symptomatology not severe enough to justify revision surgery may occur in nearly a fifth of patients after surgery. Headache was more likely to recur than objective cranial nerve or brainstem symptoms. Increasing duration of headaches, frontal headaches, and vertigo may be more refractory symptoms of Chiari I malformation.
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To monitor patency of the bypass and to accomplish comprehensive visualized evaluation of brain surface hemodynamics in childhood moyamoya patients, we performed intraoperative monitoring using novel infrared imaging system. ⋯ In all cases, patency of bypass, as well as detailed local hemodynamics and changes of brain surface temperature distribution could be evaluated. Intraoperative infrared system will be a feasible monitoring not only for noninvasive intraoperative evaluation of bypass patency but also for local hemodynamics even in patients with childhood moyamoya disease.
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High cervical quadriplegia is associated with high morbidity and mortality. Artificial respiration in these patients carries significant long-term risks such as infection, atelectasis, and respiratory failure. As phrenic nerve pacing has been proven to free many of these patients from ventilatory dependency, we hypothesized that neurotization of the phrenic nerve with the spinal accessory nerve (SAN) may offer one potential alternative to phrenic nerve stimulation via pacing and may be more efficacious and longer lasting without the complications of an implantable device. ⋯ To our knowledge, using the SAN for neurotization to the phrenic nerve for potential use in patients with spinal cord injury has not been previously explored. Following clinical trials, these data may provide a mechanism for self stimulation of the diaphragm and obviate phrenic nerve pacing in patients with high cervical quadriplegia. Our study found that such a maneuver is technically feasible in the cadaver.