Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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There is still no standard protocol for management of patients of tubercular meningitis (TBM) with hydrocephalus in poor neurological grade. In general, a trial of external ventricular drain (EVD) is an accepted method of treatment to decide whether a particular patient will benefit from shunt surgery. However, recent studies suggest that ventriculoperitoneal (VP) shunt may be undertaken without the trial of an EVD. Our study prospectively evaluates the role of direct VP shunt placement in poor grade patients of TBM with hydrocephalus. ⋯ Despite poor grade at admission, 71.4 % patients in grade III and 20 % patients in grade IV had a good outcome at 3 months follow-up. Direct VP shunt placement is a safe and effective option even in poor grade patients of TBM with hydrocephalus, with a low complication rate.
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Review Case Reports
Novel use of propranolol for management of pain in children with vertebral hemangioma: report of two cases.
Vertebral hemangioma (VH) is an exceedingly rare neoplasm in pediatric population with less than 10 cases reported in the literature. It is usually asymptomatic in adults and diagnosed incidentally at radiographic investigations of other medical conditions. In this report, we describe two children who presented to our institution with severe back pain and were diagnosed with VH. ⋯ Propranolol is a beta blocker which is safely used in the management of infantile hemangiomas. This is the first report demonstrating its efficacy in symptomatic treatment of childhood VH. The lesions did not show any regression, but the pain relief obtained was very significant under propranolol therapy.
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Neuroendoscopy has become an integral field within neurosurgery. It has allowed neurosurgeons unprecedented access to deep structures within both the cranial and spinal compartments, while allowing for minimal incisions, tissue retraction, and postoperative healing time. ⋯ In this article, we trace the origins of this vital field to ancient times, and show that much of its success is due to the brilliant minds of some luminaries such as Philipp Bozzini and Harold Hopkins. Through close collaborations between clinicians, scientists, and engineers neuroendoscopy has become an invaluable tool in the armamentarium of neurosurgeons to help solve a wide array of clinical problems.