Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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With creation of the many subdivisions within the field of neurosurgery, neurosurgeons have taken on different roles. It is important for neurosurgeons to understand all the different subjects involved to enable them to build up long-term goals in patient management and research. ⋯ Because pediatric neurosurgeons cover the whole range of neurosurgical diseases of infancy and childhood, the authors emphasize that their actions can be the basis for the management of general neurosurgical patients. A comparison between pediatric and adult neurosurgery is also drawn, with special reference to the interaction between pediatric and adult neurosurgeons.
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Over the past 15 years there have been significant changes in the field of interventional neuroradiology, which have led to the inclusion of this specialty in the management of pediatric patients with vascular disorders of the central nervous system. Miniaturization of the devices and improvements in the embolic materials used have made it possible to perform endovascular therapy safely on neonates, infants and children. ⋯ The role of endovascular therapy in the management of children with intracranial aneurysms is rapidly evolving, and experience with thrombolytic intra-arterial therapy for acute ischemic stroke is just gaining momentum. It is anticipated that in the future the role of endovascular therapy will continue to grow as part of the multidisciplinary team approach to the management of children presenting with complex vascular diseases of the central nervous system.
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A 14-year-old girl presented with seizures. Radiological examinations revealed an arachnoid cyst in left middle fossa and a cystic mass in the interpeduncular cistern. ⋯ The histological findings were characteristic of an arachnoid cyst and hamartoma, respectively. A hypothalamic hamartoma associated with an arachnoid cyst is comparatively rare; however, such a case may help clarify the genesis of this malformation.
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Multicenter Study
International Multicenter Study of Head Injury in Children. ISHIP Group.
With the object of evaluating different epidemiological factors in the acute phase of head injury (HI) in the pediatric age group in five countries (Argentina, Brazil, France, Hong-Kong and Spain), we carried out a prospective and descriptive study, in which we analyzed the clinical and radiological risk factors versus management and outcome 7-30 days after trauma. We included all children seen in the emergency department and hospitalized who were aged between 0 and 15 years and had sustained HI. Data were compiled from the clinical records and analyzed for neurological evaluation with the Glasgow Coma Scale (GCS) and the Glasgow Paediatric Coma Score (GPCS), and also by means of dynamics, symptoms, skull X-rays, CT scans. ⋯ The lethality rate was 1.6%. Our preliminary data reveal that it is very important for new guidelines on the treatment of minor HI to be prepared, because patients with minor HI had undergone the most skull X-rays and also most frequently been admitted to hospital for unnecessarily long periods of time, though the incidence of brain damage (1.6%) was lowest in this group of the study population. We intend to carry out a full analysis of the various risk factors at the end of the study.