Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Intraoperative neurophysiological techniques are becoming routine tools for neurosurgical practice. Procedures affecting the lumbosacral nervous system are frequent in adult and pediatric neurosurgery. This review provides an overview of the techniques utilized in cauda and conus operations. ⋯ A range of intraoperative neurophysiological techniques are available for neurophysiological testing of the neural structures of conus medullaris and cauda equina.
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The diagnosis, treatment, and prediction of outcome in pediatric traumatic brain injury (TBI) present significant challenges to the treating clinician. Clinical and radiological tools for assessing injury severity and predicting outcome, in particular, lack sensitivity and specificity. In patients with mild TBI, often there is uncertainty about which patients should undergo radiological imaging and who is at risk for long term neurological sequelae. In severe TBI, often there is uncertainty about which patients will experience secondary insults and what the outcome for individual patients will be. In several other clinical specialties, biomarkers are used to diagnose disease, direct treatment, and prognosticate. However, an ideal biomarker for brain injury has not been found. ⋯ The potential uses and limitations of these biomarkers in the context of TBI are discussed.
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Inflammation is an stereotypical response to tissue damage and has been extensively documented in experimental and clinical traumatic brain injury (TBI), including children. ⋯ The initiation and orchestration of inflammation in TBI, as in other tissues, is complex and multifactorial encompassing pro- and anti-inflammatory cytokines, chemokines, adhesion molecules, complement factors, reactive oxygen and nitrogen species, and other undefined factors. It is evident that inflammation can have both beneficial and detrimental effects in TBI, but the mechanisms underlying this dichotomy are mostly unknown. Modification of the inflammatory response may be neuroprotective. Monitoring inflammation is now possible with techniques such as microdialysis; however, the prognostic value of measuring inflammatory mediators in TBI is still unclear with conflicting reports. Except for corticosteroids, no anti-inflammatory agents have been tested in TBI, and the negative results with these may have been flawed by their multiple side effects. Clinical trials with anti-inflammatory agents that target multiple or central and downstream pathways are warranted in adult and pediatric TBI. This review examines the mechanisms of inflammation after TBI, monitoring, and possible routes of intervention.
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Review Case Reports
Finding on brain MRI mimicking focal cortical dysplasia in early Rasmussen's encephalitis: a case report and review.
Rasmussen's encephalitis (RE) is one of the important causes of refractory seizure. The most impressive clinical manifestation of RE is epilepsia partialis continua (EPC). Others include progressive hemiparesis and neuropsychological deterioration. Currently, the best approach to RE is hemispherectomy. ⋯ The follow-up brain MRI 1 year later showed diffuse atrophy of the brain with more atrophic change in right hemisphere, and the EPC disappeared after right hemispherectomy.
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Review Case Reports
Unusual penetrating head injury in children: personal experience and review of the literature.
A penetrating head injury belongs to the most severe traumatic brain injuries, in which communication can arise between the intracranial cavity and surrounding environment. ⋯ The prognosis of such severe trauma could be influenced very positively by a good medical care organization; obviously, the extent of brain tissue laceration is the limiting factor.