Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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The purpose of this study is to compare the surgical and imaging outcome in children who underwent brain tumour surgery with intention of complete tumour resection, prior to and following the start of intra-operative MRI (ioMRI) service. ⋯ Following the advent of ioMRI at our institution, the need for repeat resection within 6 months has been prevented in cases where ioMRI revealed unequivocal evidence of residual tumour.
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Terminal myelocystocele (TMC) is thought to be caused by a misstep during secondary neurulation. However, due to the paucity of data on secondary neurulation and the rarity of TMC, proofs of this pathogenetic mechanism are unavailable. Based on a previous observation that TMC resembles a step of secondary neurulation in chick, a closer look was taken at secondary neurulation of chick embryos focusing on the cerebrospinal fluid-filled distal neural tube (terminal balloon). ⋯ A dilated balloon doubtlessly exists in the terminal secondary neural tube in chick embryos, and its subsequent disappearance occurs in a variable time course and sequence. Arrest of apoptosis resulting in failure of detachment of the terminal balloon from the surface ectoderm may well be the basis for human TMC.
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Intraoperative neurophysiologic monitoring (IOM) is nowadays extensively used to minimize neurological morbidity in tethered cord surgery. Our goal is to describe and discuss the standard IOM techniques used during these surgical procedures and to summarize our clinical experience using a multimodal IOM approach. ⋯ Mapping techniques allow identifying and sparing functional neural tissue and vice versa to cut nonfunctional structures that may contribute to cord tethering. Monitoring techniques, MEP and BCR in particular, improve the reliability of intraoperative neurophysiology, though these may require a higher degree of neuromonitoring expertise. IOM minimizes neurological morbidity in tethered cord surgery.
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Prompt surgical decompression for symptomatic Chiari type II malformation in neonates and young infants has been reported to be effective. However, the optimal operative method has been arguable. The authors present their experiences with surgical decompression without dural opening. ⋯ Upper cervical bone decompression with delamination of the outer layer of the dura can be a safe and effective treatment for symptomatic Chiari type II malformation in neonates and young infants.
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Comparative Study
A retrospective comparison of CT and MRI in detecting pediatric cervical spine injury.
Although clinical criteria have been applied in the assessment of pediatric cervical spine trauma, no consensus has been established when imaging is required. With the increasing prevalence of computed tomography (CT) use in pediatric trauma and the concern for radiation in children, we sought to evaluate magnetic resonance imaging (MRI) and CT in detecting pediatric cervical spine injuries. ⋯ Using CT as the standard for osseous injury, MRI had a sensitivity of 100%, specificity of 97%, negative predictive value (NPV) of 75%, and positive predictive value (PPV) of 100%. Using MRI as the standard for soft tissue injury, CT had a sensitivity of 23%, specificity of 100%, NPV of 88%, and PPV of 100%. Further studies are required to investigate the use of MRI to detect osseous injuries.