Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Comparative Study
Clinical, radiological profile and outcome in pediatric Spetzler-Martin grades I-III arteriovenous malformations.
Treatment of pediatric arteriovenous malformations (AVMs) is always a challenge considering their hemorrhagic presentation, associated morbidity and mortality, and the potential long life span of these children. Spetzler-Martin grades I-III are the grey zones as far as the treatment options are concerned. With a generous multimodality approach, one can reduce the morbidity and mortality to a considerable extent. ⋯ The aim of treating a pediatric AVM should be complete obliteration of the AVM considering the high risk of hemorrhage and the morbidity and mortality associated with hemorrhage. With careful planning and adopting a multimodality treatment, complete obliteration can definitely be achieved.
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Craniofacial procedures may be needed to address symptomatic intracranial hypertension. The authors review their institutional experience in the treatment of children with symptomatic increased intracranial pressure (ICP) utilizing craniofacial reconstructive procedures. ⋯ Using modern diagnostic and surgical techniques, including invasive ICP monitoring, increased intracranial pressure can be successfully managed by an experienced, multidisciplinary, craniofacial team. Our treatment paradigm and operative management scheme is discussed.
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The purpose of the retrospective case series of eight consecutive patients is to call our attention to the optimal timing of decompressive craniectomy (DC) in children. ⋯ Considering the anamnestic data, it could be useful to perform DC at 20-22 mmHg ICP in young patients in order to prevent the potential of very fast brain swelling if there is no possibility to perform durotomy within 20 min after the onset of raising the ICP. It is especially considerable in poor countries where the emergency route could be less organized because of locations of building and extreme load of the staff. Further controlled trials are necessary to evaluate the indication and standardization of early decompressive craniectomy as a standard preventive therapy in pediatric severe traumatic brain swelling.
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Stridor, associated with vocal cord paralysis, in neonates with myelomeningocele (MMC) is a recognized symptom related to Chiari II malformation (CM). In most children, stridor appears after birth. Control of hydrocephalus, if present, and urgent decompression of the CM are recommended for treatment of these patients. Such management typically improves symptoms. Occasionally, stridor is present at birth and may be secondary, in part, to maldevelopment or prenatal ischemia of the brain stem, rather than treatable compression. There is minimal literature describing the outcome after Chiari decompression in this population. The purpose of this study was to review the outcomes of neonates with MMC and stridor at birth and compare it to MMC patients who develop stridor later. We hypothesized that unlike stridor which develops after birth, stridor at birth predicts a dismal outcome, despite aggressive surgical treatment. ⋯ In newborns with MMC, stridor at birth may predict dismal outcome despite CM decompression. Unlike the situation in neonates who develop stridor after birth, the outcome in those presenting with stridor at birth does not seem to be impacted by decompression of the CM. Nonoperative management may be an option to offer in this population. Additionally, vernix caseosa meningitis may contribute to the severe irreversible brain stem dysfunction in these newborns.
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Hydrocephalus is a common complication of tuberculous meningitis (TBM) in children. The role of ventriculoperitoneal shunt (VPS) placement in grade IV patients is controversial. The aim of this study is to investigate the clinical value of VPS placement for patients with grade IV TBM with hydrocephalus (TBMH). ⋯ This study demonstrates that direct ventriculoperitoneal shunt surgery could improve the outcome of grade IV TBMH. The response to EVD is not a reliable indication for selecting patients who would benefit from shunt surgery.