Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Comment Letter
MGMT promoter methylation in pediatric high-grade gliomas.
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The Torkildsen shunt, which bypasses the cerebrospinal fluid (CSF) flow from the lateral ventricle to the cisterna magna, has been regarded as a historical procedure. We re-evaluated the clinical usefulness of the Torkildsen shunt as a treatment for hydrocephalus in the era of modern neurosurgery. ⋯ The Torkildsen shunt can be effective in selected patients with hydrocephalus even in the era of computed tomography, magnetic resonance imaging, and neuroendoscopy. Although the surgical procedure is technically more demanding, the procedure enables one to avoid a standard ventriculoperitoneal shunt.
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Case Reports
Rotational vertebral artery occlusion in a child with multiple strokes: a case-based update.
Rotational vertebral artery occlusion (RVAO), sometimes known as "Bow hunter syndrome," is an important and diagnostically challenging cause of posterior circulation stroke in children. It is caused by impingement of osseous and/or ligamentous structures on the vertebral artery. ⋯ RVAO is an important diagnosis in children with posterior circulation stroke. Our case demonstrates the need for high clinical suspicion and careful analysis of 3D cervical spine CT images in children with posterior circulation stroke.
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The most challenging component of spinal dysraphism is cord tethering. Tethering can occur due to single or multiple lesions within the same patient. It is imperative to aggressively identify and release all the tethering lesions in order to provide maximum benefit to the patient. With increasing number of tethering lesions, the clinical profile and outcome show significant differences, and this difference is significantly more when more than two tethering lesions coexist in the same patient. ⋯ We strongly believe that the mere presence or absence of tethering is not a sufficient documentation to predict its effect on the cases of spinal dysraphism. Tethering is a complex entity that needs to be further classified in terms of the number of tethering lesions, which significantly affect the pre- and postoperative status of the patients. We would like to suggest the term "Spina Bifida Multiplex" for the cases where more than two lesions are found to be responsible for tethering.
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Comparative Study
Timing of ventriculoperitoneal shunt insertion following spina bifida closure in Kenya.
In Western medical centers, emphasis has been placed on simultaneous myelomeningocele closure and ventriculoperitoneal shunting for children with spina bifida (SB) and co-morbid hydrocephalus (HC). This is not practical in developing countries where patients present in a delayed fashion, many with open, dirty myelomeningoceles. The purpose of this study was to evaluate whether timing of shunting in relation to myelomeningocele closure affected shunt-related complications such as SB wound infection, shunt infection, and shunt malfunction. ⋯ This study indicates that in developing countries, patients with SB who present in a delayed fashion but require shunting and have sterile CSF, should have their shunts inserted 5-10 days after SB closure.