Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Secondary neuronal injury is implicated in poor outcome after acute neurological insults. Outcome can be improved with protocol-driven therapy. These therapies have largely been based on monitoring and control of intracranial pressure and the maintenance of an adequate cerebral perfusion pressure. ⋯ In recent years, brain tissue oxygen partial pressure (PbtO2) monitoring has emerged as a clinically useful modality and a complement to intracranial pressure monitors. This review examines the physiology of PbtO2 monitors and practical aspects of their use.
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The outcome of endoscopic third ventriculostomy (ETV) is worse in children younger than 2 years old and especially in infants, and controversies still exist whether ETV might be superior to shunt placement in this age group. We retrospectively analyzed the data of 23 patients younger than 6 months of age treated with ETV and assessed its feasibility as a first choice of treatment for hydrocephalus. ⋯ Based on our experience, ETV could be the first method of choice for hydrocephalus in children younger than 6 months of age, especially in patients older than 3 months of age.
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Review Case Reports
Intrauterine head stab wound injury resulting in a growing skull fracture: a case report and literature review.
Penetrating injuries of the gravid uterus are rare complications of pregnancy with gunshot wounds most common than stab wounds. Fetal head injury is an unusual sequela of these penetrating traumas. ⋯ Thirty-two cases of stab wounds to the pregnant uterus have been reported to date in medical literature with two cases of fetal head injury.Growing skull fractures are rare complications of head injury and only one case has been described in the perinatal period following blunt trauma to the mother's abdomen 2-3 weeks before birth.
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Review Multicenter Study
Anesthesia and intraoperative neurophysiological monitoring in children.
Anesthesia for pediatric patients undergoing surgery where intraoperative neurophysiological monitoring (IONM) is performed is based on an understanding of the anesthetic influence on the neural pathways involved and the physiology that supplies nutrients to the neural systems. Anesthesia in pediatric patients may be different than in adults due to the specific anesthesia considerations in children, notably the propofol infusion syndrome (PRIS) and the need to monitor immature neural pathways. This review was done to determine if the anesthesia protocols used were different than those used in adults. ⋯ Anesthesia for pediatric patients undergoing surgery where IONM is being performed is consistent with the practice and principles of anesthesia for adults. Although PRIS has not caused major alterations in most patients, concern has modified the practice of some anesthesiologists.
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Review Case Reports
Intramedullary spinal cord tumor surgery: can we do it without intraoperative neurophysiological monitoring?
The objective of this review is to discuss the utilization of intraoperative neurophysiological monitoring (IONM) during spinal cord tumor surgery. ⋯ We argue that IONM should be the standard of care for the treatment of such pathology, and a number of issues supporting this argument are discussed.