Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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The objective of this study is to establish which treatment is the best operative intervention for arachnoid cyst. ⋯ Although the shunt for arachnoid cyst can get the more rapid good radiological outcome, the shunt-related complication and dependency would be hazardous. We suggest that endoscopic or reduced open procedures offer the advantage of avoiding a large craniotomy or the known complications of a cystoperitoneal shunt in treatment of arachnoid cysts. We could get the nearly same surgical outcome without shunt complications with endoscopic or open procedures.
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Intracranial pressure (ICP) monitoring and cerebral perfusion pressure (CPP) management are the current standards to guide care of severe traumatic brain injury (TBI). However, brain hypoxia and secondary brain injury can occur despite optimal ICP and CPP. In this study, we used brain tissue oxygen tension (PbtO(2)) monitoring to examine the association between multiple patient factors, including PbtO(2), and outcome in pediatric severe TBI. ⋯ Reduced PbtO(2) is shown to be an independent factor associated with poor outcome in pediatric severe TBI in the largest study to date. It appears to have a stronger association with outcome than conventionally evaluated measures.
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Brain tissue oxygen tension (PbtO(2)) monitoring is used increasingly in adult severe traumatic brain injury (TBI) management. Several factors are known to influence PbtO(2) in adults, but the variables that affect PbtO(2) in pediatric TBI are not well described. This study examines the relationships between PbtO(2) and (1) physiological markers of potential secondary insults commonly used in pediatric TBI, in particular intracranial pressure (ICP), cerebral perfusion pressure (CPP), and systemic hypoxia, and (2) other clinical factors and treatment received that may influence PbtO(2). ⋯ Delivery of oxygen to the brain is important to limit secondary neuronal injury after severe TBI. Our data show that PbtO(2) is poorly predicted by clinical and physiological factors commonly measured in the pediatric ICU. Multimodality monitoring may be needed to detect all secondary cerebral insults in pediatric TBI.
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This study aims to describe the characteristics of severe head injuries in children less than 6 years old, victims of falls from windows, and identify the main predictive factors of mortality in this population. ⋯ Severe head injuries resulting from falls from windows carry a high risk of mortality in less than 6-year-old children. Hypothermia, hyperglycemia, and coagulation's disorders are independent predictive factors of mortality. Early deaths could be considered as direct consequences of uncontrollable brain lesions.
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Astroblastoma is an unusual brain tumor in childhood. Tumor usually arises from cerebral hemispheres. This large tumor is well-demarcated, lobulated, solid or cystic, and therefore, may resemble glioblastoma. Histopathologically, there are two types of astroblastoma: well-differentiated (low-grade) or anaplastic (high-grade). In low-grade astroblastoma, treatment of choice is complete excision. This type of tumor usually does not recur. However, anaplastic tumors can recur despite surgery, radiation, and chemotherapy and may be problematic for clinician. ⋯ High-grade astroblastomas behave like glioblastoma, as emphasized in this case report. Local control of this type of tumor seems difficult despite surgery, radiation therapy, and cisplatin-based chemotherapy.