Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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The unfavorable surgical results that have been reported with insular epilepsy surgery may be related to inadequate monitoring. Insular epilepsy surgery requires the precise monitoring and tailored removal of the epileptic zone. The purposes of this study were to precisely monitor the hidden cortex and determine the effectiveness of using different monitoring methods, including subpial depth electrodes. ⋯ We demonstrate that image-guided insular surgery with safe and accurate depth electrode guidance results in an optimal outcome and complete resection of the insular cortex.
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We report a patient who suffered from brainstem injury following ventriculoperitoneal (VP) shunt placement in the fourth ventricle. ⋯ A 20-year-old man with complex hydrocephalus and trapped fourth ventricle underwent a suboccipital placement of a VP shunt. Postprocedure patient developed double vision. Magnetic resonance imaging showed that the catheter was penetrating the dorsal brainstem at the level of the pontomedullary junction. Patient was referred to our Neuroendoscopic Clinic. Physical exam demonstrated pure right VI cranial nerve palsy. Patient underwent flexible endoscopic exploration of the ventricular system. Some of the endoscopic findings were severe aqueductal stenosis and brainstem injury from the catheter. Aqueductoplasty, transaqueductal approach into the fourth ventricle, and endoscopic repositioning of the catheter were some of the procedures performed. Patient recovered full neurological function. The combination of endoscopic exploration and shunt is a good alternative for patients with complex hydrocephalus. A transaqueductal approach to the fourth ventricle with flexible scope is an alternative for fourth ventricle pathology.
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The study aims to report a preliminary experience of image guidance during transoral surgery in a paediatric population. In paediatric practice, the small size of the oropharynx and the distortion of the craniocervical junction anatomy (whether congenital or acquired) are both factors that may compromise the transoral approach. Prior immobilisation of the craniocervical axis by virtue of posterior fixation or external halo body orthosis permits the use of intra-operative image guidance to navigate this region. ⋯ Intraoperative neuronavigation during transoral surgery is feasible in the paediatric population. In this unusual patient population, the technique appears to be of value in negotiating complex anatomy and achieving a safe and predictable decompression.
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Transient cerebellar eye closure (TCES) is a rare complication of cerebellar tumor surgery in children. The pathogenesis of this problem remains unclear, and controversy exists regarding whether it is a purely psychogenic disorder or an organic syndrome. The anatomical substrate for this transient eye closure remains unknown. Most of the cases reported were associated with the syndrome of mutism. ⋯ We are presenting this rare complication with the hope of elucidating further on clinical course of illness and literature review on the possible pathophysiological mechanism.