Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Lesions that affect the lower clivus, foramen magnum, the craniocervical junction, and the upper cervical spinal canal that are anterolateral and at times intradural require access ventral to the cerebellum and spinal cord. The posterolateral transcondylar approach provides such a route. In addition, posterior craniocervical stabilization can be accomplished at the same time. The author has reviewed the technique as well as the surgical results here. ⋯ The posterolateral transcondylar route is a versatile avenue to approach a variety of lesions ventrolateral to the brain stem and upper cervical cord. Exposure is quite satisfactory with minimal or no retraction of important neurovascular structures in the region. Modifications of this theme can be applied as the lesions require.
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Congenital and developmental osseous abnormalities and anomalies that affect the craniocervical junction complex can result in neural compression and vascular compromise and can manifest itself with abnormal cerebrospinal fluid dynamics. An understanding of the development of the craniocervical junction is essential to recognize the pathological abnormalities. ⋯ The conclusion was that os odontoideum was associated with an unrecognized fracture in children below the age of 5 with a previously normal odontoid structure as observed in our series. Atlas and axis abnormalities were reviewed in this series. This large database has provided an understanding of the natural history of many entities and allowed treatment protocols to be established that have stood the test of time.
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Previous anatomic studies have shown the conus medullaris to terminate between T12 and L1 vertebral levels in adults with normal spinal anatomy. Prior anatomic and radiographic studies of conus position with flexion and extension of the spine have had conflicting results. We performed a cadaveric study with direct visualization of the conus during flexion and extension to further study this question and potentially determine if flexion and extension of the spine during magnetic resonance imaging may prove to be a diagnostic tool in such pathologies as occult tethered cord syndrome. ⋯ Flexion of the spine does not cause the conus medullaris to change position in fresh human cadavers; however, flexion does cause the cauda equina to stretch and displace medially over the conus. Therefore, it is unlikely that the conus would change position during spine flexion during imaging or procedures such as lumbar puncture.
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Arachnoid cysts constitute 1% of all intracranial mass lesions not resulting from trauma. Suprasellar arachnoid cysts (SACs) are uncommon. Obstructive hydrocephalus is the most common cause of initial symptoms and occurs in almost 90% of the patients with suprasellar arachnoid cyst. We report on 17 patients with suprasellar arachnoid cyst who were treated with neuroendoscopic intervention. ⋯ Endoscopic surgery should be the first choice in the management of SACs. Neuroendoscopic VCC is successful in the majority of the cases.
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Case Reports
Infectious intracranial aneurysms in the pediatric population: endovascular treatment with Onyx.
Infectious intracranial aneurysms present a treatment challenge in the pediatric population. Current endovascular strategies and tools have been developed, which make treatment of infectious intracranial aneurysms with liquid embolics safe and effective. This study reviews the use of the liquid embolic Onyx in the treatment of infectious intracranial aneurysms in the pediatric population. ⋯ Endovascular therapy with liquid embolics (Onyx) has been shown to be a safe and effectual treatment option in the case of pediatric infectious intracranial aneurysms. The combination of endovascular modalities can also be used to tailor the therapeutic goal of exclusion of infectious aneurysms with good results. Further studies are needed to assess the long-term effectiveness of this approach to pediatric infectious intracranial aneurysms.