Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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The aims of this study were to describe and analyze the technique of neuroendoscopic foraminal plasty of foramen of Monro (NEFPFMO) in the treatment of isolated unilateral hydrocephalus (IUH) due to membranous occlusion, to evaluate its efficacy and safety, and to define the benefits of neuronavigational guidance of the procedure. ⋯ NEFPFMO should be the primary treatment option in patients with IUH due to membranous occlusion of foramen of Monro. It reestablishes natural anatomical communication and provides real physiological cerebrospinal fluid flow. Neuronavigation is a useful adjunct of NEFPFMO.
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Case Reports
Depressed skull fracture and epidural hematoma from head fixation with pins for craniotomy in children.
A head fixation device with pins is commonly used for immobilization of the patient's head during craniotomy. The safety of head fixation devices in children has been discussed rarely in the literature. The purpose of this report is to review our experience with complications of head fixation with pins in children undergoing craniotomies and to review the literature on this subject. ⋯ Depressed skull fractures and associated epidural hematomas need to be considered as possible complications of pin fixation of the head for craniotomy in young children.
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In children who have suffered a severe, extensive head trauma, cranioplasty is complicated because allografting is not advisable in pediatric patients and the amount of available autologous materials is limited. To overcome these problems, we employed a combination of autologous rib grafts and calvarial grafts for partial cranioplasty. ⋯ These autografts were of sufficient strength, esthetically satisfactory, and no patient developed sinking skin flap syndrome. Catcher's mask cranioplasty is a useful technique to successfully reconstruct the skull in pediatric patients with extensive cranial defects and an insufficient amount of autologous graft material.
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Clinical Trial
Correlation of hindbrain CSF flow and outcome after surgical decompression for Chiari I malformation.
Many patients with symptomatic Chiari I malformation experience symptom recurrence after surgical decompression. Improved radiographic predictors of outcome are needed to better select patients most likely to benefit from surgical intervention. We examined whether ventral or dorsal cerebrospinal fluid (CSF) flow dynamics assessed by cine phase-contrast MRI scans could predict response to posterior fossa decompression for Chiari I malformation. ⋯ The presence of decreased CSF flow both ventral and dorsal to the cervico-medullary brainstem was associated with improved response to hindbrain decompression for Chiari I malformation in children. Cine phase-contrast MRI may be a useful tool for surgical risk stratification and identifying patients that may be optimal surgical candidates. Combined ventral and dorsal hindbrain CSF flow pathology may better predict response to posterior fossa decompression compared to dorsal CSF flow pathology alone.
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Comparative Study Clinical Trial
Simultaneous endoscopic third ventriculostomy and ventriculoperitoneal shunt for infantile hydrocephalus.
We analyzed a series of consecutive hydrocephalic infants treated with implantation of a ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) simultaneously. ⋯ This simultaneous procedure could be the first choice of action for the hydrocephalic patients less than 1 year old.