Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
-
Cerebrospinal fluid (CSF) abdominal pseudocyst is an uncommon but important complication of ventriculoperitoneal shunts. From the collected series, several features about the etiology and management become apparent. Retrospective data were obtained from 12 children treated with cerebrospinal fluid abdominal pseudocyst defined an alternative approach for management of these patients. ⋯ Based on the success rate (75%) in our series submitted to this management, a ventriculoperitoneal shunt can be safely reinserted in the majority of the patients. Endoscopic third ventriculostomy could be performed in selected cases as an alternative approach. Although infection has been reported as responsible for pseudocyst formation, it was only exceptionally found in our series.
-
Myelomeningocele (MM) is one of the forms of dysraphism. Hydrocephalus secondary to Arnold-Chiari (AC) malformation is responsible for the morbidity and mortality of the disease. The intrauterine repair of MM may reverse AC and limit hydrocephalus progression. ⋯ Although it is not the standard option for surgical correction, selected MM cases with early fetal diagnosis may be eligible for intrauterine repair, when there is consensus with the Research Ethics Committees and family members.
-
Case Reports
Posttraumatic infarction in the territory supplied by the lateral lenticulostriate artery after minor head injury.
Occlusion of the intracranial arteries due to blunt head traumas has been less frequently observed in patients with minor head injuries. ⋯ Children with minor head trauma who have normal findings on initial CT scan may rarely have basal ganglionic infarction resulting from arterial spasm or thromboembolism of the perforating arteries. Hospital admission and careful observation should be considered for patients with minor head injury and persistent neurologic deficits despite normal CT findings. Magnetic resonance study is valuable for the evaluation of posttraumatic infarction, differentiating from hemorrhagic diffuse axonal injuries.
-
Clinical Trial
Early decompressive craniectomy may be effective in the treatment of refractory intracranial hypertension after traumatic brain injury.
We compared the effect of early decompressive craniectomy (<24 h) vs non-operative treatment on the outcome of children with refractory intracranial hypertension after severe traumatic brain injury. ⋯ In children who suffered severe head injury with refractory intracranial hypertension without intracranial haematoma, early decompressive craniectomy employed in the first few hours after injury before the onset of irreversible ischaemic changes may be an effective method to treat the secondary deterioration that commonly leads to death or severe neurological deficit.
-
Multicenter Study Clinical Trial
Cooperative study by the Italian neuroendoscopy group on the treatment of 61 colloid cysts.
Microsurgical resection, stereotactic aspiration and VP shunt have for years been the choice options for the treatment of colloid cysts of the third ventricle. Recently, endoscopic approaches have aroused increasing interest and gained acceptance. Although safer, this minimally invasive approach is considered less efficacious than microsurgery. Relatively long-term results are now available and some conclusions might be inferred on the usefulness of this procedure. ⋯ The endoscopic approach to the treatment of colloid cysts is safe, effective and well accepted by patients. Although asymptomatic, recurrences (11.4%) cast a persisting shadow on the long-term results, and, therefore, the controversy with the traditional microsurgical treatment remains open.