Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Comparative Study Clinical Trial
Symptomatic epilepsy in children with poroencephalic cysts secondary to perinatal middle cerebral artery occlusion.
Perinatal cerebral artery occlusion is responsible for ischemic cerebral infarction leading to brain cavitation and gliosis; the territory of the middle cerebral artery is most frequently involved. The resulting poroencephalic cysts are frequently associated with hemiplegia and epilepsy; that can be managed medically in most cases, only 6-7% of them being refractory to medical treatment. This particular subset of congenitally hemiplegic children will be possible candidates for electrophysiological investigation and eventually for resective surgery. Whatever the kind of surgical treatment, surgery should be performed as soon as possible to optimize functional brain reorganization. ⋯ Simple surgical excision of the cyst "membrane" of epileptogenic poroencephalic cysts can represent an excellent means to control epilepsy in affected children. However, postoperative seizure persistence and late recurrences, although rare, do not allow to exclude that hemispherectomy or partial resections (based on electrocorticography findings) might represent the good answer at least in some cases.
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Gamma knife radiosurgery as a noninvasive procedure is increasingly used as a treatment option in patients with intractable seizures. We investigated efficacy and safety of gamma knife radiosurgery (GKRS) for callosotomy in children. ⋯ Radiosurgical callosotomy might be offered after hemispherotomy to complete callosal resection. However, larger number of patients and longer follow-ups are needed to draw final conclusions.
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Comparative Study Clinical Trial
Role of intraoperative neurophysiology in primary surgery for obstetrical brachial plexus palsy (OBPP).
Management of conducting neuroma-in-continuity in primary surgery for obstetrical brachial plexus palsy (OBPP) is still discussed controversially. We present our experience with intraoperative neurophysiological recordings in the management of lesions in continuity in OBPP. ⋯ Intraoperative neurophysiological recordings face certain difficulties when used in small children with OBPP. Due to overoptimistic assessment of prognosis after intraoperative CNAP recordings and motor stimulation, the functional results after neurolysis of conducting neuroma-in-continuity are disappointing. Resection of neuroma-in-continuity, conducting or not, offers the best opportunity for maximal functional recovery of the compromised upper limb in OBPP. The role of intraoperative neurophysiological techniques should be confined to the diagnosis of root avulsions.
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Comparative Study Clinical Trial
Lumbar hyperlodosis in cerebral palsy: anatomic analysis and surgical strategy for correction.
We report our experience of five cases in adolescents with spastic quadriplegia who had primarily sagittal plane deformity with hyperlordosis of the lumbar spine, an uncommon condition in cerebral palsy spinal deformity. ⋯ Hyperlordosis was reduced by 26 to 48 degrees , and the horizontal sacrum was corrected by 15 to 35 degrees , which enabled the patients to sit comfortably.
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Review Case Reports
Unilateral occipital hyperhidrosis following Chiari I decompression: case report and a review of the literature.
Paroxysmal unilateral cephalic hyperhidrosis is a rare disorder of the autonomic nervous system. ⋯ To our knowledge, hyperhidrosis of the occiput has not been previously reported in a patient with Chiari I malformation with an associated syringomyelia.