Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Comparative Study Clinical Trial
Surgical evacuation of acute subdural hematoma improves cerebral hemodynamics in children: a transcranial Doppler evaluation.
The objective was to evaluate cerebral hemodynamics in young children with acute subdural hematoma (SDH) and the impact of surgical treatment using transcranial Doppler (TCD). ⋯ Children with acute bilateral HSD have a high incidence of increased intracranial pressure as assessed by TCD. Surgical evacuation improves cerebral hemodynamics. TCD could be used for assessing the need for, and the efficiency of surgical drainage.
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Comparative Study Clinical Trial
CSF shunts in children: endoscopically-assisted placement of the distal catheter.
Ventriculoperitoneal shunting is the most common treatment for hydrocephalus. Repeated shunt revisions and other previous surgical procedures can complicate the placement of the distal catheter. Occasionally, when conventional sites like the abdominal cavity and the right atrium are used up or unavailable, a ventriculopleural shunt can be inserted. ⋯ Laparoscopic and thoracoscopic assistance in the placement of the distal catheter has the benefit of allowing a safe and precise insertion with visual control of shunt function, even in patients with prior surgical interventions. Additionally, this minimally invasive technique appears to prevent new adhesions arising in the peritoneal cavity.
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Comparative Study
Spinal tuberculosis: with reference to the children of northern India.
Tuberculosis is a necrotizing bacterial infection with protean manifestation and wide distribution. There has been a great fall in the prevalence of tuberculosis in the United States since 1990, although the impact of acquired immunodeficiency syndrome (AIDS) has increased the resurgence of tuberculosis (TB). Spinal tuberculosis is the commonest form of skeletal tuberculosis. In this article, an overview of spinal tuberculosis and the personal experience of 19 children with spinal tuberculosis are presented. All the children required surgical intervention, because they manifested neurological deficit. PATHOGENESIS AND CLINICAL FEATURES: The spinal tuberculosis is a result of hematogenous dissemination from primary focus in the lungs or the lymph nodes. The central type of vertebral tuberculosis spreads along with Batson's plexus of veins, while paradiscal infection spreads through the arteries. The anterior type of vertebral body tuberculosis results from the extension of the abscess beneath the anterior longitudinal ligament and periosteum. Two types of bone and joint tuberculosis are recognized: the caseous, exudative type with abscess formation, which is more common in children, and the granular type is frequent in adults. Only 7 of the 19 children had an abscess, while 10 manifested mainly granulation tissue. Although spinal tuberculosis is an extradural disease, 2 children had intramedullary granulomas and presented a tumor-like syndrome as rare manifestations. It was interesting to encounter intradural granulation and organized intradural granuloma causing cord compression in 2 children. A frank abscess with clumping of nerve roots was encountered in the cauda of another child without vertebral involvement. There is a controversy regarding the age predilection of the disease; it is documented that it is a disease of adults in affluent countries, and a disease of the first three decades in other regions. ⋯ Opinion varies regarding the operative indication for Pott's spine. A large group of surgeons perform debridement and decompression in all cases, irrespective of neurological involvement. Others perform operative decompression only in those patients who do not respond to chemotherapy. We did surgical interventions in children with moderate to severe neurological deficits manifesting radiological compression of their neuraxis. Depending on the site of involvement and type of disease the surgical approach was decided in individual cases. Two children with healed Pott's spine also required surgery because of their spinal deformations, which caused gradual neurological deficits and pain in both. Prognosis depends on many factors; the magnitude of cord compression, duration of neural complication, age and general condition of patient. Fifteen of our children made a remarkable recovery. Children with paraplegia also made an excellent recovery of their strength and sensations.
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Sinus thrombosis following a closed mild head injury is rare. A case of dural sinus thrombosis following a mild closed head injury due to an uncommon cause is reported. ⋯ The role of inherited and acquired procoagulant factors in the aetiology of sinus thrombosis is increasingly being recognized. When a patient presents with sinus thrombosis after a closed mild head injury, it is necessary to investigate for the presence of risk factors for thrombophilia as it has implications for the long-term management of the patient.