Pediatric neurosurgery
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Pediatric neurosurgery · Jan 1994
ReviewCraniopharyngioma: endocrine abnormalities at presentation.
Craniopharyngioma is the most common childhood tumor to involve the hypothalamus and pituitary. Although endocrine disturbances can be found in 80-90% of patients at presentation, only a minority of subjects seek medical attention for an endocrine-related complaint. ⋯ In contrast, diabetes insipidus has been noted in only 9-17% of subjects prior to surgery. When possible, full evaluation of pituitary function should be performed; the minimum preoperative evaluation must include testing for and treatment of ACTH-adrenal insufficiency and diabetes insipidus.
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Pediatric neurosurgery · Jan 1994
Incidence of postoperative epilepsy in children following subfrontal craniotomy for tumor.
Thirty-one children who underwent 36 subfrontal craniotomies were retrospectively studied to determine the incidence of postoperative epilepsy and the effectiveness of antiepileptic drugs for seizure prophylaxis. The incidence of postoperative epilepsy following a subfrontal craniotomy did not exceed 12% when examined at various time periods during a 3-year postoperative course. Antiepileptic drugs were not warranted to reduce the incidence of postoperative seizures after the 1-month postoperative period and should not be used for long-term prophylactic therapy in children following a subfrontal craniotomy.
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Pediatric neurosurgery · Jan 1994
Surgery, radiation, and combination therapy in the treatment of childhood craniopharyngioma--a 20-year experience.
The records of 61 children treated for primary craniopharyngioma at the Children's Hospital in Boston and The Joint Center for Radiation Therapy from 1970 to 1990 were reviewed to determine if any information could be obtained regarding the efficacy of surgery versus radiotherapy or a combination of these modalities for this tumor. A select group of 9 children treated without biopsy by radiation therapy alone were all alive without disease progression at follow-up. ⋯ Treatment morbidity occurred in all groups, but the 10-year actuarial survival for all patients was 91%. Early postoperative imaging and pre- and posttreatment endocrine and neuropsychologic evaluations need to be carried out in all prospective studies of the treatment of craniopharyngioma in children.
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Pediatric neurosurgery · Jan 1994
Comparative StudyManagement of hydrocephalus in children with medulloblastoma: prognostic factors for shunting.
Patients with medulloblastoma frequently present with hydrocephalus. While not all patients with medulloblastoma will continue to suffer from hydrocephalus after tumor resection, there is a significant proportion who will require a permanent shunt. We have retrospectively reviewed a group of children with medulloblastoma not shunted preoperatively, and have identified several characteristics which are associated with a requirement for permanent shunt. ⋯ In particular, we found that no patient older than 10 years required a shunt. Thus, we conclude that younger patients with moderate to severe preoperative hydrocephalus and extensive tumors may benefit from perioperative CSF diversion. Other patients not meeting the above criteria can probably be safely managed with perioperative corticosteroids alone.
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Pediatric neurosurgery · Jan 1994
Isolated head injuries versus multiple trauma in pediatric patients: do the same indications for cervical spine evaluation apply?
Although the recommendations to evaluate possible cervical spine injuries in patients with isolated head injuries are identical to those with multiple trauma, to date, no such study has confirmed that risk factors are the same for both injuries. We reviewed the charts of 268 pediatric patients with isolated head injuries admitted to the Intensive Care Unit at Children's Hospital Medical Center (1985-1990) to determine which risk factors were present. In this retrospective study, we divided the patients into two groups: low risk and high risk. ⋯ Cervical spine trauma was present in 10 (7.5%) high-risk patients. Using the method of adjusted odds ratio, we found that high-risk patients had 23 times the likelihood of neck injury when compared with low-risk patients (p = 0.003, 95% confidence limit). Our results indicate that cervical spine X-rays (i.e., anteroposterior, odontoid, lateral views) are indicated only in high-risk pediatric patients with head injuries who either complain of neck pain or cannot voice such complaints because of significant head injury or preverbal age.(ABSTRACT TRUNCATED AT 250 WORDS)