Pediatric neurosurgery
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Pediatric neurosurgery · Mar 1997
Comment Case ReportsSpontaneous rapid resolution of an epidural hematoma associated with an overlying skull fracture and subgaleal hematoma in a 17-month-old child.
Acute traumatic epidural hematomas (EDH) constitute one of the most critical emergencies in neurosurgical management. The rapid spontaneous resolution (<24 h) of EDH is an extremely rare phenomenon. A 17-month-old patient fell from a height of 1.5 m and presented with a 8-mm temporal EDH, an overlying linear skull fracture, and a subgaleal hematoma without evidence of intraparenchymal injury or edema. ⋯ This is the fourth reported case of rapid spontaneously resolving EDH and the youngest one to date. All 4 cases have coincided with an overlying linear skull fracture. We propose that unlike classical EDH, rapidly resolving EDH in the absence of elevated intracranial pressure (ICP) originates from elevated interstitial pressure in the subgaleal compartment transiently decompressing into the epidural space through a skull fracture and resolving as the pressure in the subgaleal compartment decreases below ICP.
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Pediatric neurosurgery · Mar 1997
Comparative Study Clinical TrialUse of positron emission tomography for presurgical localization of eloquent brain areas in children with seizures.
Successful surgical management of a neoplastic or nonneoplastic seizure focus in close proximity to or within eloquent brain areas relies on precise delineation of the relationship between the lesion and functional brain areas. The aim of this series was to validate the usefulness and test the efficacy of noninvasive presurgical PET mapping of eloquent brain areas to predict surgical morbidity and outcome in children with seizures. To identify eloquent brain areas in 15 children (6 female and 9 male; mean age 11 years) with epileptogenic lesions PET images of regional cerebral blood flow were performed following the administration of [(15)O]water during motor, visual, articulation, and receptive language tasks. ⋯ PET mapping may also improve the outcome of extratemporal resections by allowing aggressive seizure focus resection. In addition, serial brain maps may optimize timing for surgical intervention by demonstrating reorganization of eloquent cortex often seen in younger children after cortical injury. Our results suggest that noninvasive presurgical brain mapping has the potential to reduce risk and improve neurologic outcome.