Pediatric neurosurgery
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Pediatric neurosurgery · Aug 2000
Postural changes in intracranial pressure in chronically shunted patients.
A subset of hydrocephalic patients with indwelling shunts become symptomatic when they are upright and active. Intracranial pressure (ICP) measurements in these patients have shown a significant drop in pressure when the patient is upright with return to normal levels when the patient is supine. In 20 chronically shunted hydrocephalic patients who previously had no siphon protection devices, ICP changes in supine and upright position were studied at the time when the patient had external ventriculostomy for treatment of shunt infection. ⋯ Based on these findings, we conclude that even in the absence of drainage through the shunt, chronically shunted patients still display a fall in ICP when assuming the upright position. This raises the possibility of fluid shifts other than of CSF through nonshunt pathways. Possible mechanisms involving altered CSF-venous system interaction are discussed.
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Pediatric neurosurgery · Aug 2000
Safety and efficacy of remifentanil in craniosynostosis repair in children less than 1 year old.
Few studies on analgesia with remifentanil (Rf) in children are available, and there are no data on the use of this drug in pediatric neurosurgery. Rf is a new mu-receptor opioid agonist, acting through the activation of pain inhibitory mechanisms. We conducted a prospective trial on the analgesic effects of Rf in 20 children less than 1 year of age undergoing a neurosurgical procedure for craniosynostosis repair. ⋯ This drug showed a satisfactory pain control in all the children treated. No significant side effects were noticed, except for one episode of urinary retention. In conclusion, Rf appears to be safe and effective for the treatment of acute pain in the very young child submitted to craniosynostosis repair.
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Pediatric neurosurgery · Aug 2000
Age-related differences in acute physiologic response to focal traumatic brain injury in piglets.
The goal of the present study was to determine whether age-related differences in the acute physiologic response to scaled cortical impact injury contribute to differences in vulnerability to traumatic brain injury (TBI). ⋯ CBF was shown to have a significant age-dependent response to TBI with the youngest animals exhibiting increased CBF following injury.