Pediatric neurosurgery
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Pediatric neurosurgery · Jan 2009
Review Case ReportsSynchronous ventriculoscopic and microsurgical resection of complex craniopharyngiomas.
Surgical resection of craniopharyngiomas may be challenging sometimes because of the size, location and tenacity. Simultaneous endoscopic and microsurgical resection is a novel way to approach such lesions. The aim of this report is to discuss the usefulness of combined endoscopic and microsurgical approaches in treating complex craniopharyngiomas along with a review of the literature. ⋯ Neuroendoscopy can complement microsurgery in approaching complex craniopharyngiomas particularly when these tumors are large and accompanied by hydrocephalus.
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Pediatric neurosurgery · Jan 2009
Comparative StudyMagnetic resonance diffusion tensor imaging of the optic nerves to guide treatment of pediatric suprasellar tumors.
As a preoperative planning tool, conventional magnetic resonance (MR) imaging may have limited value in differentiating tumors from white matter tracts. MR diffusion tensor imaging (MRDTI) has become a useful tool for evaluating white matter tracts in relation to surrounding structures and has been used in surgical planning for brain tumors involving white matter. We investigated the use of DTI of the optic nerves in surgical planning for pediatric suprasellar tumors. ⋯ A routine 6-direction DTI of the pediatric brain at 3 T permits a detailed DTI study of the optic nerves. Optic nerve tractography can be used to aid in the evaluation and treatment of pediatric brain tumors in the area of the optic chiasm.
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Pediatric neurosurgery · Jan 2009
Review Case ReportsPostlaminoplasty kyphotic deformity in the thoracic spine: case report and review of the literature.
In the pediatric population, a strong correlation between multilevel laminectomy and postlaminectomy spinal deformities, predominantly kyphosis, has been demonstrated. This has been observed mainly in the cervical and thoracic spine. ⋯ Moreover, to the best of our knowledge, postlaminoplasty kyphosis of the thoracic spine has not been previously described in the literature. We report the case of a pediatric patient who rapidly developed severe thoracic kyphosis 3 months after resection of a symptomatic extradural spinal arachnoid cyst and multilevel en bloc thoracic laminoplasty, and review the relevant literature.
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Pediatric neurosurgery · Jan 2009
Case ReportsBilateral decompressive craniectomy for refractory intracranial hypertension in a child with severe ITP-related intracerebral haemorrhage.
We report a 13-month-old infant who developed acutely elevated intracranial pressure (ICP) as a result of a spontaneous intracerebral haemorrhage (ICH), secondary to idiopathic thrombocytopenic purpura (ITP). Her ICP remained severely elevated despite aggressive medical measures, with persistent obtundation, right hemiparesis and a dilated left pupil. Bilateral decompressive craniectomies (DCs) were performed, which resulted in a rapid decline in ICP. ⋯ Tragically, she died of non-neurological, ITP-related complications 9 months later. In our review, we identified no other instances of bilateral DCs reported in the management of an infant with ITP and/or an ICH. We addressed three central questions: (1) Is there any value of DCs in children, and especially in infants, with elevated ICP? (2) Is there any value of DCs in the setting of non-traumatic ICH? And (3) is there any rationale for the use of bilateral versus unilateral DCs?
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Pediatric neurosurgery · Jan 2009
Case ReportsIs postoperative CT scanning predictive of subdural electrode placement complications in pediatric epileptic patients?
To understand the reliability of postoperative CT scans to predict the development of intracranial hemorrhagic complications associated with subdural electrode implants for monitoring intractable seizure, we reviewed the data of a consecutive series of children treated at our institution. ⋯ Subdural electrode implants in children are safe. The presence of a midline shift of <5 mm is common postoperatively. The presence and extension of the midline shift at the first CT scan does not seem to be predictive of the development of symptomatic complications with a mass effect. Complications happened in a delayed fashion.