Pediatric neurosurgery
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Pediatric neurosurgery · Jan 2010
Review Case ReportsVein of Galen aneurysms: presentation and endovascular management.
We present our experience with managing 13 cases of vein of Galen aneurysm with a special focus on endovascular strategies. This clinical review deals with the multivariable clinical presentation of vein of Galen aneurysms and the role of transarterial endovascular treatment. ⋯ The transarterial approach proved to be a successful way of management of true VGAM that yielded better outcomes.
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Pediatric neurosurgery · Jan 2010
Comparative StudyTrauma infant neurologic score predicts the outcome of traumatic brain injury in infants.
To investigate the clinical features of infancy traumatic brain injury (TBI) and the prognostic value of the Trauma Infant Neurologic Score (TINS), infants < 2 years of age with TBI who were admitted from 2000 to 2007 were retrospectively studied. Fifty-six patients with a mean age of 13.3 ± 6.5 months (range = 2-24) were identified. The clinical diagnoses, in terms of the severest injury, included scalp hematomas (n = 2), skull bone fractures (n = 3), epidural hematomas (n = 21), subdural hematomas (n = 14), cerebral contusion and laceration (n = 4), intracerebral hematomas (n = 7), traumatic subarachnoid hemorrhage (n = 2), diffuse axonal injury (n = 2) and diffuse brain swelling (n = 1). ⋯ However, the CCS score on admission was not as discriminating as TINS, predicting only the best and worst outcome in our series. Our study showed that the clinical features of TBI in infants were different from those seen in adults regarding both the distribution of the pathology type and the clinical presenting symptoms. We found that the TINS scoring system is useful for predicting prognosis and outcome in infancy TBI and suggest that it could be routinely used in the infantile population.
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Cervical spinal dysraphism is a rare congenital spinal pathology. The results obtained from our series are compared with the results obtained from other series of studies in the literature. ⋯ In this series, in contrast to the literature, we noted that the number of girls with spinal dysraphism with a cervical myelomeningocele and meningocele was greater than the number of boys. Chiari type II malformation, hydrocephaly and motor weakness in patients with cervical spinal dysraphism are less frequent when compared to patients with caudal spinal dysraphism. The structure of the sac is also more durable and, accordingly, a cerebrospinal fluid leakage is uncommon.
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Pediatric neurosurgery · Jan 2010
Case ReportsA unique pattern of intracranial pressure in a patient with traumatic paroxysmal sympathetic storm.
Paroxysmal sympathetic storm (PSS), or diencephalic seizure, usually appears in patients with severe traumatic brain injury and is characterized by various sympathetic symptoms. The physiological effects of this syndrome are not well studied. The authors monitored intracranial pressure (ICP) in a patient with PSS and reviewed its impact on the physiology and management of the syndrome. ⋯ Electroencephalogram did not show epileptiform discharges, and the sympathetic spells were aborted by continuous intravenous midazolam infusion. The authors report on a pattern of ICP monitoring in association with PSS. Traumatic PSS should be recognized in the appropriate setting to prevent secondary brain damage.
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Pediatric neurosurgery · Jan 2010
Case ReportsMalfunction of SynchroMed II baclofen pump delivers a near-lethal baclofen overdose.
Intrathecal baclofen therapy using implantable pumps is an established treatment for spasticity. The pumps occasionally experience serious malfunction. ⋯ Physicians who implant pumps for intrathecal baclofen administration need to be aware that these devices may suffer unheralded catastrophic failure that can lead to potentially lethal overdose administration.