Pediatric neurosurgery
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Pediatric neurosurgery · Jan 2011
Volumetric analysis of cranial vault distraction for cephalocranial disproportion.
The purpose of this study was to provide an objective analysis and quantify the intracranial volume change produced by cranial vault distraction osteogenesis. We recently published a technique to expand the cranial vault by distraction in symptomatic patients with findings of cephalocranial disproportion. Resolution of symptoms was documented in that publication. ⋯ The ability to use the same methodology to quantify ventricular volume changes was unexpected. The fact that all ventricles expanded after distraction at approximately 10% of the total intracranial volume increase indicates that compensatory mechanisms had been activated. We conclude that this occurs at the expense of cerebral blood flow.
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Pediatric neurosurgery · Jan 2011
ReviewEndoscopic minimally invasive neurosurgery: emerging techniques and expanding role through an extensive review of the literature and our own experience - part I: intraendoscopic neurosurgery.
Minimally invasive neurosurgery is a growing field, more so in recent decades. The modernization of tools, especially the endoscope, has allowed for critical improvements and crucial advancements in minimally invasive neurosurgery. The current classification scheme for endoscopic procedures needs to be updated to reflect these advancements. ⋯ Our proposed classification scheme for solely endoscopic procedures is presented. The role of the endoscope as an independent tool is clarified.
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Pediatric neurosurgery · Jan 2011
ReviewVentriculosubgaleal shunting--a strategy to reduce the incidence of shunt revisions and slit ventricles: an institutional experience and review of the literature.
Slit ventricles and multiple episodes of shunt failure are problematic in many infants and preterm neonates shunted for hydrocephalus. We utilized ventriculosubgaleal (VSG) shunting as the initial neurosurgical intervention in neonates with hydrocephalus associated with intraventricular hemorrhage and infants with myelomeningocele. ⋯ Based on our results, initial management of selected hydrocephalic infants with a VSG shunt may prove to be advantageous in the long run for these children as the number of shunt revisions and the incidence of slit ventricles are significantly less than those reported in the literature.
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Pediatric neurosurgery · Jan 2011
Perioperative factors associated with prolonged intensive care unit and hospital length of stay after pediatric neurosurgery.
This study aims to describe the association between different postoperative complications and the length of hospital stay among children undergoing neurosurgical procedures. ⋯ In this study population, most elective neurosurgical procedures were not associated with significant complications, and morbidity and mortality were low. Some complications significantly influenced patients' outcomes and should be monitored for early diagnosis. This study may improve our understanding and identification of postoperative outcomes in pediatric neurosurgery.
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Pediatric neurosurgery · Jan 2011
Case ReportsPostoperative extra-axial cerebrospinal fluid collection--its pathophysiology and clinical management.
External hydrocephalus, introduced by Dandy and Blackfan in 1914 [Am J Dis Child 1914;8:406-482], is used to describe the clinical condition of cerebrospinal fluid (CSF) accumulation in the subarachnoid space with its space expansion and increased intracranial pressure in pediatric patients. Benign subdural effusion, subdural hygroma and pseudohydrocephalus are some terms used to describe some conditions, not clearly defined at the moment as separate pathological entities. We report 3 pediatric cases which had CSF collections after craniotomy. Neuroimaging investigations revealed CSF collection after surgery. All 3 cases had a poor clinical course with resolution after shunting. This report analyzes the mechanisms and pathophysiology of postoperative extra-axial CSF collections (PECC), indicating that CSF accumulations in the extra-axial spaces (inside or outside the arachnoid) after surgery have a common pathophysiology. Therefore, the treatment protocol can be specific. ⋯ We present the occurrence of CSF collections in the extra-axial space after surgery as the specific condition of PECC. Broadly dissecting the arachnoid membrane, with a communication remaining with the ventricles, is the main factor contributing to PECC, and patients have shown that V-P shunting is an effective procedure preventing progression and effectively treating PECC.