Pediatric neurosurgery
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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
Review Case ReportsInitial experience with the use of remote control monitoring and general anesthesia during radiosurgery for pediatric patients.
The demand for general anesthesia in pediatric radiosurgery has been increasing, but the issues involved are not highlighted well in the medical literature. We developed remotely controlled monitoring and anesthesia techniques, and applied our system to three pediatric patients who underwent Gamma Knife radiosurgery with automated settings. Based on the perioperative safety management, the following issues are of considerable concern: to avoid emotional trauma associated with the treatment, to secure airway patency in a variety of head positions, and to apply all standard monitors. In this report, we describe the details of our project with a comprehensive literature review.
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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
Case ReportsInitial observations of combination barbiturate coma and decompressive craniectomy for the management of severe pediatric traumatic brain injury.
In the pediatric population, treatment of severely injured children presenting with low Glasgow Coma Score (GCS) and fixed and dilated pupils is controversial. The combination of barbiturate coma and decompressive craniectomy as an aggressive means of controlling intracranial pressure is limited to few studies. In the present series, we report our experience with aggressive combination therapy resulting in good outcomes in pediatric patients with severe traumatic brain injury (TBI). ⋯ Combination of barbiturate coma with decompressive craniectomy and external ventricular drainage led to good outcomes in a small group of pediatric patients with severe TBI. Based on this series we recommend further investigation into aggressive combination management.
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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.