Pediatric neurosurgery
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Pediatric neurosurgery · Aug 2010
Comparative StudyRhesus macaque as an animal model for posterior fossa syndrome following tumor resection.
Posterior fossa tumors are the most common brain tumors in children. Surgeons usually remove these tumors via a midline incision through the posterior vermis of the cerebellum. Though often effective, this surgery causes hypotonia, ataxia, oculomotor deficits, transient mutism, difficulty in swallowing and nausea. To date, there is no animal model that mimics these complications. We found that the rhesus macaque is a good model for the consequences of this surgery. ⋯ Our surgery in a monkey caused the same postsurgical signs observed in humans. We expect to use this model to improve the posterior fossa surgery methods.
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Pediatric neurosurgery · Jan 2010
Case ReportsA novel method for confirmation of hemispheric disconnection during hemispherotomy surgery.
Hemispherotomy has become a safe and effective surgical option for patients suffering from intractable epilepsy associated with diffuse unihemispheric malformations of cortical development. However, as compared to hemispherectomy, hemispherotomy, by leaving brain tissue behind, may leave some hemispheric connections intact, therefore increasing the risk of postoperative seizures. This is especially important to consider in the case of the highly epileptogenic hemisphere in hemimegalencephaly. ⋯ Intraoperative EEG may be a useful tool to confirm hemispheric disconnection during hemispherotomy.
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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
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 StudyExperiences with the telovelar approach to fourth ventricular tumors in children.
Fourth ventricular tumors are amongst the most common tumors in the pediatric population. Traditionally, these tumors are approached through the cerebellar vermis, but the telovelar approach is now becoming widespread. Posterior fossa syndrome/cerebellar mutism is a complication of surgery for fourth ventricular tumors whose precise cause remains elusive, but may be related to the surgical approach or injury to adjacent cerebellar structures. We present a small series of fourth ventricular tumors and our initial experience in using the telovelar approach for this surgery. ⋯ The telovelar approach provides excellent access to tumors of the fourth ventricle with sparing of the vermis in children. The high incidence of cerebellar mutism in our patients confirms that this phenomenon is unlikely to be related to vermian injury and further study is recommended.