Pediatric neurosurgery
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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 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.
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Pediatric neurosurgery · Jan 2010
Ruptured brain arteriovenous malformations in children: correlation of clinical outcome with admission parameters.
To gain a better understanding of how clinical outcome in children with ruptured brain arteriovenous malformations (bAVMs) correlates with clinical and imaging parameters on admission. ⋯ In this series of pediatric patients with ruptured bAVMs, although various grading scales correlated significantly with clinical outcome 6 months after hemorrhage, only the combined scoring scale might have the potential to be applied to predict clinical outcome in these children.
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Pediatric neurosurgery · Jan 2010
The impact of a 'resident replacement' nurse practitioner on an Academic Pediatric Neurosurgical service.
The introduction of 80-hour workweek limitations has challenged resident training programs with creative scheduling while maintaining comprehensive training experiences. The work hour restrictions may be more adaptable to a medical service, but have been very challenging to an academic surgical program. The particular challenges include maximizing academic learning opportunities, operating room experiences and direct bedside patient care while adhering to the 80-hour restriction. This paper examines the addition of a pediatric nurse practitioner (NP) to a pediatric neurosurgical academic program in response to the resident work hour restrictions. ⋯ The addition of an NP in response to resident training changes has been a positive influence on satisfaction with the pediatric neurosurgical service while reducing the reliance on residents for bedside clinical care. Patient safety appears not to have been affected. Presumably, this response to resident work hour limitations will provide the needed time to enhance resident didactic and intraoperative training experiences.
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Pediatric neurosurgery · Jan 2010
Case ReportsTranssellar transsphenoidal encephalocele: a case report.
Basal encephaloceles are rare, accounting for about 1.5% of all encephaloceles. Transsellar transsphenoidal encephaloceles are the rarest variety of basal encephaloceles. We report a rare case of transsellar transsphenoidal encephalocele managed by a transnasal transseptal approach.