Pediatric neurosurgery
-
Pediatric neurosurgery · Feb 1999
Case ReportsPediatric atlantoaxial instability: management with screw fixation.
Sixteen pediatric patients (age range 3-15 years; mean 9.4 years) with atlantoaxial instability underwent screw fixation at Columbus Children's Hospital between 1992 and 1998. Three patients with type II odontoid fractures underwent odontoid screw fixation. The remaining group of 13 patients had posterior C1-2 transarticular screw fixation and Sonntag C1-2 fusion. ⋯ This study demonstrates that children at 3 years of age and older, who sustain a type II odontoid fracture with an intact transverse ligament, can be safely managed with odontoid screws if the fracture is less than 4 weeks old. Posterior C1-2 transarticular screw fixation can be done safely and results in a high fusion rate in children older than 4 years of age. The technical difficulties of screw fixation in children are discussed.
-
Current cranioplasty materials include autologous or homologous bone grafts, wire mesh and methyl methacrylate, either alone or in combination. However, each material has its own unique disadvantages. Although hydroxyapatite has been used extensively in other specialties as a bone substitute, the coralline form has rarely been used to repair cranial bone defects. Coralline hydroxyapatite, similar to that found in bone, provides a matrix on which living tissue can form and grow. Because it is an ideal bioimplant, a method of cranioplasty using coralline hydroxyapatite was employed. ⋯ In neurosurgical procedures when a bone substitute is needed, hydroxyapatite is an effective alternative to other currently available materials.
-
Pediatric neurosurgery · Dec 1998
Case ReportsPediatric intracranial epidural abscess secondary to an infected scalp vein catheter.
The authors present a case of a 5-week-old infant developing a retrotorcular epidural abscess as a result of an infected scalp vein catheter. The abscess developed in the absence of sinusitis, otitis, trauma, or prior surgery. The diagnosis of epidural abscess was made on the basis of magnetic resonance imaging and ultrasound-guided aspiration of the fluid collection. ⋯ The patient underwent a suboccipital craniectomy with drainage of the abscess and a 6-week total course of intravenous antibiotics. Magnetic resonance imaging 4 months after the procedure and 2.5-year pediatric clinic follow-up have demonstrated no evidence of neurologic deficit or recurrence. When present, a scalp vein catheter must be considered as an etiologic agent for an intracranial epidural abscess in this age-group.
-
Pediatric neurosurgery · Aug 1998
Management of uncomplicated skull fractures in children: is hospital admission necessary?
This study was undertaken to determine the necessity for routine hospital admission of children with skull fractures, a normal neurological exam, a normal head CT, and no other injuries ('uncomplicated skull fracture'). ⋯ Patients with uncomplicated skull fractures, in the absence of recurrent emesis and/or evidence of child abuse, can be considered for discharge home. The definition of an uncomplicated skull fracture requires that a head CT be performed on these patients.