Pediatric neurosurgery
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Pediatric neurosurgery · Apr 1997
Cerebrovascular response in infants and young children following severe traumatic brain injury: a preliminary report.
To further describe the pathophysiologic processes that occur in infants and young children after severe traumatic brain injury (TBI), we retrospectively reviewed the cerebral blood flow (CBF) values and 6-month Glasgow Outcome Scores (GOS) in 30 children < or = 8 years old (25 were < or = 4 years old) with a Glasgow Coma Score (GCS) on admission of < or = 8. Twelve females and 18 males (mean age 2.1 years, range 1 month to 8 years) underwent 61 CBF studies using stable xenon computed tomography at variable times from admission to 9 days after TBI. In 12 patients, PaCO2 was manipulated an average of 8.4 torr (range 5-11 torr) and a second CBF study performed to determine CO2 vasoreactivity (CO2VR), defined as the percent change in CBF per torr change in PaCO2. ⋯ Younger age, low CBF in the early period after TBI, and a CO2VR of <2% was associated with a poor outcome in this subgroup of children. Young children (<24 months) may represent a particular high-risk group with early hypoperfusion after severe TBI. This finding may be a key factor in the pathophysiology and outcome in this age group, and may need to be addressed in our future therapeutic protocols.
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Pediatric neurosurgery · Apr 1997
Clinical TrialShaving of the scalp may increase the rate of infection in CSF shunt surgery.
Hydrocephalic patients undergo repetitive surgical procedures, most of which involve the scalp. 141 shaveless operations involving scalp incisions for cerebrospinal fluid (CSF) shunts as well as 218 historical controls were reviewed after the senior author ceased shaving the scalp. The study population has been followed for a mean of 13.4 months and the control population for a mean of 38.6 months. ⋯ Anesthesia times were not significantly different. Shaving of the scalp is not a critical step in the prevention of CSF shunt infection.
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Pediatric neurosurgery · Mar 1997
Comment Case ReportsSpontaneous rapid resolution of an epidural hematoma associated with an overlying skull fracture and subgaleal hematoma in a 17-month-old child.
Acute traumatic epidural hematomas (EDH) constitute one of the most critical emergencies in neurosurgical management. The rapid spontaneous resolution (<24 h) of EDH is an extremely rare phenomenon. A 17-month-old patient fell from a height of 1.5 m and presented with a 8-mm temporal EDH, an overlying linear skull fracture, and a subgaleal hematoma without evidence of intraparenchymal injury or edema. ⋯ This is the fourth reported case of rapid spontaneously resolving EDH and the youngest one to date. All 4 cases have coincided with an overlying linear skull fracture. We propose that unlike classical EDH, rapidly resolving EDH in the absence of elevated intracranial pressure (ICP) originates from elevated interstitial pressure in the subgaleal compartment transiently decompressing into the epidural space through a skull fracture and resolving as the pressure in the subgaleal compartment decreases below ICP.
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Pediatric neurosurgery · Mar 1997
Comparative Study Clinical TrialUse of positron emission tomography for presurgical localization of eloquent brain areas in children with seizures.
Successful surgical management of a neoplastic or nonneoplastic seizure focus in close proximity to or within eloquent brain areas relies on precise delineation of the relationship between the lesion and functional brain areas. The aim of this series was to validate the usefulness and test the efficacy of noninvasive presurgical PET mapping of eloquent brain areas to predict surgical morbidity and outcome in children with seizures. To identify eloquent brain areas in 15 children (6 female and 9 male; mean age 11 years) with epileptogenic lesions PET images of regional cerebral blood flow were performed following the administration of [(15)O]water during motor, visual, articulation, and receptive language tasks. ⋯ PET mapping may also improve the outcome of extratemporal resections by allowing aggressive seizure focus resection. In addition, serial brain maps may optimize timing for surgical intervention by demonstrating reorganization of eloquent cortex often seen in younger children after cortical injury. Our results suggest that noninvasive presurgical brain mapping has the potential to reduce risk and improve neurologic outcome.
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Pediatric neurosurgery · Jan 1997
Comparative StudySpinal lipomas in children: outcome of 270 procedures.
Spinal lipomas are a common cause of spinal cord tethering. Recently, prophylactic surgical removal of spinal lipomas has been questioned, especially of the conus medullaris. Unfortunately, few statistically significant series have been reported. ⋯ Deterioration occurred in 5 (16.7%) of the 30 children with a follow-up of more than 5 years, while 25 (83.3%) remained normal. Furthermore, in cases which had prophylactic surgery, there was not only a smaller incidence of deterioration requiring a reoperation, but this group of patients also experienced a longer time interval between initial surgery and the need for reoperation compared to the patients operated on after the onset of symptoms. The authors conclude that spinal lipomas should be operated on as soon as possible on a prophylactic basis, and careful and constant follow-up should be carried out to permit prompt reintervention in cases with deterioration.