Pediatric neurosurgery
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Pediatric neurosurgery · Jan 1994
Case ReportsDepressed skull fractures in children secondary to skull clamp fixation devices.
The use of external skull fixation devices (skull clamps) is a common practice in neurosurgery. The insertion of pins into the skull is usually routine and uneventful in adult patients. However, the safety of skull clamp fixation devices in children is not reported. ⋯ There were no sequelae associated with the depressed fractures. We conclude that skull clamp fixation devices are safe, but should be used with caution in the pediatric patient. In addition, we present several modifications of existing skull clamps which may decrease the risk of depressed skull fractures.
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Pediatric neurosurgery · Jan 1994
Biography Historical Article Classical ArticleMyelomeningocele repair: technical considerations and complications. 1988.
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The charts and cranial ultrasounds of 29 infants treated with extracorporeal membrane oxygenation (ECMO) for respiratory insufficiency secondary to meconium aspiration syndrome, primary pulmonary hypertension, congenital diaphragmatic hernia and/or sepsis were examined to identify ultrasound abnormalities. Seventeen (58.6%) developed extra-axial fluid collections, only two of which were progressive. Ten (34.5%) developed evidence of intracranial hemorrhage (ICH): seven caudate, one each in the thalamus, parietal and occipital lobes. Eight (27.65%) of the neonates had seizures while on ECMO, 5 of whom had concurrent ICH.
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A subset of children with minor head injury is known to develop serious neurological consequences, but identifying this subset has been difficult. In adults, multiple variables such as skull fracture, Glasgow Coma Scale score, unconsciousness, and amnesia are significant factors that determine whether to admit the patient to the hospital and the patient's outcome. As an objective assessment of neurological function, however, the Glasgow Coma Scale has limited usefulness in children, particularly those under 36 months of age. ⋯ Of these, 99 (13.4%) had lesions requiring surgery: 9 had subdural hematomas, 35 had epidural hematomas, 44 had depressed skull fractures, and 11 had other types of lesions. Two children (0.3%) with Glasgow Coma scores of 13 died after subsequent deterioration, 1 of a delayed epidural hematoma, the other of diffuse cerebral edema. Risk factors such as length of unconsciousness, presence of skull fractures, computed tomography findings, posttraumatic seizure, and Glasgow or Children's Coma scores were evaluated for their impact on the patient's outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
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Pediatric neurosurgery · Mar 1993
ReviewAn approach to the management of arrested and compensated hydrocephalus.
Arrested hydrocephalus is defined as adequately shunted hydrocephalus while all other forms of hydrocephalus are at various levels of compensation. Compensation occurs at some cost to the child. ⋯ Close observation with objective data is mandatory if the decision is made not to shunt the young child. In the very young, less than 3 years of age, one should probably err on the side of inserting a shunt.