Pediatric neurosurgery
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Pediatric neurosurgery · Jan 2012
Indications for pediatric external ventricular drain placement and risk factors for conversion to a ventriculoperitoneal shunt.
The external ventricular drain (EVD) is commonly used for the treatment of hydrocephalus and intracranial pressure (ICP) monitoring. In this study, we retrospectively reviewed indications for EVD placement over the last 20 years in pediatric patients at our institution. Additionally, we evaluated the rate that an EVD needed to be converted to a ventriculoperitoneal shunt (VPS) and ascertained how hydrocephalus etiology impacted long-term drainage requirements. ⋯ Traumatic brain injuries and neoplasms represent the most common indications for EVD placement in the pediatric population. While patients with neoplasm were much more likely to need conversion to a VPS for long-term cerebrospinal fluid diversion, the majority of EVDs in patients with head injuries were successfully weaned.
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Pediatric neurosurgery · Jan 2012
Case ReportsAnaesthetic management of a giant encephalocele: size does matter.
Encephalocele is a form of neural tube defect, characterized by protrusion out of the meninges and brain tissue through a bony skull defect. As per the site of origin, these encephaloceles have been classified into different types, out of which the frontoethmoidal one is exclusively common in Southeast Asia with a reported incidence of 1 in 5,000. Neurological outcome of such malformations depends on the size of the sac, neural tissue content, hydrocephalus, associated infection, and other pathologies that accompany this condition. Here we describe the anaesthetic concerns and perioperative management of a giant occipital encephalocele.
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Pediatric neurosurgery · Jan 2012
Case ReportsSpinal congenital dermal sinus presenting as a diagnostic conundrum.
Spinal congenital dermal sinus is a rare entity. Still rarer is its location over the thoracic and cervical spine. Secondary to congenital dermal sinus, intramedullary abscesses of the spinal cord are uncommon. ⋯ We report such an interesting case of thoracic spinal congenital dermal sinus associated with intramedullary abscess in an 18-month-old boy who presented with a diagnostic conundrum. The pathogenesis, clinical presentation, neuroimaging and management of such cases are discussed. Awareness, detection, timely referral and definitive operative intervention for a better neurological outcome are emphasized.
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Pediatric neurosurgery · Jan 2012
Towards development of a survival prediction tool for pediatric head injury.
The ability to provide an accurate prognosis for children with traumatic brain injury (TBI) would be useful for the children's families and the caregivers. In this study we examined whether an appropriate mathematical model can predict survival in this patient population. ⋯ An outcome predictive model for pediatric TBI can be devised using an appropriate mathematical model. It may help to estimate expected outcomes in pediatric TBI more objectively.
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Pediatric neurosurgery · Jan 2012
Factors predicting the need for cerebrospinal fluid diversion following posterior fossa tumor surgery in children.
No consensus exists regarding the management of hydrocephalus in children with posterior fossa tumors before, during or after surgery. In the present study we analyze the factors that predispose to persistent hydrocephalus and the need for a postoperative cerebrospinal fluid (CSF) diversion procedure. ⋯ The fact that less than one-third of patients require a CSF diversion after posterior fossa tumor resection refutes the role of prophylactic endoscopic third ventriculostomy. Awareness regarding the factors that can predict persistent postoperative hydrocephalus is essential for the surgeon during patient counseling and surgical planning, and also in deciding the intensity of postoperative clinical and radiological monitoring.