World Neurosurg
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Pediatric spontaneous intracranial dissecting aneurysms are rare, but systematic studies comparing hemorrhagic and ischemic presentations are lacking. This study addresses gaps in understanding their epidemiology, clinical presentation, management, and outcome. ⋯ Pediatric intracranial dissecting aneurysms, particularly hemorrhagic cases, are associated with severe neurologic deficits and higher perioperative complications. Despite similar long-term outcomes, hemorrhagic cases require prolonged hospitalization, increasing treatment costs. Optimizing management strategies for pediatric intracranial dissecting aneurysms, especially those with hemorrhagic features, is essential to improve outcomes and reduce healthcare expenditures.
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Case Reports
Use of an Irrigating External Ventricular Drain in an Infant: Proof-Of-Concept Technical Note.
This report describes the procedural nuances for use of an irrigating external ventricular drain (EVD) in an infant patient. Intraventricular hemorrhage (IVH) and other intraventricular pathologies, such as infection, can occur in a variety of situations and patient populations, with few interventions available for immediate resolution. While manual endoscopic surgical irrigation has been trialed in both adult and pediatric patient populations to clear blood products or debris, this concept has recently been further extrapolated to the use of a continuous irrigating EVD over a more extended period. While this technique has been more commonly used for subarachnoid hemorrhage in adults, study of its use in pediatric patients, particularly in infants, is lacking. ⋯ Use of irrigating EVD catheters should not be limited to the adult population. Indications for use are broad in the pediatric population and warrant further exploration.
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Colloid cysts are nonneoplastic epithelial lesions arising from the roof of the third ventricle near the foramen of Monro. They comprise approximately 0.5% to 2% of all brain lesions.1-3 Surgical resection is the definitive treatment when indicated. The microsurgical approach is generally considered the "gold standard," but the endoscopic approach has been gaining popularity.4-6 The choice is usually based on a surgeon's preference and key image findings such as the presence of hydrocephalus. ⋯ The major drawback of the endoscopic approach was previously reported as a higher recurrence rate due to incomplete removal of the cyst capsule. However, it has been shown that the rate of capsule excision may be similar to that of microsurgery, ranging from 80 to 100%.7-14 The authors demonstrate an endoscopic resection of a recurrent colloid cyst with bimanual technique through parallel channels in a ventriculoscope. Video 1 highlights the critical steps involved in preserving both vascular and neural structures during the procedure.
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Retrospective Cohort Study. ⋯ The SFI provides a more precise assessment of muscle and fat distribution in the posterior cervical region than body mass index and is generally higher in patients with spinal cervical spondylosis who experience neck pain. These findings suggest the importance of early functional exercises postsurgery for potentially improving surgical outcomes in this patient population.
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Ultrasound imaging is inexpensive, portable, and widely available. The development of a real-time transcutaneous spinal cord perfusion monitoring system would allow more precise targeting of mean arterial pressure goals following acute spinal cord injury (SCI). There has been no prior demonstration of successful real-time cord perfusion monitoring in humans. ⋯ CEUS is a viable platform for monitoring real-time cord perfusion in patients who have undergone prior cervical laminectomies. Further development has the potential to change clinical management acute SCI by tailoring treatments to measured tissue perfusion parameters.