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Sommaires des Revues - Pediatric Neurosurgery

PNE : Last 10 articles


Last 10 articles published in Pediatric Neurosurgery


Craniofacial Distraction in the Management of Anterior Plagiocephaly: A Novel Idea and a Systematic Review of the Literature  Voir?

Background: The objective of this work is to present a review of all reports involving the management of unicoronal synostosis with distraction osteogenesis (DO). Also, we have innovated a new method in the treatment of cases of anterior plagiocephaly at a young age using DO. Methods: We present a case in which anterior plagiocephaly was treated by DO of both metopic and hemicoronal sutures in a 4-month-old female patient. A comprehensive systematic literature review was completed using the search terms “distraction osteogenesis,” “unicoronal synostosis,” “anterior plagiocephaly,” and “craniosynostosis.” We excluded all experimental articles and reviewed clinical reports detailing the use of DO in the management of unicoronal synostosis. Results: The study sample of this review consisted of 16 reports published over a period of 17 years that were analyzed in detail. The total number of patients treated by DO was 120, and the mean age at operation was 12 months. In the case presented, successful correction of the unicoronal synostosis was achieved. Conclusion: Hemicoronal and metopic suture distraction in anterior plagiocephaly achieves considerable improvement in the midline shift of the anterior cranial base and naso-orbital complex.
Pediatr Neurosurg

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Functional Neuroanatomy of Secondary Self-Injurious Behavior  Voir?

Background: Secondary self-injurious behavior (SSIB) is underreported and predominantly not associated with suicide. In both adults and children, SSIB can cause intractable self-harm and is associated with a variety of clinical disorders, particularly those involving dysfunctional motor control. Methods: We performed a literature review evaluating the clinical efficacy of deep-brain stimulation (DBS) as modulating SSIB observations and review current progress in preclinical SSIB animal studies. Results: Neuromodulation is an effective therapeutic option for several movement disorders. Interestingly, this approach is emerging as a potentially effective treatment for movement disorder-associated SSIB (secondary); however, it is important to understand the neuroanatomy, clinical appraisal, and outcome data when considering surgical therapy for SSIB. Conclusion: The current review examines the literature encompassing animal models and human case studies while identifying existing hypotheses from cytoarchitectonic-based targeting to neurotransmitter-based pathways. This review also highlights the need for awareness of an underrecognized pathology that may be amenable to DBS.
Pediatr Neurosurg

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Fungating Growth of Squamous Cell Carcinoma in Long-Standing Meningocele  Voir?

Squamous cell carcinoma is known to occur as a serious complication of chronic burns, scars, and ulcers, but very rarely has it been reported to occur in a long-neglected meningocele. The authors wish to present the case of a 21-year-old man who presented to us when a previously asymptomatic meningocele developed a squamous cell carcinoma on the meningocele sac. The squamous cell carcinoma was excised in toto, followed by excision of the redundant meningocele sac. The neural placode was closed and dural closure done with an artificial dural patch. Reconstruction of the defect thus created was performed by a lumbar perforator-based reverse latissimus dorsi myocutaneous flap. The patient did not develop any postoperative neurological deficits and made an uneventful recovery in the postoperative period. He received adjuvant radiation therapy and is doing well at 4 months' follow-up.
Pediatr Neurosurg

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Postoperative Immobilization following Occipitocervical Fusion in the Pediatric Population: Outcome Evaluation and Review of Literature  Voir?

The scientific literature does not have a consensus about the role and method of postoperative immobilization after occipitocervical fusion in the pediatric population. The primary goal of this study is to review the medical literature and evaluate different immobilization methods and their impact on fusion, following the surgical management of craniocervical instability in children. It started with an extensive research of randomized controlled trials, series of cases and case reports, describing occipitocervical junction pathologies, clinical, epidemiological characteristics, and treatment. The search was performed using the Pubmed database evaluating all the literature involving postoperative immobilization after occipitocervical fusion in pediatric patients. The results showed that most cases of occipitocervical stabilization were due to congenital spinal instability followed by trauma in most series. The most common type of surgery performed was occipitocervical fusion using screw and rod constructs. The different methods of postoperative immobilization did not affect outcomes. Then, we can conclude that screw-and-rod constructions in occipitocervical fusion augment the rates of fusion, independently from which immobilization was used, even when none was used at all.
Pediatr Neurosurg

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Changing Trends in Brain Imaging Technique for Pediatric Patients with Ventriculoperitoneal Shunts  Voir?

Background: Children with ventriculoperitoneal shunts (VPS) undergoing brain computed tomography (CT) for shunt malfunction evaluation are at risk for later malignancy due to radiation exposure. We aimed to determine if and how hospitals have adopted radiation-avoiding magnetic resonance imaging (MRI) techniques. Methods: We performed a secondary analysis of the Pediatric Health Information System (PHIS) database. Children with VPS presenting to acute wards at 31 PHIS hospitals between January 1, 2007 and January 2, 2015 and receiving noncontrast neuroimaging on day of service 0/1 were included. Outcome measures were (1) incidence of MRI over time and (2) comparison of demographic characteristics between hospitals with MRI representing higher versus lower proportions (>15% or <15%) of total brain imaging. Results: MRIs increased by 18.1% from 2007 to 2015. Hospitals were assigned to high-use (n = 12) or minimal-use (n = 19) MRI groups based on year 2014/2015 MRI percentages. The only identified difference was an older mean age in the high-use group (8.1 vs. 7.5 years; p = 0.03). Conclusions: MRI is increasingly used to evaluate patients with VPS. Hospitals with more MRI use had older patients and no increase in cost or length of stay. Initiating local quality improvement projects may help identify barriers to MRI uptake and increase use.
Pediatr Neurosurg

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Risk Factors for Intraoperative Hypocapnia in Pediatric Neurosurgical Patients: A Retrospective Cohort Study  Voir?

Background: Hypocapnia has been associated with an increased risk and adverse outcomes in the injured brain. This study aimed to identify risk factors of intraoperative hypocapnia in pediatric neurosurgical patients when tidal volumes and respiratory rates were determined based on their weight and age, respectively. Methods: Electronic medical records of pediatric patients (≤18 years) who underwent neurosurgery from December 2014 to January 2016 were retrospectively reviewed. Minute ventilation was fixed according to each patient's weight and age. Hypocapnia was defined as arterial partial pressure of carbon dioxide <35 mm Hg from intraoperative arterial blood gas analysis. Patients were divided into hypocapnia and nonhypocapnia groups. Risk factors for intraoperative hypocapnia were found using univariable and multivariable logistic regression analyses. Results: Of the 333 pediatric patients analyzed, 101 (30%) and 232 (70%) were included in the hypocapnia and nonhypocapnia groups, respectively. There was no difference in the minute ventilation between the two groups. The hypocapnia group had more patients taking valproate (8.9 vs. 2.2%; p = 0.008; OR, 4.441; 95% CI, 1.449-13.61) and carbonic anhydrase inhibitors (7.9 vs. 2.2%; p = 0.018; OR, 3.905; 95% CI, 1.245-12.25). An operation for hydrocephalus was more commonly performed in the hypocapnia group (26.7 vs. 15.9%; p = 0.017; OR, 1.923; 95% CI, 1.094-3.379). In the multivariable regression analysis, valproate (OR, 3.939; 95% CI, 1.250-12.41; p = 0.019), carbonic anhydrase inhibitor (OR, 3.345; 95% CI, 1.029-10.88; p = 0.045), and operation for hydrocephalus (OR, 1.838; 95% CI, 1.032-3.272; p = 0.039) were independent risk factors for intraoperative hypocapnia. Conclusions: Pediatric patients taking valproate and carbonic anhydrase inhibitors and who were scheduled for surgery of hydrocephalus were at risk of developing intraoperative hypocapnia during neurosurgery, a finding warning the surgeon that a conventional ventilatory strategy would endanger these patients.
Pediatr Neurosurg

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A Case of Giant Supratentorial Choroid Plexus Carcinoma in a Young Girl  Voir?


Pediatr Neurosurg
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Posterior Third Ventricular Glioblastoma with Primary Leptomeningeal Metastasis in a Child  Voir?


Pediatr Neurosurg
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The Use of External Ventricular Drainage to Reduce the Frequency of Wound Complications in Myelomeningocele Closure  Voir?

Introduction: Myelomeningocele (MMC) is an open neural tube defect routinely surgically closed within 48 h of birth to prevent secondary infection. Up to 18% of patients experience wound complications, and 85% require shunting for hydrocephalus. We hypothesized that wound complications could be reduced by cerebrospinal fluid (CSF) diversion at the time of closure. Methods: Institutional review board approval was obtained to review records of the 88 patients who underwent MMC closure between January 2005 and June 2016 at the Children's Hospital of Pittsburgh. Twenty-three patients (26%) had an external ventricular drain (EVD) placed at the time of MMC closure and underwent 7-11 days of CSF drainage. Fourteen patients (16%) had a shunt placed at the time of MMC closure, and 51 (58%) had no form of CSF diversion at the time of MMC closure. Results: Patients with an EVD or shunt placed at the time of closure had no wound complications. In contrast, 8 patients (16%) without CSF diversion at closure developed wound complications (p = 0.048). Seven of the 8 wound complications occurred in the 71 patients with evidence of hydrocephalus at birth (p = 0.98). Of patients with evidence of hydrocephalus at the time of MMC closure, wound complications had a higher rate of occurrence among patients who did not receive a shunt or EVD at closure (p = 0.01). When comparing only patients with evidence of hydrocephalus at birth, the EVD group alone had a lower rate of wound complications than patients who did not receive CSF diversion at the time of closure (p = 0.031). Conclusions: These results suggest that addressing hydrocephalus at the time of MMC closure significantly reduces the likelihood of wound complications and may justify temporary CSF diversion at birth, at least in those patients manifesting hydrocephalus.
Pediatr Neurosurg

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Diffuse Leptomeningeal Glioneural Tumour Simulating Tuberculous Meningitis in a 13-Year-Old Girl  Voir?


Pediatr Neurosurg
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Dernière mise à jour : 21/02/2018 : 10:36


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