Category Archives: Pediatrics

Manual de Neurocirugía infantil en español

El neuropediatra Javier López Pisón y el neurocirujano Javier Orduna Martínez, del hospital Infantil Miguel Servet de Zaragoza, han editado el primer manual escrito en español sobre Neurocirugía infantil destinada a los pediatras.

La publicación, que recoge los Fundamentos de la Patología Neuroquirúrgica para Pediatras, consiste en un manual actualizado, con respuestas eficaces y eficientes a los problemas que se presentan en el quehacer diario de la atención pediátrica.

El texto surgió a petición de los propios pediatras y ha contado con la colaboración de 110 expertos de diversas especialidades, según informaron ayer fuentes del Gobierno aragonés.

Aunque una gran parte de los colaboradores trabajan en el hospital Miguel Servet o el Clínico, muchos otros especialistas proceden de centros de otras comunidades españolas como San Joan de Déu y Valle de Hebrón (Barcelona), La Fe (Valencia), Virgen del Rocío (Sevilla), Nacional de Parapléjicos y Virgen de la Salud (Toledo) o el Doce de Octubre, La Paz y Niño Jesús (Madrid).

El manual se aborda desde la compleja perspectiva de la Pediatría, que contempla la evolución constante del niño en un continuo proceso de crecimiento y de cambio. Y en el ámbito de la Neurocirugía se descarta una simple extrapolación al niño de la actividad en el paciente adulto. «El libro, presentado ayer, implica de lleno la Neurocirugía en esa variabilidad que exige la Pediatría para acometer las diferencias del manejo de la misma enfermedad en el lactante, en el niño o en el adolescente», añadieron estas fuentes.

Además, el carácter práctico de la obra contempla la exigencia de la Medicina actual de resolver los problemas del paciente «con la mayor eficacia y coste-efectividad posibles».

Update: Chiari type 1 deformity

Chiari type 1 deformity is a hindbrain disorder associated with elongation of the cerebellar tonsils, which descend below the foramen magnum into the spinal canal.

The hindbrain is not malformed but deformed. Accordingly, “Chiari type 1 deformity,” not “Chiari type 1 malformation” is the correct term to characterize primary tonsillar herniation.

Defined as cerebellar tonsillar herniation ≥ 5 mm below the foramen magnum 1).

Classification

Chiari malformation Type 1.5 (CM 1.5) was defined as the association of Chiari malformation Type I (CM I) and brainstem herniation.

Although CM 1.5 patients presented with brainstem herniation and more severe tonsillar herniation, other clinical and imaging features and surgical outcomes were similar with CM I patients. Liu et al. think CM 1.5 is just a subtype of CM I, rather than a unique type of Chiari malformations 2).


Taylor et al. identifies two subtypes, crowded and spacious, that can be distinguished by MRI appearance without volumetric analysis. Earlier age at surgery and presence of syringomyelia are more common in the crowded subtype. The presence of the spacious subtype suggests that crowdedness alone cannot explain the pathogenesis of Chiari I malformation in many patients, supporting the need for further investigation 3).

Epidemiology

Chiari type 1 deformity is commonly seen in pediatric neurology, neuroradiology, and neurosurgery and may have various clinical presentations depending on patient age. In addition, Chiari type 1 deformity is increasingly found by neuroimaging studies as an incidental finding in asymptomatic children 4).

In the past, it was estimated that the condition occurs in about one in every 1,000 births. However, the increased use of diagnostic imaging has shown that CM may be much more common. Complicating this estimation is the fact that some children who are born with the condition may not show symptoms until adolescence or adulthood, if at all. CMs are more prevalent in certain groups, including people of Celtic descent.

A statistically significant (P = .03) female predominance of the malformation was observed, with a female: male ratio of approximately 3:2.

Associated skeletal anomalies were seen in 24% of patients.

Syringomyelia was detected in 40% of patients, most commonly between the C-4 and C-6 levels. Of the 25 patients who presented with spinal symptoms, 23 (92%) proved to have a syrinx at MR imaging. When the syrinx extended into the medulla (n = 3), however, brainstem symptoms predominated. Patients with objective brain stem or cerebellar syndrome had the largest mean tonsillar herniations. Patients with tonsillar herniations greater than 12 mm were invariably symptomatic, but approximately 30% of patients with tonsils herniating 5-10 mm below the foramen magnum were asymptomatic at MR imaging. “Incidental” Chiari I malformations are thus much more common than previously recognized, and careful clinical assessment remains the cornerstone for proper diagnosis and management 5).

Etiology

The innate bony dysontogenesis in patients with CMI contributes to tonsilar ectopia and exacerbates CSF flow obstruction. A pressure gradient that existed between syringomyelia(SM) and SAS supports the perivascular space theory that is used to explain SM formation. Our findings demonstrate that phase-contrast magnetic resonance imaging (PCMR) maybe a useful tool for predicting patient prognosis 6).

In adult CIM, most tonsillar herniations are asymmetrical and most syringomyelia is eccentrical. The dominant side of tonsillar herniation determines the side of syrinx deviation, which in turn determines the main side of clinical presentations and the convex side of scoliosis. The results suggest that the more the descended tonsil tilts to one side, the more the syrinx tilts to the same side 7).

Syndromic craniosynostosis

Chiari malformation Type I (CM-I) related to syndromic craniosynostosis in pediatric patients has been well-studied. The surgical management consists of cranial vault remodeling with or without posterior fossa decompression. There were also cases, in whom CM-I was diagnosed prior to the craniosynostosis in early childhood.

A 16-year-old boy who admitted with symptoms related to CM-I. With careful examination and further genetic investigations, a diagnosis of Crouzon syndrome was made, of which the patient and his family was unaware before. The patient underwent surgery for posterior fossa decompression and followed-up for Crouzon’s syndrome.

This is the only case report indicating a late adolescent diagnosis of Crouzon syndrome through clinical symptoms of an associated CM-I 8).

Familial clustering

A population-based genealogical resource with linked medical data was used to define the observed familial clustering of Chiari malformation Type I (CM-I). METHODS All patients with CM-I were identified from the 2 largest health care providers in Utah; those patients with linked genealogical data were used to test hypotheses regarding familial clustering. Relative risks (RRs) in first-, second-, and third-degree relatives were estimated using internal cohort-specific CM-I rates; the Genealogical Index of Familiality (GIF) test was used to test for an excess of relationships between all patients with CM-I compared with the expected distribution of relationships for matched control sets randomly selected from the resource. Pedigrees with significantly more patients with CM-I than expected (p < 0.05) based on internal rates were identified. RESULTS A total of 2871 patients with CM-I with at least 3 generations of genealogical data were identified. Significantly increased RRs were observed for first- and third-degree relatives (RR 4.54, p < 0.001, and RR 1.36, p < 0.001, respectively); the RR for second-degree relatives was elevated, but not significantly (RR 1.20, p = 0.13). Significant excess pairwise relatedness was observed among the patients with CM-I (p < 0.001), and borderline significant excess pairwise relatedness was observed when all relationships closer than first cousins were ignored (p = 0.051). Multiple extended high-risk CM-I pedigrees with closely and distantly related members were identified. CONCLUSIONS This population-based description of the familial clustering of 2871 patients with CM-I provided strong evidence for a genetic contribution to a predisposition to CM-I 9).

Pathophysiology

The pathophysiology of CMI is poorly understood and it remains unknown how ICP alterations relate to symptoms and radiological findings.

There is some evidence of impaired intracranial compliance as an important pathophysiological mechanism 10).

Magnetic resonance imaging measurement of transcranial CSF flow and blood flow may lead to a better understanding of the pathophysiology of Chiari malformations and may prove to be an important diagnostic tool for guiding for the treatment of patients with Chiari I malformation 11).

The pathogenesis of a Chiari I malformation of the cerebellar tonsils is grouped into 4 general mechanisms. 12).

It appears that the pathogenesis of Chiari malformation with or without associated basilar invagination and/or syringomyelia is primarily related to atlantoaxial instability. The data suggest that the surgical treatment in these cases should be directed toward atlantoaxial stabilization and segmental arthrodesis. Except in cases in which there is assimilation of the atlas, inclusion of the occipital bone is neither indicated nor provides optimum stability. Foramen magnum decompression is not necessary and may be counter-effective in the long run 13). It occurs in children and adults. Clinical symptoms mainly develop from alterations in CSF flow at the foramen magnum and the common subsequent development of syringomyelia.


Patients with Chiari malformation type 1 (CMI) often present with elevated pulsatile and static intracranial pressure (ICP).

Several lines of evidence suggest common pathophysiological mechanisms in Chiari malformation Type I (CMI) and idiopathic intracranial hypertension (IIH). It has been hypothesized that tonsillar ectopy, a typical finding in CMI, is the result of elevated intracranial pressure (ICP) combined with a developmentally small posterior cranial fossa (PCF).

The study of Frič and Eide showed comparable and elevated pulsatile intracranial pressure, indicative of impaired intracranial compliance, in both CMI and IIH cohorts, while static ICP was higher in the IIH cohort. The data did not support the hypothesis that reduced PCFV combined with increased ICP causes tonsillar ectopy in CMI. Even though impaired intracranial compliance seems to be a common pathophysiological mechanism behind both conditions, the mechanisms explaining the different clinical and radiological presentations of CMI and IIH remain undefined14).

Natural history

Chiari malformation Type I was incidentally detected on MR images in 11 of 22 patients. The remaining 11 patients had minimal clinical signs at presentation that were not regarded as necessitating immediate surgical treatment. Seventeen patients (77.3%) showed progressive improvement in their symptoms or remained asymptomatic at the last follow-up whereas 5 patients (22.7%) experienced worsening, which was mild in 2 cases and required surgical correction in the remaining 3 cases. On MR imaging a mild reduction in tonsillar herniation was appreciated in 4 patients (18.18%), with complete spontaneous resolution in 1 of these. In 16 patients, tonsillar herniation remained stable during follow-up.

Data confirm the common impression that in both asymptomatic and slightly symptomatic patients with CM-I, a conservative approach to treatment should be adopted with periodic clinical and radiological examinations 15).

Clinical Features

Although the most common presentation is occipital headache, the association of audio-vestibular symptoms is not rare.

The headache is commonly aggravated by Valsalva and sensory and motor deficits.

In a series of 71 patients, pain was the commonest symptom (69% of patients); other symptoms included weakness (56%), numbness (52%), and unsteadiness (40%). The presenting physical signs consisted of a foramen magnum syndrome (22%), central cord syndrome (65%), or a cerebellar syndrome (11%) 16).

Audio-vestibular manifestations

The appearance of audio-vestibular manifestations in CM-I makes it common to refer these patients to neurotologists. Unsteadiness, vertiginous syndromes and sensorineural hearing loss are frequent. Nystagmus, especially horizontal and down-beating, is not rare. It is important for neurotologists to familiarise themselves with CM-I symptoms to be able to consider it in differential diagnosis 17).


Feinberg et al present a case of Chiari malformation manifesting as isolated trismus, describe the typical symptoms associated with Chiari malformation, and discuss the potential anatomical causes for this unique presentation. A 3-year-old boy presented with inability to open his jaw for 6 weeks with associated significant weight loss. The results of medical and radiological evaluation were negative except for Chiari malformation type 1 with cerebellar tonsils 12 mm below the level of the foramen magnum. The patient underwent Chiari decompression surgery. Postoperatively, his ability to open his mouth was significantly improved, allowing resumption of a regular diet. Postoperative MRI revealed almost complete resolution of the syringobulbia. To the best of the authors’ knowledge, this is the first reported case of isolated trismus from Chiari malformation with syringobulbia 18).

Diagnosis

Along with tonsillar herniation, imaging studies have documented additional abnormalities, including smaller and overcrowded posterior cranial fossa 19) 20) 21) 22) 23).

MRI Findings After Surgery for Chiari Malformation Type I is important when evaluating postoperative changes 24).


Sagittal MRI overestimates the degree of tonsillar ectopia. Misdiagnosis may occur if sagittal imaging alone is used. The cerebellar tonsils are paramedian structures, and this should be kept in mind when interpreting midline sagittal MRI.

Treatment

An accurate and reliable selection of patients based on clinical and neuroimaging findings is paramount for the success of neurosurgical treatment25).

see Posterior fossa decompresion for Chiari type 1 deformity.

Outcome

Efforts to guide preoperative counseling and improve outcomes research are impeded by reliance on small, single-center studies.

Approximately 1 in 8 pediatric CM-I patients experienced a surgical complication, whereas medical complications were rare. Although complex chronic conditions (CCC) were common in pediatric CM-I patients, only hydrocephalus was independently associated with increased risk of surgical events. These results may inform patient counseling and guide future research efforts 26).

CM-I in children is not a radiologically static entity but rather is a dynamic one. Radiological changes were seen throughout the 7 years of follow-up. A reduction in tonsillar herniation was substantially more common than an increase. Radiological changes did not correlate with neurological examination finding changes, symptom development, or the need for future surgery. Follow-up imaging of asymptomatic children with CM-I did not alter treatment for any patient. It would be reasonable to follow these children with clinical examinations but without regular surveillance MRI 27).

Outcome assessment for the management of Chiari malformation type 1 is difficult because of the lack of a reliable and specific surgical outcome assessment scale. Such a scale could reliably correlate postoperative outcomes with preoperative symptoms.

Chicago Chiari Outcome Scale (CCOS)

Outcome is poor in approximately 3 in 10 patients 28).

The degree of tonsillar herniation has not been a reliable predictor of either symptom severity 29) or surgical outcome 30).

Arnautovic et al. identified 145 operative series of patients with CM-I, primarily from the United States and Europe, and divided patient ages into 1 of 3 categories: adult (> 18 years of age; 27% of the cases), pediatric (≤ 18 years of age; 30%), or unknown (43%). Most series (76%) were published in the previous 21 years. The median number of patients in the series was 31. The mean duration of the studies was 10 years, and the mean follow-up time was 43 months. The peak ages of presentation in the pediatric studies were 8 years, followed by 9 years, and in the adult series, 41 years, followed by 46 years. The incidence of syringomyelia was 65%. Most of the studies (99%) reported the use of posterior fossa/foramen magnum decompression. In 92%, the dura was opened, and in 65% of these cases, the arachnoid was opened and dissected; tonsillar resection was performed in 27% of these patients. Postoperatively, syringomyelia improved or resolved in 78% of the patients. Most series (80%) reported postoperative neurological outcomes as follows: 75% improved, 17% showed no change, and 9% experienced worsening. Postoperative headaches improved or resolved in 81% of the patients, with a statistical difference in favor of the pediatric series. Postoperative complications were reported for 41% of the series, most commonly with CSF leak, pseudomeningocele, aseptic meningitis, wound infection, meningitis, and neurological deficit, with a mean complication rate of 4.5%. Complications were reported for 37% of pediatric, 20% of adult, and 43% of combined series. Mortality was reported for 11% of the series. No difference in mortality rates was seen between the pediatric and adult series 31).

Complications

Patients treated for Chiari I malformation (CM-I) with posterior fossa decompression (PFD) may occasionally and unpredictably develop postoperative hydrocephalus. The clinical risk factors predictive of this type of Chiari-related hydrocephalus (CRH) are unknown.

Younger patients, those with extensive intraoperative blood loss, and those found during surgery to have a fourth ventricular web were at higher risk for the development of CRH. Clinicians should be alert to evidence of CRH in this patient population after PFD surgery 32).

Sports

There is currently no consensus on the safety of sports participation for patients with Chiari I malformation (CM-I).

A prospective survey was administered to 503 CM-I patients at 2 sites over a 46-month period. Data were gathered on imaging characteristics, treatment, sports participation, and any sport-related injuries. Additionally, 81 patients completed at least 1 subsequent survey following their initial entry into the registry and were included in a prospective group, with a mean prospective follow-up period of 11 months.

Of the 503 CM-I patients, 328 participated in sports for a cumulative duration of 4641 seasons; 205 of these patients participated in contact sports. There were no serious or catastrophic neurological injuries. One patient had temporary extremity paresthesias that resolved within hours, and this was not definitely considered to be related to the CM-I. In the prospective cohort, there were no permanent neurological injuries.

No permanent or catastrophic neurological injuries were observed in CM-I patients participating in athletic activities. The authors believe that the risk of such injuries is low and that, in most cases, sports participation by children with CM-I is safe 33).

Case series

2017

Brock et al., analyzed prospectively 49 patients with CM operated at the Hospital das Clinicas, College of Medicine, University of São Paulo. Patients underwent decompressive surgery with or without opening of the duramater after intraoperative ultrasonography measuring flow rate. A value of 3cm/s was considered a cut-off. Quality of life before and after surgery and the improvement of neck pain and headache were evaluated.

Among 49 patients enrolled, 36 patients (73%) had CSF flow above 3 cm/s and did not undergo duraplasty. In 13 (27%) patients with initial flow <3 cm/s, a dural opening was performed together with duraplasty. All patients improved comparing pre and post operative scores and all clinical parameters evaluated did not differ between both surgical groups. Patients submitted to bone decompression alone had fewer complication rate.

Intraoperative USG with measurement of CSF allows the proper selection of patients with CM that can have a less invasive surgery with bone decompression without duraplasty 34).

2015

A retrospective cohort study was performed for patients 0-18 years of age who underwent surgical correction for Chiari Type I malformation with syrinx between 1995 and 2013. Basic demographic information was collected as well as data for preoperative symptoms, prior surgical history, perioperative characteristics, and postsurgical outcomes. Descriptive statistics were performed in addition to bivariate analyses. Candidate predictor variables were identified based on an association with tonsillar cautery with p < 0.10. Forward stepwise likelihood ratio was used to select candidate predictors in a binary logistic regression model (Pin = 0.05, Pout = 0.10) most strongly associated with the outcome. RESULTS A total of 171 patients with Chiari Type I malformation with syrinx were identified, and 43 underwent tonsillar cautery. Patients who underwent tonsillar cautery had 6.11 times greater odds of improvement in their syrinx (95% CI 2.57-14.49, p < 0.001). There was no effect of tonsillar cautery on increased perioperative complications as well as the need for repeat decompressions. CONCLUSIONS Tonsillar cautery is safe and effective in the treatment of Chiari Type I malformation with syrinx and may decrease time to syrinx resolution after cervicomedullary decompression. Tonsillar cautery does not increase postoperative complications in pediatric Chiari Type I malformation patients 35)


156 consecutive pediatric patients in whom the senior authors performed PFD without dural opening from 2003 to 2013. Patient demographics, clinical symptoms and signs, radiographic findings, intraoperative ultrasound results, and neuromonitoring findings were reviewed. Univariate and multivariate regression analyses were performed to determine risk factors for recurrence of symptoms and the need for reoperation. RESULTS Over 90% of patients had a good clinical outcome, with improvement or resolution of their symptoms at last follow-up (mean 32 months). There were no major complications. The mean length of hospital stay was 2.0 days. In a multivariate regression model, partial C-2 laminectomy was an independent risk factor associated with reoperation (p = 0.037). Motor weakness on presentation was also associated with reoperation but only with trend-level significance (p = 0.075). No patient with < 8 mm of tonsillar herniation required reoperation.

The vast majority (> 90%) of children with symptomatic CM-I will have improvement or resolution of symptoms after a PFD without dural opening. A non-dural opening approach avoids major complications. While no patient with tonsillar herniation < 8 mm required reoperation, children with tonsillar herniation at or below C-2 have a higher risk for failure when this approach is used 36).


Thirty-nine cases of CM-1 with and without syringomyelia (SM) were included. There were 18 patients in the nonduraplasty and 21 in the duraplasty group. Syringomyelia, tonsillar herniation (TH), preoperative symptom duration, and postoperative SM size were compared.

No significant difference was found between improvement in the duraplasty group (81%) and the non-duraplasty group (61.1%). In cases whose symptom duration was 0-36 months, improvement in the duraplasty group (93%) was significantly better than in the nonduraplasty group (50%) (p < 0.01). The rate of syrinx regression was 92.3% in the duraplasty group and 12.5% in the non-duraplasty group (p < 0.05). In cases with SM, the improvement was 21.4% in the non-duraplasty group compared to 78.6% in the duraplasty group (p=0.056). In cases with TH greater than 10 mm, the improvement was 66.7% in the non-duraplasty group, whereas all six cases (100%) in the duraplasty group had improved.

In SM associated cases, cases with TH greater than 10 mm, and whose symptom duration is less than 36 months, duraplasty is a more reliable choice despite a slightly higher rate of complications 37).

2014

In 21 patients, 12 cases had osteo-compression on the cerebellar hemisphere, 18 cases had thickened adhered fabric ring that stretched from arachnoid membrane to cerebellar hemisphere, and 15 cases with syringomyelia. The patients were followed up for 6 months to 3 years after the surgery. All patients showed a remarkable recovery of syringomyelia. There were no morbidity or death related to the surgery. Most of ACM-1 patients, the osteo- and membrane compression on cerebellar hemisphere and tonsil were observed during the operation. Therefore, decompression of foramen magnum and posterior craniocervical combined with the removal of cerebellomedullary fissure arachnoid membrane and placement of an artificial dural graft should be considered as a comprehensive option of minimally invasive surgery and rational and radical treatment of ACM-1. Our experience showed that, by using our procedure, shunting becomes no longer necessary in the treatment of ACM-1-associated syringomyelia 38).

1992

Of the 25 patients who presented with spinal symptoms, 23 (92%) proved to have a syrinx at MR imaging. When the syrinx extended into the medulla (n = 3), however, brain stem symptoms predominated. Patients with objective brain stem or cerebellar signs had the largest mean tonsillar herniations. Patients with tonsillar herniations greater than 12 mm were invariably symptomatic, but approximately 30% of patients with tonsils herniating 5-10 mm below the foramen magnum were asymptomatic at MR imaging. “Incidental” Chiari I malformations are thus much more common than previously recognized, and careful clinical assessment remains the cornerstone for proper diagnosis and management 39).

1983

In a series of 71 patients, pain was the commonest symptom (69% of patients); other symptoms included weakness (56%), numbness (52%), and unsteadiness (40%). The presenting physical signs consisted of a foramen magnum compression syndrome (22%), central cord syndrome (65%), or a cerebellar syndrome (11%). Myelography was performed in 69 patients, and was the most useful investigation. Only 23% of plain radiographs were abnormal. In addition to tonsillar descent, the operative findings included arachnoid adhesions (41%) and syringomyelia (32%). All patients underwent suboccipital craniectomy and C1-3 laminectomy. Respiratory depression was the most frequent postoperative complication (14%), and one patient died from sleep apnea. Early postoperative improvement of both symptoms (82%) and signs (70%) was followed by later relapse in 21% of patients, showing an initial benefit following surgery. None of the patients with a cerebellar syndrome deteriorated, whereas 56% of patients with evidence of foramen magnum compression and 66% of those with a central cord syndrome maintained their initial improvement. The authors conclude that posterior fossa decompression appears to benefit some patients, although a significant proportion might be expected to relapse within 2 to 3 years after operation, depending upon the presenting syndrome 40).

Case reports

2007

A 13-year-old obese boy with a 3-week history of headaches, neck pain, torticollis and progressive visual deterioration was admitted. Bilateral chronic papilledema and decrease in visual acuity were found in the presence of a previously diagnosed CMI.

Intracranial pressure monitoring demonstrating increased pressure levels was followed by a suboccipital decompression, C1 laminectomy and duroplasty. Post-operatively, the boy improved markedly, the 6 months follow-up opthalmological examination demonstrated resolution of papilloedema, but consecutive bi-lateral optic nerve atrophy.

IH with progressive visual deterioration represents one of the varying clinical presentations of CMI and may be classified as a secondary form of idiopathic intracranial hypertension (IH). Neuro-ophthalmological examination in all patients with CMI is recommended to identify the real incidence of this presentation. Altered CSF dynamics, venous hypertension and obesity as co-factors may be causative pathophysiologic factors 41).

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Greenberg JK, Olsen MA, Yarbrough CK, Ladner TR, Shannon CN, Piccirillo JF, Anderson RC, Wellons JC 3rd, Smyth MD, Park TS, Limbrick DD Jr. Chiari malformation Type I surgery in pediatric patients. Part 2: complications and the influence of comorbid disease in California, Florida, and New York. J Neurosurg Pediatr. 2016 May;17(5):525-32. doi: 10.3171/2015.10.PEDS15369. Epub 2016 Jan 22. PubMed PMID: 26799408.
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Whitson WJ, Lane JR, Bauer DF, Durham SR. A prospective natural history study of nonoperatively managed Chiari I malformation: does follow-up MRI surveillance alter surgical decision making? J Neurosurg Pediatr. 2015 Aug;16(2):159-66. doi: 10.3171/2014.12.PEDS14301. Epub 2015 May 1. PubMed PMID: 25932776.
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Aliaga L, Hekman KE, Yassari R, Straus D, Luther G, Chen J, Sampat A, Frim D. A novel scoring system for assessing Chiari malformation type I treatment outcomes. Neurosurgery. 2012 Mar;70(3):656-64; discussion 664-5. doi: 10.1227/NEU.0b013e31823200a6. PubMed PMID: 21849925.
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Khan AA, Bhatti SN, Khan G, et al. Clinical and radiological findings in Arnold Chiari malformation. J Ayub Med Coll Abbottabad. 2010;22(2):75-78.
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NoudelR,GomisP,SotoaresG,etal.Posteriorfossavolumeincreaseaftersurgery for Chiari malformation type I: a quantitative assessment using magnetic resonance imaging and correlations with the treatment response. J Neurosurg. 2011;115(3): 647-658.
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Arnautovic A, Splavski B, Boop FA, Arnautovic KI. Pediatric and adult Chiari malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes. J Neurosurg Pediatr. 2015 Feb;15(2):161-77. doi: 10.3171/2014.10.PEDS14295. Epub 2014 Dec 5. PubMed PMID: 25479580.
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Guan J, Riva-Cambrin J, Brockmeyer DL. Chiari-related hydrocephalus: assessment of clinical risk factors in a cohort of 297 consecutive patients. Neurosurg Focus. 2016 Nov;41(5):E2. PubMed PMID: 27798986.
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Strahle J, Geh N, Selzer BJ, Bower R, Himedan M, Strahle M, Wetjen NM, Muraszko KM, Garton HJ, Maher CO. Sports participation with Chiari I malformation. J Neurosurg Pediatr. 2016 Apr;17(4):403-9. doi: 10.3171/2015.8.PEDS15188. Epub 2015 Dec 4. PubMed PMID: 26636249.
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Brock RS, Taricco MA, de Oliveira MF, de Lima Oliveira M, Teixeira MJ, Bor-Seng-Shu E. Intra Operative Ultrasonography for Definition of Less Invasive Surgical Technique in Patients with Chiari Type I Malformation. World Neurosurg. 2017 Feb 9. pii: S1878-8750(17)30152-3. doi: 10.1016/j.wneu.2017.02.003. [Epub ahead of print] PubMed PMID: 28192262.
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Stanko KM, Lee YM, Rios J, Wu A, Sobrinho GW, Weingart JD, Jackson EM, Ahn ES, Chaichana KL, Jallo GI. Improvement of syrinx resolution after tonsillar cautery in pediatric patients with Chiari Type I malformation. J Neurosurg Pediatr. 2015 Oct 30:1-8. [Epub ahead of print] PubMed PMID: 26517059.
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Kennedy BC, Kelly KM, Phan MQ, Bruce SS, McDowell MM, Anderson RC, Feldstein NA. Outcomes after suboccipital decompression without dural opening in children with Chiari malformation Type I. J Neurosurg Pediatr. 2015 May 1:1-9. [Epub ahead of print] PubMed PMID: 25932779.
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Gurbuz MS, Karaaslan N, Caliskan T, Unal E, Berkman MZ. Comparison of the Surgical Results for Foramen Magnum Decompression with and without Duraplasty in Chiari Malformation Type 1. Turk Neurosurg. 2015;25(3):419-24. doi: 10.5137/1019-5149.JTN.11235-14.1. PubMed PMID: 26037182.
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Liang CJ, Dong QJ, Xing YH, Shan M, Wen LX, Qiang ZY, Ping ZQ, Tao PZ, Ping HX. Posterior fossa decompression combined with resection of the cerebellomedullary fissure membrane and expansile duraplasty: a radical and rational surgical treatment for Arnold-Chiari type I malformation. Cell Biochem Biophys. 2014 Dec;70(3):1817-21. doi: 10.1007/s12013-014-0135-x. PubMed PMID: 25018150.
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Kurschel S, Maier R, Gellner V, Eder HG. Chiari I malformation and intra-cranial hypertension:a case-based review. Childs Nerv Syst. 2007 Aug;23(8):901-5. Epub 2007 May 8. PubMed PMID: 17486353.

Nursing Care of the Pediatric Neurosurgery Patient

Nursing Care of the Pediatric Neurosurgery Patient

Nursing Care of the Pediatric Neurosurgery Patient

List Price:$149.00

ADD TO SHOPPING CART

This updated third edition is a detailed reference for nurses and other health care providers who care for children with neurosurgical conditions. The explanations of pathophysiology, anatomy, neurodiagnostic imaging, and treatment options for each neurosurgical diagnosis will help to clarify the rationale behind the nursing care. Descriptions of presenting symptoms, history and findings on neurological examination will help nurses understand the neurological disorder and identify problems. New chapters have been added on skull and scalp anomalies, pediatric concussion, abuse head trauma and on neuroimaging. Each chapter includes case studies, impact on families, patient and family education, and practice pearls. Staff and student nurses working in clinics, critical care units, pediatric units, operating rooms, post-anesthesia care units, emergency departments, and radiology departments will benefit from the information presented. Although this book is written for nurses, child life therapists, physical and occupational therapists, medical students and neurosurgery residents will also find it helpful. Parents of children with neurosurgical disorders will also find it a useful resource in understanding their child’s condition.


Product Details

  • Published on: 2017-04-28
  • Original language: English
  • Number of items: 1
  • Dimensions: 10.25″ h x 7.25″ w x 1.50″ l,
  • Binding: Hardcover
  • 613 pages

Editorial Reviews

Review

From the reviews:

“…The attributes of this text result in a much wider appeal than to just pediatric neurosurgical nurses. This book will prove useful to anyone remotely interested in pediatric neurosurgery. I have no hesitation in recommending a copy be in every neurosurgical residency library. Hospitals will find this a useful textbook reference to place on the pediatrics floors for nurses and pediatric house staff to be able to quickly and concisely review any of the various neurosurgical subjects along with appropriate surgical interventions. Libraries will find this book is a must addition if they have patrons interested in neurosurgery. My only caveat is that I suspect this book will have a high disappearance (ie, “borrowing”) rate due to its value as a great educational tool.” (J.T. Goodrich, JAMA, November 2007)

“This book provides a one-of-a-kind clinical resource for nursing staff who work with this challenging population of patients. In addition to the easy-to-read text, this book includes 119 figures and 61 tables of valuable information to enhance nursing practice. … is written for nurses who are for pediatric neurosurgery patients but is also a tremendous reference for students and others in the healthcare profession. … This book will be a tremendous resource for me, and for the patients and staff with whom I work.” (Julie A Warren, Doody’s Review Service, August, 2007)

“The architecture of the book, subdivided in 12 multi-authored chapters, is quite solid, each contribution offering the basic knowledge necessary to understand the pathophysiology of a given disease, the essential of the surgical management, and the nurses’ considerations. Each chapter is nicely illustrated and enriched by numerous tables aimed at illustrating specific points, as well as providing further sources of information when needed … . Although this book is written by nurses, also medical students and neurosurgeons in training will find its reading quite useful.” (Concezio Di Rocco, Child’s Nervous System, Vol. 23, 2007)

From the Back Cover
This updated third edition is a detailed reference for nurses and other health care providers who care for children with neurosurgical conditions. The explanations of pathophysiology, anatomy, neurodiagnostic imaging, and treatment options for each neurosurgical diagnosis will help to clarify the rationale behind the nursing care. Descriptions of presenting symptoms, history and findings on neurological examination will help nurses understand the neurological disorder and identify problems. New chapters have been added on skull and scalp anomalies, pediatric concussion, abuse head trauma and on neuroimaging. Each chapter includes case studies, impact on families, patient and family education, and practice pearls. Staff and student nurses working in clinics, critical care units, pediatric units, operating rooms, post-anesthesia care units, emergency departments, and radiology departments will benefit from the information presented. Although this book is written for nurses, child life therapists, physical and occupational therapists, medical students and neurosurgery residents will also find it helpful. Parents of children with neurosurgical disorders will also find it a useful resource in understanding their child’s condition.

About the Author

Cathy C. Cartwright, MSN, RN-BC, PCNS, FAAN is a Pediatric Clinical Nurse Specialist and Director of Advanced Professional Practice at Children’s Mercy Hospital, Kansas City, Missouri. Prior to this position, she worked at the Children’s Hospital, University Hospitals and Clinics, Columbia, Missouri in a variety of positions, including Pediatric Clinical Nurse Specialist in Neurosurgery, Manager of Pediatric Services, Pediatric Outreach Coordinator, and Manager of the Pediatric Intensive Care Unit. She has received many awards, including the 2015 Magnet Nurse of the Year for Exemplary Professional Practice, an Excellence in Advanced Practice Award from the American Association of Neuroscience Nurses, March of Dimes Future of Nursing Award (Pediatric) and a Circle of Excellence Award (Management). She was President of the American Association of Neuroscience Nurses in 2009-10, having previously served on its Board of Directors. She has an extensive publication record and has given numerous national and international presentations.
Donna C. Wallace is currently a Pediatric Nurse Practitioner in the Neurosurgery Division of Banner Children Specialists, at Cardon Children’s Medical Center in Mesa, Arizona. Prior to that, she was a Nurse Practitioner for 16 years at the Barrow Neurological Institute in Phoenix, Arizona. Ms. Wallace has been a manager, and has also held several teaching positions. She has received several awards including the Mary Decker Mentorship Award, and the Excellence in Advanced Practice Award, from the American Association of Neuroscience Nursing (AANN). Additionally, she has served on the AANN Board of Directors.  Her passion for writing has resulted in numerous articles and lectures.

Journal of Neurosurgery: Pediatrics March 2017

  • FREE

    Factors influencing outcomes of the treatment of positional plagiocephaly in infants: a 7-year experience

    Sandi Lam, MD, MBA1, I-Wen Pan, PhD1, Ben A. Strickland, MD1, Caroline Hadley, MD1, Bradley Daniels, BS1, Jim Brookshier, CPO, LPO2, and Thomas G. Luerssen, MD1 1Department of Neurosurgery/Division of Pediatric Neurosurgery, Texas Children’s Hospital/Baylor College of Medicine; and 2Hanger Clinic, Houston, Texas

    Pages 273-281

    Abstract | Full Text | PDF (3028 KB) | Add to Favorites

  • The health belief model and factors associated with adherence to treatment recommendations for positional plagiocephaly

    Sandi Lam, MD, MBA1, Thomas G. Luerssen, MD1, Caroline Hadley, MD1, Bradley Daniels, BS1, Ben A. Strickland, MD1, Jim Brookshier, CPO, LPO2, and I-Wen Pan, PhD1 1Department of Neurosurgery/Division of Pediatric Neurosurgery, Texas Children’s Hospital/Baylor College of Medicine; and 2Hanger Orthotics, Houston, Texas

    Pages 282-288

    Abstract | Full Text | PDF (1390 KB) | Add to Favorites

  • Preoperative transdural collateral vessels in moyamoya as radiographic biomarkers of disease

    Armide Storey, BS1, R. Michael Scott, MD1, Richard Robertson, MD2, and Edward Smith, MD1Departments of 1Neurosurgery and 2Radiology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts

    Pages 289-295

    Abstract | Full Text | PDF (5810 KB) | Add to Favorites

  • Possible toxicity following embolization of congenital giant vertex hemangioma: case report

    Ingrid Kieran, MD1, Zaitun Zakaria, MD2, Chandrasekaran Kaliaperumal, FRCSEd2, Declan O’Rourke, MRCP3, Alan O’Hare, FRCR4, Eoghan Laffan, FFR5, John Caird, FRCSI(SN)2, Mary D. King, FRCPI, FRCPCH3, and Dylan J. Murray, FRCS, FDS, FFD1Departments of 1Plastic and Craniofacial Surgery, 2Neurosurgery, 3Pediatric Neurology, and 5Radiology, Temple Street Children’s University Hospital; and 4Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland

    Pages 296-299

    Abstract | Full Text | PDF (3000 KB) | Add to Favorites

  • Correlations of atrial diameter and frontooccipital horn ratio with ventricle size in fetal ventriculomegaly

    Jared M. Pisapia, MD1,2, Martin Rozycki, MS2, Hamed Akbari, MD, PhD2, Spyridon Bakas, PhD2, Jayesh P. Thawani, MD1, Julie S. Moldenhauer, MD3, Phillip B. Storm, MD1,4, Deborah M. Zarnow, MD5, Christos Davatzikos, PhD2, and Gregory G. Heuer, MD, PhD1,4 1Department of Neurosurgery; 2Center for Biomedical Image Computing and Analytics, University of Pennsylvania; 3Center for Fetal Diagnosis and Treatment, Special Delivery Unit; and Divisions of 4Neurosurgery and 5Neuroradiology, Children’s Hospital of Philadelphia, Pennsylvania

    Pages 300-306

    Abstract | Full Text | PDF (5343 KB) | Add to Favorites

  • Hydrocephalus in a patient with an unruptured pial arteriovenous fistula: hydrodynamic considerations, endovascular treatment, and clinical course

    Jesús A. Morales-Gómez, MD1, Vicente V. Garza-Oyervides, MD1, José A. Arenas-Ruiz, MD1, Mariana Mercado-Flores, MD2, C. Guillermo Elizondo-Riojas, MD, PhD2, Frederick A. Boop, MD3, and Ángel Martínez-Ponce de León, MD1 1Servicio de Neurocirugía and 2Centro Universitario de Imagen Diagnóstica, Hospital Universitario “Dr. José Eleuterio González,” Monterrey, Nuevo León, México; and 3Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee

    Pages 307-311

    Abstract | Full Text | PDF (2829 KB) | Add to Favorites

  • Endonasal management of pediatric congenital transsphenoidal encephaloceles: nuances of a modified reconstruction technique. Technical note and report of 3 cases VIDEO

    Mehdi Zeinalizadeh, MD1,2, Seyed Mousa Sadrehosseini, MD3, Zohreh Habibi, MD4, Farideh Nejat, MD4, Harley Brito da Silva, MD5, and Harminder Singh, MD6 1Brain and Spinal Cord Injuries Repair and Research Center, 2Department of Neurological Surgery, and 3Department of Otolaryngology-Head & Neck Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences; and 4Department of Neurological Surgery, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran; 5Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington; and 6Department of Neurological Surgery, Stanford University School of Medicine, Stanford, California

    Pages 312-318

    Abstract | Full Text | PDF (6177 KB) | Add to Favorites

  • Report of effective trametinib therapy in 2 children with progressive hypothalamic optic pathway pilocytic astrocytoma: documentation of volumetric response

    Catherine Miller, MD1, Daniel Guillaume, MD1, Kathryn Dusenbery, MD2, H. Brent Clark, MD, PhD3, and Christopher Moertel, MD4Departments of 1Neurosurgery, 2Radiation Oncology, 3Pathology, and 4Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, Minnesota

    Pages 319-324

    Abstract | Full Text | PDF (3138 KB) | Add to Favorites

  • FREE

    Initial experience with endoscopic ultrasonic aspirator in purely neuroendoscopic removal of intraventricular tumors VIDEO

    Giuseppe Cinalli, MD, Alessia Imperato, MD, Giuseppe Mirone, MD, Giuliana Di Martino, MD, Giancarlo Nicosia, MD, Claudio Ruggiero, MD, Ferdinando Aliberti, MD, and Pietro Spennato, MDDepartment of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital, Naples, Italy

    Pages 325-332

    Abstract | Full Text | PDF (8382 KB) | Add to Favorites

  • Long-term follow-up of superior gluteal artery perforator flap closure of large myelomeningoceles

    Brett A. Whittemore, MD1, Dale M. Swift, MD2, Bradley E. Weprin, MD2, and Frederick J. Duffy Jr., MD3Departments of 1Neurosurgery and 2Pediatric Neurosurgery, University of Texas Southwestern Medical Center, Dallas; and 3Department of Plastic Surgery, Medical City Hospital, Dallas, Texas

    Pages 333-338

    Abstract | Full Text | PDF (5729 KB) | Add to Favorites

  • Solitary fibrous tumors of the spine: a pediatric case report with a comprehensive review of the literature

    Gregory W. Albert, MD1,2, and Murat Gokden, MD3 1Division of Neurosurgery, Arkansas Children’s Hospital; and Departments of 2Neurosurgery and 3Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas

    Pages 339-348

    Abstract | Full Text | PDF (3947 KB) | Add to Favorites

  • Clinical and surgical management of a congenital Type II split cord malformation presenting with progressive cranial neuropathies: case report VIDEO

    Patrick R. Maloney, MD1, Meghan E. Murphy, MD1, Molly J. Sullan, MS2, Kathryn M. Van Abel, MD2, Shelagh A. Cofer, MD2, John C. Cheville, MD3, and Nicholas M. Wetjen, MD1Departments of 1Neurosurgery, 2Otolaryngology, and 3Pathology, Mayo Clinic School of Medicine, Rochester, Minnesota

    Pages 349-353

    Abstract | Full Text | PDF (6478 KB) | Add to Favorites

  • Interdural cavernous sinus dermoid cyst in a child: case report

    Flavio Giordano, MD1, Giacomo Peri, MD1, Giacomo M. Bacci, MD, PhD2, Massimo Basile, MD3, Azzurra Guerra, MD4, Patrizia Bergonzini, MD4, Anna Maria Buccoliero, MD5, Barbara Spacca, MD1, Lorenzo Iughetti, MD, PhD4, PierArturo Donati, MD1, and Lorenzo Genitori, MD1 1Department of Neurosurgery, 2Neuro-ophthalmology Unit, 3Radiology Unit, and 5Pathology Unit, Anna Meyer Hospital, Firenze; and 4Department of Pediatrics, Ospedale Policlinico, University of Modena, Italy

    Pages 354-360

    Abstract | Full Text | PDF (3846 KB) | Add to Favorites

  • Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program–Pediatrics

    Benjamin J. Kuo, BS1,2,3, Joao Ricardo N. Vissoci, PhD1,2, Joseph R. Egger, PhD2, Emily R. Smith, PhD1,2, Gerald A. Grant, MD6, Michael M. Haglund, MD, PhD1,2,4, and Henry E. Rice, MD2,5 1Division of Global Neurosurgery and Neuroscience and 2Global Health Institute, Duke University, Durham, North Carolina; 3Duke-NUS Medical School, Singapore; Departments of 4Neurosurgery and 5Surgery, Duke University Medical Center, Durham, North Carolina; and 6Department of Neurosurgery, Stanford University, Stanford, California

    Pages 361-371

    Abstract | Full Text | PDF (1738 KB) | Add to Favorites

  • Letter to the Editor: Postoperative hyponatremia

    María José Mayorga-Buiza, MD, PhD, Mónica Rivero-Garvía, MD, PhD, Javier Márquez-Rivas, MD, PhD, Carlos Velásquez-Rodríguez, MD, and Emilio Gómez-González, PhDHospital Universitario Virgen del Rocío, Seville, Spain; Marqués de Valdecilla Hospital, Santander, Spain; and Seville University, Engineering School, Seville, Spain

    Pages 372-374
    Response

    Citation | Full Text | PDF (4495 KB) | Add to Favorites

  • Letter to the Editor: Early seizure prophylaxis in pediatric severe traumatic brain injury: still a long way to go

    Eduardo Mekitarian Filho, MD, MSc, PhDUniversity of São Paulo, São Paulo, Brazil

    Pages 374-375
    Response

    Monica S. Vavilala, MD, Qian Qiu, MBA, Paige J. Ostahowski, BA, Nithya Kannan, MD, Douglas F. Zatzick, MD, Richard G. Ellenbogen, MD, Linda Ng Boyle, PhD, Pamela H. Mitchell, PhD, Mark S. Wainwright, MD, PhD, Richard B. Mink, MD, MACM, Jonathan I. Groner, MD, Michael J. Bell, MD, and Christopher C. Giza, MD

    Citation | Full Text | PDF (4495 KB) | Add to Favorites

  • Letter to the Editor: Cranial vault remodeling

    Miguel Gelabert-González, PhD, Eduardo Arán-Echabe, MD, and José María Santín-Amo, MDUniversity of Santiago de Compostela, Spain

    Pages 375-376
    Response

    Joseph Lopez, MD, MBA, Alan Utria, MD, Regina S. Cho, BS, Gerhard S. Mundinger, MD, Craig Vander Kolk, MD, George I. Jallo, MD, Edward S. Ahn, MD, and Amir Dorafshar, MBChB

    Citation | Full Text | PDF (4495 KB) | Add to Favorites

Update: Infantile acute subdural hematoma

Etiology

Acute subdural hematoma in infants is distinct from that occurring in older children or adults because of differences in mechanism, injury thresholds, and the frequency with which the question of nonaccidental injury is encountered.

When trauma occur the motor vehicle accidents are the most frequent.

In the series of Loh et al. the most common cause of injury was shaken baby syndrome 1).

The accuracy of the history obtained from the caregivers of infants may be low in severe infantile head trauma. Therefore, medical professionals should treat the mechanism of injury obtained from caregivers as secondary information and investigate for possible abusive head trauma (AHT) in cases with inconsistencies between the history that was taken and the severity of the injury observed 2).


Chronic subdural effusions in infancy may arise from trauma, from various types of meningitis, from severe dehydration, or “idiopathically” 3).

Diagnosis

Diagnosis can be made by computed tomography or magnetic resonance imaging 4).

Large subdural hematoma of the right convexity up to 3 cm thick, which causes severe cerebral compression, with cingulate herniation and transtentorial herniation.

The hematoma shows liquid-liquid levels, with a higher density lower in relation to sedimented hematoma.

Signs of diffuse brain edema.

Outcome

Early recognition and suitable treatment may improve the outcome of this injury. If treatment is delayed or the condition is undiagnosed, acute subdural hematoma may cause severe morbidity or even fatality 5).

Case series

2002

Medical records and films of 21 cases of infantile acute subdural hematoma were reviewed retrospectively. Diagnosis was made by computed tomography or magnetic resonance imaging. Medical records were reviewed for comparison of age, gender, cause of injury, clinical presentation, surgical management, and outcome.

Twenty-one infants (9 girls and 12 boys) were identified with acute subdural hematoma, with ages ranging from 6 days to 12 months. The most common cause of injury was shaken baby syndrome. The most common clinical presentations were seizure, retinal hemorrhage, and consciousness disturbance. Eight patients with large subdural hematomas underwent craniotomy and evacuation of the blood clot. None of these patients developed chronic subdural hematoma. Thirteen patients with smaller subdural hematomas were treated conservatively. Among these patients, 11 developed chronic subdural hematomas 15 to 80 days (mean = 28 days) after the acute subdural hematomas. All patients with chronic subdural hematomas underwent burr hole and external drainage of the subdural hematoma. At follow-up, 13 (62%) had good recovery, 4 (19%) had moderate disability, 3 (14%) had severe disability, and 1 (5%) died. Based on GCS on admission, one (5%) had mild (GCS 13-15), 12 (57%) had moderate (GCS 9-12), and 8 (38%) had severe (GCS 8 or under) head injury. Good recovery was found in 100% (1/1), 75% (8/12), and 50% (4/8) of the patients with mild, moderate, and severe head injury, respectively. Sixty-three percent (5/8) of those patients undergoing operation for acute subdural hematomas and 62% (8/13) of those patients treated conservatively had good outcomes.

Infantile acute subdural hematoma if treated conservatively or neglected, is an important cause of infantile chronic subdural hematoma. Early recognition and suitable treatment may improve the outcome of this injury. If treatment is delayed or the condition is undiagnosed, acute subdural hematoma may cause severe morbidity or even fatality 6).

2000

Hwang et al., reviewed a total of 16 infant head injury patients under 12 months of age who were treated in from 1989 to 1997. Birth head injury was excluded. The most common age group was 3-5 months. Early seizures were noted in 7 cases, and motor weakness in 6. Three patients with acute intracranial hematoma and another 3 with depressed skull fracture were operated on soon after admission. Chronic subdural hematomas (SDHs) developed in 3 infants. Initial CT scans showed a small amount of SDH that needed no emergency operation. Resolution of the acute SDH and development of subdural hygroma appeared on follow-up CT scans within 2 weeks of injury. Two of these infants developed early seizures. Chronic SDH was diagnosed on the 68th and 111th days after the injuries were sustained, respectively. The third patient was the subject of close follow-up with special attention to the evolution of chronic SDH in view of our experience in the previous 2 cases, and was found to have developed chronic SDH on the 90th day after injury. All chronic SDH patients were successively treated by subduro-peritoneal shunting. In conclusion, the evolution of chronic SDH from acute SDH is relatively common following infantile head injury. Infants with head injuries, especially if they are associated with acute SDH and early development of subdural hygroma, should be carefully followed up with special attention to the possible development of chronic SDH 7).

1987

A retrospective analysis of the infantile acute subdural hematoma was made by Ikeda et al., with special reference to its pathogenesis.

In 11 of 15 cases, the hematomas were bilateral or a contralateral subdural fluid collection was present. In 7 of 11 patients who underwent operation the collection was bloody fluid and/or clotted blood. In 3 patients, a subdural membrane, as seen in adult chronic subdural hematoma, was found. In only 1 patient with unilateral hematoma was clotted blood present without subdural membrane. The thickest collection of clotted blood was in the parasagittal region. It is postulated that in most cases hemorrhage occurs after minor head injury, from the bridging veins near the superior sagittal sinus, into a pre-existing subdural fluid collection such as chronic subdural hematoma or subdural effusion with cranio-cerebral disproportion, and that infants without intracranial disproportion are unlikely to have acute subdural hematoma caused by minor head injury 8).

1986

Aoki et al. report six Japanese cases of child abuse with subdural hematoma and discuss differences from those in the United States. The majority of abused children with subdural hematomas in Japan have suffered direct violence to the face and head, resulting in external signs of trauma. Failure to detect these external traces of trauma, however, might result in an incorrect diagnosis of infantile acute subdural hematoma attributed to accidental trivial head injury. Child abuse with subdural hematoma in the United States is frequently caused by whiplash shaking injury in which external signs of trauma may not be evident. In the United States, retinal hemorrhage and subdural hematoma together suggest child abuse; some cases of infantile acute subdural hematoma might be mistakenly diagnosed as child abuse. Thus, the constellation of retinal bleeding and subdural hematoma combined with the absence of visible signs of trauma is differently interpreted in the United States and Japan 9).

1984

Twenty-six cases of infantile acute subdural hematoma treated between 1972 and 1983 were reviewed. The series was limited to infants with acute subdural hematoma apparently due to minor head trauma without loss of consciousness, and not associated with cerebral contusion. Twenty-three of the patients were boys, and three were girls, showing a clear male predominance. The patients ranged in age between 3 and 13 months, with an average age of 8.1 months, the majority of patients being between 7 and 10 months old. Most of the patients were brought to the hospital because of generalized tonic convulsion which developed soon after minor head trauma, and all patients had retinal and preretinal hemorrhage. The cases were graded into mild, intermediate, and fulminant types, mainly on the basis of the level of consciousness and motor weakness. Treatment for fulminant cases was emergency craniotomy, and that for mild cases was subdural tapping alone. For intermediate cases, craniotomy or subdural tapping was selected according to the contents of the hematoma. The follow-up results included death in two cases, mild physical retardation in one case, and epilepsy in one case. The remaining 23 patients showed normal development. The relationship between computerized tomography (CT) findings and clinical grading was analyzed. Because some mild and intermediate cases could be missed on CT, the importance of noting the characteristic clinical course and of funduscopic examination is stressed 10).

Case reports

 2008

An unusual case of ruptured infantile cerebral aneurysm. An eight-month-old infant was delivered to the hospital in poor condition, after convulsions, with no history of trauma. His emergent CT study revealed acute subdural hematoma. The clinical and radiological picture evoked suspicion that the hematoma was of aneurysmal origin. The infant was operated with special preparations and precautions appropriate for aneurysmal surgery, and has shown a good recovery. It is important to consider the possibility of vascular accident in infants with subdural hematoma of nontraumatic origin. A good outcome may be achieved when appropriate preparations are made prior to surgery 11).

2005

Huang et al. the case of an infant with a traumatic acute subdural hematoma that resolved within 65 hours. A 23-month-old boy fell from a height of approximately 10 m. Brain computed tomography disclosed a left subdural hematoma with midline shift. The associated clots resolved spontaneously within 65 hours of the injury. Although they may mimic more clinically significant subdural hematomas, such collections of clots are likely to be located at least partly within the subarachnoid space. Their recognition may influence decisions regarding both surgical evacuation and the likelihood of non-accidental injury. Clinical and radiographic features distinguishing these “disappearing subdural hematomas” from more typical subdural hematomas are discussed 12)

Own case report

A 1 year old , according to anamnesis provided by the parents, they consulted in the last month for cough clinic with low expectoration, nasal congestion, Tº up to 38ºC of 24 hrs evolution. According to an emergency report: the previous week the patient presents right facial edema, of 2 days duration.

Scratch injuries in legs.

In the next days vomiting with progressive decay.

In the following hours after admission coma, respiratory arrest with bradycardia

Large subdural hematoma of the right convexity up to 3 cm thick, which causes severe cerebral compression, with cingulate herniation and transtentorial herniation.

The hematoma shows liquid-liquid levels, with a higher density lower in relation to sedimented hematoma.

Signs of diffuse brain edema.

In the surgical intervention xanthochromia appears at the beginning, later dark red liquid without clots. Later a subdural membrane is seen on the arachnoid surface, very characteristic of chronic subdural hematoma.


1) , 4) , 5) , 6)

Loh JK, Lin CL, Kwan AL, Howng SL. Acute subdural hematoma in infancy. Surg Neurol. 2002 Sep-Oct;58(3-4):218-24. PubMed PMID: 12480224.

2)

Amagasa S, Matsui H, Tsuji S, Moriya T, Kinoshita K. Accuracy of the history of injury obtained from the caregiver in infantile head trauma. Am J Emerg Med. 2016 Sep;34(9):1863-7. doi: 10.1016/j.ajem.2016.06.085. PubMed PMID: 27422215.

3)

Amacher AL, Li KT. Indirect trauma as a cause of acute infantile subdural hematomas. Can Med Assoc J. 1973 Jun 23;108(12):1530. PubMed PMID: 4714878; PubMed Central PMCID: PMC1941542.

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Hwang SK, Kim SL. Infantile head injury, with special reference to the development of chronic subdural hematoma. Childs Nerv Syst. 2000 Sep;16(9):590-4. PubMed PMID: 11048634.

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Ikeda A, Sato O, Tsugane R, Shibuya N, Yamamoto I, Shimoda M. Infantile acute subdural hematoma. Childs Nerv Syst. 1987;3(1):19-22. PubMed PMID: 3594464.

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Aoki N, Masuzawa H. Subdural hematomas in abused children: report of six cases from Japan. Neurosurgery. 1986 Apr;18(4):475-7. PubMed PMID: 3703222.

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Aoki N, Masuzawa H. Infantile acute subdural hematoma. Clinical analysis of 26 cases. J Neurosurg. 1984 Aug;61(2):273-80. PubMed PMID: 6737052.

11)

Adeleye AO, Shoshan Y, Cohen JE, Spektor S. Ruptured middle cerebral artery aneurysm in an infant presenting as acute subdural hematoma: a case report. Pediatr Neurosurg. 2008;44(5):397-401. doi: 10.1159/000149908. PubMed PMID: 18703887.

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Huang SH, Lee HM, Lin CK, Kwan AL, Howng SL, Loh JK. Rapid resolution of infantile acute subdural hematoma: a case report. Kaohsiung J Med Sci. 2005 Jun;21(6):291-4. PubMed PMID: 16035574.

XXXIII Reunión de la SENEP 2017

Se celebrará en Madrid los próximos días 9, 10 y 11 de Febrero de 2017.

Este año, el tema escogido para la Reunión es “Encuentro con los expertos” (“Meet the experts”).

8:15 h – 8:30 h Apertura de Secretaría y recogida de documentación.
SALA COLUMNAS
8:30 h – 9:10 h TALLER: Brainlab (Grupo 1)
9:15 h – 9:55 h TALLER: Osteoplac (Grupo 1)
10:00 h – 10:40 h TALLER: Brainlab (Grupo 2)
10:45 h – 11:25 h TALLER: Osteoplac (Grupo 2)
SALA A. PALACIOS
8:30 h – 9:10 h TALLER: BBraun (Grupo 2)
9:15 h – 9:55 h TALLER: Acuña y Fombona (Grupo 2)
10:00 h – 10:40 h TALLER: BBraun (Grupo 1)
10:45 h – 11:25 h TALLER: Acuña y Fombona (Grupo 1)
11:30 h – 11:50 h Pausa-Café.
11:50 h – 12:10 h Inauguración de la XXXIII Reunión de la SENEP.
12:15 h – 13:45 h “COLUMNA”
Modera: Dr. Antonio Huete Allut y Dr. Mario García Conde.
12:15 h – 12:45 h.
Malformaciones de charnela occipital. Dr. Dominique Thompson.
Paediatric Neurosurgeon, Great Ormond Street Hospital for Children NHS Trust,
Camden, Londres.
12:45 h – 13:15 h.
Syringomyelia in children. Dr. Michel Zerah. Hôpital Necker-Enfants Malades, París.
13:15 h – 13:45 h.
Embriology of the Neural tube defects with costo-vertebral abnormalities
and other congenital abnormalities. Dr Soner Duru. Profesor Doctor.
Universidad de Duzce, Turquía.
13:45 h – 15:30 h Almuerzo de trabajo.
8:30 h – 11:00 h “ONCOLOGÍA”
Modera: Dr. José Hinojosa Mena-Bernal y Dra. Sonia Tejada Solís.
8:30 h – 9:00 h.
Gliomas de la vía óptica: ¿Cuándo intervenir quirúrgicamente?
Dra. Martina Messing-Junger. Neurocirujana. St. Augustine. Asklepios, Bonn.
9:00 h – 9:30 h.
Intraoperative MRI in LGG. Dr. Connor Mallucci.
Alder Hey Children’s Hospital. Liverpool.
9:30 h – 10:00 h.
Tumores de los hemisferios cerebrales. Dr. Artur Da Cunha.
Presidente de la Sociedad Brasileña de Neurocirugía Pediátrica.
10:00 h – 10:30 h.
Antenatal tumors. Dr. Michel Zerah. Hôpital Necker-Enfants Malades, París.
 10:30 h – 11:00 h.
Abordajes a tumores del III Ventrículo. Dr. Fernando Carceller Benito.
Hospital Universitario La Paz, Madrid.
11:00 h – 11:15 h Pausa – Café.
11:15 h – 11:55 h Taller Baxter.
Taller Hemostasia y Sellado
12:00 h – 14:00 h “ONCOLOGÍA”
Modera: Dr. Javier Orduna Martínez y Dr. Enrique Ferrer Rodríguez.
12:00 h – 12:30 h.
El manejo inicial de los Craneofaringiomas a la edad pediátrica: controversias.
Prof. Maurice Choux. Consultor en el Departamento de Neurocirugía
Pediátrica – Hôpital des Enfants, La Timone.

12:30 h – 13:00 h.
Manejo de los tumores de la región pineal. Dr. Amets Sagarribay.
Centro Hospitalar de Lisboa Central.
13:00 h – 13:30 h.
Astrocitomas y ependimomas de fosa posterior.
Dr. Antonio Guillén Quesada.
Hospital San Juan de Dios, Barcelona.
13:30 h – 14:00 h.
Meduloblastoma: actualización diagnóstica y terapéutica. Dra. Belén Rivero Martín.
Hospital Universitario Infantil Niño Jesús, Madrid.
14:00 h – 15:30 h  Almuerzo de trabajo.
9:00 h – 9:40 h TALLER: Epilepsia. Livanova.
10:00 h – 11:40 h “EPILEPSIA”
Modera: Dr. Francisco Villarejo Ortega y Dr. Antonio López López-Guerrero.
10:00 h – 10:20 h.
Demanda estructural de la nueva cirugía de la Epilepsia.
Dr. Enrique Ferrer Rodríguez. Jefe de Servicio de Neurocirugía
Hospital San Juan de Dios, Barcelona.
10:25 h – 10:45 h.
Tratamiento quirúrgico de las displasias corticales en área elocuente:
indicación, técnica y resultados. Dr. Marcelo Budke. Hospital Universitario
Infantil Niño Jesús, Madrid.
10:50 h – 11:10 h.
Estimulación del nervio vago: técnica e indicaciones.
Dra. Cristina Torres Díaz. Hospital de la Princesa, Madrid.
11:20 h – 11:40 h.
Monitorización invasiva en epilepsia infantil.
Dra. Rebeca Conde Sardon. Hospital La Fe, Valencia.
11:45 h – 12:15 h Pausa – Café.
12:15 h – 13:55 h “HIDROCEFALIA”
Modera: Dra. Eva Cardona Gallego y Dra. Beatriz Pascual Martín.
12:15 h – 12:35 h.
Utilidad y controversias en el tratamiento endoscópico de la hidrocefalia
en lactantes. Dr. Mario García Conde. Hospital Universitario de Canarias, Tenerife.
12:40 h – 13:10 h.
Actualizaciones y controversias en la hidrocefalia pediátrica.
Dra. Mª Antonia Poca Pastor. Hospital Universitario Vall D’Hebron, Barcelona.
13:15 h – 13:35 h.
Hidrocefalia posthemorrágica: clasificación pronóstica.
Dr. Bienvenido Ros López. Hospital Regional Universitario, Málaga.
13:35 h – 13:55 h.
Complicaciones y sobredrenaje en las derivaciones de LCR.
Dr. Pablo Miranda Lloret. Hospital La Fe, Valencia.
14:00 h “CÓCTEL DE DESPEDIDA”
Círculo de Bellas Artes-Sala Valle Inclán

Book: Pediatric Vascular Neurosurgery: Disorders and their Management

Pediatric Vascular Neurosurgery: Disorders and their Management

Pediatric Vascular Neurosurgery: Disorders and their Management

List Price: $179.00

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This book answers frequently asked questions about common pediatric neurosurgical conditions related to vascular malformations of the brain and spinal cord, in an attempt to fill in the gap and answer numerous questions that arises after a diagnosis is made.

Pediatric patients with neurosurgical conditions are almost always referred from either primary care physicians, neurologists internists or a specialist in family medicine. Recently, neurosurgeons treating adult population also refer a pediatric patient to their colleague specialized in this field.
There are over 1500 academic and private hospitals in the US who have dedicated tertiary Neurosurgery services and cater thousands of small children every year, in addition to numerous centers that have level 1 and 2 trauma care. However, there are few tertiary level Pediatric centers which can provide quality care for neurosurgical conditions.
This book is specially written and illustrated for residents, fellows and consultants/attendings in all pediatric related specialties, including but not limited to Neurosurgery, Neurology, Pediatrics, Radiology, Anesthesia.

Product Details

  • Published on: 2017-01-03
  • Original language: English
  • Number of items: 1
  • Dimensions: 9.30″ h x .0″ w x 6.10″ l, .0 pounds
  • Binding: Hardcover
  • 327 pages

Editorial Reviews

From the Back Cover
This book focuses on core concepts of vascular neurosurgery in pediatric population,. It is designed to fill the knowledge gaps and to answer the frequently sought questions on various management strategies for commonly encountered pediatric neurosurgical conditions. The chapters, authored by experts in their respective field, provide a standard of care based on current diagnostic and management guidelines for pediatric neurosurgical diseases.

Pediatric Vascular Neurosurgery – Disorders and their Management is specially written and illustrated for residents, fellows and consultants in all pediatric related specialties, including but not limited to Neurosurgery, Neurology, Pediatrics, Neuroradiology and Neuroanesthesia.

About the Author
Dr Abhishek Agrawal, M.D.: House Staff, Department of Neurosurgery/ Radiology, Brigham and Women’s’ Hospital, Harvard Medical School, Boston.

Dr Gavin Britz, MBCCh, MPH, MBA, FAANS: Chairman, Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas