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Postoperative pain management strategies following selective dorsal rhizotomy in pediatric cerebral palsy patients: a systematic review of published regimens. 小儿脑瘫患者选择性背根切断术后疼痛治疗策略:已发表方案的系统回顾。
IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-30 DOI: 10.1007/s00381-024-06559-6
Victor M Lu, Sima Vazquez, Toba N Niazi

Background: Surgical selective dorsal rhizotomy (SDR) in appropriate pediatric cerebral palsy patients is an effective treatment for spasticity. However, there remains heterogeneity reported in postoperative pain management with and without opioid medication in this delicate cohort. The objective of this study was to aggregate pertinent metadata by means of systematic review to summarize all relevant postoperative pain regimens in the literature.

Methods: Searches of multiple electronic databases from inception to June 2024 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Outcomes and regimens were then summarized.

Results: A total of 16 cohort studies were included in this study published between 1989 and 2024. Amongst all studies, outcomes were reported for a total of 636 with median cohort age 6.3 years, and median cohort male proportion 62% was reported. Four studies reported regimens involving systemic analgesia, 8 studies reported regimens involving epidural analgesia, and the remaining 4 studies reported regimens involving intrathecal analgesia. All studies primary pain management involved opioid medication, with 8 studies having opioid medication available as indicated, 3 studies having opioid medication as a single dose, and the remaining studies having opioid medication as a continuous agent in the immediate postoperative period. Across all studies, rates of desaturations, nausea and/or vomiting, and pruritis ranged from 0 to 55%, 25 to 82%, and 15 to 70% respectively. Eleven of the 16 studies included a comparative component, demonstrating that their regimen was at least comparable to their control regimen, if not superior.

Conclusions: Multiple variations of postoperative pain management in pediatric cerebral palsy patients following SDR have been reported in the literature, involving systemic, epidural, and intrathecal analgesia. Concerns for adverse effects with the utilization of opioid medication has led to the trend towards multimodal pain management relying more on non-opioid medication regimens in the more recent literature.

背景:对合适的小儿脑瘫患者进行手术选择性背侧肌根切术(SDR)是治疗痉挛的有效方法。然而,在这一微妙的群体中,术后疼痛治疗中使用或不使用阿片类药物的报道仍存在异质性。本研究的目的是通过系统综述的方式汇总相关元数据,总结文献中所有相关的术后疼痛治疗方案:方法:按照 PRISMA 指南搜索了从开始到 2024 年 6 月的多个电子数据库。根据预先指定的标准对文章进行筛选。然后对结果和治疗方案进行总结:本研究共纳入了 16 项发表于 1989 年至 2024 年的队列研究。在所有研究中,共报告了 636 人的结果,队列年龄中位数为 6.3 岁,队列男性比例中位数为 62%。4 项研究报告了涉及全身镇痛的治疗方案,8 项研究报告了涉及硬膜外镇痛的治疗方案,其余 4 项研究报告了涉及鞘内镇痛的治疗方案。所有研究的主要疼痛治疗方法都涉及阿片类药物,其中 8 项研究根据指示使用阿片类药物,3 项研究使用单剂量阿片类药物,其余研究在术后立即使用阿片类药物作为持续性药物。在所有研究中,饱和度下降、恶心和/或呕吐以及瘙痒症的发生率分别为 0% 至 55%、25% 至 82% 和 15% 至 70%。在 16 项研究中,有 11 项研究包含了比较部分,表明其方案即使不优于对照方案,也至少与对照方案相当:文献报道了小儿脑瘫患者术后 SDR 镇痛的多种不同方案,包括全身镇痛、硬膜外镇痛和鞘内镇痛。由于担心使用阿片类药物会产生不良反应,因此在最近的文献中更多地采用了非阿片类药物的多模式疼痛治疗方法。
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引用次数: 0
Radiographic severity is associated with worse executive function in metopic craniosynostosis. 放射学严重程度与偏位颅畸形患者的执行功能恶化有关。
IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-06-21 DOI: 10.1007/s00381-024-06493-7
Mariana N Almeida, David P Alper, Carlos Barrero, Neil Parikh, Sacha C Hauc, Jake Moscarelli, Michael Golinko, John Persing, Jordan Swanson, Michael Alperovich

Background: Children with metopic synostosis have been found to have more neurocognitive and behavioral difficulties. The variables that may affect future neurodevelopmental outcomes, including presenting morphologic severity, have not been fully studied. In the largest study to date, we aimed to assess what portends worse neurocognitive and behavioral outcomes at school age.

Methods: Children 6-18 years old with surgically corrected metopic nonsyndromic craniosynostosis underwent neurocognitive testing. Parents completed behavior rating surveys about their child: Conners-3 (ADHD), Social Responsiveness Scale-2 (autism spectrum disorder), Behavior Rating Inventory of Executive Function-2 (BRIEF-2: executive function), and Child's Behavior Checklist (overall behavior). The endocranial bifrontal angle (EBA), adjusted EBA (aEBA), frontal angle (FA), and AI-derived metopic severity score (MSS) were determined on pre-operative CT images. Multivariate linear regressions were used to evaluate the association of age at surgery and severity.

Results: There were 87 children who underwent neurocognitive testing (average age 10.9 ± 3.3 years) of whom 67 also completed behavioral assessments. Greater phenotypical severity of metopic synostosis (lower FA, aEBA, and EBA) was associated with worse scores on the subscales of the BRIEF-2 (executive function) and executive subscale of the Conners-3. Increasing age at surgery was associated with worse executive function subscale scores of the Conners-3 when controlling for each severity measurement and sociodemographic risk.

Conclusion: Children with greater phenotypic severity of metopic synostosis have worse executive function at school age. The majority of children with metopic synostosis have signs of ADHD. Later surgeries (greater than 12 months) may impact executive functioning, regardless of the degree of severity. Future research should aim at identifying the direct structural changes to the brain.

背景:研究发现,患有偏侧突眼的儿童有更多的神经认知和行为障碍。目前尚未对可能影响未来神经发育结果的变量(包括目前的形态学严重程度)进行全面研究。在迄今为止最大规模的研究中,我们旨在评估哪些因素会导致学龄期的神经认知和行为结果更差:方法:6-18 岁经手术矫正的异位非综合征颅脑发育不良儿童接受神经认知测试。家长填写有关孩子的行为评分调查表:康纳斯-3(多动症)、社会反应量表-2(自闭症谱系障碍)、执行功能行为评级量表-2(BRIEF-2:执行功能)和儿童行为检查表(整体行为)。根据术前 CT 图像确定颅内双额角 (EBA)、调整后 EBA (aEBA)、额角 (FA) 和源自 AI 的偏侧严重性评分 (MSS)。采用多变量线性回归评估手术年龄与严重程度的关系:共有 87 名儿童接受了神经认知测试(平均年龄为 10.9 ± 3.3 岁),其中 67 名儿童还完成了行为评估。偏侧突触症的表型严重程度越高(FA、aEBA和EBA越低),BRIEF-2(执行功能)分量表和Conners-3执行分量表的得分越低。在控制各项严重程度测量和社会人口风险的情况下,手术年龄的增加与Conners-3执行功能分量表得分的降低有关:结论:表型严重度较高的异位突触症儿童在学龄期的执行功能较差。大多数患有异位突触症的儿童都有多动症的症状。无论严重程度如何,后期手术(超过 12 个月)都可能影响执行功能。未来的研究应着眼于确定大脑结构的直接变化。
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引用次数: 0
Occipital encephalocele: a retrospective analysis and assessment of post-surgical neurodevelopmental outcome. 枕状脑积水:手术后神经发育结果的回顾性分析和评估。
IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-06-24 DOI: 10.1007/s00381-024-06506-5
Soumen Kanjilal, Pawan Kumar Verma, Shreyash Rai, Ashutosh Kumar, Kamlesh Singh Bhaisora, Ved Prakash Maurya, Kuntal Kanti Das, Anant Mehrotra, Arun Kumar Srivastava, Awadhesh Kumar Jaiswal

Background: Encephalocele represent a group of disorders which is characterised by extracranial herniation of the leptomeninges, brain, and CSF through a structural defect in the cranium. They are usually associated with other intracranial anomalies which may impact the neurological development.

Aim: This study aimed to assess the predictors of neurological development of patients undergone surgical excision of occipital encephalocele.

Methods: All patients with occipital encephaloceles operated over the last decade (2012-2022). The sac size, presence of hydrocephalous, and associated anomalies were noted. The biopsy of these patients were reviewed and categorised as those which contains mature neural tissue and those without. The neurological outcomes were assessed by social, language, cognitive, and motor milestone and has been stratified into no delay, mild (1 of 4), moderate (2 or 3 of 4), and severe development delay (4 of 4).

Results: Total of 35 patients were included with median age of 10 months (IQR = 5-20 months). Fifteen (42.9%) patients had sac size of ≥ 5 cm, and 23 (65.7%) patients had mature neural tissues on biopsy. The median follow-up period was 6.4 years (IQR = 4.38-10.65) years. Seventeen (49.6%) patients had moderate to severe developmental delay. The sac size of ≥ 5 cm (AOR = 33.5; 95%CI = 3.35-334.8) (p = 0.003) and presence of mature neural content in the sac (AOR = 13.32; 95%CI = 1.1-160.36) (p = 0.041) were associated with significant neurodevelopmental delay.

Conclusion: The presence of a large sac of ≥ 5 cm and the presence of mature neural tissues on histopathological specimen of patients with encephalocele point towards the possibility of poor neurological development.

背景:脑疝是一组疾病,其特点是颅骨结构缺陷导致颅外的脑膜、脑和脑脊液疝出。目的:本研究旨在评估手术切除枕状脑积水患者神经系统发育的预测因素:过去十年(2012-2022 年)接受手术的所有枕叶脑瘤患者。注意囊的大小、是否存在脑积水以及相关的异常情况。对这些患者的活检结果进行审查,并将其分为含有成熟神经组织和不含成熟神经组织的两类。神经系统结果通过社交、语言、认知和运动里程碑进行评估,并分为无发育迟缓、轻度(4 例中的 1 例)、中度(4 例中的 2 或 3 例)和重度发育迟缓(4 例中的 4 例):共纳入 35 名患者,中位年龄为 10 个月(IQR = 5-20 个月)。15名患者(42.9%)的囊肿大小≥5厘米,23名患者(65.7%)的活检结果显示神经组织成熟。中位随访时间为 6.4 年(IQR = 4.38-10.65 年)。17名患者(49.6%)有中度至重度发育迟缓。囊肿大小≥5 cm (AOR = 33.5; 95%CI = 3.35-334.8) (p = 0.003)和囊肿中存在成熟的神经内容物 (AOR = 13.32; 95%CI = 1.1-160.36) (p = 0.041)与明显的神经发育迟缓有关:结论:脑疝患者存在≥5厘米的大囊,且组织病理学标本中存在成熟的神经组织,这表明患者的神经系统发育可能较差。
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引用次数: 0
Placenta as a source of autologous graft in postnatal correction of myelomeningocele. 将胎盘作为自体移植的来源,用于脊髓空洞症的产后矫正。
IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-30 DOI: 10.1007/s00381-024-06635-x
Ingrid Maciel Barbosa, Alefe Luiz Gonçalves Rabelo, Edvaldo José Rodrigues Cardoso, Dyecika Souza Couto

Objective: This integrative literature review aims to discuss the benefits and limitations of postnatal surgery to correct myelomeningocele using the placenta as an autologous graft used on the lesion; in addition, it seeks to highlight the placental properties and the benefits and indications of surgery.

Methods: For this production, the PRISMA criteria were used. PubMed was used as a database on October 19, 2023, and three searches were made, all using the words "myelomeningocele" and "surgery" varying only between "amnion," "placenta," and "chorion" as the third word. A total of 91 articles were found, and after analysis of duplicates and inclusion and exclusion criteria, only 11 articles were used in this systematic review.

Results: Properties of the amniotic membrane were observed, such as anti-inflammatory, stimulation of native tissue growth, regenerating action by the secretion of neutrophil factors, promotion of epithelialization, inhibition of fibrosis and healing, and antibacterial effect. It is observed that there are benefits in using the placenta as an autograft and there are contradictions between the periods of surgery.

Conclusion: Due to its properties that accelerate healing, the absence of the possibility of rejection, and its easy access make this choice more frequently adopted. We are confident in saying that the effectiveness of the amniotic membrane is widely reliable.

目的:这篇综合性文献综述旨在讨论利用胎盘作为病变部位的自体移植,通过产后手术矫正脊髓空洞症的益处和局限性;此外,它还试图强调胎盘的特性以及手术的益处和适应症:方法:本研究采用了 PRISMA 标准。于 2023 年 10 月 19 日使用 PubMed 作为数据库,并进行了三次检索,所有检索均使用 "脊髓膜膨出症 "和 "手术 "这两个词,仅在 "羊膜"、"胎盘 "和 "绒毛膜 "这三个词之间有所变化。共找到 91 篇文章,在对重复文章、纳入和排除标准进行分析后,只有 11 篇文章被用于本次系统性综述:结果:观察到羊膜的特性,如抗炎、刺激原生组织生长、分泌中性粒细胞因子的再生作用、促进上皮化、抑制纤维化和愈合以及抗菌作用。据观察,使用胎盘作为自体移植的益处与手术期之间存在矛盾:结论:胎盘具有加速愈合的特性,不会产生排斥反应,而且容易获取,因此越来越多的人选择自体移植。我们有信心说,羊膜的有效性是广泛可靠的。
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引用次数: 0
Atypical venous drainage system and distinct vascular characteristics in pediatric intracerebral hemorrhage caused by multiple micro arteriovenous malformations. 多发性微动静脉畸形导致的小儿脑内出血的非典型静脉引流系统和独特的血管特征。
IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-04 DOI: 10.1007/s00381-024-06636-w
Katsuya Saito, Go Ikeda, Yoshimitsu Akutsu, Hideyuki Kano, Hiroyoshi Akutsu

Background: Hemorrhagic brain micro-arteriovenous malformations (micro-AVMs) are considered to constitute a relatively significant portion of pediatric AVMs, though they are often associated with a low bleeding rate, as seen in hereditary hemorrhagic telangiectasia, which frequently involves multiple micro-AVMs. We present a rare case of a 10-year-old girl with multiple hemorrhagic micro-AVMs. Intraoperative findings during the emergency operation for hematoma evacuation and post-operative superselective angiography highlighted the unique angioarchitecture of three micro-AVMs (two lesions in the superficial areas and one lesion in the deep-seated area) and the atypical bleeding source due to the complex congestive venous drainage system. One micro-AVM was successfully occluded by a transarterial emboliozation, and remaining two micro-AVMs underwent gamma knife irradiation as a salvage therapy.

Conclusion: Superselective angiography is crucial for detecting micro-AVMs, offering detailed insights into small, localized abnormal vascular drainage systems, and guiding therapeutic strategy. Additionally, micro-AVM-associated unique vascular hypersensitivity, such as vasospasm, requires careful consideration, as invasive procedures may significantly alter the visibility of the entire micro-AVM network.

背景:出血性脑微小动静脉畸形(micro-AVMs)被认为在小儿动静脉畸形中占比较大的比例,尽管它们通常与低出血率有关,如遗传性出血性毛细血管扩张症(经常涉及多个微小动静脉畸形)。我们报告了一例罕见的 10 岁女孩多发性出血性微小血管瘤病例。术中紧急血肿清除手术和术后超选择性血管造影术的发现,凸显了三个微小血管瘤(两个病变位于浅表区域,一个病变位于深层区域)独特的血管结构,以及复杂的充血性静脉引流系统导致的非典型出血源。经动脉栓塞术成功堵塞了一个微小血管瘤,其余两个微小血管瘤接受了伽马刀照射作为挽救治疗:结论:超选择性血管造影对于检测微小血管瘤至关重要,它能详细了解局部小的异常血管引流系统,并指导治疗策略。此外,与微小血管瘤相关的独特血管超敏反应(如血管痉挛)也需要慎重考虑,因为侵入性手术可能会显著改变整个微小血管瘤网络的可见度。
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引用次数: 0
Imaging features of pediatric meningiomas: emphasis on unusual locations. 小儿脑膜瘤的影像学特征:重点关注异常位置。
IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-10 DOI: 10.1007/s00381-024-06525-2
Qingyang Shi, Jiajie Tian, Tingting Zhou, Na Tan, Tijiang Zhang, Xiaoxi Chen

Purpose: This article aims to analyze pediatric meningioma's imaging characteristics, especially those in unusual locations.

Methods: Pediatric patients with pathologically confirmed meningiomas at our hospital from January 2010 to January 2024 were enrolled. Meningiomas located in the cerebral convexity, parasagittal falcine region, anterior skull base, middle skull base, sphenoid ridge, cerebellopontine angle (CPA), olfactory groove, or juxtasella were considered in usual locations. Meningiomas found in other areas were considered in unusual locations. Clinical information, pathology results, and imaging features of pediatric meningiomas in usual and usual locations were analyzed and compared.

Results: A total of 18 patients (19 meningiomas) were enrolled, including 14 males and 4 females, with an average age of 14 years (ranging from 6 to 18 years). A total of 12 (63.2%) meningiomas were in the unusual location, including four (33.3%) were intraparenchymal, four (33.3%) were intraventricular, two (16.7%) were intraosseous, one (8.3%) case was in the paranasal sinus, and one (8.3%) was intraspinal. The meningiomas in unusual locations usually lacked the meningeal tail sign, and the misdiagnosis rate on preoperative imaging was significantly higher than that of meningiomas in usual locations.

Conclusion: Pediatric meningiomas are prone to occur in unusual locations. When they occur in usual locations, they often lack typical radiographic features of meningiomas, leading to potential misdiagnosis before surgery. Recognition of the imaging characteristics of meningiomas in unusual locations in children may facilitate accurate preoperative imaging diagnosis.

目的:本文旨在分析小儿脑膜瘤的影像学特征,尤其是异常位置的脑膜瘤:方法:选取 2010 年 1 月至 2024 年 1 月在我院就诊并经病理证实为脑膜瘤的小儿患者为研究对象。位于脑凸、矢状镰旁区、前颅底、中颅底、蝶骨脊、小脑角(CPA)、嗅沟或并鞍的脑膜瘤被认为是常见位置。发现于其他部位的脑膜瘤则被视为不常见部位。分析并比较了常见位置和非常见位置小儿脑膜瘤的临床信息、病理结果和影像学特征:共有18名患者(19个脑膜瘤)入选,其中男性14名,女性4名,平均年龄14岁(6至18岁不等)。共有12例(63.2%)脑膜瘤位于异常部位,其中4例(33.3%)位于实质内,4例(33.3%)位于脑室内,2例(16.7%)位于骨内,1例(8.3%)位于鼻窦旁,1例(8.3%)位于椎管内。异常部位的脑膜瘤通常没有脑膜尾征,术前影像学误诊率明显高于常见部位的脑膜瘤:结论:小儿脑膜瘤易发生在异常部位。结论:小儿脑膜瘤容易发生在不常见的位置,当发生在常见位置时,往往缺乏脑膜瘤的典型影像学特征,导致术前误诊。认识儿童异常部位脑膜瘤的影像学特征有助于术前做出准确的影像学诊断。
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引用次数: 0
Surgical strategy in treatment of metopic synostosis in a single centre experience: technical note and quantitative analysis of the outcomes. 单中心治疗异位突眼的手术策略:技术说明和结果定量分析。
IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-13 DOI: 10.1007/s00381-024-06520-7
Mino Zucchelli, Federica Ruggiero, Micol Babini, Mariella Lefosse, Alessandro Borghi, Naiara Rodriguez-Florez, Achille Tarsitano, Francesca Nicolini, Ercole Galassi

Purpose: Trigonocephaly is the most common craniosynostosis involving orbits. Although some degree of agreement has been reached regarding surgical timing and indications for treatment, there is no consensus regarding the ideal operative technique to guarantee an optimal morphological outcome. The purpose of this study is to describe both strategies and to compare morphological outcomes by means of morphological surface analysis obtained from three-dimensional (3D) stereophotogrammetry, with two different techniques.

Methods: We retrospectively investigated 43 patients with metopic synostosis surgically treated between 2004 and 2020. Two different techniques were applied, addressed as technique A and B. Ten patients undergone postoperative 3d stereophotogrammetry were enrolled, and cephalometric measurements were taken and compared to a cohort of unaffected patients matched by age and gender.

Results: Comparison of the groups demonstrated a hypercorrection of the metopic angle of the second technique, associated with a slightly lower correction of the interfrontoparietal diameter. The metopic angle showed to be significantly undercorrected with the first method.

Conclusions: Alternated barrel staving technique appears to be a quick and satisfactory method in cranial remodelling for metopic synostosis. It guarantees an optimal aesthetic result in the first years after surgery.

目的:三颅头畸形是最常见的涉及眼眶的颅脑发育畸形。尽管在手术时机和治疗适应症方面已达成了一定程度的共识,但在保证最佳形态学结果的理想手术技术方面仍未达成共识。本研究旨在描述这两种策略,并通过三维立体摄影测量获得的形态学表面分析,比较两种不同技术的形态学结果:我们对 2004 年至 2020 年间接受手术治疗的 43 例偏头并合症患者进行了回顾性研究。10名患者在术后接受了三维立体摄影测量,头颅测量结果与年龄和性别匹配的未受影响患者进行了比较:结果:两组患者的比较结果表明,第二种技术的偏角校正过度,而额顶间直径的校正略低。结论:交替桶跷跷板技术似乎是一种有效的矫正方法:结论:交替桶状镫骨技术似乎是一种快速、令人满意的颅骨重塑方法,可用于治疗偏侧合眼症。结论:交替桶状镫骨技术是一种快速、令人满意的颅骨重塑方法,可确保术后第一年达到最佳的美学效果。
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引用次数: 0
Hippocampal resection during hemispherotomy: is it needed? 半球切除术中的海马切除术:需要吗?
IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-07 DOI: 10.1007/s00381-024-06604-4
Lottem Bergman, Ben Shofty, Ariel Agur, Shimrit Uliel Sibony, Jeffrey M Treiber, Daniel J Curry, Itzhak Fried, Howard L Weiner, Jonathan Roth

Purpose: Hemispherotomy is an effective surgery for intractable pediatric hemispheric epilepsy. Over the years, the surgical goal has shifted from a complete hemispheric resection (anatomical hemispherectomy) to a disconnective hemispherotomy (DH). Multiple techniques for DH have been described, and often, anterior temporal lobectomy (ATL, with hippocampal resection) is performed. The goal of the current study is to assess the role of hippocampal resection in DH.

Methods: We retrospectively collected all clinical data of children (< 18 years old) who underwent DH between 2001 and 2022 at two tertiary large centers. Epilepsy status and surgical outcome were compared, based on whether the hippocampus was resected (as part of an ATL) or disconnected at the amygdala and atrial segment of the fornix (with no ATL).

Results: A total of 86 patients (32 females) were included. The most common epilepsy etiologies were stroke (31), Rasmussen's encephalitis (16), cortical dysplasia (10), and hemimegaloencephaly (9). The mean age at surgery was 7 (± 4.9) years. The average number of anti-seizure medications (ASMs) at surgery was 3 (± 1.2). Hemispherotomy techniques included peri-insular (54), vertical (23 [19 endoscopic + 4 parasagittal]), and trans-sylvian (9). The mean follow-up was 41.5 (± 38) months. Forty-three patients had hippocampal resection, and 43 patients had a hippocampal disconnection. Both groups had similar Engel outcome scores (p = 0.53).

Conclusions: Disconnective hemispherotomy is highly effective for pediatric intractable hemispheric epilepsy. Our data suggest that the inclusion of hippocampal resection does not provide additional benefit.

目的:半球切除术是治疗顽固性小儿半球癫痫的有效手术。多年来,手术目标已从完全半球切除术(解剖半球切除术)转变为断裂半球切除术(DH)。目前已描述了多种 DH 技术,通常会进行前颞叶切除术(ATL,同时切除海马)。本研究旨在评估海马切除术在 DH 中的作用:我们回顾性地收集了所有患儿的临床数据(结果:共有 86 名患者(32 名女性)接受了海马切除术:共纳入 86 名患者(32 名女性)。最常见的癫痫病因是中风(31例)、拉斯穆森脑炎(16例)、大脑皮质发育不良(10例)和巨脑症(9例)。手术时的平均年龄为 7(± 4.9)岁。手术时平均服用抗癫痫药物(ASM)3次(±1.2)。半球切除术的技术包括岛周(54例)、垂直(23例[19例内窥镜+4例副矢状面])和经矢状面(9例)。平均随访时间为 41.5 (± 38) 个月。43名患者进行了海马切除,43名患者进行了海马断开。两组患者的恩格尔结果评分相似(P = 0.53):结论:断开半球切除术对小儿难治性半球癫痫非常有效。我们的数据表明,海马切除术不会带来额外的益处。
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引用次数: 0
Regression of microcephaly as a protective factor of neuropsychomotor development in fetal surgery for occipital encephalocele. 小头畸形的消退是胎儿枕部颅脑手术中神经心理运动发育的保护因素。
IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-04 DOI: 10.1007/s00381-024-06597-0
Jardel Mendonça Nicácio, Sergio Cavalheiro, Marcos Devanir Silva da Costa, Patricia Alessandra Dastoli, Italo Capraro Suriano, Mauricio Mendes Barbosa, Stéphanno Gomes Pereira Sarmento, Tereza Cristina Carbonari de Faria, Antonio Fernandes Moron

Purpose: Encephaloceles are neural tube closure defects characterized by herniation of intracranial contents through the skull, with a mortality rate of 33.3%. Approximately 50% of patients who survived have some degree of neuropsychomotor developmental impairment or seizures. This study aimed to analyze the relationship between good neuropsychomotor development (NPMD) in patients undergoing fetal occipital encephalocele correction and the reversal of microcephaly, comparing these outcomes with those observed in patients who underwent postnatal surgery.

Methods: The 22 participants were categorized into two groups: 10 in the fetal group (FG) and 12 in the postnatal group (PNG). During the study, 1 patient was excluded from the FG and 2 patients were excluded from the PNG, totaling 19 patients in the study. All patients were diagnosed, evaluated, and monitored by the same healthcare service between July 2012 and July 2018. All participants were subjected to a careful developmental assessment using the Bayley Scale of Infant Development, Second Edition (BSID-II), up to 2 years and 11 months of age. Additionally, CP measurements were taken during the first year of life to monitor their progress. The relationship between microcephaly reversal and NPMD was studied.

Results: The CP adjusted for gestational age showed a tendency toward the reversal of progressive microcephaly after correction of encephaloceles in the FG. We found a statistically significant difference in the median BSID-II score between the PNG and FG. Patients in the FG maintained normal CP development in the first year of life, whereas those in the PNG remained microcephalic.

Conclusion: The reversal of microcephaly in the FG directly influences good NPMD and can be considered a protective factor.

目的:脑畸形是一种神经管闭合缺陷,其特点是颅内内容物通过颅骨疝出,死亡率高达 33.3%。存活的患者中约有 50%存在一定程度的神经运动发育障碍或癫痫发作。本研究旨在分析接受胎儿枕部颅脑畸形矫正术的患者神经心理运动发育良好(NPMD)与小头畸形逆转之间的关系,并将这些结果与产后手术患者的结果进行比较:22名参与者分为两组:胎儿组(FG)10人,产后组(PNG)12人。在研究过程中,1 名患者被排除在 FG 组之外,2 名患者被排除在 PNG 组之外,共计 19 名患者参与了研究。2012年7月至2018年7月期间,所有患者均由同一医疗服务机构进行诊断、评估和监测。所有参与者均接受了仔细的发育评估,评估使用的是贝利婴儿发育量表第二版(BSID-II),评估年龄为 2 岁 11 个月。此外,他们还在出生后第一年进行了CP测量,以监测他们的发育情况。研究了小头畸形逆转与非畸形儿之间的关系:结果:按胎龄调整后的CP显示,在矫正FG中的脑畸形后,渐进性小头畸形有逆转的趋势。我们发现,PNG 和 FG 的 BSID-II 中位数得分在统计学上存在显著差异。FG患者在出生后第一年的CP发育保持正常,而PNG患者仍为小头畸形:结论:FG 患儿小头畸形的逆转直接影响到良好的新生儿疾病,可被视为一种保护因素。
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引用次数: 0
High flow pial arteriovenous fistula with dural sinus malformation of the posterior circulation. 伴有硬脑膜窦后循环畸形的高流量皮腔动静脉瘘。
IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-29 DOI: 10.1007/s00381-024-06650-y
Nikhila Reddy, Shailesh B Gaikwad, Savyasachi Jain, Bheru Dan Charan, Shariq Ahmad Shah

Posterior fossa congenital pial arteriovenous fistulas are rare vascular anomalies associated with high morbidity. These anomalies often present challenges to neurointerventionists due to their complex morphological features. We successfully treated two technically challenging, infratentorial large pial arteriovenous fistulas (AVFs) associated with complete flow steal in the basilar artery. The first case involved an 18-year-old male with a posterior fossa single-hole AVF characterized by dilated venous pouches and retrograde venous reflux. After an unsuccessful initial coiling attempt, this patient was treated using a double microcatheter coiling technique, supported by a large balloon for flow control. The second case involved a 9-month-old infant with a complex two-hole posterior fossa pial AVF and a large venous sac. This patient was treated with coil embolization of the fistula and with balloon protection of the vertebrobasilar junction. Both patients recovered without postoperative complications and showed significant improvement on follow-up. These cases provide valuable insights into the management and characteristics of pial arteriovenous fistulas.

后窝先天性静脉动静脉瘘是一种罕见的血管畸形,发病率很高。由于形态特征复杂,这些畸形常常给神经介入医生带来挑战。我们成功治疗了两例具有技术挑战性的、伴有基底动脉完全血流窃取的胸膜下大腔动静脉瘘(AVF)。第一个病例是一名 18 岁的男性,后窝单孔动静脉瘘的特点是静脉袋扩张和静脉逆流。在最初的卷曲尝试失败后,这名患者接受了双微导管卷曲技术治疗,并使用大球囊进行流量控制。第二例患者是一名 9 个月大的婴儿,患有复杂的后窝两孔髓内 AVF 和一个大的静脉囊。该患者接受了瘘管线圈栓塞和椎-基底动脉交界处球囊保护治疗。两名患者术后均无并发症,随访结果显示病情明显好转。这些病例为我们了解椎动脉动静脉瘘的治疗和特点提供了宝贵的资料。
{"title":"High flow pial arteriovenous fistula with dural sinus malformation of the posterior circulation.","authors":"Nikhila Reddy, Shailesh B Gaikwad, Savyasachi Jain, Bheru Dan Charan, Shariq Ahmad Shah","doi":"10.1007/s00381-024-06650-y","DOIUrl":"10.1007/s00381-024-06650-y","url":null,"abstract":"<p><p>Posterior fossa congenital pial arteriovenous fistulas are rare vascular anomalies associated with high morbidity. These anomalies often present challenges to neurointerventionists due to their complex morphological features. We successfully treated two technically challenging, infratentorial large pial arteriovenous fistulas (AVFs) associated with complete flow steal in the basilar artery. The first case involved an 18-year-old male with a posterior fossa single-hole AVF characterized by dilated venous pouches and retrograde venous reflux. After an unsuccessful initial coiling attempt, this patient was treated using a double microcatheter coiling technique, supported by a large balloon for flow control. The second case involved a 9-month-old infant with a complex two-hole posterior fossa pial AVF and a large venous sac. This patient was treated with coil embolization of the fistula and with balloon protection of the vertebrobasilar junction. Both patients recovered without postoperative complications and showed significant improvement on follow-up. These cases provide valuable insights into the management and characteristics of pial arteriovenous fistulas.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":" ","pages":"4375-4380"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Child's Nervous System
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