Child's Nervous System最新文献

Purpose: Meningomyelocele (MMC), a severe congenital defect of the central nervous system, is commonly associated with high morbidity and mortality. Surgical closure of MMC is essential to prevent infection, cerebrospinal fluid leakage, and nerve damage. In cases with large defects, flap surgery is required. This study examines whether preserving musculocutaneous perforators which enters to the flap itself during the repair with bipedicle fasciocutaneous flaps improves outcomes compared to flaps without perforator preservation.

Methods: We retrospectively analyzed 79 MMC patients who underwent repair with bipedicle fasciocutaneous flaps from January 2013 to December 2022. Patients were divided into two groups: Group 1 (perforators not preserved) and Group 2 (perforators preserved). We evaluated flap perfusion, complications, operation time, hospital stay, and discharge readiness.

Results: Results showed that Group 2 had a lower incidence of early postoperative venous insufficiency (15.2% vs. 34.29%, p < 0.05), partial flap necrosis (4.55% vs. 11.43%, p < 0.05), wound dehiscence (6.82% vs. 22.86%, p < 0.05), and secondary surgeries (13.64% vs. 25.71%, p < 0.05). Group 2 patients were ready for discharge significantly sooner (6.93 days vs. 9.26 days, p < 0.05). No significant differences were observed in operation time or blood loss between the groups.

Conclusion: Preserving perforators in bipedicle fasciocutaneous flaps enhances flap viability, reduces complication rates, and shortens hospital stays. This technique should be adopted for MMC repairs to improve clinical outcomes.

Background: Craniopharyngioma (CP) surgery in children leads to high rate of recurrence, and morbid complications. Transcranial approach is the most frequently proposed surgical technique, but transsphenoidal endoscopic approach is also used. Pre- and post-operative complications of the tumor are well known, but early multidisciplinary management could improve the long-term outcome of these patients. The aim of this study was to analyse the risk factors for pre-and post-operative long-term complications in a series of patients operated with an aggressive removal for CP.

Methods: A retrospective study of 26 children diagnosed with CP was carried out. The surgical total removal was possible in 88% of cases after the revision of the post-operative MRI realized in the first 48 h.

Results: Children with hypothalamic involvement were more likely to have endocrine deficits and to be overweight or obese pre-operatively. They also had a higher risk of early post-operative complications, and late morbidities.

Conclusion: Children with CP and strong hypothalamic involvement, have a higher risk of pre- and post-operative complications but complete removal is associated with a high rate of cure with global good neuropsychological results. Early multidisciplinary post-operative management should be reinforced to improve the long-term outcome but surgery with total removal can insure definitive acceptable clinical results.

Purpose: Hemispherotomy is an effective treatment for well-selected patients with drug-resistant hemispheric epilepsy. Successful hemispherotomy leading to seizure cessation has been associated with improved neurodevelopmental outcomes and reduced healthcare utilization. This study reports seizure outcomes and complications in a large, consecutive, single-surgeon series of pediatric hemispherotomy cases using a surgical approach with modifications to previously-reported techniques.

Methods: All patients undergoing transsylvian peri-insular hemispherotomy for drug-resistant hemispheric epilepsy between May 2017 and April 2021 by a single surgeon were prospectively enrolled in an epilepsy surgery registry. With retrospective review of medical records, data were collected on baseline characteristics (demographics, epilepsy history, anti-seizure medications, neurodevelopmental status, EEG features, and imaging characteristics), operative complications, hospital course, and seizure outcomes (Engel scale at 12- and 24-month follow-up).

Results: All 32 consecutive patients (aged 15 months-19 years) were seizure-free (Engel Class 1) 12 and 24 months after hemispherotomy. At 12 months, 31 patients (97%) had Engel Class 1A outcomes, and 1 patient (3%) had an Engel Class 1D outcome. These results were maintained through 24-month follow-up. Among 31 patients taking anti-seizure medications before surgery, 22 (71%) were weaned off all agents by 24 months. One patient (3%) developed post-operative hydrocephalus requiring ventriculoperitoneal shunt placement.

Conclusion: In an etiologically heterogeneous cohort of patients undergoing hemispherotomy for drug-resistant epilepsy, a modified transsylvian peri-insular technique led to high rates of sustained seizure freedom with minimal complications.

Background: There are different types of fever after hemispherotomy; to our knowledge, this is the first time in literature in which baclofen was used to control central fever following hemispherotomy.

Case presentation: A 12-year-old female patient who has a history of neonatal hemorrhagic stroke presented with uncontrolled seizures despite receiving three antiepileptic drugs. MRI brain showed marked volume reduction in the left cerebral hemisphere. She underwent a left modified hemispherotomy. Two weeks after surgery, she developed a fever with evidence of infection for which she underwent surgical debridement, the fever subsided gradually and she was discharged after 2 weeks. Then 1 week later, she presented again with a fever and the T-max was 39 °C. After the exclusion of infection and aseptic meningitis, there was a possibility of central fever for which we started baclofen at 5 mg once per day and gradually increased the dose till she reached 20 mg per day at which the fever vanished. The patient remained seizure-free and afebrile for 10 months after surgery.

Conclusions: Postoperative fever is very common after hemispherectomy or functional hemispherotomy, and the non-infectious etiology is the most encountered. Central fever is a diagnosis of exclusion and its diagnosis leads to avoiding the misuse of antibiotics. We found baclofen safely and successively controlled central fever after hemispherotomy.

Background: A retained medullary cord (RMC) is an uncommon, closed spinal dysraphism characterized by a robust extended cord-like structure that extends continuously from the conus medullaris to the dural cul-de-sac. There have been six reports of RMC extending to a related sacral subcutaneous meningocele. To the best of authors' knowledge, the combination of retained medullary cord with thoracic arachnoid cyst has never been reported in the literature.

Case presentation: We present a case of the above combination in a 2-year-old child who underwent resection of RMC and fenestration of associated anteriorly placed arachnoid cyst under neuromonitoring. It is prudent to delineate functional and nonfunctional cord segment with neuromonitoring before truncating. The child improved significantly after surgery, and at 1-year follow-up, the child was able to walk with support.

Conclusion: Surgery for RMC involves delineation with neuromonitoring and resection of the nonfunctional cord. Fenestration of the arachnoid cyst must be included in surgical planning, which can be performed as a staged procedure or at same setting.

Introduction: Catheter migration and coiling are rare complications of ventriculoperitoneal shunt (VPS).

Case report: A 4-month-old girl presented with poor feeding and vomiting. At presentation, the patient showed sunset phenomenon and tense fontanelles. Magnetic resonance imaging revealed tetraventricular dilation.

Results: The patient underwent right VPS and was discharged on postoperative day (POD) 8. She visited hospital 33 days later, with considerable swelling in the right frontoparietal region. Radiography revealed upward VPS catheter migration and coiling. The patient underwent shunt revision and was discharged on POD 8. However, 12 days later, she returned to hospital with frequent vomiting. Neuroimaging revealed an outward migration of the ventricular catheter. The patient underwent shunt revision again, which was complicated by meningitis. After resolution of it, a left VPS was installed.

Conclusions: VPS catheters installed in loose pediatric connective tissues are influenced by many factors that may cause an unexpected catheter migration.

Purpose: This review aims to evaluate the scientific evidence on the efficacy and safety of cranial orthotic therapy (helmet therapy) in children under 12 months with moderate to severe posicional plagiocephaly and brachycephaly.

Methods: A systematic review was performed in PubMed, EMBASE, and Cochrane databases. Additional searches were conducted in regulatory agency repositories for relevant notifications.

Results: A total of 19 studies were included in the review, assessing various treatment modalities for PP. Repositioning therapy demonstrated effectiveness in reducing cranial asymmetry for mild to moderate cases, but several studies (class I and II evidence) indicated that it was less effective than both physical therapy and helmet use. Physical therapy, particularly manual therapy combined with caregiver counseling, showed superior outcomes for non-synostotic cranial asymmetry. Helmet therapy was consistently recommended for infants with moderate to severe deformities, with better outcomes when initiated during early infancy.

Conclusion: Helmet therapy is safe and effective for specific cases, especially moderate to severe PP or brachycephaly, with improved results when started early. However, available studies have methodological limitations, and the decision to use helmet therapy should be individualized, considering the severity of the deformity, patient age, and response to other treatments.

Purpose: This study aimed to record the 30-day and inpatient morbidity and mortality in paediatric patients undergoing neurosurgery for brain tumours in a tertiary neurosciences centre over a 10-year period. The intention was to establish the frequency of significant adverse events and review the current published rates of morbidity in this patient group.

Methods: All deaths and adverse events occurring within our department are prospectively recorded. Each adverse event was categorised, allocated a clinical impact severity score, and linked to a neurosurgical procedure wherever possible. Where a patient suffered several adverse events in the same admission, each event was recorded separately. If a patient had been discharged home, an adverse event was recorded if it occurred within 30 days of admission.

Results: A total of 285 procedures were performed in 209 patients (aged < 16 years). Eighty-five significant adverse events were identified. Four clinical indicators are the following: Significant adverse event rate: 78 (27.4%) operations were linked to at least one significant adverse event. Unscheduled return to theatre rate: 33 (11.6%) operations were associated with an adverse event that resulted in an unscheduled return to theatre. Surgical site infection rate: Eight (2.8%) operations were associated with an infection. Post-procedure hydrocephalus treatment rate: 37 (13.0%) operations were followed by a further surgical procedure to treat hydrocephalus.

Conclusion: Complications and adverse events occur frequently following neurosurgery for intracranial tumours in children. Prospective, continuous surveillance will promote improvement in the neurosurgical care delivered to this patient group.

Introduction: Tuberculomas represent a significant complication of central nervous system (CNS) infection resulting from tuberculosis. The objective of our study was to evaluate the demographic and clinical characteristics, diagnosis, treatment, and prognosis of pediatric patients with CNS tuberculoma.

Methods: The study population comprised patients aged 0-18 years who were diagnosed with CNS tuberculoma in the Division of Pediatric Infectious Diseases at Cukurova University Balcali Hospital between January 1, 2002, and September 1, 2024. A retrospective analysis was conducted on the files to examine the demographic and clinical characteristics, radiological data, and treatment of the patients. The definitive diagnosis was established through acid-fast bacilli staining and tuberculosis culture of the CNS lesion. The probable diagnosis was made on the basis of clinical epidemiologic factors, histopathology, molecular methods, and typical radiographic findings.

Results: CNS was tuberculoma detected in 22 patients (8.3%) of the 265 individuals diagnosed with TB. Of the total number of patients, 12 (54.5%) were male and 10 (45.5%) were female. The median age of the patients was 60 months (25th to 75th interquartile range 15.8 and 144.0, respectively), and the most common presenting complaint was fever (77.3%). A lumbar puncture was conducted in 19 patients (86.4%), and brain imaging was performed on all of them. Biopsies from the brain lesions were obtained in two patients. The mean follow-up period was 9.3 ± 5.4 years. The antituberculosis treatment was administered until the lesions had disappeared. Complete recovery was observed in 14 patients (63.6%), while eight patients (36.4%) exhibited sequelae. Tuberculoma did not result in mortalities among the patients.

Conclusion: Diagnosis of CNS tuberculoma is often difficult due to non-specific symptoms and difficulties in sampling. Early diagnosis and appropriate treatment can prevent mortality and morbidity. When we encounter suspicious radiologic findings in brain imaging, especially magnetic resonance imaging, it should be considered in the differential diagnosis.