Journal of neurosurgery. Pediatrics
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J Neurosurg Pediatr · Jan 2009
The pediatric neurosurgical workforce: defining the current supply. Clinical article.
The purpose of this study was to determine a reliable estimate of the size, demographic, and practice characteristics of the current pediatric neurosurgical workforce. The authors also sought to differentiate pediatric from nonpediatric neurosurgical practitioners and compare the demographic and practice characteristics of these 2 groups. The term "pediatric practitioner" will be used in this study to describe a practitioner whose practice is > 75% pediatric patients in accordance with the American Board of Pediatric Neurological Surgery (ABPNS) requirements for board certification in pediatric neurosurgery. Those practitioners with < 75% pediatric patients in their practice will be designated as "nonpediatric practitioners." ⋯ The authors estimate that there are fewer than 200 pediatric neurosurgeons currently practicing in the United States. Current practice patterns unique to pediatrics may have important implications in recruiting and retaining the next generation of pediatric neurosurgeons.
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J Neurosurg Pediatr · Jan 2009
Case ReportsIntraventricular baclofen for dystonia: techniques and outcomes. Clinical article.
The aim of this study was to evaluate the use of intraventricular baclofen (IVB) for the treatment of severe generalized secondary and heredodegenerative dystonia. ⋯ Intraventricular baclofen is an effective method of infusing baclofen to treat severe, generalized secondary dystonia, and, at times, heredodegenerative dystonia. The site of baclofen's activity when treating dystonia may be at the cortical level, and intraventricular infusion may result in higher baclofen concentrations over the cortex than intrathecal infusion. Additional studies are necessary to determine whether IVB is effective at lower doses than those used with intrathecal baclofen administration.
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J Neurosurg Pediatr · Jan 2009
Review Case ReportsPediatric spinal clear cell meningioma. Case report.
In this report the authors describe a unique case of spinal clear cell meningioma in a 13-year-old girl. Clear cell meningiomas (CCMs) are not uncommon. To the authors' knowledge, 14 cases of pediatric CCM occurring in the spinal canal have been reported. ⋯ Postoperatively there has been no recurrence in > 2 years. In this paper the authors report a case of CCM and provide a comprehensive literature review on this disease. Current recommendations for its management are still debatable, especially in the pediatric population, and the authors propose an algorithm for its treatment and surveillance.
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J Neurosurg Pediatr · Jan 2009
Changes in cerebral perfusion hormone profile and cerebrospinal fluid flow across the third ventriculostomy after endoscopic third ventriculostomy in patients with aqueductal stenosis: a prospective study. Clinical article.
The object of the present study was 3-fold: 1) to study regional cerebral perfusion before and after endoscopic third ventriculostomy (ETV) in patients with obstructive hydrocephalus by using (99m)Tc ethyl cysteinate dimer SPECT: 2) to study any correlation between clinically successful third ventriculostomy and CSF flow across the third ventriculostomy; and 3) to determine any changes in hormone profile following ETV. ⋯ Clinical improvement is not well correlated with a decrease in ventricular size following ETV. Brain SPECT is a valuable tool for the follow-up of patients with hydrocephalus after ETV, particularly in cases in which MR imaging findings are not clear. There are subtle hormonal changes in patients with hydrocephalus that may improve following ETV.
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J Neurosurg Pediatr · Jan 2009
Case ReportsJefferson fractures of the immature spine. Report of 3 cases.
Jefferson fractures of the immature spine have received little attention in the study of pediatric spinal trauma. Fractures through synchondroses are a possibility in the immature spine, in addition to fractures through osseous portions of the vertebral ring, and they create opportunities for misinterpretation of diagnostic imaging. ⋯ The possibility of a Jefferson fracture should be considered for any child presenting with neck pain, cervical muscle spasm, or torticollis following a head injury, despite a seemingly normal cervical spine study. Jefferson fractures in young children are probably much more common than previously recognized.