Journal of neurosurgery. Pediatrics
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J Neurosurg Pediatr · Dec 2017
Lessons learned from administration of high-dose methylprednisolone sodium succinate for acute pediatric spinal cord injuries.
OBJECTIVE Methylprednisolone sodium succinate (MPSS) has been studied as a pharmacological adjunct that may be given to patients with acute spinal cord injury (ASCI) to improve neurological recovery. MPSS treatment became the standard of care in adults despite a lack of evidence supporting clinical benefit. More recently, new guidelines from neurological surgeon groups recommended no longer using MPSS for ASCI, due to questionable clinical benefit and known complications. ⋯ CONCLUSIONS High-dose MPSS for ASCI was not delivered to pediatric patients according to protocol with a high degree of reliability. Patients receiving steroids for pediatric ASCI were significantly more likely to experience complications than patients not receiving steroids. The findings presented, including complications of steroid use, support removal of high-dose MPSS as a treatment option for pediatric ASCI.
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J Neurosurg Pediatr · Dec 2017
Magnetic resonance imaging-guided laser interstitial thermal therapy as treatment for intractable insular epilepsy in children.
OBJECTIVE Seizure onset within the insula is increasingly recognized as a cause of intractable epilepsy. Surgery within the insula is difficult, with considerable risks, given the rich vascular supply and location near critical cortex. MRI-guided laser interstitial thermal therapy (LiTT) provides an attractive treatment option for insular epilepsy, allowing direct ablation of abnormal tissue while sparing nearby normal cortex. ⋯ The patient outcomes suggest that LiTT can successfully treat intractable seizures originating within the insula and offers an attractive alternative to open resection. This is the first description of LiTT applied to insular epilepsy and represents one of only a few series describing the use of LiTT in children. The results indicate that seizure reduction after LiTT compares favorably to that after conventional open surgical techniques.
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J Neurosurg Pediatr · Dec 2017
Case ReportsShunt freedom and clinical resolution of idiopathic intracranial hypertension after bariatric surgery in the pediatric population: report of 3 cases.
Idiopathic intracranial hypertension (IIH), formerly known as pseudotumor cerebri, is a disease of elevated intracranial pressure that is thought to develop due to impaired CSF absorption related to elevated venous sinus pressure in the setting of increased intraabdominal and thoracic pressures. Symptoms can be disabling and, if left untreated, can lead to permanent visual loss. Previous treatments directed toward vision preservation include CSF diversion through shunting and optic nerve sheath fenestration. ⋯ Two of the 3 patients had their shunts removed and continued to be shunt free 1.5 years later at last follow-up; the third patient remained shunt dependent with the pressure set at 200 mm H2O. Given the significant complications inherent to multiple shunt revisions, earlier intervention for weight loss, including bariatric surgery, in these patients might have prevented complications and the associated health care burden. The authors recommend a multidisciplinary approach for IIH treatment with early consideration for weight loss interventions in select patients.
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J Neurosurg Pediatr · Dec 2017
Posttraumatic complications in pediatric skull fracture: dural sinus thrombosis, arterial dissection, and cerebrospinal fluid leakage.
OBJECTIVE Skull fracture is associated with several intracranial injuries. The object of this study was to determine the rate of fracture associated with venous thrombosis, intracranial arterial dissection (ICAD), and cerebrospinal fluid (CSF) leakage in pediatric patients. Further, the authors aimed to highlight the features of pediatric skull fracture that predict poor neurological outcomes. ⋯ Poor prognostic factors include diastasis, an age > 2 years, and fracture caused by vehicle-related accidents or being struck by or against an object. In this series, the rates of venous thrombosis and ICAD were low, and the authors do not advocate vascular imaging unless these disease entities are clinically suspected. Patients with skull base fracture should be closely monitored for CSF leakage.