Journal of neurosurgery
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Journal of neurosurgery · Nov 2007
Case ReportsDetection of a residual nidus by surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography in a child with a cerebral arteriovenous malformation.
With the use of indocyanine green (ICG) as a novel fluorescent dye, and its integration into a compact system that takes advantage of modern video technology, fluorescence angiography has recently reemerged as a viable option. In this report, the authors show the efficacy of ICG videoangiography in the case of a child with a cerebral arteriovenous malformation (AVM). ⋯ This is a safe and simple method that can be used to assess the microcirculation of the brain. The ICG videoangiography is helpful in resecting residual cerebral AVM, especially in cases of diffuse-type AVM.
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Journal of neurosurgery · Nov 2007
Physician agreement with evidence-based recommendations for the treatment of severe traumatic brain injury in children.
The aim of this study was to evaluate physician agreement with published recommendations and guidelines for the management of severe traumatic brain injury (TBI) in children and to identify markers associated with physician responses matching published guidelines. ⋯ Overall, physician responses coincided with the published guidelines and recommendations. Examples of variable conformance most likely reflect the paucity of available data and lack of randomized controlled trials in the field of severe TBI.
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Journal of neurosurgery · Nov 2007
Infections of pediatric cerebrospinal fluid shunts related to fundoplication and gastrostomy.
There is conflicting information in the literature regarding the increased risk of ventriculoperitoneal (VP) shunt infection after abdominal surgical procedures such as gastrostomy tube (GT) placement and Nissen fundoplication (NF) in the young patient. To further elucidate this potential association, the authors reviewed their institutional experience with such cases. ⋯ Based on this study, an NF procedure/GT placement in a child with a VP shunt appears to carry approximately the same risk of shunt infection as a shunt placement operation. Moreover, the microbiology observed in these patients with infection did not differ significantly from the usual microorganisms responsible for VP shunt infections in infants/neonates. Finally, but not conclusively, an open NF procedure/GT placement may carry a higher infection risk than a laparoscopic-assisted NF procedure/GT placement.
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Journal of neurosurgery · Nov 2007
Case ReportsIntraoperative real-time contrast-enhanced ultrasound angiography: a new adjunct in the surgical treatment of arteriovenous malformations.
The goal of this study was to combine the use of ultrasound contrast agents with intraoperative ultrasound techniques to identify intraoperatively a patient's vascular anatomy, including feeding arteries and draining veins of an intracranial arteriovenous malformation (AVM). ⋯ Intraoperative ultrasonography provided high-quality images in every case. Although plain imaging failed to show an identifiable AVM boundary, color Doppler flow imaging clearly delineated the shape and margin of the AVM. Nevertheless, neither mode of imaging enabled the surgeons to categorically distinguish between feeding and draining vessels. The real-time perfusion process of microbubbles was first visualized 20 to 30 seconds after the SonoVue bolus injection, and the burst-refill technique made possible identification of the vascular anatomy of malformation lesions in multiple planes. CONCLUSIONS; Using both an ultrasound contrast agent and the burst-refill technique provided a rapid, convenient, and precise way of locating AVM feeding arteries intraoperatively. The combined technique seems warranted in the intraoperative treatment of AVMs.
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Journal of neurosurgery · Nov 2007
Accurate placement of cerebrospinal fluid shunt ventricular catheters with real-time ultrasound guidance in older children without patent fontanelles.
The authors present a technique in which real-time ultrasound monitoring is used to aid the insertion of cerebrospinal fluid (CSF) shunt ventricular catheters in children without patent fontanelles. Experience with the technique is reviewed. Intraoperative ultrasound is used to identify the compartments of the lateral ventricles and the choroid plexus prior to catheter insertion. ⋯ Postoperative computed tomography scans revealed all ventricular catheters placed accurately into the intended compartment of the ventricular system (for example, frontal horn or trigone). No procedure-related complications were noted. Real-time transcranial ultrasound monitoring through an enlarged bur hole is a feasible, safe, and effective technique for the placement of ventricular catheters in pediatric patients without a patent fontanelle.