Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Review Case Reports
Spontaneous resolution of an acute epidural hematoma with normal intracranial pressure: case report and literature review.
Traumatic epidural hematomas are critical emergencies in neurosurgery, and patients symptomatic from acute epidural hematomas are typically treated with rapid surgical decompression. However, some patients, if asymptomatic, may be treated with close clinical observation and serial imaging. Although rare, rapid spontaneous resolution of epidural hematomas in the pediatric population has even been reported, with only seven cases in the literature. ⋯ We report the case of a rapidly resolving epidural hematoma in a 13-year-old boy. This case allows for more detailed inferences to be made concerning the nature of the epidural hematoma's resolution, as it is the first reported case in which an intracranial pressure monitor has been utilized. We also review the literature and discuss the nature of rapid spontaneous epidural hematoma resolution.
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Comparative Study
Changes in third ventricular size in pediatric patients undergoing endoscopic third ventriculostomy.
Optimal methods of evaluating radiographic data following endoscopic third ventriculostomy (ETV) are not yet known. This study analyzes imaging parameters, including third ventricular width and cross-sectional area (CSA), in pediatric ETV patients. ⋯ Third ventricular imaging parameters (width and mid-sagittal CSA) exhibited more pronounced responses to ETV than lateral ventricular measurements in pediatric hydrocephalic patients.
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Posterior fossa tumors are the most common brain tumor of children. Aggressive resection correlates with long-term survival. A high incidence of posterior fossa syndrome (PFS), impairing the quality of life in many survivors, has been attributed to damage to bilateral dentate nucleus or to cerebellar output pathways. Using diffusion tensor imaging (DTI), we examined the involvement of the dentothalamic tracts, specifically the superior cerebellar peduncle (SCP), in patients with posterior fossa tumors and the association with PFS. ⋯ PFS can occur with bilateral injury to the outflow from dentate nuclei. In children with PFS, this may occur due to bilateral injury to the superior cerebellar peduncle. These tracts sit immediately adjacent to the wall of the ventricle and are highly vulnerable when an aggressive resection for these tumors is performed.
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Purely endoscopic endonasal approaches to surgical resection of pediatric suprasellar craniopharyngiomas are uncommonly performed. The aim of the study is to assess the feasibility and to describe the short-term outcomes of endonasal endoscopic approaches for the gross total resection of suprasellar craniopharyngiomas in the pediatric population. ⋯ Complete radiographic resection of pediatric craniopharyngioma can be achieved via a purely endoscopic endonasal approach. In particular, this approach can be performed safely using the "two-nostrils-four-hands" technique with intraoperative neuronavigation. This approach should be highly considered in patients with progressive visual dysfunction. Further studies are needed to characterize the long-term surgical and clinical outcome of pediatric patients treated with this surgical approach.