Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Cerebrospinal fluid shunt failure is related to additional morbidity. Misplacement of ventricular catheters occurs in 40 % with freehand technique and is a risk factor for shunt failure. The goal of this study was to analyze the impact of intraoperative real-time ultrasound on catheter positioning and outcome in children. ⋯ This analysis demonstrated an improvement of catheter positioning with ultrasound guidance. In the absence of additional burden or risks, this method should be favored over freehand technique. It remains to be demonstrated in a randomized controlled fashion to what extent improved catheter position translates into improved outcome.
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Based on a landmark study by Lin et al. of the two-dimensional flow in ventricular catheters (VCs) via computational fluid dynamics (CFD), we studied in a previous paper the three-dimensional flow patterns of five commercially available VC. We found that the drainage of the cerebrospinal fluid (CSF) mostly occurs through the catheter's most proximal holes. In this paper, we design five VC prototypes with equalized flow characteristics. ⋯ New catheter designs with variable hole diameter, number of holes, and ratio hole/segment along the catheter allow the fluid to enter the catheter more uniformly along its length, thus reducing the chance that the catheter becomes occluded.
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The optimal surgical treatment for symptomatic middle fossa arachnoid cyst is still controversial. The most leading therapeutic options include cyst shunting and fenestration (endoscopic, microsurgical). We present our experience on surgical treatments of arachnoid cysts. ⋯ Microsurgical fenestration with keyhole craniotomy to provide passage between cysts to basal cisterns together with cystoperitoneal shunting during the same operation is still an effective and safe method in cases with symptomatic middle fossa arachnoid cysts in children.
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Comparative Study
A comparison of the effects of desflurane versus propofol on transcranial motor-evoked potentials in pediatric patients.
The aim was to compare the effects of propofol and desflurane anesthesia on transcranial motor evoked potentials (MEPs) from pediatric patients undergoing surgery for spinal deformities. ⋯ MEPs with good amplitudes were obtained under desflurane only anesthesia that were comparable to propofol only anesthesia in pediatric patients during surgery for spinal deformities. There was no evidence for anesthetic fade over the time period examined. When used by itself, desflurane can be considered a viable alternative to propofol anesthesia.
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To delineate microstructural changes in transected white matter tracts after corpus callosotomy in relation to seizure recurrence using tract-based spatial statistics of diffusion tensor imaging (DTI-TBSS). ⋯ Using DTI-TBSS analysis, we characterized and visualized microstructural white matter changes over time in relation to seizure recurrence in callosotomy patients, suggesting that reorganization of some transected white matter tracts may be related to seizure recurrence. DTI-TBSS analysis can provide reliable and useful information about the state of white matter bundles affected by corpus callosotomy in a noninvasive manner.