Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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The use of electrocorticographically (ECoG)-guided cortical resection in children with lesional epilepsy is controversial. Given the important developmental issues associated with recurrent childhood seizures, sustained seizure control is a key therapeutic goal. We therefore evaluated the effect of the decision to perform lesionectomy or ECoG-guided cortical resection on seizure outcome and surgical morbidity in the pediatric population. ⋯ Overall, using ECoG to guide additional cortical resection may lead to more robust seizure freedom in children with lesional epilepsy without increasing their risk of surgical morbidity.
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Intrathecal baclofen (ITB) therapy is an accepted treatment modality for spasticity and dystonia. Several complications related to ITB have been described, including mechanical malfunctions, infections, cerebrospinal fluid fistula, and baclofen withdrawal or overdose. In this study, we present our institutional experience with ITB therapy, emphasizing complication avoidance and lessons learned. ⋯ ITB therapy is associated with complications, many of which require additional surgery. Some of these complications are avoidable by adhering to a strict surgical technique and a proper criterion for patient selection.
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Dolichoectasia describes the elongation, dilatation and tortuosity of an arterial vessel. In adults, clinical presentation of basilar dolichoectasia (BD) is most often with ischaemic stroke. True BD has been very rarely reported in childhood, but the implication is of a congenital susceptibility. ⋯ This first description of childhood BD associated with ischaemic infarction adds to the understanding of this rarely reported arteriopathy.
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This study compares endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in the treatment of pediatric patients with marked obstructive hydrocephalus due to midline posterior fossa tumors. ⋯ The shorter duration of surgery, the lower incidence of morbidity, the absence of mortality, the lower incidence of procedure failure, and the significant advantage of not becoming shunt dependent make ETV be recommended as the first choice in the treatment of pediatric patients with marked obstructive hydrocephalus due to midline posterior fossa tumors.