Neurosurgery clinics of North America
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Although head injury is a common occurrence in childhood, most of the brain injury that occurs is mild and uncomplicated. There are some differences between adults with head injuries and children with head injuries, and some of these differences are reviewed. Specific circumstances unique to childhood head injury are presented, including the importance of recognizing child abuse.
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Neurosurg. Clin. N. Am. · Jan 1991
ReviewAspects on pathophysiology of nerve entrapments and nerve compression injuries.
The microanatomy of the neuron and the peripheral nerve, which is a composite tissue, should be considered when discussing the pathophysiology of nerve compression injuries. Acute and chronic compression of peripheral nerve can induce changes in intraneural microcirculation and nerve fiber structure, increase vascular permeability with subsequent edema formation, and impair anterograde and retrograde axonal transport, which all contribute to the clinical symptoms and deterioration of nerve function. ⋯ Diabetes mellitus may confer on the peripheral nerve an increased susceptibility to compression injuries. Clinical stages of compression syndromes, such as carpal tunnel syndrome, may be related to specific pathophysiologic events occurring in the nerve.
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Neurosurg. Clin. N. Am. · Jan 1991
ReviewNeurosurgical management of birth injuries of the brachial plexus.
While most newborns with birth injury of the brachial plexus make a full spontaneous recovery, the minority who do not can expect lifelong disability from weakness, disturbed patterns of muscle activity, contracture, and deformity. Those children who are destined to a poor recovery can be identified in early infancy. Early reconstruction of the brachial plexus carries low morbidity and has been shown by many to support useful shoulder and elbow function. Patients who are referred later in childhood may still benefit from plexus exploration, but how to best use clinical and electrophysiologic data to plan a surgical intervention that will improve on the natural history remains to be elucidated for this group.
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Neuroimaging entails knowing both which modality to use and when in the sequence of clinical evaluation to use a particular modality. This article review the role, both diagnostic and prognostic, of neuroimaging in the various categories of intradural spinal disease and presents the spectrum of neuroimaging modalities.
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It is obvious that the past decade has witnessed considerable progress in the management of children with medulloblastoma. Better surgical technique has led to more aggressive surgery with less morbidity. ⋯ It remains unknown, however, whether the patient with a medulloblastoma is ever "cured." Certainly, in the future, control of this tumor will depend on new therapeutic modalities, which will be developed on the basis of a better understanding of the biology of these primitive tumors. A better understanding of tumor immunology, cytogenetics, and biochemistry is a goal for the future.