Pediatric neurosurgery
-
Pediatric neurosurgery · Aug 2010
Comparative StudyRhesus macaque as an animal model for posterior fossa syndrome following tumor resection.
Posterior fossa tumors are the most common brain tumors in children. Surgeons usually remove these tumors via a midline incision through the posterior vermis of the cerebellum. Though often effective, this surgery causes hypotonia, ataxia, oculomotor deficits, transient mutism, difficulty in swallowing and nausea. To date, there is no animal model that mimics these complications. We found that the rhesus macaque is a good model for the consequences of this surgery. ⋯ Our surgery in a monkey caused the same postsurgical signs observed in humans. We expect to use this model to improve the posterior fossa surgery methods.
-
Pediatric neurosurgery · Jan 2010
Case ReportsMalfunction of SynchroMed II baclofen pump delivers a near-lethal baclofen overdose.
Intrathecal baclofen therapy using implantable pumps is an established treatment for spasticity. The pumps occasionally experience serious malfunction. ⋯ Physicians who implant pumps for intrathecal baclofen administration need to be aware that these devices may suffer unheralded catastrophic failure that can lead to potentially lethal overdose administration.
-
Pediatric neurosurgery · Jan 2010
The impact of a 'resident replacement' nurse practitioner on an Academic Pediatric Neurosurgical service.
The introduction of 80-hour workweek limitations has challenged resident training programs with creative scheduling while maintaining comprehensive training experiences. The work hour restrictions may be more adaptable to a medical service, but have been very challenging to an academic surgical program. The particular challenges include maximizing academic learning opportunities, operating room experiences and direct bedside patient care while adhering to the 80-hour restriction. This paper examines the addition of a pediatric nurse practitioner (NP) to a pediatric neurosurgical academic program in response to the resident work hour restrictions. ⋯ The addition of an NP in response to resident training changes has been a positive influence on satisfaction with the pediatric neurosurgical service while reducing the reliance on residents for bedside clinical care. Patient safety appears not to have been affected. Presumably, this response to resident work hour limitations will provide the needed time to enhance resident didactic and intraoperative training experiences.
-
Pediatric neurosurgery · Jan 2010
Case ReportsTranssellar transsphenoidal encephalocele: a case report.
Basal encephaloceles are rare, accounting for about 1.5% of all encephaloceles. Transsellar transsphenoidal encephaloceles are the rarest variety of basal encephaloceles. We report a rare case of transsellar transsphenoidal encephalocele managed by a transnasal transseptal approach.
-
Pediatric neurosurgery · Jan 2010
Comparative StudyExperiences with the telovelar approach to fourth ventricular tumors in children.
Fourth ventricular tumors are amongst the most common tumors in the pediatric population. Traditionally, these tumors are approached through the cerebellar vermis, but the telovelar approach is now becoming widespread. Posterior fossa syndrome/cerebellar mutism is a complication of surgery for fourth ventricular tumors whose precise cause remains elusive, but may be related to the surgical approach or injury to adjacent cerebellar structures. We present a small series of fourth ventricular tumors and our initial experience in using the telovelar approach for this surgery. ⋯ The telovelar approach provides excellent access to tumors of the fourth ventricle with sparing of the vermis in children. The high incidence of cerebellar mutism in our patients confirms that this phenomenon is unlikely to be related to vermian injury and further study is recommended.