Is external hydrocephalus a possible differential diagnosis when child abuse is suspected? Editorial

This is a retrospective review of 28 infants collected from two different countries and institutions whom their caregivers had been convicted of “child abuse.” The purpose, descriptions, and the conclusion are well accepted but the article as a whole is rather confusing for the general neurosurgical community. The authors speculate that the terms, “benign enlargement of the subarachnoid spaces (BESS)” and subdural collections are sometimes misdiagnosed leading serious medico-legal problems. Subdural collections represent various conditions which are used interchangeably such as subdural hygroma, chronical subdural hematoma, and external hydrocephaly

Prognostic value of Ki-67 index in primary intracranial tumors of infants

Objective Primary intracranial tumors are rare tumors in infants. They differ from those found in other pediatric age groups in terms of clinical presentation, histopathological diagnosis, adjuvant therapies, and outcome. Ki-67 index has also shown promising results as a prognostic factor in different types of intracranial tumors in children and adults. However, the importance and the best cutoff point of Ki-67 index in primary intracranial tumors of infants remains unclear. We aimed to analyze prognostic value of Ki-67 index in primary intracranial tumors of infants. Methods This study retrospectively reviewed the records of 28 infants undergoing surgical resection for primary intracranial tumors between April 2016 and March 2021. We analyzed clinical characteristics, tumor location, extent of resection, histopathological diagnosis, Ki-67 index, and overall survival (OS). To define the most relevant cutoff value for Ki-67 index, "Cutoff Finder " was used. Results The median age at diagnosis was 188 days for all patients. Fifteen of the patients were boys and 13 were girls. Tumors were located supratentorial in 13 patients and infratentorial in 15 patients. Gross total resection was performed in 7 of 13 supratentorial tumors and 9 of 15 infratentorial tumors. The mean Ki-67 index of the supratentorial tumors was 49.6%, the median was 55%; for infratentorial tumors, the mean was 49.9%, and the median was 70%. Tumor grade (p = 0.019) and Ki-67 index (p = 0.003) were found as significant predictors of OS in log-rank testing for Kaplan-Meier survival analysis. Univariate cox regression analysis identified high Ki-67 index as prognostic factor for worse OS, with hazard ratio of 8.852 (95% CI 1.95-64.80; p = 0.0108). High Ki-67 index was found as independent prognostic factor for worse OS in multivariate cox regression analysis (HR 7.036; 95% CI 1.229-65.82; p = 0.0457). Conclusion High-grade and high Ki-67 index were associated with worse outcome. Ki-67 index did show a distinct prognostic value for OS within our cohort at a cutoff value of 72.5%

Pediatric arteriovenous malformations

Contrary to their embryological origin, cerebral arteriovenous malformations have traditionally been regarded as an adult disease. Among various types of congenital vascular disease, classified based on their histopathologic features, “true” arteriovenous malformations (AVM’s) are the most challenging in terms of treatment. Most AVMs present in adulthood, with a mean age of patients at presentation of approximately 30-40 years. Nevertheless, the previously reported incidence rates in population based studies are increasing most probably due to detection of asymptomatic cases. Especially availability and extensive utilization of the non-invasive, highly diagnostic magnetic resonance (MR) imaging almost as a screening test enabled to detect AVMs far before they become symptomatic. This is especially true for the pediatric cases; while in previously reported series consisting of mostly symptomatic cases less than 10% would be children, this percentage is almost doubled in more recent reports [1, 2]. Added the difficulties of treating immature child brain with diverse physiology and metabolism, increasing number of asymptomatic AVMs brings more challenge to decision making for treatment. Nevertheless, spontaneous intracerebral hemorrhage is far more common as the initial sign in pediatric population associated with higher morbidity and mortality [1]. This chapter focuses on unique properties of pediatric AVMs contributing the treatment of choice with various modalities

Complications in craniosynostosis surgery

Kraniosinostoz terimi bir ya da birden fazla sütürün prematür olarak kapanmasını ifade eder. Bazı yazarlar tarafından sütürlerdeki bu erken kapanmanın ve olağandışı büyümenin, gelişmekte olan beyin dokusunu etkileyebildiği öne sürülmektedir. Bu durum sadece kozmetik problem yaratabileceği gibi, sendromik olgularda daha ciddi problemlere de yol açabilmektedir. Kraniosinostozlar nadir görülen bir hastalık grubu olup, sıklıkla tek sütür sinostozu olarak karşımıza çıkar. Tedavisinde açık cerrahi yöntemler ve endoskopik yöntemler kullanılabilir. Açık cerrahi yöntemler tek sütürektomiden ekstensif kalvaryal şekillendirme yöntemlerine kadar geniş bir aralığı kapsamaktadır. İnfantil ve çocuk yaşta olduğu gerek anestezi, gerekse cerrahi aşama ayrı bir özen ve dikkat gerektirmektedir. Kanama bu tür cerrahilerde en fazla görülen komplikasyondur ve çok küçük kanamalar bile infantil çağda beraberinde ciddi komplikasyonlar doğurmaktadır. Bunun dışında enfeksiyon, hipotermi, beyin omurilik sıvısı (BOS) fistulü, intrakranial yaralanma, venöz yaralanmalar, nöbet, hava embolisi, kranyal defektin kapanmaması ve istenilen kozmetik ve fonksiyonel sonuca ulaşılamaması da diğer komplikasyonlar arasındadır.The term of craniosynostosis belongs to premature closure of one or more cranial sutures. Some authors state that this premature closure and abnormal growth can affect the developing brain tissue. Although this condition can only lead to cosmetic problems, it can cause more serious problems in some syndromic cases. Craniosynostosis is a rare disorder and is usually seen as singlesuture synostosis. Treatment options are open and endoscopic surgical techniques. Open surgical techniques include a range of simple suturectomy to extensive total calvarial remodeling surgeries. In infant or child age, both the anesthesia and surgery stages need more attention and care. Bleeding is the most prominent complication and minimal blood loss can also cause more serious complications in the infant age group. The other complications are infections, hypothermia, cerebrospinal fluid (CSF) fistula, intracranial injury, venous injury, seizure, air embolism, non-closure of cranial bone defect and undesirable cosmetic and functional results

Pediatric Craniovertebral Junction DiseasesSurgical Management of Craniovertebral Junction Diseases in Children /

VIII, 376 p. 163 illus.online resource

CMV encephalitis with intracranial hemorrhages in newborn/infant

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Heart rate variability remains reduced and sympathetic tone elevated after temporal lobe epilepsy surgery

PURPOSE: There is evidence of autonomic dysregulation in temporal lobe epilepsy. The structures removed during temporal lobectomy are important centers of central cardiovascular control; therefore surgery may conceivably alter the cardiovascular autonomic function. The effects of temporal lobectomy on autonomic cardiac control are controversial. We investigated the effects of temporal lobectomy on heart rate variability (HRV) in the early and late postoperative periods. METHODS: We used 1-h ECG recordings to assess heart rate variability by spectral analysis in 24 consecutive patients who underwent temporal lobectomy due to intractable temporal lobe epilepsy. ECG recordings were performed before and twice (early and late) after surgery. The results were compared with age and sex matched controls. RESULTS: When compared with controls, all the time and frequency domain indices (SDRR, RMSSD, TP, LF and HF) were significantly lower in the patient group before surgery. Findings were similar in the early and late post-operative periods except that the LF/HF ratio increased in the patient group after the late post-operative period. Within the patient group, compared to pre-operative results, normalized HF was increased in the early post-operative period; however in the late post-operative period, LF/HF ratio was increased. CONCLUSIONS: These findings show that in patients with intractable temporal lobe epilepsy, HRV is decreased globally in both sympathetic and parasympathetic domains. While the total HRV remains reduced throughout the postoperative periods, the LF/HF ratio, i.e., sympathovagal balance is altered, in favor of parasympathetic side early after surgery, but towards the sympathetic side after the first postoperative month. rights reserved

Preoperative and postoperative high angular resolution diffusion imaging tractography of cerebellar pathways in posterior fossa tumors

This study aimed to utilize high angular resolution diffusion magnetic resonance imaging (HARDI) tractography in the mapping of the pathways of the cerebellum associated with posterior fossa tumors (infratentorial neoplasms) and to determine whether it is useful for preoperative and postoperative evaluation. Retrospective data from 30 patients (age 2-16 yr) with posterior fossa tumor (17 low grade, 13 high grade) and 30 age-sex-matched healthy controls were used. Structural and diffusion-weighted images were collected at a 3-tesla scanner. Tractography was performed using Diffusion Toolkit software, Q-ball model, FACT algorithm, and angle threshold of 45 degrees. Manually assessed regions of interest were placed to identify reconstructed fiber pathways passing through the superior, medial, and inferior cerebellar peduncles for the preoperative, postoperative, and healthy control groups. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), and track volume measures were obtained and analyzed. Statistically significant differences were found between the preop/postop, preop/control, and postop/control comparisons for the volume of the tracts in both groups. Displacement and disruption of the pathways seemed to differ in relation to the severity of the tumor. The loss of pathways after the operation was associated with selective resection during surgery due to tumor infiltration. There were no FA differences but significantly higher ADC in low-grade tumors, and no difference in both FA and ADC in high-grade tumors. The effects of posterior fossa tumors on cerebellar peduncles and reconstructed pathways were successfully evaluated by HARDI tractography. The technique appears to be useful not only for preoperative but also for postoperative evaluation.United States Department of Health & Human Services National Institutes of Health (NIH) - US

Double curve linear incision approach in cases of sagittal craniosynostosis

Craniosynostosis is the premature fusion of one or more sutures in the cranial dome or anterior skull base, resulting in an abnormal head shape. This pathological process is observed less frequently in Eastern geography and approximately one in 2000 to 2500 births in Western countries. Isolated sagittal synostosis accounts for more than half of craniosynostosis cases. In our study, the duration of surgery, duration of anaesthesia, duration of hospital stay, estimated amount of bleeding during surgery and the months of surgery were examined in 16 patients. The performed craniotomy is not different from the four different craniotomies described in the literature. Strip craniectomy and barrel osteotomy were performed on each patient. According to the incisions described in the literature, the incision type and location are different. As the described incision provides less skin dissection, less bleeding and less dead space formation allows surgery in earlier months