Upper urinary tract deterioration and possible etiologies in intractable voiding dysfunction: Role of occult spinal malformation

Objectives: To evaluate the presence of upper urinary tract deterioration (UUTD) and accompanying pathologies in children treated with the diagnosis of non-neurogenic bladder-sphincter dysfunction (NNBSD). Patients and Methods: We retrospectively reviewed the medical records of 316 consecutive patients with NNBSD who were treated. All cohort were grouped into two: Group I (Treatment success; n=284), Group II (Treatment failure with any form of occult spinal pathology; n=32). Thirty-four children with treatment-failure and normal magnetic resonance imaging (MRI) findings were excluded. Groups were compared for pre- and posttreatment pediatric lower urinary tract symptom score (PLUTSS), presence of UUTD and urodynamic findings. Results: The mean PLUTSS was significantly less in Group I compared with Group II at pre-treatment and 3 months thereafter the initial treatment (12.20 ± 5.90 and 5.20 ± 4.90 vs 20.3 ± 2.14 and 18 ± 3.4, respectively p<0.01). The mean cystometric capacities and detrusor leak point pressure (DLPP) of Group II prior to initial treatment and after 6 months of the untethering surgery were found to be 194, 267 mL and 28, 12cm H2O, respectively (p<0.05). Presence of UUTD was significantly correlated with DLPP >20 cm H2O and presence of vesicoureteral reflux (VUR)

Surgical Results of Pediatric Patients with Hypothalamic Hamartoma

Objectives:Hypothalamic hamartomas (HH) are congenital lesions present with gelastic seizures and precocious puberty. Disconnective surgery is a safe and effective treatment method in patients with HH. In this study, we aim to share demographic information, presenting symptoms, surgical complications and surgical outcomes in pediatric patients with HH who were operated in our clinic.Methods:In this retrospective study, 12 pediatric patients with HH, who were operated in Acibadem University, School of Medicine, Department of Neurosurgery, Division of Pediatric Neurosurgery and Epilepsy Surgery Clinic between years 2007–2018 were included. All clinical materials, including patient notes, cranial magnetic resonance imaging, electroencephalogram recordings and endocrinological data of patients, were collected. Variables evaluated in the statistical analysis were age, sex, presenting symptom, radiological appearance, treatment outcome. Surgical outcome was evaluated by the Engel classification system. Statistical analysis was performed using SPSS 20.0 software.Results:There were eight (66.7) males and four (33.3%) females within the patient cohort. Median age at the time of diagnosis was 3.1 years (4 months–6 years). Median follow-up period was 98.3 months (24–177 months). Presenting symptoms were gelastic seizures in six (50%) patients, precocious puberty in three (25%) patients and both gelastic seizures and precocious puberty in three patients. All patients had disconnective surgery for HH. None of the patients had a postoperative neurological deficit. The seizure outcome in seven (77%) of the nine patients with seizure were Engel class 1 after the surgery. Signs and symptoms of precocious puberty persist after surgery in three (50%) of six patients who had presented with precocious puberty in the preoperative period. There was no statistically significant relationship between age, sex and type of HH (p>0.05). There was also no significant relationship between the type of HH and presenting symptom, operation route or treatment outcome (p>0.05).Conclusion:Disconnective surgery is a safe and effective treatment method in pediatric patients with HH. Since most of the patients presents with seizures and/or endocrinological problems, thorough preoperative and postoperative neurological and endocrinological follow-up is recommended

Epilepsy Surgery in Pediatric Patients: A Single-Center Experience

Objectives:Epilepsy surgery is one of the treatment options in pediatric patients with drug-resistant epilepsy. Our aim is to share demographic data, surgical outcome, possible surgical complications, and factors that affect surgical outcome in pediatric patients with drug-resistant epilepsy who were operated in our clinic.Methods:In this retrospective study, 85 patients who were operated in Acibadem Hospital Pediatric Epilepsy Surgery Clinic between years 2005 and 2017 were included. We investigated the influence of sex, age at seizure onset, side and frequency of seizures, time to surgery, type of epilepsy surgery, and histopathology on pediatric epilepsy surgery outcome. Surgical outcome was assessed by Engel classification system. Statistical analysis was performed with SPSS 20.0 software.Results:There were 56 male (66%) and 29 female (34%) participants. Median of the age of seizure onset is 2 years (1 day–15 years). Median of age at operation is 6.2 years (3 months–16 years). Median of the duration of seizure until surgery is 3.2 years (3 months–15.5 years). Median follow-up is 5.6 years (3 months–13.5 years). There were permanent motor neurological deficits in 3 patients (3.5%). The best surgical outcome was achieved in patients with resective surgeries (p<0.01). Age at seizure onset was the most important factor that influences surgical outcome in our patients (p<0.05).Conclusion:Epilepsy surgery is one of the safe and effective treatment options in pediatric patients with drug-resistant epilepsy

Late Remission of Seizures After Functional Hemispherotomy in a Child With Congenital Middle Cerebral Artery Infarct

Hemispherotomy can be a useful procedure in hemispheric syndromes, such as Rasmussen’s encephalitis, congenital stroke, or hemimegalencephaly. The seizures associated with these syndromes usually remit immediately after hemispherotomy. Presently described is a patient who had a functional hemispherotomy for a congenital middle cerebral artery stroke and whose seizures remitted 2½ years after the operation. His postoperative electroencephalogram showed contralateral abnormalities. However, these disappeared with the remission of seizures. One may argue that the disconnection of the abnormal hemisphere could result in the cessation of the epileptogenic potential of the healthy hemisphere by terminating secondary epileptogenesis

Hypothalamic hamartoma presenting with infantile spasms

Hypothalamic hamartomas (HH) generally present with gelastic seizures. It is very unusual for a pediatric patient with HH to present with infantile spasms (IS)