Anesthetic management of a pediatric patient during surgical excision of primary cerebral hydatid cyst

Hydatid cysts develop in humans with the transmission of Echinococcus Granulosus or more rarely Echinococcus Multilocularis. The disease develops in the liver 50-75%, and in the lungs 15-35% of the cases. Intracranial hydatid cyst is seen 0.5-3% of the cases. In this case report, we aimed to present the anesthetic approach and possible anaphylactic reaction in a giant primary intracranial hydatid cyst. A five years and eight months old boy (19 kg, 114 cm) was admitted to the emergency room with complaints of a headache, nausea, vomiting, and deviation of the eyes for about 1 month. Fundus examination revealed bilateral disc elevation and severe papillary edema. Cranial magnetic resonance imaging showed a large hydatid cyst in the right parietal lobe. The patient was scheduled for craniotomy by the neurosurgeons. After induction and endotracheal intubation, 1 mg.kg-1 pheniramine hydrogen maleate and 1 mg.kg-1 methylprednisolone were administered as a protective measure against anaphylaxis. The cyst excised by Dowling method, and no rupture observed. The patient, who did not have any perioperative complication, was extubated and followed in the intensive care unit of neurosurgery department. Cerebral hydatid cyst is rare and usually seen in children. This could be explained by the presence of right-to-left shunts. The gold standard in the treatment of cerebral hydatid cysts is surgical removal. In order to prevent recurrence and anaphylactoid reaction, the cyst should be removed without rupturing it. The hemodynamic changes with cyst rupture are seen milder in the patients receiving prophylactic treatment. [Med-Science 2018; 7(2.000): 443-5

Topiramate as a neuroprotective agent in a rat model of spinal cord injury

Topiramate (TPM) is a widely used antiepileptic and antimigraine agent which has been shown to exert neuroprotective effects in various experimental traumatic brain injury and stroke models. However, its utility in spinal cord injury has not been studied extensively. Thus, we evaluated effects of TPM on secondary cellular injury mechanisms in an experimental rat model of traumatic spinal cord injury (SCI). After rat models of thoracic contusive SCI were established by free weight-drop method, TPM (40 mg/kg) was given at 12-hour intervals for four times orally. Post TPM treatment, malondialdehyde and protein carbonyl levels were significantly reduced and reduced glutathione levels were increased, while immunoreactivity for endothelial nitric oxide synthase, inducible nitric oxide synthase, and apoptotic peptidase activating factor 1 was diminished in SCI rats. In addition, TPM treatment improved the functional recovery of SCI rats. This study suggests that administration of TPM exerts neuroprotective effects on SCI

Long-Term Outcomes of Pediatric Meningioma Surgery: Single Center Experience with 23 Patients

Aim: To evaluate the long-term outcomes and prognostic variables in a surgical cohort of pediatric meningiomas treated in a single institution. Material and methods: Medical records and follow-up notes of 23 pediatric patients aged < 18 years (12 male and 11 female; mean age on presentation, 13.1 ± 4.4 years) harboring 27 meningiomas operated between 1994 and 01/2019 at Hacettepe University Ihsan Dogramaci Children’s Hospital were evaluated. Results: One patient had neurofibromatosis (NF) type 1, and five patients had NF2. Tumors were most commonly located in the convexity (n=6) and parasagittal or falcine (n=6). Gross total resection was performed in 70.4% of cases. WHO grade I tumors accounted for 56% of all cases, whereas high-grade meningiomas accounted for 44% (33% grade II, 11% grade III). The mean follow-up duration was 10.3 ± 7.7 years. Three patients (13%) died during follow-up, and 76.2% of the patients had favorable outcome (Glasgow Outcome Scale > 3) during the last follow-up assessment. Ten patients (43.5%) had relapse. In univariate analysis, low histological grade (p=0.030) and gross total resection (p=0.024) were associated with favorable outcome. The 10-year overall survival rate was 86%. Conclusion: Meningiomas in the pediatric age group are surgically treatable tumors with fairly good outcomes. However, relapses are common even for low-grade tumors; therefore, long-term surveillance and aggressive treatment are needed.Wo

Existence of Cotton Granuloma After Removal of a Parasagittal Meningioma : Clinical and Radiological Evaluation -A Case Report-

Hemostatic agents, routinely used in neurosurgery to achieve intraoperativehemostasis may cause foreign body reaction. These may produce clinicallysymptomatic and radiologically apparent mass lesions. It should be kept in mind thatretained cotton or rayon materials may mimic the appearance of a tumor or an abscesson MRI scan, especially at sides of previous craniotomies. Here we report a case ofintracranial foreign body granuloma which occurred due to remained cottonoid afterremoval of a parasagittal meningioma. This entity was also documented by MRimaging technics included diffusion weighted, flair and ADC mapping

Does Ventricular Opening Promote Remote Cerebellar Haemorrhage?

Cerebellar haemorrhage after supratentorial craniotomy is a rare complication Because of its significant morbidity and mortality rates, being aware of this complication is important for early diagnosis. In a 30-year-old male with multiple intracranial cavernomas, remote cerebellar haemorrhage (RCH) was observed after removal of symptomatic left temporal lesion. The lateral wall of the temporal horn that was tightly attached to the cavernoma was also opened and excessive drainage of the CSF occurred. The haemorrhage is attributed to opening of the ventricle wall and excessive drainage of cerebrospinal fluid (CSF) during the procedure

Early Rehabilitation Improves Neurofunctional Outcome After Surgery In Children With Spinal Tumors

To investigate the effect of early rehabilitation on neurofunctional outcome after surgery in children with spinal tumors, this study reviewed the medical charts and radiographic records of 70 pediatric patients (1–17 years old) who received spinal tumor surgical removal. The peddiatric patients received rahabilitation treatment at 4 (range, 2–7) days after surgery for 10 (range, 7–23) days. Results from the Modified McCormick Scale, Functional Independence Measure for Children, American Spinal Injury Association Impairment Scale and Karnofsky Performance Status Scale demonstrated that the sensory function, motor function and activity of daily living of pediatric children who received early rehabilitation were significantly improved. Results also showed that tumor setting and level localization as well as patients's clinical symptoms have no influences on neurofunctional outcomes.PubMedWoSScopu

Effects of Age at Auditory Brainstem Implantation: Impact on Auditory Perception, Language Development, Speech Intelligibility

Objective: To study the effect of age at auditory brainstem implant (ABI) surgery on auditory perception, language, and speech intelligibility. Study design: Retrospective single cohort design. Setting: Tertiary referral center. Patients: In this study, 30 pediatric ABI users with no significant developmental issues were included. Participants were divided into two groups, according to age at surgery (Early Group: < 3 yr old [n = 15], Late Group: ≥ 3 yr old [n = 15]). Groups were matched by duration of ABI use and participants were evaluated after 5 years (±1 yr) experience with their device. The mean age at ABI surgery was 22.27 (ranged ± 6.5) months in the early group, 45.53 (ranged ± 7.9) months in the late group. Intervention(s): Retrosigmoid craniotomy and ABI placement. Main outcome measure(s): Auditory perception skills were evaluated using the Meaningful Auditory Integration Scale and Categories of Auditory Performance from the Children's Auditory Perception Test Battery. We used a closed-set pattern perception subtest, a closed-set word identification subtest, and an open-set sentence recognition subtest. Language performance was assessed with the Test of Early Language Development and Speech Intelligibility Rating, which was administered in a quiet room. Results: In this study, the results demonstrated that the Early Group's auditory perception performance was better than the Late Group after 5 years of ABI use, when children had no additional needs (U = 12, p < 0.001). Speech intelligibility was the most challenging skill to develop, in both groups. Due to multiple regression analysis, we found that auditory perception categories can be estimated with speech intelligibility scores, pattern perception scores, receptive language scores, and age at ABI surgery variables in ABI users with no additional handicaps. Conclusions: ABI is a viable option to provide auditory sensations for children with cochlear anomalies. ABI surgery under age 3 is associated with improved auditory perception and language development compared with older users.Wo

Is the Knowledge Pertaining to Adult Glioblastomas Enough for Pediatric Cases? Prognostic Factors in Childhood

AIM: Pediatric glioblastoma (GBM) is still a topic obscurity. The aim of this study was to explore clinical, radiological and pathological features, and prognostic factors affecting the outcomes. MATERIAL and METHODS: We retrospectively reviewed our database for prognostic factors for 42 consecutive pediatric patients with histologically proven GBM treated in our hospital. RESULTS: The study reached at 20 boys and 22 girls, with a mean age of 10.2 years. Almost all patients (97.6%) had supratentorial tumors; lobar/hemispheric (68.3%), thalamic (26.8%) and suprasellar-hypothalamic region (4.8%). Total of 11/42 children had seeding metastases (mean 11.5 months) either preoperatively or postoperatively. Gross total resection (GTR) was achieved in 13 patients (30.9%) in the first surgery. Perioperative mortality and morbidity rates were 4.7% and 19%, respectively. Patients were followed for an average of 18.1 months. The median progression-free and overall survivals were 7.0 (95% CI: 5.9-8.0) and 11.0 (95% CI: 8.9-13.1) months, respectively. 1-year, 2-year and 5-year progression-free survival and overall survivals were 30.9% vs. 50.0%, 11.9% vs. 19.0%, 4.8% vs. 9.5%; respectively. CONCLUSION: Gross total resection should be safely attempted in pediatric GBM. In addition, a thorough and frequent radiological evaluation of the entire neuraxis for seeding metastases is recommended both at diagnosis and follow-ups.WoSScopu