Ischemic stroke following elective craniotomy in children

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In Brief

The authors performed a retrospective review of cases in which patients developed a perioperative stroke following an elective craniotomy from 2010 through 2017. They analyzed demographic, medical, radiologic, and outcome variables from an in-house institutional database. Perioperative ischemic stroke in neurosurgical patients following an elective craniotomy is an understudied issue, particularly in the pediatric population.

ABBREVIATIONS ACA = anterior cerebral artery; AChA = anterior choroidal artery; ACS NSQIP-P = American College of Surgeons National Surgical Quality Improvement Program–Pediatric; CVA = cerebrovascular accident; DWI = diffusion weighted imaging; iMRI = intraoperative MRI; MCA = middle cerebral artery; mRS = modified Rankin Scale; PCA = posterior cerebral artery.

Article Information

Correspondence Paul Klimo Jr.: Semmes Murphey, Memphis, TN. pklimo@semmes-murphey.com.

INCLUDE WHEN CITING Published online December 21, 2018; DOI: 10.3171/2018.10.PEDS18491.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Examples of anterior perforator infarcts. A: Axial CT image obtained in a patient with a recurrent artery of Heubner stroke. Hypodensity is visible within the anterior caudate head, internal capsule, and anterior lentiform nucleus. B: Axial diffusion-weighted (DW) image showing a lateral lenticulostriate stroke.

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    Examples of posterior perforator infarcts. A: Axial DW image showing a mesencephalon stroke caused by injury to the top of a basilar artery perforator. B: Axial DW image showing a left thalamic stroke in the territory of PCA perforators.

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    Axial DW image showing an ovoid area of diffusion restriction within the posterior limb of the left internal capsule in the territory of the AChA.

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    False-negative iMRI. A: Axial T2-weighted image showing a heterogeneous multicystic craniopharyngioma filling the third ventricle with extension into the lateral ventricles. B: Sagittal contrast-enhanced T1-weighted image showing the large multicystic lesion effacing the third ventricle and interpeduncular fossa. C: Axial DW image from iMRI scan showing no appreciable diffusion restriction in the right lentiform nucleus or thalamus. Spatial distortion artifact and localized signal dropout from intraventricular air are noted. D: Axial DW image from the postoperative MRI study showing diffusion restriction in the right globus pallidus and right ventral thalamus consistent with an AChA infarction.

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