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Prognostic value of leukocytosis in pediatric traumatic brain injury

Soumya Mukherjee, Gnanamurthy Sivakumar, John R. Goodden, Atul K. Tyagi, and Paul D. Chumas

T raumatic brain injury (TBI) is a leading cause of death and disability in the pediatric age group, accounting for more than half of all childhood fatalities in developed countries. 1 However, prognostic factors in children with TBI remain unclear due to a dearth of studies focusing on the pediatric population. Indeed, guidelines for management of pediatric TBI are mainly derived from adult guidelines. 2 Yet, there is evidence supporting the fact that pediatric patients with TBI may be more prone to brain swelling than adult patients, and that therefore the

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Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients

Brian K. Owler, Kathryn A. Browning Carmo, Wendy Bladwell, T. Arieta Fa’asalele, Jane Roxburgh, Tina Kendrick, and Andrew Berry

care for patients with acute neurosurgical conditions. The Newborn and Paediatric Emergency Transport Service (NETS) is a dedicated intensive care retrieval service, using road and rotary and fixed wing vehicles ( http://www.nets.org.au ). Over 254 hospitals in NSW/ACT call on NETS to assist children up to 16 years of age. The retrieval team normally comprises a specialist intensive care nurse and doctor. While this model works well for the majority of patients, for some patients, outcome has been compromised by the lack of timely access to specialized

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Critical assessment of pediatric neurosurgery patient/parent educational information obtained via the Internet

Michael Garcia, Christopher Daugherty, Bertha Ben Khallouq, and Todd Maugans

infrastructure and backbone supported by a consortium of commercial providers. 18 Around this time, nearly 2 decades ago, the senior author (T.M.) and 2 colleagues wrote an article assessing the nascent Internet as a pediatric neurosurgery information resource. 22 The authors concluded that the information available was variable but generally relevant. Since then, the popularity and scope of the Internet has grown exponentially in an ever-changing environment 18 —from the use of floppy disks to hard drives to laptop computers and mobile devices. Today, Internet searches are

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Outcomes of instrumented fusion in the pediatric cervical spine

Clinical article

Steven W. Hwang, Loyola V. Gressot, Leonardo Rangel-Castilla, William E. Whitehead, Daniel J. Curry, Robert J. Bollo, Thomas G. Luerssen, and Andrew Jea

C ervical spine arthrodesis is typically used in the pediatric population when a patient has instability related to congenital or traumatic pathology. The etiology of mechanical instability includes trauma, os odontoideum, infection, atlantoaxial rotatory subluxation, juvenile rheumatoid arthritis, Down syndrome, mucopolysaccharidoses, spondyloepiphyseal dysplasia, iatrogenic causes, tumors, and other less common entities. 13 , 20 , 27 , 28 , 32 , 36 , 55 , 69 , 80 Although it only accounts for 1%–4% of overall spinal trauma, pediatric spinal trauma is

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Anatomical suitability of C1–2 transarticular screw placement in pediatric patients

Douglas L. Brockmeyer, Julie E. York, and Ronald I. Apfelbaum

–2 screw placement. In addition, a method for determining a potential screw trajectory was discussed. They concluded that 18 to 23% of patients “may not be suitable for posterior C1–2 transarticular screw fixation on at least one side.” Although that study is helpful as a reference, it cannot be applied directly to the pediatric population without discussing the unique anatomy of the developing craniovertebral junction and accounting for the challenges presented by congenital vertebral anomalies. In a recently published case series in which upper cervical fusion

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Effect of clevidipine on intracranial pressure in pediatric neurosurgical patients: a single-center retrospective review

Elizabeth Vadasz, Jeffrey Moss, Nathan Chang, May Casazza, and Lindsey Rasmussen

H emodynamic control in pediatric patients undergoing neurosurgical procedures is critical to avoid adverse outcomes, including hemorrhage, secondary neurological injury, and reductions in cerebral perfusion pressure (CPP). Intracranial pressure (ICP) monitoring is useful in neurocritical care patients, because elevations in ICP and hemodynamic instability correlate with poor cerebral perfusion and reduced brain tissue oxygenation. 1 Consensus guidelines in pediatric patients recommend ICP targets of < 20 mm Hg to prevent reductions in cerebral perfusion

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Hemispherectomy for treatment of refractory epilepsy in the pediatric age group: a systematic review

Christoph J. Griessenauer, Smeer Salam, Philipp Hendrix, Daxa M. Patel, R. Shane Tubbs, Jeffrey P. Blount, and Peter A. Winkler

on hemispherectomy with emphasis on seizure outcome stratified by type of hemispherectomy and underlying etiology. Methods A PubMed search was performed, of the literature until October 2013, with the search terms “hemispherectomy” and “outcome” limited to papers written in the English language with a focus on the pediatric age group. Additionally, papers retrieved from the references listed in the papers found in the PubMed search were also evaluated. Two reviewers independently applied the following inclusion criteria: reports of a total of 10 or more

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Acute spinal cord injury associated with multilevel pediatric idiopathic intervertebral disc calcification: case report

Sandi K. Lam, Christian M. Niedzwecki, Bradley Daniels, Rory R. Mayer, Mili M. Vakharia, and Andrew Jea

extrusion, and collaboration with the Physical Medicine and Rehabilitation team. The ultimate goal in the management of PIIVDC will be prevention of disc herniation and neurological compromise. Short of that goal, it is important to aim to reasonably predict the clinical outcomes for patients with a given severity of disease and a proposed treatment plan. Conclusions PIIVDC is a rare entity typically affecting the pediatric population. While it is generally treated by conservative management, with resorption of herniated calcified lesions over time, surgical

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Prognosis by tumor location for pediatric spinal cord ependymomas

Clinical article

Michael C. Oh, Eli T. Sayegh, Michael Safaee, Matthew Z. Sun, Gurvinder Kaur, Joseph M. Kim, Derick Aranda, Annette M. Molinaro, Nalin Gupta, and Andrew T. Parsa

E pendymoma arising in the brain or spinal cord is a common CNS tumor in children. 30 Spinal cord ependymoma constitutes only 13.1% of all pediatric ependymomas 24 and is the most common spinal cord tumor, followed by nerve sheath tumors and malignant neuronal/glial tumors. 24 , 37 Spinal cord ependymoma also demonstrates an older age distribution among children, as compared with tumors arising in a supratentorial or infratentorial location. 4 The WHO divides spinal cord ependymoma into 3 histological types: myxopapillary ependymomas and subependymomas

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Fast-sequence MRI studies for surveillance imaging in pediatric hydrocephalus

Clinical article

Daxa M. Patel, R. Shane Tubbs, Gigi Pate, James M. Johnston Jr., and Jeffrey P. Blount

Furthermore, recent evolution of MRI pulse sequences now allows for visibility of ventricular characteristics in the pediatric population. 13 , 17 , 18 , 21 The T2-weighted single-shot fast spin echo demonstrates ventricular size and gradient recalled-echo visualizes the shunt catheter. Nevertheless, to date, only 3 investigations of the utility of fsMRI for hydrocephalus assessment have been performed, and 2 of these were feasibility studies nearly 10 years ago. 1 , 15 , 20 We have incorporated an fsMRI protocol into our routine shunt surveillance and investigate its