Posterior interhemispheric retrocallosal approach to pineal region and posterior fossa lesions in a pediatric population

Object The purpose of this study was to evaluate the posterior interhemispheric retrocallosal approach (PIRA) for its safety and efficacy in the resection of pineal region and posterior fossa lesions in children. Methods Twenty-nine PIRAs were performed in 26 children between March 1997 and March 2009, and these cases were retrospectively reviewed. There were 15 girls and 11 boys in the series. The median age at the time of surgery was 7 years (range 7 months–17 years). Twenty-seven cases were treated for tumor, 1 for loculated hydrocephalus, and 1 for an aneurysm. Results Of the 27 cases treated for tumor, there were 20 (74%) gross-total resections, 5 (19%) subtotal resections, and 2 (7%) biopsies. One bridging vein was sacrificed in 6 cases and 2 bridging veins were divided in 1 case, whereas in 3 cases there was sacrifice of a single deep cerebral vein. No patient developed radiographic evidence of venous infarction. Approach-related complications were low, and included 2 cases of transient homonymous hemianopia. There were no surgery-related deaths. Conclusions This approach allows for ample access to pineal region and posterior fossa lesions, with low postoperative morbidity.

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Incidence of venous infarction after sacrificing middle-third superior sagittal sinus cortical bridging veins in a pediatric population

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.11.peds09261 ◽

2011 ◽

Vol 7 (3) ◽

pp. 224-228 ◽

Cited By ~ 12

Author(s):

Sean A. McNatt ◽

Ivan J. Sosa ◽

Mark D. Krieger ◽

J. Gordon McComb

Keyword(s):

Los Angeles ◽

Mr Imaging ◽

Superior Sagittal Sinus ◽

Pediatric Population ◽

Operative Procedure ◽

Neurological Injury ◽

Venous Infarction ◽

Transcallosal Approach ◽

Sagittal Sinus ◽

Bridging Veins

Object The interhemispheric transcallosal approach offers an excellent surgical corridor for the treatment of deep-seated midline lesions. The approach typically requires the sacrifice of one or more middle-third superior sagittal sinus (SSS) cortical bridging veins, which introduces the risk of venous infarction and associated neurological injury. The authors studied the incidence of venous infarcts following this operative approach in a pediatric population. Methods The authors performed a retrospective review of surgical cases involving pediatric patients treated at the Children's Hospital Los Angeles between 1990 and 2007, in which an interhemispheric transcallosal operative procedure was performed and one or more middle-third SSS cortical bridging veins were occluded. Postoperative MR imaging studies done 1–3 days following the procedure were analyzed and compared with preoperative studies. Results Sixty-three patients met the inclusion criteria. No patient developed MR imaging evidence of venous infarction. Conclusions The occlusion of one or more middle-third SSS cortical bridging veins related to the interhemispheric transcallosal approach resulted in no incidence of cerebral venous infarction in this pediatric population.

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Incidence of venous infarction after sacrificing middle-third superior sagittal sinus cortical bridging veins in a pediatric population

Yearbook of Neurology and Neurosurgery ◽

10.1016/j.yneu.2011.04.059 ◽

2011 ◽

Vol 2011 ◽

pp. 269-270

Author(s):

P. Klimo

Keyword(s):

Superior Sagittal Sinus ◽

Pediatric Population ◽

Venous Infarction ◽

Sagittal Sinus ◽

Bridging Veins

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Microsurgical anatomy of the pineal region

Journal of Neurosurgery ◽

10.3171/jns.1980.53.2.0205 ◽

1980 ◽

Vol 53 (2) ◽

pp. 205-221 ◽

Cited By ~ 68

Author(s):

Isao Yamamoto ◽

Naoki Kageyama

Keyword(s):

Cranial Nerves ◽

Pineal Region ◽

Superior Cerebellar Artery ◽

Cerebral Vein ◽

Microsurgical Anatomy ◽

Content Type ◽

Cerebellar Artery ◽

Bridging Vein ◽

Tentorial Notch ◽

Relationship Of

✓ Thirty cadaver brains were examined under × 6 to 16 magnification in order to define the microsurgical anatomy of the pineal region, particularly the relationship of the pineal body, posterior cerebral artery, superior cerebellar artery, vein of Galen, basal vein of Rosenthal, internal cerebral vein, straight sinus, bridging vein, the size of the tentorial notch, and the third and the fourth cranial nerves. The infratentorial and supratentorial approaches to the pineal region are compared from the viewpoint of microsurgical anatomy.

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The Safety and Efficacy Evaluation of Dexmedetomidine for Procedural Sedation and Postoperative Behaviors in Pediatric Populations: A Systematic Review and Meta-analysis

Annals of Pharmacotherapy ◽

10.1177/10600280211009845 ◽

2021 ◽

pp. 106002802110098

Author(s):

Linguang Gan ◽

Xiaohong Zhao ◽

Xiangjian Chen

Keyword(s):

Pediatric Population ◽

Meta Analysis ◽

Procedural Sedation ◽

Cochrane Library ◽

Control Group ◽

High Dose ◽

Efficacy Evaluation ◽

Safety And Efficacy ◽

Ovid Medline ◽

Pediatric Populations

Background: This study systematically evaluated the safety and efficacy of dexmedetomidine for procedural sedation and postoperative behaviors in a pediatric population as well as whether the results met the information required to draw conclusions. Objective: To evaluate the safety and efficacy evaluation of dexmedetomidine for procedural sedation and postoperative behaviors in a pediatric population. Methods: PubMed, Cochrane library, Web of Science and Ovid MEDLINE were searched to obtain randomized controlled trials (RCTs) comparing dexmedetomidine with control medicine and comparing different doses of dexmedetomidine. Results: There were a total of 16 RCTs for a total of 3240 patients. Dexmedetomidine slowed down the heart rate (HR; mean difference: −13.27; 95% CI: −16.41 to 10.14; P < 0.001) and reduced postoperative delirium (risk ratio [RR]: 0.31; 95% CI: 0.20-0.50; P < 0.001), the number of pain patients (RR: 0.48; 95% CI: 0.30-0.75; P = 0.002), and desaturation (RR: 0.34; 95% CI: 0.13-0.89; P = 0.03) compared with the control group. The limitation was that it was difficult to determine the range of low- and high-dose dexmedetomidine. Conclusion and Relevance: Dexmedetomidine slowed down intraoperative HR within the normal range, which might reduce myocardial oxygen consumption. It reduced postoperative pain and postoperative complications: delirium and desaturation. Dexmedetomidine showed no dose-dependent increase in the procedural sedation time of pediatric patients. Clinically, dexmedetomidine can improve pediatric procedural sedation and postoperative behavior, and it can be considered as a related medicine for safety in pediatric surgery.

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P06.05 The Sitting Position in the Very Young Pediatric Population: Pearls and Pitfalls of a 10-Years’ Experience

Neuro-Oncology ◽

10.1093/neuonc/noab180.083 ◽

2021 ◽

Vol 23 (Supplement_2) ◽

pp. ii25-ii25

Author(s):

S Linsler ◽

F Teping ◽

J Oertel

Keyword(s):

Posterior Fossa ◽

Pediatric Population ◽

Clinical Status ◽

Skull Fracture ◽

Special Focus ◽

Posterior Fossa Surgery ◽

Sitting Position ◽

Endoscopic Techniques ◽

Age At Surgery ◽

Persistent Foramen Ovale

Abstract BACKGROUND To investigate pearls and pitfalls of the sitting positioning in the pediatric population with special focus on related morbidity and surgical practicability. MATERIAL AND METHODS A retrospective analysis of a prospectively maintained internal database was performed. All pediatric patients younger than 18 years at date of surgery, who underwent procedures in sitting position between 01/2010 and 10/2020 were included into this analysis. RESULTS A total of 42 of posterior fossa surgeries were performed in 38 children between 01/2010 and 10/2020. Mean age at surgery was 8.9 years (13 months - 18 years). Mean height and weight were 134.4 (± 30.2) cm and 36.6 (± 21.7) kg respectively. Three children (7.9%) were diagnosed with persistent foramen ovale. Electrophysiologic monitoring was unremarkable during positioning in all cases. Mean time needed for anesthesiologic preparation and positioning was 84.5 (± 20.6) minutes. Perioperative blood transfusion was needed in 5 cases (11.9%). Incidence of VAE was 11.9%. There was no VAE related severe complication. One child (2.4%) showed postoperative skull fracture and epidural bleeding due to skull clamp application. Clinical status immediately after surgery was favorable or stable in 33 of the cases (78.6%). CONCLUSION Attentive performance and an experienced surgical team provided; the sitting position remains a safe variant for posterior fossa surgery in the pediatric population. Precautious skull clamp application and appropriate monitoring is highly recommended. Considering eloquent aspects, the sitting position offers excellent anatomical exposure and is ideal for combination with endoscopic techniques.

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Papillary tumor of the pineal region in a 15-month-old boy

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.2.peds10434 ◽

2011 ◽

Vol 7 (5) ◽

pp. 534-538 ◽

Cited By ~ 16

Author(s):

Jessica Li ◽

Pablo F. Recinos ◽

Brent A. Orr ◽

Peter C. Burger ◽

George I. Jallo ◽

...

Keyword(s):

Pediatric Population ◽

Proton Beam Therapy ◽

Pineal Region ◽

Biological Behavior ◽

Imaging Diagnosis ◽

Papillary Tumor ◽

Distinct Entity ◽

Pineal Region Tumor ◽

Appropriate Treatment

The papillary tumor of the pineal region (PTPR) is a distinct entity that is particularly rare in the pediatric population. The authors document the youngest reported patient with this clinicopathological entity to date. A case of PTPR in a 15-month-old boy is described. Initially thought to be a tectal glioma, the tumor was later identified as a pineal region tumor after demonstrating growth on routine imaging. Diagnosis of PTPR was established by histopathological evaluation of biopsy samples, which revealed papillary, cystic, and solid tumor components. The patient's postoperative course was complicated by tumor growth despite several debulking procedures and chemotherapy, as well as persistent hydrocephalus requiring 2 endoscopic third ventriculostomies and eventual ventriculoperitoneal shunt placement. After a 15-month follow-up period, the patient has received proton-beam therapy and has a stable tumor size. The PTPR is a recently described tumor of the CNS that must be included in the differential diagnosis of pineal region masses. The biological behavior, prognosis, and appropriate treatment of PTPR have yet to be fully defined.

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Syringobulbia in a Pediatric Population

Neurosurgery ◽

10.1227/01.neu.0000188282.72429.79 ◽

2005 ◽

Vol 57 (6) ◽

pp. 1147-1153 ◽

Cited By ~ 15

Author(s):

Jeremy D.W. Greenlee ◽

Arnold H. Menezes ◽

Bryan A. Bertoglio ◽

Kathleen A. Donovan

Keyword(s):

Posterior Fossa ◽

Cranial Nerve ◽

Fourth Ventricle ◽

Pediatric Population ◽

Demographic Data ◽

Posterior Fossa Decompression ◽

Radiographic Findings ◽

Presenting Symptoms ◽

Cranial Nerve Dysfunction ◽

Cranial Nerve Palsies

Abstract OBJECTIVE: To better understand the presentation, management, and outcome of syringobulbia in the pediatric age group. METHODS: The University of Iowa pediatric neurosurgery database was searched for patients under the age of 18 with a diagnosis of syringobulbia. The patients' records were retrospectively reviewed for demographic data, chief complaint and presenting symptoms, neurological and radiographic findings, treatment, outcome, and complications. Children with open neural tube defects and Chiari II malformations were excluded. RESULTS: Six pediatric patients were identified as meeting inclusion criteria. The average age at time of surgery was 14.8 years. The chief complaints were vision impairment in three children and numbness, gait instability, and headache worsened with Valsalva in one patient each. Other prominent symptoms included sleep apnea and weakness. All patients showed at least one cranial nerve dysfunction. Radiographs revealed hindbrain herniation and associated syringomyelia in all cases. Two patients had scoliosis. Treatment was posterior fossa decompression with cerebellar tonsillar shrinkage, opening of foramen of Magendie, and duraplasty. Two patients also required concomitant ventral decompression. The cavity of syringobulbia communicated with syringomyelia and the fourth ventricle in most children but was distinct from the fourth ventricle. Two patients received fourth ventricle to subarachnoid shunts. Follow-up averaged 3.2 years, and all patients clinically improved after surgery. Magnetic resonance imaging documented resolution of syringobulbia in all cases, with syringomyelia improving in all cases. There was no permanent morbidity or mortality in the series. CONCLUSION: Syringobulbia is strongly associated with Chiari malformation and syringomyelia, and patients often present because of cranial nerve palsies. Posterior fossa decompression is a safe and effective treatment.

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Safety and efficacy of stereoelectroencephalography in pediatric focal epilepsy: a single-center experience

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.5.peds1856 ◽

2018 ◽

Vol 22 (4) ◽

pp. 444-452 ◽

Cited By ~ 5

Author(s):

Hannah E. Goldstein ◽

Brett E. Youngerman ◽

Belinda Shao ◽

Cigdem I. Akman ◽

Arthur M. Mandel ◽

...

Keyword(s):

Pediatric Patients ◽

Surgical Intervention ◽

Focal Epilepsy ◽

Wound Care ◽

Pediatric Population ◽

Attractive Alternative ◽

Safety And Efficacy ◽

Single Center Experience ◽

A Minor

OBJECTIVEPatients with medically refractory localization-related epilepsy (LRE) may be candidates for surgical intervention if the seizure onset zone (SOZ) can be well localized. Stereoelectroencephalography (SEEG) offers an attractive alternative to subdural grid and strip electrode implantation for seizure lateralization and localization; yet there are few series reporting the safety and efficacy of SEEG in pediatric patients.METHODSThe authors review their initial 3-year consecutive experience with SEEG in pediatric patients with LRE. SEEG coverage, SOZ localization, complications, and preliminary seizure outcomes following subsequent surgical treatments are assessed.RESULTSTwenty-five pediatric patients underwent 30 SEEG implantations, with a total of 342 electrodes placed. Ten had prior resections or ablations. Seven had no MRI abnormalities, and 8 had multiple lesions on MRI. Based on preimplantation hypotheses, 7 investigations were extratemporal (ET), 1 was only temporal-limbic (TL), and 22 were combined ET/TL investigations. Fourteen patients underwent bilateral investigations. On average, patients were monitored for 8 days postimplant (range 3–19 days). Nearly all patients were discharged home on the day following electrode explantation.There were no major complications. Minor complications included 1 electrode deflection into the subdural space, resulting in a minor asymptomatic extraaxial hemorrhage; and 1 in-house and 1 delayed electrode superficial scalp infection, both treated with local wound care and oral antibiotics.SEEG localized the hypothetical SOZ in 23 of 25 patients (92%). To date, 18 patients have undergone definitive surgical intervention. In 2 patients, SEEG localized the SOZ near eloquent cortex and subdural grids were used to further delineate the seizure focus relative to mapped motor function just prior to resection. At last follow-up (average 21 months), 8 of 15 patients with at least 6 months of follow-up (53%) were Engel class I, and an additional 6 patients (40%) were Engel class II or III. Only 1 patient was Engel class IV.CONCLUSIONSSEEG is a safe and effective technique for invasive SOZ localization in medically refractory LRE in the pediatric population. SEEG permits bilateral and multilobar investigations while avoiding large craniotomies. It is conducive to deep, 3D, and perilesional investigations, particularly in cases of prior resections. Patients who are not found to have focally localizable seizures are spared craniotomies.

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