scholarly journals Incidental durotomy in the pediatric spine population

2018 ◽  
Vol 22 (5) ◽  
pp. 591-594
Author(s):  
James L. West ◽  
Madison Arnel ◽  
Atilio E. Palma ◽  
John Frino ◽  
Alexander K. Powers ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Primary Repair ◽  
Pediatric Population ◽  
Treatment Options ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Pedicle Screws ◽  
Tethered Cord ◽  
Csf Leak ◽  
Incidental Durotomy

OBJECTIVESpine surgery is less common in children than adults. These surgeries, like all others, are subject to complications such as bleeding, infection, and CSF leak. The rate of incidental durotomy in the pediatric population, and its associated complications, has scarcely been reported in the literature.METHODSThis is a retrospective chart review of all pediatric patients operated on at Wake Forest Baptist Health from 2012 to 2017 who underwent spine surgeries. The authors excluded any procedures with intended durotomy, such as tethered cord release or spinal cord tumor resection.RESULTSFrom 2012 to 2017, 318 pediatric patients underwent surgery for a variety of indications, including adolescent idiopathic scoliosis (51.9%), neuromuscular scoliosis (27.4%), thoracolumbar fracture (2.83%), and other non–fusion-related indications (3.77%). Of these patients, the average age was 14.1 years, and 71.0% were female. There were 6 total incidental durotomies, resulting in an overall incidence of 1.9%. The incidence was 18.5% in revision operations, compared to 0.34% for index surgeries. Comparison of the revision cohort to the durotomy cohort revealed a trend toward increased length of stay, operative time, and blood loss; however, the trends were not statistically significant. The pedicle probe was implicated in 3 cases and the exact cause was not ascertained in the remaining 3 cases. The 3 durotomies caused by pedicle probe were treated with bone wax; 1 was treated with dry Gelfoam application and 2 were treated with primary repair. Only 1 patient had a persistent leak postoperatively that eventually required wound revision.CONCLUSIONSIncidental durotomy is an uncommon occurrence in the pediatric spinal surgery population. The majority occurred during placement of pedicle screws, and they were easily treated with bone wax at the time of surgery. Awareness of the incidence, predisposing factors, and treatment options is important in preventing complications and disability.

384 Post-Operative ICU Admission for Elective Craniotomy for Intra-axial Brain Tumor Resection

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 291-292
Author(s):  
Farhan A Mirza ◽  
Catherine Y Wang ◽  
Thomas Pittman
Keyword(s):  
Brain Tumor ◽  
Pediatric Patients ◽  
Prolonged Mechanical Ventilation ◽  
Pediatric Population ◽  
External Ventricular Drain ◽  
Tumor Resection ◽  
Retrospective Chart Review ◽  
Icu Admission ◽  
Icu Stay ◽  
Brain Tumor Resection

Abstract INTRODUCTION We reviewed our practice at the University of Kentucky in order to assess the safety of admitting adult and pediatric patients to floor beds after craniotomy, exclusively for intra-axial brain tumor resection. METHODS Retrospective chart review of patients, adults and pediatric, who underwent craniotomy by a single surgeon (TP) for intra axial brain tumor resection between January 2012 and December 2015. 413 patient charts were reviewed, 16 were omitted due to incomplete records. RESULTS >421 craniotomies for intra axial brain tumor resection were performed. 397 patients underwent surgery, 35 of whom were <18 years of age.188 females and 209 males. 351 patients (331 adults, 20 pediatric) were admitted to floor beds. In this group, length of operation was <4 hours in 346 patients (99.1%) and >4 hours in only 5 patients (0.9%). 3 patients (0.8%) required transfer to ICU within 24 hours of floor admission. 55 adult patients required ICU stay for various reasons: 9 patients had pre-operative or intra operative EVD placement; 15 patients required prolonged ventilation; 1 patient had to be taken back to the operating room for hemorrhage evacuation; 5 had intraventricular tumors and were planned ICU admissions; 26 patients were admitted pre-operatively to an ICU bed on a non neurosurgical service and were returning to their assigned beds. In the pediatric population, 15 patients required ICU stay: 8 were for EVD management and 7 for prolonged operation or frequent neurological evaluations. In this group, the length of operation was <4 hours in 40 patients(57.1%) and >4 hours in 30 patients (42.9%). CONCLUSION Admitting adult and pediatric patients to floor beds after craniotomy for intra-axial brain tumor resection is safe. There are some conditions that mandate ICU admission: these include prolonged mechanical ventilation and the presence of an external ventricular drain.

scholarly journals Risks, costs, and outcomes of cerebrospinal fluid leaks after pediatric skull fractures: a MarketScan analysis between 2007 and 2015

2019 ◽  
Vol 47 (5) ◽  
pp. E10
Author(s):  
Kunal Varshneya ◽  
Adrian J. Rodrigues ◽  
Zachary A. Medress ◽  
Martin N. Stienen ◽  
Gerald A. Grant ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Skull Fracture ◽  
Neurological Deficits ◽  
Csf Leak ◽  
Skull Fractures ◽  
Pediatric Head Trauma ◽  
Cerebrospinal Fluid Leaks ◽  
Neurosurgical Intervention ◽  
Csf Leaks

OBJECTIVESkull fractures are common after blunt pediatric head trauma. CSF leaks are a rare but serious complication of skull fractures; however, little evidence exists on the risk of developing a CSF leak following skull fracture in the pediatric population. In this epidemiological study, the authors investigated the risk factors of CSF leaks and their impact on pediatric skull fracture outcomes.METHODSThe authors queried the MarketScan database (2007–2015), identifying pediatric patients (age < 18 years) with a diagnosis of skull fracture and CSF leak. Skull fractures were disaggregated by location (base, vault, facial) and severity (open, closed, multiple, concomitant cerebral or vascular injury). Descriptive statistics and hypothesis testing were used to compare baseline characteristics, complications, quality metrics, and costs.RESULTSThe authors identified 13,861 pediatric patients admitted with a skull fracture, of whom 1.46% (n = 202) developed a CSF leak. Among patients with a skull fracture and a CSF leak, 118 (58.4%) presented with otorrhea and 84 (41.6%) presented with rhinorrhea. Patients who developed CSF leaks were older (10.4 years vs 8.7 years, p < 0.0001) and more commonly had skull base (n = 183) and multiple (n = 22) skull fractures (p < 0.05). These patients also more frequently underwent a neurosurgical intervention (24.8% vs 9.6%, p < 0.0001). Compared with the non–CSF leak population, patients with a CSF leak had longer average hospitalizations (9.6 days vs 3.7 days, p < 0.0001) and higher rates of neurological deficits (5.0% vs 0.7%, p < 0.0001; OR 7.0; 95% CI 3.6–13.6), meningitis (5.5% vs 0.3%, p < 0.0001; OR 22.4; 95% CI 11.2–44.9), nonroutine discharge (6.9% vs 2.5%, p < 0.0001; OR 2.9; 95% CI 1.7–5.0), and readmission (24.7% vs 8.5%, p < 0.0001; OR 3.4; 95% CI 2.5–4.7). Total costs at 90 days for patients with a CSF leak averaged $81,206, compared with $32,831 for patients without a CSF leak (p < 0.0001).CONCLUSIONSThe authors found that CSF leaks occurred in 1.46% of pediatric patients with skull fractures and that skull fractures were associated with significantly increased rates of neurosurgical intervention and risks of meningitis, hospital readmission, and neurological deficits at 90 days. Pediatric patients with skull fractures also experienced longer average hospitalizations and greater healthcare costs at presentation and at 90 days.

Pathophysiology of adult tethered cord syndrome: review of the literature

2010 ◽  
Vol 29 (1) ◽  
pp. E2 ◽  
Author(s):  
William R. Stetler ◽  
Paul Park ◽  
Stephen Sullivan
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Tethered Spinal Cord ◽  
Spinal Cord Blood Flow ◽  
Pubmed Database ◽  
Spinal Cord Tethering

Object Tethering of the spinal cord has been a recognized cause of neurological symptoms in pediatric patients and is increasingly being recognized as a cause of symptoms in adults as well. The pathophysiology surrounding spinal cord tethering has begun to be understood in the pediatric population but is still unclear in adult patients. Methods Using a PubMed database literature search, the authors reviewed the pathology and pathophysiology surrounding the tethered spinal cord, focusing particularly on the pathophysiology of adult tethered cord syndrome (TCS). Results Experimental data obtained in pediatric patients at surgery and in animal models indicate that spinal cord tethering causes a reduction in spinal cord blood flow and dysfunction of neuronal mitochondrial terminal oxidase. Retrospective analyses of patients undergoing surgery for adult TCS show that many adults developed symptoms following an event that could stretch the spinal cord, while others did not. Many patients also were found to have structural lesions in addition to a tethered spinal cord at diagnosis. Conclusions Both adult and pediatric TCSs are likely the result of a relative lack of blood flow to the spinal cord, causing dysfunction in mitochondrial oxidative phosphorylation. The likely reason the syndrome present later and differently in adults is that a secondary threshold of tension or a cumulative effect of repetitive, transient tension is placed on the cord before symptoms are recognized.

scholarly journals Overactive bladder in children

2017 ◽  
Vol 11 (1-2S) ◽  
pp. 74 ◽  
Author(s):  
Sophie Ramsay ◽  
Stéphane Bolduc
Keyword(s):  
Quality Of Life ◽  
Overactive Bladder ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Treatment Options ◽  
Self Esteem ◽  
Behavioural Therapy ◽  
Stepwise Approach ◽  
Pediatric Use

Overactive bladder (OAB) is a highly prevalent disorder in the pediatric population. This condition is especially troublesome for pediatric patients and their families when associated with incontinence, since it negatively affects self-esteem and impairs children’s development. From the patient’s perspective, urgency and urge incontinence can have a significant impact, negatively affecting their quality of life. For a therapy to have true benefit, changes must not only be statistically significant, but must also be perceived as meaningful by the patient. A stepwise approach is favoured to treat this pathology, starting with behavioural therapy, followed by medical management, and eventually more invasive procedures.Antimuscarinic agents are the mainstay of medical treatment for OAB. Oxybutynin is the most commonly used antimuscarinic in the pediatric population. However, some patients have a suboptimal response to antimuscarinics and many experience bothersome side effects, which have been documented with all antimuscarinics to a significantly higher degree than placebo. Although there have been reports about the use of tolterodine, fesoterodine, trospium, propiverine, and solifenacin in children, to date, only oxybutynin has been officially approved for pediatric use by medical authorities in North America.This review will address alternative treatment options for pediatric patients presenting with OAB, from conservative measures to more invasive therapies.

Graft dural closure is associated with a reduction in CSF leak and hydrocephalus in pediatric patients undergoing posterior fossa brain tumor resection

2020 ◽  
Vol 25 (3) ◽  
pp. 228-234
Author(s):  
Andrew T. Hale ◽  
Stephen R. Gannon ◽  
Shilin Zhao ◽  
Michael C. Dewan ◽  
Ritwik Bhatia ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Wound Infection ◽  
Posterior Fossa ◽  
Pediatric Patients ◽  
Tumor Resection ◽  
Csf Leak ◽  
Multivariate Logistic Regression ◽  
Dural Closure ◽  
Csf Diversion ◽  
Persistent Hydrocephalus

OBJECTIVEThe authors aimed to evaluate clinical, radiological, and surgical factors associated with posterior fossa tumor resection (PFTR)–related outcomes, including postoperative complications related to dural augmentation (CSF leak and wound infection), persistent hydrocephalus ultimately requiring permanent CSF diversion after PFTR, and 90-day readmission rate.METHODSPediatric patients (0–17 years old) undergoing PFTR between 2000 and 2016 at Monroe Carell Jr. Children’s Hospital of Vanderbilt University were retrospectively reviewed. Descriptive statistics included the Wilcoxon signed-rank test to compare means that were nonnormally distributed and the chi-square test for categorical variables. Variables that were nominally associated (p < 0.05) with each outcome by univariate analysis were included as covariates in multivariate linear regression models. Statistical significance was set a priori at p < 0.05.RESULTSThe cohort consisted of 186 patients with a median age at surgery of 6.62 years (range 3.37–11.78 years), 55% male, 83% Caucasian, and average length of follow-up of 3.87 ± 0.25 years. By multivariate logistic regression, the variables primary dural closure (PDC; odds ratio [OR] 8.33, 95% confidence interval [CI] 1.07–100, p = 0.04), pseudomeningocele (OR 7.43, 95% CI 2.23–23.76, p = 0.0007), and hydrocephalus ultimately requiring permanent CSF diversion within 90 days of PFTR (OR 9.25, 95% CI 2.74–31.2, p = 0.0003) were independently associated with CSF leak. PDC versus graft dural closure (GDC; 35% vs 7%, OR 5.88, 95% CI 2.94–50.0, p = 0.03) and hydrocephalus ultimately requiring permanent CSF diversion (OR 3.30, 95% CI 1.07–10.19, p = 0.0007) were associated with wound infection requiring surgical debridement. By multivariate logistic regression, GDC versus PDC (23% vs 37%, OR 0.13, 95% CI 0.02–0.87, p = 0.04) was associated with persistent hydrocephalus ultimately requiring permanent CSF diversion, whereas pre- or post-PFTR ventricular size, placement of peri- or intraoperative extraventricular drain (EVD), and radiation therapy were not. Furthermore, the addition of perioperative EVD placement and dural closure method to a previously validated predictive model of post-PFTR hydrocephalus improved its performance from area under the receiver operating characteristic curve of 0.69 to 0.74. Lastly, the authors found that autologous (vs synthetic) grafts may be protective against persistent hydrocephalus (p = 0.02), but not CSF leak, pseudomeningocele, or wound infection.CONCLUSIONSThese results suggest that GDC, independent of potential confounding factors, may be protective against CSF leak, wound infection, and hydrocephalus in patients undergoing PFTR. Additional studies are warranted to further evaluate clinical and surgical factors impacting PFTR-associated complications.

scholarly journals Cerebrospinal Fluid Leak after Repair of Congenital Spinal Pathologies, Incidence and Management

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
BILAL KHAN ◽  
USMAN HAQQANI ◽  
RIZWAN ULLAH KHATTAK ◽  
SHAFAAT HUSSAIN
Keyword(s):  
Primary Repair ◽  
Spinal Dysraphism ◽  
Tethered Cord ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Spinal Deformities ◽  
Common Complication ◽  
The Mean ◽  
Fluid Leak

Objective:  To know the incidence of CSF leak and role of tincture benzoyl in the management of CSF leak after the repair of congenital spinal deformities like myelomeningocele, meningocele and tethered cord syndrome.Materials and Methods:  All patients who were operated for congenital spinal surgeries in the form of MMC, Meningocele and TCS by a single surgeon were followed for a minimum of 3 months. Patients with already CSF leak/ruptured MMC prior to surgery were not part of the study. The particulars like gender and type of surgery, days since first surgery, associated infection, hydrocephalus and type of management were noted on a proforma.Results:  A total of 73 patients with spinal dysraphism were operated during the study period and of them about 13 patients returned with problems of the CSF leak. The mean duration and duration since the CSF leak was from 6 days to 16 days. Among them, 10 patients had an MMC repair and one patient had TCS release, while 2 patients were having meningocele repair. The patients were stitched and one patient was re-operated two times for repair of CSF leak. Two patients had a CSF leak along with post op signs of HCP that settled by placing a shunt along with primary repair of the wound reinforced with tincture benzoyl in a single setting. Conclusion:  CSF leak is a common complication following repair of spinal dysraphism and most patients can be managed with the application of tincture benzoyl alone or after simple skin reinforcement.

scholarly journals Orbital Lymphangioma: Case Report and Management Paradigms

2017 ◽  
Vol 36 (02) ◽  
pp. 136-140
Author(s):  
Alex Roman ◽  
Larissa Bianchini ◽  
Bárbara Battistel ◽  
Miguel Franzoi Neto ◽  
Daniela Schwingel
Keyword(s):  
Case Report ◽  
Present Report ◽  
Pediatric Population ◽  
Treatment Options ◽  
Tumor Resection ◽  
Neck Region ◽  
Systemic Circulation ◽  
Needle Aspiration ◽  
Intralesional Injection ◽  
Sclerosing Agents

Introduction Lymphangioma is a rare congenital vascular malformation of the head and neck region isolated from the systemic circulation. It has a benign etiology, and represents 1–3% of all orbital tumors. These hamartomas often present in the pediatric population with a slightly female predilection. They have a lymphocytic composition, and may increase in size with episodes of viral infection, causing proptosis. Discussion The management of this lesion is controversial, hardly curative, and depends on the clinical presentation. The treatment options include partial surgical resection of the major cyst, needle aspiration, surgical debulking, systemic steroids, sildenafil, intralesional injection of the sclerosing agents, and local radiotherapy. Case Report In the present report, we describe an uncommon case of lymphangioma in a 6-year-old female who was first submitted to neurosurgery for tumor resection and received sildenafil therapy later, with promising results. Conclusion The treatment of orbital lymphangiomas remains a controversial topic, and the use of sildenafil along with needle aspiration and microsurgical removal is a viable option of treatment. However, many issues, such as the ideal duration of the therapy, the dosage regimen and the recurrence rate, still remain unclear. Our case report adds promising data on this pathology, even though larger trials are needed to properly elucidate the remaining questions.

scholarly journals Vertebral plate and ligament composite laminoplasty in spinal cord tumor surgery: Analysis of 94 patients

2021 ◽  
Vol 12 (1) ◽  
pp. 040-045
Author(s):  
Xu Hao ◽  
Wang Lin
Keyword(s):  
Spinal Cord ◽  
Spinal Deformity ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Cervical Vertebra ◽  
Csf Leak ◽  
Tumor Surgery ◽  
Bone Fusion ◽  
Significant Difference ◽  
Similar Risk

Abstract Objectives The aim of this study was to evaluate the value and long-term effect of laminectomy or laminoplasty in spinal cord tumor surgery. Patients and methods Patients with spinal cord tumor treated in Department of Neurosurgery from January 2016 to October 2019 were included in this study. Posterior median approach tumor resection was preceded in 94 cases. Vertebral plate and ligament composite replant (laminoplasty group) was proceeded in 34 cases, and vertebral plate resection (laminectomy group) was proceeded in 60 cases. All patients were followed up and neurological function imagings were conducted 1 week, 3 months, and 6 months postsurgery to evaluate the surgical efficiency and spinal stability. Results Total resection was achieved in 84 patients (89.0%); subtotal resection was achieved in 10 patients (11%). There was no significant difference between thelaminectomy group and laminoplasty group in terms of operative time, surgical site, infection rate, cerebrospinal fluid (CSF) infection, CSF leak, and length of hospitalization (P > 0.05). The incidence of postoperative spinal deformity was 15.0% in the laminectomy group and 11.7% in the laminoplasty group (P > 0.05). Laminoplasty vs laminectomy was associated with a similar risk of progressive deformity. However, for the cervical patients, there is significant difference (P < 0.05) in the spinal deformity. For the patients with incision vertebral segments >3, there is no significant difference in the spinal deformity (P > 0.05). Bone fusion was achieved in 7 (20%) patients in the laminoplasty group. Laminoplasty vs laminectomy was associated with a similar risk of progressive deformity. Conclusion Vertebral plate and ligament composite replant is a simple and practical method in spinal cord tumor surgery. Neither every case got bone fusion nor positive results turned out in survival analysis, but it is still valuable in reducing spinal deformity, especially in cervical vertebra spinal cord tumor surgery.

Resection of a Thoracic Hemangioblastoma in a Patient With Von Hippel-Lindau: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. 395-395 ◽  
Author(s):  
Simone E Dekker ◽  
Thomas A Ostergard ◽  
Chad A Glenn ◽  
Berje Shammassian ◽  
Efrem Cox ◽  
...  
Keyword(s):  
Treatment Options ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
En Bloc ◽  
Intramedullary Spinal Cord ◽  
Von Hippel Lindau ◽  
3 Dimensional ◽  
Intramedullary Lesion ◽  
Postoperative Mri ◽  
History Of

Abstract This 3-dimensional operative video illustrates resection of a thoracic hemangioblastoma in a 30-year-old female with a history of Von Hippel-Lindau disease. The patient presented with right lower extremity numbness and flank pain. Magnetic resonance imaging (MRI) demonstrated an enhancing intradural intramedullary lesion at T 7 consistent with a hemangioblastoma. The patient underwent a thoracic laminectomy with a midline dural opening for tumor resection. This case demonstrates the principles of intradural intramedullary spinal cord tumor resection. In this particular case, internal debulking was untenable owing to the vascular nature of hemangioblastomas. The operative video demonstrates en bloc tumor removal. Postoperative MRI demonstrated gross total resection. The postoperative course was uneventful. The natural history of this disease, treatment options, and potential complications are discussed.

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