Pinning in pediatric neurosurgery: the modified rubber stopper technique

2020 ◽  
Vol 26 (1) ◽  
pp. 98-103
Author(s):  
Melissa A. LoPresti ◽  
Joshua Nguyen ◽  
Sandi K. Lam
Keyword(s):  
Pediatric Patients ◽  
Pediatric Neurosurgery ◽  
Rubber Stopper ◽  
Microsurgical Techniques ◽  
Head Clamp

Head immobilization devices with skull pins are commonly used by neurosurgeons to stabilize the head for microsurgical techniques and to maintain accurate intraoperative neuronavigation. Pediatric patients, who may have open fontanelles, unfused sutures, and thin skulls, are vulnerable to complications during placement in pins. We review the various methods of pinning in pediatric neurosurgery and revisit the modified rubber stopper technique using a commonly available rubber stopper from a medication bottle over a standard adult pin of a Mayfield head clamp to prevent the pins from plunging through the thin pediatric skull.

scholarly journals Pediatric neurosurgery telemedicine clinics: a model to provide care to geographically underserved areas of the United States and its territories

2016 ◽  
Vol 18 (6) ◽  
pp. 753-757 ◽  
Author(s):  
Hector E. James
Keyword(s):  
Pediatric Patients ◽  
Pediatric Neurosurgery ◽  
Clinical History ◽  
The United States ◽  
Nursing Personnel ◽  
Cultural Barriers ◽  
University Of Florida ◽  
Clinic Patient ◽  
The University ◽  
Physical Findings

OBJECTIVE The author describes the creation, structuring, and development of a pediatric neurosurgery telemedicine clinic (TMC) to provide telehealth across geographical, time, social, and cultural barriers. METHODS In July 2009 the University of Florida (UF) Division of Pediatric Neurosurgery received a request from the Southeast Georgia Health District (Area 9–2) to provide a TMC to meet regional needs. The Children's Medical Services (CMS) of the State of Georgia installed telemedicine equipment and site-to-site connectivity. Audiovisual connectivity was performed in the UF Pediatric Neurosurgery office, maintaining privacy and HIPAA (Health Insurance Portability and Accountability Act) requirements. Administrative steps were taken with documentation of onsite training of the secretarial and nursing personnel of the CMS clinic. Patient preregistration and documentation were performed as required by the UF College of Medicine–Jacksonville. Monthly clinics are held with the CMS nursing personnel presenting the pertinent clinical history and findings to the pediatric neurosurgeon in the presence of the patient/parents. Physical findings and diagnostic studies are discussed, and management decisions are made. RESULTS The first TMC was held in August 2011. A total of 40 TMC sessions have been held through January 2016, with a total of 43 patients seen: 13 patients once; 13 patients twice; 8 patients for 3 visits; 2 for 4 visits; 2 for 6 visits; 2 for 5 visits; 2 for 7 visits; and 1 patient has been seen 8 times. CONCLUSIONS Pediatric patients in areas of the continental US and its territories with limited access to pediatric neurosurgery services could benefit from this model, if other pediatric neurosurgery centers provide telehealth services.

scholarly journals Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery

2017 ◽  
Vol 19 (4) ◽  
pp. 421-427 ◽  
Author(s):  
Brandon A. Sherrod ◽  
Brandon G. Rocque
Keyword(s):  
Length Of Stay ◽  
Surgical Site Infection ◽  
Pediatric Patients ◽  
Pediatric Neurosurgery ◽  
Neurosurgical Procedures ◽  
Site Infection ◽  
Improvement Program ◽  
Superficial Infection ◽  
Index Procedure ◽  
Postoperative Length

OBJECTIVE Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. METHODS The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program–Pediatric (NSQIP-P) 2012–2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. RESULTS A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p < 0.001 for each). Post-SSI sepsis rates (6.3% vs 28.0% for superficial versus deep SSI, respectively; p < 0.001), wound disruption rates (4.9% vs 22.4%, p < 0.001), and reoperation rates (23.6% vs 70.1%, p < 0.001) were significantly greater for patients with deep SSIs. Postoperative length of stay in patients discharged before SSI development was not significantly different for deep versus superficial SSI (4.2 ± 2.7 vs 3.6 ± 2.4 days, p = 0.094). No patient with SSI died within 30 days after surgery. CONCLUSIONS Thirty-day SSI is associated with significant 30-day morbidity in pediatric patients undergoing nonshunt neurosurgery. Rates of SSI-associated complications are significantly lower in patients with superficial infection than in those with deep infection. There were no cases of SSI-related mortality within 30 days of the index procedure.

Endoscopic Third Ventriculostomy in Pediatric Patients: The Canadian Experience

Neurosurgery ◽  
2007 ◽  
Vol 60 (5) ◽  
pp. 881-886 ◽  
Author(s):  
James M. Drake
Keyword(s):  
Pediatric Patients ◽  
Endoscopic Third Ventriculostomy ◽  
Cox Model ◽  
Pediatric Neurosurgery ◽  
Third Ventriculostomy ◽  
Time To Failure ◽  
Success Rates ◽  
Accurate Analysis ◽  
Young Infants ◽  
Small Series

Abstract OBJECTIVE Reports from relatively small series of pediatric patients predominantly from single centers have hampered accurate analysis of outcome from endoscopic third ventriculostomy. We combined patients from nine pediatric neurosurgery centers across Canada to obtain a better estimate of outcome and identify factors affecting success of the procedure. METHODS Databases were recoded for uniformity. Failure of the procedure was defined as any subsequent operation or death resulting from hydrocephalus. Time to failure was analyzed by Kaplan-Meier estimate and Cox proportional hazard analysis. RESULTS During a 15-year period (1989–2004), 368 patients underwent the procedure. The average age was 6.5 years, and 57% were male. Aqueduct stenosis and tumors were the most common etiology, comprising 34 and 29%, respectively. Twenty-two percent of the patients had been previously shunted. The 1- and 5-year success rates were 65 and 52%, respectively. Factors included in the Cox model were age, sex, etiology of hydrocephalus, previous surgery, center volume, and surgeon volume. By multivariate analysis, only age had a significant effect on outcome, with younger patients failing at higher rates, particularly neonates and infants. CONCLUSION Based on data from multiple Canadian centers, age seems to be the primary determinant of outcome in endoscopic third ventriculostomy in pediatric patients. Failure rates are particularly high in neonates and young infants; thus, the role of this procedure in this age group should be carefully considered.

scholarly journals Laparoscopic assisted ventriculoperitoneal shunt revisions as an option for pediatric patients with previous intraabdominal complications

2014 ◽  
Vol 72 (4) ◽  
pp. 307-311 ◽  
Author(s):  
Fernanda O. de Carvalho ◽  
Antonio R. Bellas ◽  
Luciano Guimarães ◽  
José Francisco Salomão
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Pediatric Patients ◽  
Pediatric Neurosurgery ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Abdominal Pseudocyst ◽  
Effective Option ◽  
Video Laparoscopy ◽  
Laparoscopic Assisted

Multiple shunt failure is a challenge in pediatric neurosurgery practice and one of the most feared complications of hydrocephalus. Objective: To demonstrate that laparoscopic procedures for distal ventriculoperitoneal shunt failure may be an effective option for patients who underwent multiple revisions due to repetitive manipulation of the peritoneal cavity, abdominal pseudocyst, peritonitis or other situations leading to a “non reliable” peritoneum. Method: From March 2012 to February 2013, the authors reviewed retrospectively the charts of six patients born and followed up at our institution, which presented with previous intra-peritoneal complications and underwent ventriculoperitoneal shunt revision assisted by video laparoscopy. Results: After a mean follow-up period of nine months, all patients are well and no further shunt failure was identified so far. Conclusion: Laparoscopy assisted shunt revision in children may be, in selected cases, an effective option for patients with multiple peritoneal complications due to ventriculo-peritoneal shunting.

scholarly journals Postoperative Analgesia for Pediatric Craniotomy Patients: A Randomized Controlled Trial

2019 ◽  
Author(s):  
Fei Xing ◽  
LiXin An ◽  
FuShan Xue ◽  
ChunMei Zhao ◽  
YaFan Bai
Keyword(s):  
Postoperative Analgesia ◽  
Severe Pain ◽  
Pediatric Patients ◽  
Group Versus ◽  
Pediatric Neurosurgery ◽  
Control Group ◽  
Morphine Group ◽  
Pain Scores ◽  
Background Infusion ◽  
Lower Pain

Abstract Background: Pain is often observed in pediatric patients after craniotomy procedures, which could lead to some serious postoperative complications. However, the optimal formula for postoperative analgesia for pediatric neurosurgery has not been well established. This study aimed to explore the optimal options and formulas for postoperative analgesia in pediatric neurosurgery. Methods: Three hundred and twenty patients aged 1 to 12-years old who underwent craniotomy were randomly assigned to receive 4 different regimens of patient-controlled analgesia. The formulas used were as follows: Control group included normal saline 100 ml, with a background infusion of 2 ml/h, bolus 0.5 ml; Fentanyl group was used with a background infusion of 0.1-0.2 μg/k·h, bolus 0.1-0.2 μg/kg; Morphine group was used with a background infusion of 10-20 μg/kg·h, bolus 10-20 μg/kg; while Tramadol group was used with a background infusion of 100-400 μg/kg·h, bolus 100-200 μg/kg. Postoperative pain scores and analgesia-related complication were recorded respectively. Comparative analysis was performed between the four groups. Results: In comparison of all groups with each other, lower pain scores were shown at 1 hour and 8 hour after surgery in Morphine group versus Tramadol, Fentanyl and Control groups (P<0.05). Both Tramadol and Fentanyl groups showed lower pain scores in comparison to Control group (P<0.05). Nausea and vomiting were observed more in Tramadol group in comparison to all other groups during the 48 hours of PCIA usage after operation (P=0.020). Much more rescue medicines including ibuprofen and morphine were used in Control group (CI=0.000-0.019). Changes in consciousness and respiratory depression were not observed in study groups. Moderate-to-severe pain was observed in a total of 56 (17.5%) of the study population. Multiple regression analysis for identifying risk factors for moderate-to-severe pain revealed that, younger children (OR=1.161, 1.027-1.312, P=0.017), occipital craniotomy (OR=0.374, 0.155-0.905, P=0.029), and morphine treatment (OR=0.077, 0.021-0.281, P<0.001) are the relevant factors. Conclusions: Compared with other analgesic projects, PCIA or NCIA analgesia with morphine appears to be the safest and most effective postoperative analgesia program for pediatric patients who underwent neurosurgical operations. Trial registration: Chinese Clinical Trial Registry. No: ChiCTR-IOC-15007676. Prospective registration. http://www.chictr.org.cn.

scholarly journals Postoperative Analgesia for Pediatric Craniotomy Patients: A Randomized Controlled Trial

2019 ◽  
Author(s):  
Fei Xing ◽  
LiXin An ◽  
FuShan Xue ◽  
ChunMei Zhao ◽  
YaFan Bai
Keyword(s):  
Postoperative Analgesia ◽  
Severe Pain ◽  
Pediatric Patients ◽  
Controlled Trial ◽  
Pediatric Neurosurgery ◽  
Control Group ◽  
Clinical Trial Registry ◽  
Pain Scores ◽  
Significant Difference ◽  
Lower Pain

Abstract Background: Pain is often observed in pediatric patients after craniotomy procedures, which could lead to some serious postoperative complications. However, the optimal formula for postoperative analgesia for pediatric neurosurgery has not been well established. This study aimed to explore the optimal options and formulas for postoperative analgesia in pediatric neurosurgery. Methods: Three hundred and twenty patients aged 1 to 12-years old who underwent craniotomy were randomly assigned to receive 4 different regimens of patient-controlled analgesia (PCIA or NCIA). Postoperative pain scores at different time point after surgery and analgesia-related complication were recorded respectively. Comparative analysis was performed between the four groups. Results: In all groups, significantly lower pain scores were observed at one to 8 hours in the morphine group (P<0.05). There was no significant difference in pain scores between the fentanyl and tramadol groups (P>0.05), both of which had lower pain scores than the placebo group (P<0.05). However, a higher incidence of nausea and vomiting occurred in the tramadol group during the 48 hours of NCIA usage after operation (P=0.020). Much more rescue medicines including ibuprofen and morphine were used in control group (CI=0.000-0.019). No consciousness change and respiratory depression was observed in all groups. There were 56 children experienced moderate-severe pain(17.5%), younger children (OR=1.161, 1.027-1.312, P=0.017), occipital craniotomy (OR=0.374, 0.155-0.905, P=0.029), morphine treatment, were relevant factors of moderate-severe pain in pediatric patients. Conclusions: Compared with other analgesic projects, PCIA or NCIA analgesia with morphine appears to be the safest and most effective postoperative analgesia program for pediatric patients who underwent neurosurgical operations. Trial registration: Chinese Clinical Trial Registry. No: ChiCTR-IOC-15007676. Prospective registration. http://www.chictr.org.cn. Keywords: Pain, Postoperative, Child, Craniotomy

Tetanic stimulation of the pudendal nerve prior to transcranial electrical stimulation augments the amplitude of motor evoked potentials during pediatric neurosurgery

2021 ◽  
pp. 1-9
Author(s):  
Tsunenori Takatani ◽  
Yasushi Motoyama ◽  
Young-Soo Park ◽  
Taekyun Kim ◽  
Hironobu Hayashi ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Evoked Potentials ◽  
Success Rate ◽  
Pudendal Nerve ◽  
Pediatric Patients ◽  
Motor Evoked Potentials ◽  
Pediatric Neurosurgery ◽  
Transcranial Electrical Stimulation ◽  
Tetanic Stimulation ◽  
Stimulation Of

OBJECTIVE Reportedly, tetanic stimulation prior to transcranial electrical stimulation (TES) facilitates elicitation of motor evoked potentials (MEPs) by a mechanism involving increased corticomotoneuronal excitability in response to somatosensory input. However, the posttetanic MEP following stimulation of a pure sensory nerve has never been reported. Furthermore, no previous reports have described posttetanic MEPs in pediatric patients. The aim of this study was to investigate the efficacy of posttetanic MEPs in pediatric neurosurgery patients and to compare the effects on posttetanic MEP after tetanic stimulation of the sensory branch of the pudendal nerve versus the standard median and tibial nerves, which contain a mixture of sensory and motor fibers. METHODS In 31 consecutive pediatric patients with a mean age of 6.0 ± 5.1 years who underwent lumbosacral surgery, MEPs were elicited by TES without tetanic stimulation (conventional MEPs [c-MEPs]) and following tetanic stimulation of the unilateral median and tibial nerves (mt-MEPs) and the sensory branch of the pudendal nerve (p-MEP). Compound muscle action potentials were elicited from abductor pollicis brevis (APB), gastrocnemius (Gc), tibialis anterior (TA), and adductor hallucis (AH) muscles. The success rate of monitoring each MEP and the increases in the ratios of mt-MEP and p-MEP to c-MEP were investigated. RESULTS The success rate of monitoring p-MEPs was higher than those of mt-MEPs and c-MEPs (87.5%, 72.6%, and 63.3%, respectively; p < 0.01, adjusted by Bonferroni correction). The mean increase in the ratio of p-MEP to c-MEP for all muscles was significantly higher than that of mt-MEP to c-MEP (3.64 ± 4.03 vs 1.98 ± 2.23, p < 0.01). Subanalysis of individual muscles demonstrated significant differences in the increases in the ratios between p-MEP and mt-MEP in the APB bilaterally, as well as ipsilateral Gc, contralateral TA, and bilateral AH muscles. CONCLUSIONS Tetanic stimulation prior to TES can augment the amplitude of MEPs during pediatric neurosurgery, the effect being larger with pudendal nerve stimulation than tetanic stimulation of the unilateral median and tibial nerves. TES elicitation of p-MEPs might be useful in pediatric patients in whom it is difficult to elicit c-MEPs.

The posterior petrosal approach: technique and applications in pediatric neurosurgery

2009 ◽  
Vol 4 (4) ◽  
pp. 353-362 ◽  
Author(s):  
Paul Klimo ◽  
Samuel R. Browd ◽  
Svetlana Pravdenkova ◽  
William T. Couldwell ◽  
Marion L. Walker ◽  
...  
Keyword(s):  
Skull Base ◽  
Pediatric Patients ◽  
Pathological Condition ◽  
Perioperative Complications ◽  
Pediatric Neurosurgery ◽  
Petrous Bone ◽  
Jugular Foramen ◽  
Subtotal Resection ◽  
Cranial Neuropathies ◽  
Brain Retraction

Object Various lesions occur in deep locations or at the skull base in pediatric patients and require skull base approaches for resection. Skull base surgery confers the advantages of improved line of sight, a wider operative corridor, and reduced brain retraction. The posterior petrosal approach provides simultaneous access to lesions in the posterior middle fossa and posterior fossa from the top of the clivus to the level of the jugular foramen. It allows visualization of the ventrolateral brainstem and may be combined with various other supra- and infratentorial approaches, thus giving the surgeon a wide array of access routes to the lesion. Methods The authors conducted a retrospective review of all cases involving pediatric patients undergoing a posterior petrosal approach, either alone or in combination with other cranial approaches. Preoperative and postoperative data were collected, including presentation, neurological examination, imaging findings, pathological condition, operative details, perioperative complications, and postoperative outcomes. Results There were 13 patients (6 female, 7 male) with a mean age of 12.6 years (range 14 months–9 years). The posterior petrosal was the sole skull base cranial approach in 4 patients, whereas the posterior petrosal was combined with 1 or more other cranial approaches in 9. A gross-total resection was achieved in 7 patients, subtotal resection in 5, and a biopsy was performed in 1. Complications occurred in 9 patients, including 7 new or worsened cranial neuropathies. There was no perioperative mortality. Conclusions Although infrequently used in pediatric neurosurgery, the posterior petrosal approach is a highly versatile approach that can access intra- and extraaxial pathology centered on the petrous bone. The authors believe that patient outcomes are directly related to the degree of experience using this approach. Therefore, if this approach is to be used, they recommend collaboration with a skull base neurosurgeon.

scholarly journals Are Opioids Overprescribed to Pediatric Neurosurgery Patients? A Prospective Study on Prescribing Practices and Patient Use

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Leah Burroughs ◽  
Denise Ash ◽  
Laurie Ackerman
Keyword(s):  
Hospital Discharge ◽  
Pediatric Patients ◽  
Pediatric Neurosurgery ◽  
The United States ◽  
Medical Setting ◽  
Opioid Overdose ◽  
Neurosurgical Procedures ◽  
Accidental Ingestion ◽  
Opioid Medication ◽  
Opioid Medications

Background and Hypothesis: The opioid crisis continues to worsen in the United States with opioid overdose deaths reaching record highs in 2020. While a large body of literature exists surrounding the risks of opioids in adults, opioids also pose unique risks to pediatric patients, including accidental ingestion, nonmedical use, and acute cerebellitis causing death. Opioid medications prescribed in the medical setting are often an unwitting source of excess opioids, with half of pediatric overdoses in those under 2 years of age. Although legislative efforts have significantly limited opioid prescribing, recent studies suggest these medications may still be overprescribed. We hypothesized opioid medications are overprescribed to pediatric neurosurgery patients upon hospital discharge. Methods: Pediatric patients undergoing neurosurgical procedures at Riley Hospital for Children were identified prospectively. Surgery type, length of stay, and inpatient use of opioid medications were collected. Patients prescribed an opioid medication upon hospital discharge were contacted 7 days after discharge and asked to report the number of doses of opioid medication used. Results: Thirty patients were successfully contacted 7 days after hospital discharge. Patients underwent a variety of cranial and spinal procedures and the mean length of hospital stay was 3.9 days. An average of 24.9 doses of opioid medication were prescribed at hospital discharge, while an average of 3.8 doses were used by patients in the 7 days following hospital discharge. Twelve patients (40%) had used zero doses of the prescribed opioid medication at 7-day follow-up. Conclusions: Pediatric neurosurgery patients used only 15.3% of prescribed opioids in 7 days after hospital discharge. This creates an excess of leftover opioid medication that may increase the risk of accidental ingestion and misuse. The present study highlights the need for educational initiatives for providers to minimize excess opioids prescribed and for parents to safely dispose of leftover opioid medication.

scholarly journals Treatments for obstructive hydrocephalus secondary to malignant midline intracranial tumors during the perioperative period — a retrospective study of 372 pediatric patients from a single institution

2021 ◽  
Author(s):  
Yunwei Ou ◽  
Kaiyu Fan ◽  
Zhiming Liu ◽  
Zhiyi Liao ◽  
Heng Zhang ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Obstructive Hydrocephalus ◽  
Tumor Resection ◽  
Pediatric Neurosurgery ◽  
Perioperative Period ◽  
Third Ventriculostomy ◽  
Intracranial Tumors ◽  
Recurrence Rates ◽  
Significant Difference ◽  
The Mean

Abstract Objective Common treatments for obstructive hydrocephalus caused by malignant midline intracranial tumors during the perioperative period include ventriculoperitoneal shunt (VPS) placement/endoscopic third ventriculostomy (ETV) and direct tumor resection, but which of these treatments is superior remains unclear. The purpose of this study is to explore the management of hydrocephalus during the perioperative period and subsequent outcomes. Methods Data from 372 patients with obstructive hydrocephalus due to malignant midline intracranial tumors under the age of 18 years referred to the Department of Pediatric Neurosurgery at Beijing Tiantan Hospital between January 2018 and September 2019 were collected. We also collected their clinical features and outcomes for further statistical analysis. Results A total of 372 pediatric patients were treated for obstructive hydrocephalus. In total, 215 patients underwent preoperative VPS placement; the effectiveness of preoperative VPS placement was 98.1% (211/215), and the mean duration of relapse was 63.5 ± 15.7 days. Forty children underwent ETV before tumor removal; the effectiveness of preoperative ETV was 90.0% (36/40), and the mean duration of relapse was 53.8 ± 44.9 days. A total of 117 patients underwent direct tumor resection after being diagnosed; the recurrence rate of hydrocephalus was 20.5% (24/117), and the mean duration of relapse was 125.0 ± 170.8 days. There was a significant difference between preoperative VPS placement followed by resection and postoperative VPS placement and preoperative ETV followed by resection and postoperative VPS placement (p = 0.013). Conclusion Malignant midline intracranial tumors in pediatric patients usually lead to obstructive hydrocephalus, and preoperative intervention for hydrocephalus (VPS or ETV) will improve patient outcomes. The optimal management strategy for obstructive hydrocephalus due to malignant midline intracranial tumors is preoperative VPS placement or ETV due to their low hydrocephalic recurrence rates and high effectiveness.

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