pediatric neurosurgery
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2022 ◽  
Vol 12 ◽  
Author(s):  
Iacopo Lanini ◽  
Debora Tringali ◽  
Rosapia Lauro Grotto

Brain tumors are a common form of solid tumors in children and, unfortunately, they are characterized by a very uncertain prognosis. The treatment of this pathology often includes one or more very invasive surgical procedures, quite often in the very first steps of the treatment. Cases of brain tumors in children represent one of the greatest challenges for health care professionals in the domain of pediatric neurosurgery. This is clearly due to the complexity of the therapeutic plan, but also to the nature of the bond that is established between the child, the parents, and the members of the staff during the often-dramatic initial phase of the illness. In this phenomenological-hermeneutic study, we explore both the emotional and organizational needs, as well as the available professional and personal resources of the staff in the Neurosurgery ward of the Meyer Children’s Hospital in Florence (Italy). The ward staff, composed of 7 surgeons, a pediatric neuro-oncologist, 12 nurses, and 4 auxiliary health care professionals, underwent in-depth interviews that were recorded (with the consensus of the participants). The recordings were then transcribed and submitted to content analysis according to COREQ standards. A complex picture of emotional as well as organizational demands emerged from the data. Shared experiences were pointed out, together with more specific and idiosyncratic contents characteristic of different professional roles. The focus of the present paper was twofold, first, we considered the needs that are overtly expressed by the staff, and then we discussed the main sources of their motivational drives. We found that the latter is mainly found in the quality of the therapeutic bond that is established with the children and the family members, together with the deep interest in one’s own professional activity and the effective complementarity and integration of the personal and professional qualities of the staff members within the multidisciplinary caring group.


2022 ◽  
pp. 243-259
Author(s):  
Stavros Polyzoidis ◽  
Laura Stone McGuire ◽  
Dimitrios Nikas ◽  
Keyoumars Ashkan

Cureus ◽  
2021 ◽  
Author(s):  
Viktoriya Grayson ◽  
Mitchell W Couldwell ◽  
Esther Dupepe ◽  
Joe Iwanaga ◽  
CJ Bui ◽  
...  

2021 ◽  
Author(s):  
Leeat Granek ◽  
Shahar Shapira ◽  
Jonathan Roth ◽  
Shlomi Constantini

Introduction: Pediatric neurosurgery is a sub-specialty of medicine that is responsible for diagnosing, managing, and treating neurological disease in children with the use of surgery. Good intraoperative decisions making is critical to ensuring patient safety, yet almost nothing is known about what factors play a role in intraoperative decisions. As such, the purpose of this paper was to explore the factors that influence intraoperative decisions when pediatric neurosurgeons encounter something unexpected or uncertain during surgery. Methods: The study utilized the Grounded Theory method of data collection and analysis. Twenty-six pediatric neurosurgeons from 12 countries around the world were interviewed between June-October 2020 about the factors that go into making intraoperative decisions. Data was analyzed line by line and constant comparison was used to examine relationships within, and across codes and categories. Results: Pediatric neurosurgeons reflected on six factors while operating in order to come to a decision about how to proceed when they encountered an uncertainty or complication. The study findings resulted in a conceptual model that describes how concrete data including biological and technological factors and contextual data including emotional/relational factors, surgeon factors, and cultural factors influence risk assessment when making an intraoperative decision during surgery. Conclusions: The findings from this research can be used for training and educating surgeons about intraoperative decision-making processes. Pedagogical modules can be developed that includes training sessions on factors that may implicitly and explicitly influence thinking processes during an operation. Surgeons may also benefit from having open discussions with surgical colleagues about the rich, emotional, intellectual scope of the work that they do with all the challenges that these relationships can bring into decision-making in the operating room.


2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Leah Burroughs ◽  
Denise Ash ◽  
Laurie Ackerman

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.


Author(s):  
Esmaeil Mohammadi ◽  
Sina Azadnajafabad ◽  
Mehrdad Goudarzi ◽  
Keyvan Tayebi Meybodi ◽  
Farideh Nejat ◽  
...  

OBJECTIVE Guidelines recommend antimicrobial prophylaxis (AMP) preoperatively for "clean" spinal and cranial surgeries, while dose and timing remain controversial. The use of multiple-dose AMP for such surgeries is under debate in the pediatric context. In this clinical study, the authors aimed to compare single-dose with multiple-dose prophylactic antibiotic usage in cranial and spinal neurosurgical interventions of pediatric patients. METHODS All neurosurgical patients aged 28 days to 18 years who underwent surgery at a single tertiary center were assessed. Three cohorts (noninstrumented clean spinal, noninstrumented cranial, and instrumented cranial interventions), each of which comprised two 50-patient arms (i.e., single-dose AMP and multiple-dose AMP), were included after propensity score–matched retrospective sampling and power analysis. Records were examined for surgical site infections. Using a previously published meta-analysis as the prior and 80% acceptance of equivalence (margin of OR 0.88–1.13), logistic regression was carried out for the total cohort and each subcohort and adjusted for etiology by consideration of multiple-dose AMP as reference. RESULTS The overall sample included 300 age- and sex-matched patients who were evenly distributed in 3 bi-arm cohorts. There was no statistical intercohort difference based on etiology or type of operation (p < 0.05). Equivalence analysis revealed nondiscriminating results for the total cohort (adjusted OR 0.65, 95% CI 0.27–1.57) and each of the subcohorts (noninstrumented clean spinal, adjusted OR 0.65, 95% CI 0.12–3.44; noninstrumented cranial, adjusted OR 0.52, 95% CI 0.14–2.73; and instrumented cranial, adjusted OR 0.68, 95% CI 0.13–3.31). CONCLUSIONS No significant benefit for multiple-dose compared with single-dose AMPs in any of the pediatric neurosurgery settings could be detected. Since unnecessary antibiotic use should be avoided as much as possible, it seems that usage of single-dose AMP is indicated.


2021 ◽  
Vol 135 (6) ◽  
pp. 1849-1856
Author(s):  
Christopher L. Taylor

The history of neurosurgery at UT Southwestern Medical Center in Dallas, Texas, is reviewed. Kemp Clark, MD, started the academic neurosurgical practice at Parkland Hospital in 1956. Clark developed a robust training program that required the resident to operate early. In 1972, the Dallas Veterans Affairs Hospital was added to the training program. Duke Samson, MD, became chair in 1988. He emphasized technical excellence and honest reporting of surgical outcomes. In 1989, Zale Lipshy University Hospital opened and became a center for neurosurgical care, and Hunt Batjer, MD, became chair in 2012. The program expanded significantly. Along with principles established by his predecessors, Batjer emphasized the need for all neurosurgeons to engage the community and to be active in policy leadership through local and national organizations. During his tenure, the pediatric neurosurgery group at Children’s Medical Center Dallas was integrated with the department, and a multidisciplinary spine service was developed. In 2014, the Peter O’Donnell Jr. Brain Institute was established, and the William P. Clements Jr. University Hospital opened. For 64 years, UT Southwestern Medical Center has been fertile ground for academic neurosurgery, with a strong emphasis on excellence in patient care.


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Martin A. Schick ◽  
Jonas Pippir ◽  
Manuel F. Struck ◽  
Jürgen Brugger ◽  
Winfried Neuhaus ◽  
...  

Abstract Objective Colloid solutions are commonly used to maintain perioperative fluid homeostasis. In regard to perioperative infant-centered care, data about the impact of colloids are rare. New data suggest a possible positive effect of hydroxyethyl starch (HES) concerning blood brain barrier. Therefore we conduct a retrospective single center study of children scheduled for neurosurgery, age < five with a blood loss > 10% of body blood volume, receiving either 6% HES 130/0.4 or 5% human albumin (HA). Results Out of 913 patients, 86 were included (HES = 30; HA = 56). Compared to HES [16.4 ± 9.2 ml/kg body weight (mean ± SD)] HA group received more colloid volume (25.7 ± 11.3), which had more blood loss [HA 54.8 ± 45.0; HES 30.5 ± 30.0 (%) estimated blood volume] and higher fluid balances. Fibrinogen was decreased and activated partial thromboplastin time was elevated in HA group. Urinary output, creatinine and urea levels did not differ between the two groups. Serum calcium, total protein levels were lower in HES group. HA treated infants tended to have shorter ICU and hospital stays. We conclude that none of the investigated colloid solutions were without leverage to infants. Consequently randomized controlled trials about perioperative goal-directed fluid replacement of children undergoing (neuro)-surgery with major blood loss are needed.


Author(s):  
Eylem Ocal ◽  
Eliana E. Kim ◽  
Milagros Niquen-Jimenez ◽  
Gleice Salibe de Oliveira ◽  
Souad Bakhti ◽  
...  

Pediatric neurosurgery is an ever-evolving field, and at the heart of it are talented and hardworking neurosurgeons who harness technology and research to enhance the standard of neurosurgical care for children. Recent studies have found that female neurosurgeons tend to choose a career focused on pediatric neurosurgery more than other subspecialties. However, the achievements and contributions of women in pediatric neurosurgery are not well known. To address this, an international working group of pediatric neurosurgeons was established from the World Federation of Neurosurgical Societies (WFNS) Women in Neurosurgery (WINS) group and Pediatric Neurosurgery Committee. The working group reviewed the current literature and collected information through personal communications with the global WINS network. Despite the increasing number of women entering neurosurgical training, the number of female pediatric neurosurgeons is still a mere handful worldwide. In this article, the authors summarize the current status of female pediatric neurosurgeons across the globe, highlighting their achievements as well as the gender bias and challenges that they face at every level of progression of their career. A better organized pediatric neurosurgery workforce, with more female representation and mentorship, would encourage future generations of diverse genders toward a career in this field.


Author(s):  
Kathrin Zimmerman ◽  
Nathan A. Shlobin ◽  
Arsalaan Salehani ◽  
Brandon G. Rocque

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