About our paper “Intradural spinal cord arteriovenous shunts in the pediatric population: natural history, endovascular management and follow-up”

André Léri (1875–1930 AD) and his legacy to neuroscience

A singular association of migraine with brainstem aura and Alice in Wonderland syndrome Abstract Background In this work, we describe an association of brainstem headache with aura (BHA) and Alice in Wonderland syndrome (AIWS) in a 17-year-old male, suffering from crises of vertigo, weakness, dysarthria, and diplopia, in half-hour duration, followed by diffuse or occipital headache, lasting several hours. Methods The frequency of the attacks was monthly, and once there was short loss of consciousness. The last episodes were accompanied by symptoms such as deformation of figures and objects, small or large in shape. Results Diagnostic examinations were performed, mainly neuroimaging tests such as brain MRI and brain angio-MRI, all resulting normal; and treatment with flunarizine was followed by improvement of both BHA and AIWS symptoms. Conclusions There would be a correlation between BHA and AIWS, presumably represented by dysfunction of temporo-parieto-occipital carrefour.

Laparoscopy-assisted placement of a ventriculobiliary shunt: a technical note Abstract Purpose Hydrocephalus is a common condition in pediatric neurosurgeon’s clinical practice. Peritoneal and atrial shunting is the treatment of choice in the immense majority of patients. Sometimes, there are complex cases that may need innovative solutions in order to implant the distal catheter of the shunt: in these situations, the gallbladder is a well-described option and it can be safely used. Methods We report the case of a 4-month-old baby with a wide optic-chiasmal hypothalamic glioma generating hydrocephalus with high protein values in CSF. Ventriculobiliary shunting was decided, and the distal catheter was directed by the assistance of laparoscopic surgery. Results The outcome was satisfactory. Conclusions As far as we know, laparoscopic placement of a distal catheter in the gallbladder has not been described in the literature; herein, we describe the tenets and the technical tips of this approach.

Pediatric miliary tuberculosis presenting with stroke: contribution to the paper “Tuberculosis of the central nervous system in children”

Strabismus in hydrocephalus patients Abstract Purpose To evaluate the characteristics and outcomes of strabismus in patients with hydrocephalus. Methods A retrospective chart review of patients with strabismus and hydrocephalus is performed in the Department of Pediatric Ophthalmology between 2012 and 2018. Results Seventeen patients between the ages of 6 months and 13 years met the criteria of strabismus and hydrocephalus. Although all had developmental delay, five patients out of 17 were premature (lower than 36 weeks of gestation). All patients had ventriculoperitoneal shunt placement for congenital hydrocephalus. Three patients had exotropia, whereas 14 had esotropia. Glasses were prescribed to 13 patients: hyperopic correction in 12 and myopic correction in one patient. Surgical correction with bimedial recession was performed in five patients. Four of them achieved successful ocular alignment. Conclusions Children with hydrocephalus most likely have esotropia. Although good ocular alignment is achieved with surgical correction in some patients, some patients may benefit from glasses.

E-bike-related cranial injuries in pediatric population Abstract Purpose E-bikes are being used increasingly by all age groups. Children riding e-bikes often do not use safety equipment such as helmets, and are at increased risk for injuries requiring neurosurgery. The most common type of injury among pediatric e-bikers is head and neck trauma. We describe our experience treating cranial injuries. Methods Data regarding children (< 18 years old) with e-bike-related cranial injuries were collected retrospectively from two tertiary centers. Results Twenty patients were included. Seventeen were e-bike users, and three were hit as pedestrians. The average age at admission was 11.3 ± 4.85 (range 1.5–17) years old. All 17 e-bike users did not wear a helmet. Seventeen of the 20 (85%) suffered from skull fractures (70% involving the frontal bone), nine involving more than one region. Six patients (30%) had intracerebral contusions, 3 (15%) an epidural hematoma, and 6 (30%) a subdural hematoma. Three patients (15%) underwent surgery, two of them for depressed skull fracture reduction, and one for insertion of intracranial pressure monitor. One patient died (5%); 1 (5%) had a Glasgow Outcome Scale (GOS) of 3, 5 (25%) had a GOS of 2, and 13 (65%) were discharged without any neurological deficit (GOS 1). Conclusion E-bikes may inflict various cranial injuries, including fractures and intracranial bleeds, and may lead to significant morbidity and mortality. Education of children to use protective gear, wide exposure of younger adolescents to traffic laws, and limiting the use of e-bikes to older children, are all necessary actions.

Kyphectomy and interbody fixation using lag screws in a child with myelomeningocele kyphosis: a technical case report Abstract A 5-year-old boy had a thoracolumbar-level MMC that had been repaired at the day after birth and kyphotic deformity got worse as he grew. He complained of discomfort about not being able to take a supine posture and decided to perform surgery for kyphosis. In our case, surgical correction is offered to stop the deformity progression, manage the associated pain, and finally to gain sitting and supine posture. We report the surgical procedure with 4 levels of en bloc kyphectomy and using the lag screws. Especially when lag screws are used, several complications including posterior instrumentation failure, hardware prominence and wound break down can be solved by removing the implants after bone fusion has been achieved.

Rosette-forming glioneuronal tumour of dorsolumbar spinal cord

Cervical intradural extramedullary epidermoid cyst at the background of congenital scoliosis with a semi-segmented C6 hemivertebra Abstract In the present case study, we present a female adolescent patient harboring a rare clinical presentation of spinal intradural extramedullary epidermoid cyst concomitant with congenital scoliosis. A 17-year-old female patient was admitted to the clinic with long-lasting neck pain. She was neurologically intact yet had cervicothoracic scoliosis. Cervical MRI and CT depicted a right C6 hemivertebra, fused to the lower endplate of the C5 vertebra. At the same vertebra level, she had an intradural extramedullary mass lesion anterior to the spinal cord. We planned to excise the mass lesion first. We used neuromonitoring during the surgery and made the surgery via posterior approach. We observed a pearl-like mass lesion anterolateral to the spinal cord. We excised the mass lesion with its capsule microsurgically via peace-meal route. She was neurologically stable following the surgery. Histopathological diagnosis was epidermoid cyst. Most of spinal inclusion cysts occur secondary to spinal dysraphism or iatrogenic inoculation. Isolated spinal inclusion cyst located anterior to the spinal cord concomitant with vertebral anomalies should be kept in mind before making proper surgical planning. Surgery is the modality of choice for spinal inclusion cyst and should be performed under the guidance of neuromonitoring, especially in cases with lesions located at higher spinal levels.