Absorbable plate degradation mimicking local abscess: letter to the editor

Endovascular embolization of dural arteriovenous fistula in a child presented with slight conjunctival hyperemia Abstract Background Dural arteriovenous fistulas (DAVFs) are rare in pediatrics. A case of DAVF diagnosed because of a slight conjunctival hyperemia and endovascular coil embolization at 2 years old is reported. Case description The 2-year-old boy presented with a slight conjunctival hyperemia of the left eye for 1 month. Magnetic resonance imaging (MRI) examination of the head showed abnormal blood flow in the left middle cranial fossa. On digital subtraction angiography, a DAVF with a dural feeder shunt and a venous varix at the middle cranial fossa was confirmed. After transarterial coil embolization, shunt blood flow disappeared. Conclusions This report describes a case of DAVF with a slight conjunctival hyperemia treated by coil embolization in a child.

Solitary tumefactive demyelinating pseudotumor masquerading as a low-grade glioma in a child

An experimental challenge to bring the empirical study design a step closer to evidence-based medicine and quit ethically problematic situations

In response to the letter to the editor related to “Management and Prevention of Cranioplasty Infections” by Shay T, Mitchell KA, Gordon CR Recognizing a problem is the first step in fixing it

Quantitative color-coded digital subtraction neuroangiography for pediatric arteriovenous shunting lesions Abstract Background Several complex pediatric neurovascular conditions are amenable to endovascular treatment. Given the unique anatomical and physiological challenges in children, there is an ongoing need for tools and techniques that provide accurate information for treatment planning, while minimizing exposure to ionizing radiation and contrast. This is more so for neonates and infants with high-flow arteriovenous (AV) shunts that are challenging to assess using conventional techniques. Objective In this brief report, we describe, through representative cases, the potential role of quantitative color-coded digital subtraction angiography (qDSA) in neuroendovascular procedures in children with high-flow AV shunting lesions. Methods Images were obtained using an ArtisQ biplane system (Siemens Healthineers, Erlangen, Germany). Post-processing was performed at a dedicated workstation (Syngo, Siemens) using the iFlow module to generate color-coded maps of individual digital subtraction angiography runs. Conclusion Color-coded qDSA provides real-time quantitative information in high-flow AV shunting neurovascular lesions. This can potentially help direct treatment choices, optimize endovascular treatment protocols, monitor outcomes, and determine treatment end points.

Refractory epilepsy associated with ventriculoperitoneal shunt over-drainage: case report Abstract Epilepsy and intracranial pressure (ICP) can be interrelated. While shunt malfunction is recognized as a cause of seizures, shunt over-drainage is seldom reported as such. We report a child who had undergone ventriculoperitoneal shunt insertion at the age of 6 months following an excision of a left ventricle choroid plexus papilloma, who developed refractory epilepsy since the age of 3 years. An MRI showed small ventricles. The child presented with acute hydrocephalus due to proximal shunt malfunction at the age of 11 years and was treated with an endoscopic third ventriculostomy. Following the procedure, the seizures abated. Our case suggests that intractable epilepsy may be related to intracranial hypotension. Potential treatments for shunt over-drainage may be indicated even in the absence of classic over-drainage symptoms, in the presence of refractory epilepsy.

Progressively enlarging childhood chronic subdural hematoma surgically treated 26 years after diagnosis Abstract Pediatric chronic subdural hematoma (CSDH) is a relatively common disorder. Treatment often requires burr hole drainage or subduroperitoneal shunt placement; some patients are managed conservatively. However, the long-term outcome of untreated pediatric CSDH is unknown. The authors report a case of a huge, progressively enlarging subdural granuloma that was surgically treated 26 years after the initial diagnosis of CSDH. This 30-year-old male patient presented with worsening intermittent atonic seizure-like movements, which had been noted since he was 4 years old. At that time, the patient was diagnosed with CSDH at an outside hospital, but an operation was refused by the parents. Magnetic resonance imaging (MRI) performed at 23 years of age showed a huge subdural mass on the right frontoparietal region and a smaller mass on the left side with a significant midline shift. Upon presentation at the age of 30, MRI revealed worsening of the right subdural mass and midline shift. Subsequently, the patient underwent craniotomy and subtotal removal of the mass and capsule. The volume of the content was approximately 430 cc. Untreated pediatric CSDH can grow progressively, even over several decades. Patients with CSDH, especially those managed conservatively, should be closely monitored for worsening symptoms over a long-term follow-up period.

Validation of the Azeri version of the Pediatric Epilepsy Side Effects Questionnaire Abstract Purpose Long-lasting use of antiepileptic drugs in children with epilepsy negatively influences their quality of life and compliance. The purpose of this study was validation of the Azeri version of the Pediatric Epilepsy Side Effects Questionnaire (PESQ). Methods We collected the PESQ from caregivers of children with epilepsy. In order to screen for comorbid behavioral and emotional problems, the Strengths and Difficulties Questionnaire (SDQ) was used. Demographic and medical data were collected through patient charts. We conducted factor analysis and assessed internal consistency and construct validity of the PESQ. Results Caregivers of 120 patients with different epileptic syndromes completed the PESQ (age range 2–18; mean age 9.8 ± 4.0; male 56.7%; polytherapy 24%). The factor loading in the principal component analysis confirmed five-factor structure of the PESQ. The internal consistency coefficient of the total side effects scale of the PESQ was strong (0.86). Children receiving polytherapy showed higher scores on all subscales and the total score of the PESQ, supporting its construct validity. The total scores of the PESQ and the SDQ strongly correlated. Conclusions The PESQ can be used as a reliable and valid measure assessing antiepileptic drug side effects across the epilepsy spectrum.

Volume change of cranial arachnoid cysts after successful endoscopic fenestration in symptomatic children Abstract Introduction Endoscopic fenestration remains a first-line treatment option for symptomatic arachnoid cysts. After fenestration, the cyst does not collapse but reaches an equilibrium state. The aim of this study was to evaluate the change in cyst volume following successful fenestration and symptomatic improvement. Methods Cyst volume was measured on serial MR scans of 4 children (1 female, 3 males) with symptomatic arachnoid cysts (middle fossa n = 2, choroidal fissure n = 1 and posterior fossa n = 1), who experienced symptom resolution after endoscopic fenestration. Average follow-up was 20.5 months (range 3–48). Results Significant cyst volume reduction was seen in all four patients. In patient 1, preoperative cyst volume was 336 cm3 and decreased to 194 cm3 at 7 months (42% reduction). In patient 2, preoperative volume was 12.64 cm3 and reduced to 1.51 cm3 at 3 months (88% reduction). In patient 3, preoperative volume was 105 cm3 and reduced to 72 cm3 in 2 months (30% reduction). In patient 4, preoperative volume was 125 cm3 and reduced to 54 cm3 at 7 months (56% reduction). All remained stable after 7 months and there has been no late increase in volume. Conclusions Significant reduction in arachnoid cyst volume at the order of 30–40% is seen after successful endoscopic fenestration. The cyst volume appears to decrease gradually in the first 3–7 months and reaches a plateau after that. Complete resolution of symptoms in the presence of residual volume may indicate that cyst volume below a threshold may not correlate directly with clinical status.