| 1. |
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| 2. |
- Borota, Ljubisa, et al.
(author)
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Complete functional recovery in a child after endovascular treatment of basilar artery occlusion caused by spontaneous dissection : a case report
- 2022
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In: Child's Nervous System. - : Springer Nature. - 0256-7040 .- 1433-0350. ; 38:8, s. 1605-1612
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Journal article (peer-reviewed)abstract
- Stroke caused by dissection of arteries of the vertebrobasilar system in children is still poorly investigated in terms of etiology, means of treatment, course of disease, and prognosis. The aim of this report was to describe the unusual course of a spontaneous dissection of the basilar artery (BA) in a child treated with endovascular techniques and to point out that the plasticity of the brain stem can fully compensate for structural damage caused by stroke. We report the case of a 15-year-old boy who suffered a wake-up stroke with BA occlusion caused by spontaneous dissection. A blood clot was aspirated from the false lumen and the true lumen re-opened, but the patient deteriorated a few hours later, and repeated angiography revealed that the intimal flap was detached, occluding the BA again. The lumen of BA was then reconstructed by a stent. Despite a large pons infarction, the patient was completely recovered 11 months after the onset. The case was analyzed with angiograms and magnetic resonance imaging, macroscopic and microscopic pathological analysis, computed tomographic angiography, magnetic resonance-based angiography, and diffusion tensor imaging. This case illustrates that applied endovascular techniques and intensive care measures can alter the course of potentially fatal brain stem infarction. Our multimodal analysis gives new insight into the anatomical basis for the plasticity mechanism of the brain stem.
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| 3. |
- Cederberg, David, et al.
(author)
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What has inflammation to do with traumatic brain injury?
- 2010
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In: Child's Nervous System. - : Springer Science and Business Media LLC. - 1433-0350 .- 0256-7040. ; 26:2, s. 221-226
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Inflammation is an stereotypical response to tissue damage and has been extensively documented in experimental and clinical traumatic brain injury (TBI), including children. DISCUSSION: The initiation and orchestration of inflammation in TBI, as in other tissues, is complex and multifactorial encompassing pro- and anti-inflammatory cytokines, chemokines, adhesion molecules, complement factors, reactive oxygen and nitrogen species, and other undefined factors. It is evident that inflammation can have both beneficial and detrimental effects in TBI, but the mechanisms underlying this dichotomy are mostly unknown. Modification of the inflammatory response may be neuroprotective. Monitoring inflammation is now possible with techniques such as microdialysis; however, the prognostic value of measuring inflammatory mediators in TBI is still unclear with conflicting reports. Except for corticosteroids, no anti-inflammatory agents have been tested in TBI, and the negative results with these may have been flawed by their multiple side effects. Clinical trials with anti-inflammatory agents that target multiple or central and downstream pathways are warranted in adult and pediatric TBI. This review examines the mechanisms of inflammation after TBI, monitoring, and possible routes of intervention.
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| 4. |
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| 5. |
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| 6. |
- Davis, Charles, et al.
(author)
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Adaptation of the cranium to spring cranioplasty forces.
- 2010
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In: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. - : Springer Science and Business Media LLC. - 1433-0350. ; 26:3, s. 367-71
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Journal article (peer-reviewed)abstract
- During spring-assisted cranioplasty, the spring transmits forces through adjacent cranium. We have previously demonstrated that the ectocranial-endocranial thickness of cranial sutures increases significantly over time in the presence of continuous spring forces. We wished to investigate if cranial bone showed similar adaptational responses.
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| 7. |
- Elfving, Maria, et al.
(author)
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Ectopic recurrence of a craniopharyngioma in a 15-year-old girl 9 years after surgery and conventional radiotherapy: case report.
- 2011
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In: Child's Nervous System. - : Springer Science and Business Media LLC. - 1433-0350 .- 0256-7040. ; 27, s. 845-851
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Journal article (peer-reviewed)abstract
- This 15-year-old girl was operated due to an ectopic recurrence of a craniopharyngioma along the previous surgical route. She presented with a sellar craniopharyngioma at the age of 4 years and underwent a right subfrontal craniotomy. Two and a half years later she had a local recurrence in the sella that was resected along the same surgical route. Postoperative cranial radiotherapy was administered with 50 Gy divided into 28 fractions. Nine years later, magnetic resonance imaging (MRI) revealed a local recurrence within the sella together with a supraorbital cystic mass. Both tumors were surgically removed. Microscopic examination revealed recurrence of an adamantinous craniopharyngioma at both localisations. Histopathological preparations showed a higher MIB-1 index at the simultaneous recurrences in the sella and in the frontal lobe and also an elevated focal p53 expression, compared to previous operations, suggesting a transformation to a more aggressive tumor. This is the first case report of ectopic recurrence in a child that had received conventional radiotherapy of 50 Gy to the sella. Careful intra-operative procedure is probably crucial for preventing ectopic recurrences. The future will reveal if the transsphenoidal surgical route will put an end to ectopic tumor recurrence in patients with a craniopharyngioma.
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| 8. |
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| 9. |
- Falk, AC, et al.
(author)
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Management and classification of children with head injury
- 2005
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In: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. - : Springer Science and Business Media LLC. - 0256-7040. ; 21:6, s. 430-436
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Journal article (peer-reviewed)
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| 10. |
- Fernell, Elisabeth, 1948, et al.
(author)
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Overt hydrocephalus at birth--origin and outcome.
- 1987
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In: Child's Nervous System. - 0256-7040. ; 3:6, s. 350-353
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Journal article (peer-reviewed)abstract
- Based on a survey of the population, which included 202 infants with infantile hydrocephalus those who had had overt hydrocephalus at birth were selected and analyzed with respect to origin and outcome. The present series consisted of 47 infants (23% of the total series), 83% of whom were born at term and 17% before term. In the study period 1967-1982, the prevalence was 0.12/1,000 births. Among infants with maldevelopment of the CNS and/or other organs, the mortality before 2 years of age was 37%, and among the survivors the rate of neurological sequelae was 88%. The corresponding figures for infants with uncomplicated hydrocephalus, i.e., without other maldevelopment, was 20% and 44%, respectively. The prognosis was especially poor for infants born before term. It was concluded that the prognosis was largely determined by maldevelopment affecting the CNS macro- or microarchitecture.
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| 11. |
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| 12. |
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| 13. |
- Gronbaek, Jonathan Kjaer, et al.
(author)
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Left-handedness should not be overrated as a risk factor for postoperative speech impairment in children after posterior fossa tumour surgery : a prospective European multicentre study
- 2022
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In: Child's Nervous System. - : Springer Nature. - 0256-7040 .- 1433-0350. ; 38:8, s. 1479-1485
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Journal article (peer-reviewed)abstract
- Purpose Cerebellar mutism syndrome (CMS) is a severe neurological complication of posterior fossa tumour surgery in children, and postoperative speech impairment (POSI) is the main component. Left-handedness was previously suggested as a strong risk factor for POSI. The aim of this study was to investigate the relationship between handedness and the risk of POSI. Methods We prospectively included children (aged < 18 years) undergoing surgery for posterior fossa tumours in 26 European centres. Handedness was assessed pre-operatively and postoperative speech status was categorised as either POSI (mutism or reduced speech) or habitual speech, based on the postoperative clinical assessment. Logistic regression was used in the risk factor analysis of POSI as a dichotomous outcome. Results Of the 500 children included, 37 (7%) were excluded from the present analysis due to enrolment at a reoperation; another 213 (43%) due to missing data about surgery (n = 37) and/or handedness (n = 146) and/or postoperative speech status (n = 53). Out of the remaining 250 (50%) patients, 20 (8%) were left-handed and 230 (92%) were right-handed. POSI was observed equally frequently regardless of handedness (5/20 [25%] in left-handed, 61/230 [27%] in right-handed, OR: 1.08 [95% CI: 0.40-3.44], p = 0.882), also when adjusted for tumour histology, location and age. Conclusion We found no difference in the risk of POSI associated with handedness. Our data do not support the hypothesis that handedness should be of clinical relevance in the risk assessment of CMS.
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| 14. |
- Gronbaek, J. Kjaer, et al.
(author)
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Postoperative speech impairment and cranial nerve deficits after secondary surgery of posterior fossa tumours in childhood : a prospective European multicentre study
- 2022
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In: Child's Nervous System. - : Springer Nature. - 0256-7040 .- 1433-0350. ; 38:4, s. 747-758
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Journal article (peer-reviewed)abstract
- Purpose Brain tumours constitute 25% of childhood neoplasms, and half of them are in the posterior fossa. Surgery is a fundamental component of therapy, because gross total resection is associated with a higher progression-free survival. Patients with residual tumour, progression of residual tumour or disease recurrence commonly require secondary surgery. We prospectively investigated the risk of postoperative speech impairment (POSI) and cranial nerve dysfunction (CND) following primary and secondary resection for posterior cranial fossa tumours. Methods In the Nordic-European study of the cerebellar mutism syndrome, we prospectively included children undergoing posterior fossa tumour resection or open biopsy in one of the 26 participating European centres. Neurological status was assessed preoperatively, and surgical details were noted post-operatively. Patients were followed up 2 weeks, 2 months and 1 year postoperatively. Here, we analyse the risk of postoperative speech impairment (POSI), defined as either mutism or reduced speech, and cranial nerve dysfunction (CND) following secondary, as compared to primary, surgery. Results We analysed 426 children undergoing primary and 78 undergoing secondary surgery between 2014 and 2020. The incidence of POSI was significantly lower after secondary (12%) compared with primary (28%, p = 0.0084) surgery. In a multivariate analysis adjusting for tumour histology, the odds ratio for developing POSI after secondary surgery was 0.23, compared with primary surgery (95% confidence interval: 0.08-0.65, p = 0.006). The frequency of postoperative CND did not differ significantly after primary vs. secondary surgery (p = 0.21). Conclusion Children have a lower risk of POSI after secondary than after primary surgery for posterior fossa tumours but remain at significant risk of both POSI and CND. The present findings should be taken in account when weighing risks and benefits of secondary surgery for posterior fossa tumours.
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| 15. |
- Gudrunardottir, Thora, et al.
(author)
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Treatment developments and the unfolding of the quality of life discussion in childhood medulloblastoma: a review.
- 2014
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In: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. - : Springer Science and Business Media LLC. - 1433-0350. ; 30:6, s. 979-990
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Research review (peer-reviewed)abstract
- To describe how the quality of life (QOL) discussion in childhood medulloblastoma (MB) relates to treatment developments, survival and sequelae from 1920 to 2014. Articles containing "childhood medulloblastoma" and "quality of life" were identified in PubMed. Those containing phrases pertaining to psychological, emotional, behavioral or social adjustment in the title, abstract or keywords were selected. Inclusion of relevant older publications was assured by cross-checking references. 1920-1930s: suction, electro-surgery, kilovolt (KV) irradiation. Survival = months. Focus on operative mortality, symptoms and survival. 1940s: radiotherapy improved. 1950s: chemotherapy and intubation. Survival = years. Opinions oscillated between optimism/awareness of physical sequelae of radiotherapy. 1960s: magnified vision, ventriculo-peritoneal (VP) shunts, megavolt (MV) irradiation. Long-term survival shifted the attention towards neurological problems, disability and carcinogenesis of radiotherapy. 1970s: CT, microscope, bipolar coagulation, shunt filters, neuroanesthesia, chemotherapy trials and staging studies. Operative mortality decreased and many patients (re)entered school; emphasis on neuropsychological sequelae, IQ and academic performance. 1980s: magnetic resonance imaging (MRI), Cavitron ultrasonic aspiration (CUSA), laser surgery, hyper-fractionated radiotherapy (HFRT). Cerebellar mutism, psychological and social issues. 1990s: pediatric neurosurgery, proton beams, stem cell rescue. Reflections on QOL as such. 21st century: molecular genetics. Premature aging, patterns of decline, risk- and resilience factors. QOL is a critical outcome measure. Focus depends on survival and sequelae, determined after years of follow-up. Detailed measurements are limited by time, money and human resources, and self-reporting questionnaires represent a crude measure limited by subjectivity. Therapeutic improvements raise the question of QOL versus cure. QOL is a potential primary research endpoint; multicenter international studies are needed, as are web-based tools that work across cultures.
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| 16. |
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| 17. |
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| 18. |
- Liminga, Gunnar, et al.
(author)
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Acute disseminated encephalomyelitis with delayed onset and feasibility of the Miethke shunt and sensor reservoir system : a case report
- 2021
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In: Child's Nervous System. - : Springer Science and Business Media LLC. - 0256-7040 .- 1433-0350. ; 37:12, s. 3891-3895
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Journal article (peer-reviewed)abstract
- Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating central nervous system disorder with predilection for early childhood. Delayed onset of ADEM is rare, and herein we present a previously healthy 5-year-old boy, with an unusual clinical course of ADEM with high intracranial pressure (ICP) and acute visual loss that was at first diagnosed as idiopathic intracranial hypertension without papilledema (IIHWOP). The boy underwent acute neurosurgical intervention with ventriculoperitoneal (VP) shunt using Miethke valve and sensor reservoir system and received high-dose steroid treatment with symptom relieve within days. This is the first case report using this system in such a young child, and we find it feasible and valuable also in younger children when VP shunt with ICP measurement is indicated.
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| 19. |
- Lindquist, Barbro, 1950, et al.
(author)
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Cognitive functions in children with myelomeningocele without hydrocephalus.
- 2009
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In: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. - : Springer Science and Business Media LLC. - 1433-0350. ; 25:8, s. 969-75
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The aim of this study was to explore the separate effects of myelomeningocele (MMC) and hydrocephalus on intelligence and neuropsychological functions in a population-based series of children. MATERIAL AND METHODS: Of the 69 children with MMC born in 1992-1999 in western Sweden, nine did not develop hydrocephalus. Eight of them participated in this study and were compared with age- and gender-matched children with MMC in combination with hydrocephalus and with controls. RESULTS: Children with only MMC had an IQ of 103 compared with 75 in those with hydrocephalus added to the MMC and they had significantly better immediate and long-term memory and executive functions. When compared with controls, they had difficulty with learning and executive functions, but when the two children with an IQ of <70 were excluded, those with only MMC performed just as well as the controls. CONCLUSION: Hydrocephalus rather than MMC in itself appeared to cause the cognitive deficits found in children with MMC.
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| 20. |
- Lindquist, Barbro, 1950, et al.
(author)
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Quality of life in adults treated in infancy for hydrocephalus.
- 2014
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In: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. - : Springer Science and Business Media LLC. - 1433-0350. ; 30:8, s. 1413-1418
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Journal article (peer-reviewed)abstract
- The objective was to analyze quality of life in a very long-term follow-up study of now adult individuals, treated for hydrocephalus (without spina bifida) during infancy. METHODS: The entire series was population-based, and the subgroup under study consisted of the 29 individuals without intellectual disability, who consented to participate. About one third had concomitant mild cerebral palsy or epilepsy or both. A Finnish validated questionnaire, the 15D, was used to measure quality of life. RESULTS: There was no significant difference between the study group and the controls with regard to the total quality of life score. Individuals with associated cerebral palsy and/or epilepsy had a lower total score compared with both those without associated impairments and controls. Most participants differed from controls in the dimension of mental/memory function which pertains to executive functions, an ability of considerable importance for daily life skills. CONCLUSION: It is important to follow children with hydrocephalus over time-due to the different etiological panorama, interventions, and associated impairments this group displays. This is the only way to learn more about critical factors that require attention and that predict quality of life in adulthood.
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| 21. |
- Lindquist, Barbro, 1950, et al.
(author)
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Very long-term follow-up of cognitive function in adults treated in infancy for hydrocephalus.
- 2011
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In: Child'S Nervous System. - : Springer Science and Business Media LLC. - 1433-0350 .- 0256-7040. ; 27:4, s. 597-601
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Journal article (peer-reviewed)abstract
- PURPOSE: The aim was to investigate the very long-term cognitive outcome in adults who had been shunt treated for hydrocephalus during their first year of life. METHODS: In a population-based series of 72 children born in 1967-1978 and shunt treated for infantile hydrocephalus, 43 were found to have a normal cognitive function when assessed at 6-17years of age. Twenty-five of them agreed to participate in a follow-up study of cognition at a mean age of 35years (range, 30-41years). The Wechsler Adult Intelligence Scale (WAIS-III) was used. RESULTS: The median full-scale IQ was 101 (range, 83-120), median verbal IQ was 104 (81-115) and performance IQ was 99 (80-127). The corresponding IQs in childhood in the 16 subjects who had been tested previously with the WISC were 101 (84-124), 108 (86-135), and 101 (73-124). Specific cognitive deficits were found for working memory and processing speed. Shunt complications did not affect IQ. CONCLUSION: This very long-term follow-up study of normally gifted children with hydrocephalus revealed that, as adults, they still had preserved cognitive functions despite recurrent shunt dysfunction. The results are encouraging and represent a tribute to neurosurgical intervention. Continued follow-up studies are needed since the etiological panorama and treatment procedures of children with hydrocephalus are changing over time.
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| 22. |
- Lynoe, N, et al.
(author)
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Questions about isolated traumatic shaking and confessions
- 2017
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In: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. - : Springer Science and Business Media LLC. - 1433-0350. ; 33:5, s. 731-732
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Journal article (other academic/artistic)
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| 23. |
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| 24. |
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| 25. |
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| 26. |
- Magnéli, Sara, et al.
(author)
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Telemetric intracranial pressure monitoring : a noninvasive method to follow up children with complex craniosynostoses. A case report
- 2016
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In: Child's nervous system (Print). - : Springer Science and Business Media LLC. - 0256-7040 .- 1433-0350. ; 32:7, s. 1311-1315
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Journal article (peer-reviewed)abstract
- INTRODUCTION: There are no reliable noninvasive methods of monitoring ICP. Most assessments are made by indirect measures and are difficult to follow over time. Invasive studies can be used but up until now have required in-hospital transcutaneous measurements. Accurate ICP recordings over longer periods of time can be very valuable in timing different surgical procedures in syndromal cases. This case shows that telemetric ICP monitoring can be used for long-term follow-up in patients that may need repeated surgeries related to their craniosynostosis condition.CASE REPORT: In this report, the telemetric ICP probe (Raumedic Neurovent-P-tel) was implanted before surgery and was used for repeated "noninvasive" ICP recordings pre- and postoperatively in a patient with craniosynostosis. The patient was an eight-year-old girl with pansynostosis with only the right lambdoid suture open. A telemetric ICP probe was implanted the day before cranial vault remodeling and the ICP was monitored pre- and postoperatively. The ICP was above 15 mmHg 72.2 % of the monitoring time before surgery, and the amplitude of the curve was greater than normal suggesting impaired compliance. Direct postoperative ICP was normal, and the amplitude was lower. The ICP was then monitored both in out-patient clinic and in four longer hospital stays. Both the values and the curves were analyzed, and the time with ICP above 15 mmHg decreased over time, and the waveform amplitude of the curves improved.CONCLUSION: This "noninvasive" way of recording ICP is a feasible and helpful tool in decision-making and intervening in patients with craniosynostosis.
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| 27. |
- Mortazavi, MM, et al.
(author)
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The ventricular system of the brain : a comprehensive review of its history, anatomy, histology, embryology, and surgical considerations
- 2014
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In: Child's nervous system (Print). - : Springer Science and Business Media LLC. - 0256-7040 .- 1433-0350. ; 30:1, s. 19-35
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Research review (peer-reviewed)abstract
- The cerebral ventricles have been recognized since ancient medical history. Their true function started to be realized more than a thousand years later. Their anatomy and function are extremely important in the neurosurgical panorama. The literature was searched for articles and textbooks of different topics related to the history, anatomy, physiology, histology, embryology and surgical considerations of the brain ventricles. Herein, we summarize the literature about the cerebral ventricular system.
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| 28. |
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| 29. |
- Nordström, Carl-Henrik
(author)
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Cerebral energy metabolism and microdialysis in neurocritical care.
- 2010
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In: Child's Nervous System. - : Springer Science and Business Media LLC. - 1433-0350 .- 0256-7040. ; 26, s. 465-472
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Journal article (peer-reviewed)abstract
- It is of obvious clinical importance to monitor cerebral metabolism-in particular, cerebral energy metabolism and indicators of cellular damage-online at the bedside. The technique of cerebral microdialysis provides the opportunity for continuous monitoring of metabolic changes in the tissue before they are reflected in peripheral blood chemistry or in systemic physiological parameters. The basic idea of microdialysis is to mimic the function of a blood capillary by positioning a thin dialysis tube in the tissue and to be used to analyze the chemical composition of the interstitial fluid. The biochemical variables used during routine monitoring were chosen to cover important aspects of cerebral energy metabolism (glucose, pyruvate and lactate), to indicate excessive interstitial levels of excitatory transmitter substance (glutamate) and to give indications of degradation of cellular membranes (glycerol). Furthermore, pharmokinetic studies can be conducted using microdialysis. This article discusses technical and physiological aspects of microdialysis, and its clinical applications in brain injury.
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| 30. |
- Nowinski, Daniel, et al.
(author)
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Posterior cranial vault expansion in the treatment of craniosynostosis : Comparison of current techniques
- 2012
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In: Child's nervous system (Print). - : Springer Science and Business Media LLC. - 0256-7040 .- 1433-0350. ; 28:9, s. 1537-1544
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Journal article (peer-reviewed)abstract
- Surgical procedures which aim at expanding the posterior cranial vault have come to play an increasingly important role in the treatment of syndromic craniosynostosis. The posterior cranial vault may be expanded by formal cranioplasty or by less invasive methods based on gradual posterior cranial vault expansion or distraction. These procedures share the common goals to prevent intracranial hypertension and progression toward turricephaly by effectively increasing the intracranial volume. They also reduce any local brain compression within the posterior cranial fossa. This review describes the various techniques available for less invasive and gradual posterior cranial vault expansion and their rationale based on our experience on the last 40 cases. Volumetric data for three different surgical techniques have been compared (two cases of posterior cranial vault expansion by free-floating parieto-occipital bone flap, two with springs, and two with internal distractors). The volumetric analysis showed an expansion of 13 and 24 % for the free posterior flap, 18 and 25 % for the translambdoid springs, and 22 and 29 % for the distractors. Although these figures are not strictly comparable, our data suggest that these three techniques offer a potential for a significant increase in skull volume. The indications for such procedures must, however, be tailored according to the age and condition of the single patient.
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| 31. |
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| 32. |
- Persson, Eva-Karin, 1956, et al.
(author)
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Hydrocephalus in children born in 1999-2002: epidemiology, outcome and ophthalmological findings
- 2007
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In: Childs Nerv Syst. - : Springer Science and Business Media LLC. - 0256-7040. ; 23:10, s. 1111-8
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The purpose of this study was to monitor incidence and outcome in children with hydrocephalus. MATERIALS AND METHODS: This is a population-based prospective study of all the children with hydrocephalus born in western Sweden in 1999-2002. Etiological and clinical information was collected from records, neuroimaging and ophthalmological examinations. Comparisons with 208 children born in 1989-1998 were made. RESULTS: The incidence was 0.66 per 1,000 live births, 0.48 for infantile hydrocephalus and 0.18 for hydrocephalus associated with myelomeningocele. The corresponding rates for 1989-1998 were 0.82, 0.49 and 0.33. Ventriculo-peritoneal shunt treatment was used in 42 of the 54 children and endoscopic third ventriculostomy in 12. Revisions were performed in 33 (61%). Neurological impairments were present in 63%, and they were more common in children born preterm than in those born at term. The radiological extent of parenchymal lesions correlated significantly with outcome. Ophthalmological abnormalities were found in 80%, including visual impairment in one third. CONCLUSION: The incidence of post-haemorrhagic hydrocephalus in children born extremely preterm increased; a group running a high risk of neurological sequelae. Ophthalmological abnormalities were frequent and need to be assessed in all children with hydrocephalus. The high rate of morbidity and complications necessitates the further development of preventive and treatment methods.
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| 33. |
- Persson, Eva-Karin, 1956, et al.
(author)
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Very long-term follow-up of adults treated in infancy for hydrocephalus.
- 2011
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In: Child's Nervous System. - : Springer Science and Business Media LLC. - 1433-0350 .- 0256-7040. ; 27:9, s. 1477-1481
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Journal article (peer-reviewed)abstract
- PURPOSE: The purpose of this study is to perform a population-based, very long-term follow-up of adults who had been shunt treated for hydrocephalus in infancy. METHODS: The 72 children with hydrocephalus born in 1967-1978 in western Sweden, who had participated in a follow-up at school age, were re-examined at 30-43years of age. The 29 with mental retardation were described in terms of developmental level and survival, whereas the remaining 43 were invited to take part in a follow-up and 28 accepted. The assessments included a semi-structured interview pertaining to medical issues, academic achievements and social function. RESULTS: Six children had died, i.e. a mortality rate of 8%. Mental retardation was present in 29 (40%), severe (IQ <50) in 13 and mild (IQ 50-70) in 16. Four of the 28 (14%) had cerebral palsy and 8 (28%) had other motor problems. Five (18%) had epilepsy and nine (32%) had visual impairments. A total of 20 (71%) reported some kind of health problem. Repeated revisions of the shunt had been performed in 23 (82%). Many worried about their shunt and requested a systematic medical follow-up. Nineteen subjects (68%) lived with a partner and 16 (57%) were parents. The majority had completed secondary school and 9 (32%) had completed university studies, while 18 (64%) worked full time, equal to the general population. CONCLUSION: In general, the group of normally gifted individuals with hydrocephalus, who had been shunt treated during infancy, was functioning well as adults and participated in society to the same extent as other people.
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| 34. |
- Persson, K., et al.
(author)
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Preoperative word-finding difficulties in children with posterior fossa tumours : a European cross-sectional study
- 2024
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In: Child's Nervous System. - 0256-7040 .- 1433-0350. ; 40:1, s. 87-97
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Journal article (peer-reviewed)abstract
- Purpose: Posterior fossa tumour surgery in children entails a high risk for severe speech and language impairments, but few studies have investigated the effect of the tumour on language prior to surgery. The current crosslinguistic study addresses this gap. We investigated the prevalence of preoperative word-finding difficulties, examined associations with medical and demographic characteristics, and analysed lexical errors. Methods: We included 148 children aged 5–17 years with a posterior fossa tumour. Word-finding ability was assessed by means of a picture-naming test, Wordrace, and difficulties in accuracy and speed were identified by cut-off values. A norm-based subanalysis evaluated performance in a Swedish subsample. We compared the demographic and medical characteristics of children with slow, inaccurate, or combined slow and inaccurate word finding to the characteristics of children without word-finding difficulties and conducted a lexical error analysis. Results: Thirty-seven percent (n = 55) presented with slow word finding, 24% (n = 35) with inaccurate word finding, and 16% (n = 23) with both slow and inaccurate word finding. Children with posterior fossa tumours were twice as slow as children in the norming sample. Right-hemisphere and brainstem location posed a higher risk for preoperative word-finding difficulties, relative to left-hemisphere location, and difficulties were more prevalent in boys than in girls. The most frequent errors were lack of response and semantically related sideordinated words. Conclusion: Word-finding difficulties are frequent in children with posterior fossa tumours, especially in boys and in children with right-hemisphere and brainstem tumours. Errors resemble those observed in typical development and children with word-finding difficulties.
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| 35. |
- Rabiei, Katrin, 1979, et al.
(author)
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Surgery for intracranial arachnoid cysts in children—a prospective long-term study
- 2016
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In: Child's Nervous System. - : Springer Science and Business Media LLC. - 0256-7040 .- 1433-0350. ; 32, s. 1257-1263
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Journal article (peer-reviewed)abstract
- © 2016, Springer-Verlag Berlin Heidelberg. Purpose: Intracranial arachnoid cysts are cystic malformations found in both adults and children. While many are asymptomatic, some cause symptoms and warrant surgical treatment. In this prospective population-based study, we aimed to study the short- and long-term outcome after surgical intervention in children with arachnoid cysts referred to our centre. Methods: Twenty-seven pediatric patients (13 f. 14 m, mean age 9.4years) with de novo cysts were consecutively included during a 5-year period. The presenting symptoms were headache (n=12), balance disturbance and dizziness (n=6), seizures (n=6), hydrocephalus (n=5), and macrocephaly (n=1). Twenty-two patients underwent surgical treatment with either microsurgical (n=17) or endoscopic fenestration (n=5) of the cyst wall. Cyst volume was measured with OsiriX® software pre- and postoperatively. Short-term and long-term follow-up of all patients was conducted 3months and 8.6years (7–10.5years) postoperatively. Results: Three months after surgery, 59% of the patients were improved regarding at least one major complaint, and average cyst volume was reduced to 33.3ml (0–145ml). At the long-term follow-up of 8.6years, 77% of the patients were improved regarding at least one symptom but subjective symptoms remained in 59%. There was no permanent postoperative morbidity. We found no association between radiological reduction of cyst volume and clinical improvement. Conclusion: Our findings support a restrictive attitude to surgery for intracranial arachnoid cysts, in the absence of objectively verified symptoms and signs or obstruction of CSF pathways.
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| 36. |
- Roccatagliata, L, et al.
(author)
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Pediatric intracranial arteriovenous shunts: a global overview
- 2013
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In: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. - : Springer Science and Business Media LLC. - 1433-0350. ; 29:6, s. 907-919
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Journal article (peer-reviewed)
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| 37. |
- Sandvik, U, et al.
(author)
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Interferon or late effect of radiotherapy?
- 2016
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In: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. - : Springer Science and Business Media LLC. - 1433-0350. ; 32:2, s. 229-230
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Journal article (other academic/artistic)
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| 38. |
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| 39. |
- Serlo, W, et al.
(author)
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Functions and complications of shunts in different etiologies of childhood hydrocephalus.
- 1990
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In: Child's Nervous System. - 0256-7040. ; 6:2, s. 92-94
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Journal article (peer-reviewed)abstract
- Shunt function and complications in different etiologies of childhood hydrocephalus were studied in a series of 306 patients involving 1102 shunt operations. Shunts in patients with hydrocephalus caused by neoplasms proved to be most prone to shunt complications. The patency time for shunts in these patients was significantly shorter than for shunts in other patient categories [Standard number of deviations (SND) 5.9; P less than 0.001, Meyer-Kaplan life table analysis]. When the two main groups of infantile hydrocephalus-congenital obstructive hydrocephalus and hydrocephalus caused by perinatal intracerebral hemorrhage-were compared, the latter group proved to be significantly more prone to shunt infections (P less than 0.01), with an infection rate of 17.8% compared with 8.9% for the former group. The importance of this fact is stressed by the observation that these patients appear to constitute an increasing percentage of hydrocephalic patients. According to the present study, patients with congenital intracranial cysts and hydrocephalus are less prone to shunt complications, i.e., the infection rate is 6.8%, which is significantly less than that of patients with other types of hydrocephalus (P less than 0.01; chi-square test).
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| 40. |
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| 41. |
- Sjöström, Anders, 1951, et al.
(author)
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The light-flash-evoked response as a possible indicator of increased intracranial pressure in hydrocephalus.
- 1995
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In: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. - 0256-7040. ; 11:7
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Journal article (peer-reviewed)abstract
- Surgical treatment of infantile hydrocephalus by shunt implantation may result in suboptimal intracranial pressure. Major neurological impairments and death are usually prevented by shunt treatment, but minor sequelae may persist or develop. The introduction of adjustable shunts has improved the possibilities of optimizing shunt function and minimizing the risk of such impairments. However, it is still impossible to determine the intracranial pressure without invasive measurements. Clinical findings and procedures such as computed tomography (CT) are not always enough to allow a conclusion as to whether a child's signs and symptoms are the result of suboptimal intracranial pressure (shunt dysfunction) or are of another etiology. With the aim of reducing the number of invasive pressure measurements and CT scans, we investigated the effect of increased intracranial pressure on the visual evoked response (VER). Binocular light flash stimuli of supramaximal intensity were used and VER recordings were performed from Oz and Cz. The VER results from a group of 31 infants and children with hydrocephalus and 2 children with pseudotumor cerebri were compared with responses from a control group of 35 healthy children. The results show that a subpotential, P' (P-prime), usually just preceding P1 (P100), had an increased latency ( > 96 ms) in all hydrocephalic children before surgery. The P' latency in this group was usually even above 110 ms. The latencies of other VER potentials were also increased but not as consistently as P'. After surgical intervention the VER latencies decreased and usually normalized. The P' latency in four children in the control group was just above the borderline latency, but was less than 110 ms.(ABSTRACT TRUNCATED AT 250 WORDS)
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| 42. |
- Squier, W., et al.
(author)
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Demonstration of fluid channels in human dura and their relationship to age and intradural bleeding
- 2009
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In: Child's Nervous System. - : Springer Science and Business Media LLC. - 1433-0350 .- 0256-7040. ; 25:8, s. 925-931
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Journal article (peer-reviewed)abstract
- This paper aims to make a systematic study of human dura to establish the presence of fluid transport channels and their relationship to age. Samples of parasagittal dura from autopsy cases from mid-gestation to the ninth decade were examined by light microscopy. We have demonstrated the presence of unlined rounded spaces, uncommon in the fetus and neonate but increasingly evident after 30 weeks of postnatal life. We have shown that intradural bleeding is inversely correlated with the presence of these channels and with age. We suggest that dural maturation, involving the development of arachnoid granulations, may be related to dilatation of intradural fluid channels, allowing them to be identified histologically. The risk of reflux of blood into the dura appears to reduce with age.
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| 43. |
- Svedung Wettervik, Teodor, et al.
(author)
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ICP, PRx, CPP, and ∆CPPopt in pediatric traumatic brain injury : the combined effect of insult intensity and duration on outcome
- 2023
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In: Child's Nervous System. - : Springer. - 0256-7040 .- 1433-0350. ; 39:9, s. 2459-2466
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Journal article (peer-reviewed)abstract
- PurposeThe aim was to investigate the combined effect of insult intensity and duration, regarding intracranial pressure (ICP), pressure reactivity index (PRx), cerebral perfusion pressure (CPP), and optimal CPP (CPPopt), on clinical outcome in pediatric traumatic brain injury (TBI).MethodThis observational study included 61 pediatric patients with severe TBI, treated at the Uppsala University Hospital, between 2007 and 2018, with at least 12 h of ICP data the first 10 days post-injury. ICP, PRx, CPP, and increment CPPopt (actual CPP-CPPopt) insults were visualized as 2-dimensional plots to illustrate the combined effect of insult intensity and duration on neurological recovery.ResultsThis cohort was mostly adolescent pediatric TBI patients with a median age at 15 (interquartile range 12-16) years. For ICP, brief episodes (minutes) above 25 mmHg and slightly longer episodes (20 min) of ICP 20-25 mmHg correlated with unfavorable outcome. For PRx, brief episodes above 0.25 as well as slightly lower values (around 0) for longer periods of time (30 min) were associated with unfavorable outcome. For CPP, there was a transition from favorable to unfavorable outcome for CPP below 50 mmHg. There was no association between high CPP and outcome. For increment CPPopt, there was a transition from favorable to unfavorable outcome when increment CPPopt went below -10 mmHg. No association was found for positive increment CPPopt values and outcome.ConclusionsThis visualization method illustrated the combined effect of insult intensity and duration in relation to outcome in severe pediatric TBI, supporting previous notions to avoid high ICP and low CPP for longer episodes of time. In addition, higher PRx for longer episodes of time and CPP below CPPopt more than -10 mmHg were associated with worse outcome, indicating a potential role for autoregulatory-oriented management in pediatric TBI.
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| 44. |
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| 45. |
- Uvebrant, Paul, 1951, et al.
(author)
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Evaluation of cerebrospinal fluid shunt function in hydrocephalic children using 99mTc-DTPA.
- 1992
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In: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. - 0256-7040. ; 8:2, s. 76-80
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Journal article (peer-reviewed)abstract
- The increasing numbers and survival of children with shunt-treated hydrocephalus make it mandatory to refine the methods for cerebrospinal fluid (CSF) shunt function evaluation. Radionuclide shuntography with 99mTc-DTPA, which has proved to be a safe and effective method, was performed in eight children with suspected CSF-shunt dysfunction. Characteristic shuntography patterns were found for proximal and distal CSF-shunt catheter obstruction as well as for overdrainage and normal CSF-shunt function. Shuntography contributed to the explanation of suspected CSF-shunt dysfunction in all children investigated.
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| 46. |
- Zahid, Nida, et al.
(author)
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Predictors of neurocognition outcomes in children and young people with primary brain tumor presenting to tertiary care hospitals of Karachi, Pakistan : a prospective cohort study
- 2024
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In: Child's Nervous System. - : Springer. - 0256-7040 .- 1433-0350.
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Journal article (peer-reviewed)abstract
- IntroductionPrimary brain tumors are a common cause of morbidity and mortality in children and young people (CYP) globally. Impaired neurocognitive function is a potential severe consequence in primary brain tumor (PBT) survivors. There are no in-depth studies from low- and middle-income countries (LMICs) to inform management and follow-up. The research questions of this study were as follows: Are the sociodemographic factors (lower age of CYP, female gender, low socioeconomic status, low parental education), disease-related factors (high grade of tumor, presence of seizures, presence of hydrocephalous), and treatment-related factors (adjuvant therapy, no surgical intervention, post-treatment seizures, placement of shunts) associated with decline in neurcognition outcomes 12 months post-treatment in CYP with PBTs?MethodsA prospective cohort study was conducted from November 2020 to July 2023 at the Aga Khan University Hospital and Jinnah Postgraduate Medical Centre, tertiary care hospitals in Karachi, Pakistan. All CYP aged 5 to 21 years with a newly diagnosed PBTs were eligible. The neurocognition assessment was undertaken by a psychologist at two points, i.e., pre-treatment and at 12 months post-treatment using validated tools. The verbal intelligence was assessed by Slosson Intelligence tool, revised 3rd edition (SIT-R3), perceptual reasoning by Raven’s Progressive Matrices (RPM), and the Processing Speed Index by Wechsler Intelligence Scale (WISC V) and Wechsler Adult Intelligence Scale (WAIS-IV). The data were analyzed by STATA version 12 software. Generalized estimating equation (GEE) was used to determine the factors associated with the mean change in 12 months post-treatment verbal and non-verbal neurocognition scores. Unadjusted and adjusted beta coefficients with their 95% confidence intervals were reported.ResultsA total of 48 CYPs with PBTs were enrolled, 23 (48%) of them were lost to follow-up and 10 (21%) died. The remaining 25 (52%) were reassessed 12 months after treatment. On multivariable analysis, a significant decline in verbal intelligence scores at 12 months was predicted by post-treatment seizures beta = − 20.8 (95% CI, − 38.2, − 3.4), mothers having no formal educational status and lower household monthly income. Similarly, a significant decline in perceptual reasoning scores was also predicted by post-treatment seizures beta = − 10.7 (95% CI, − 20.6, − 0.8), mothers having no formal education and having lower household monthly income. Worsening of processing speed scores at 12 months post-treatment were predicted by tumor histology, post-treatment seizures beta = − 33.9 (95% CI, − 47.7, − 20.0), lower educational status of the mother, and having lower household monthly. However, an improvement was seen in processing speed scores after surgical tumor resection.ConclusionIn this novel study, the post-treatment mean change in verbal and non-verbal neurocognition scores was associated with sociodemographic, tumor, and treatment factors. These findings may have potential implications for targeted early psychological screening of higher risk CYP with PBTs. Identification of these predictors may serve as a foundation for developing more cost-effective treatment thereby alleviating the burden of neurocognitive morbidity. However to establish generalizability, future research should prioritize larger-scale, multicountry studies. (Trial registration: ClinicalTrials.gov Identifier: NCT05709522)
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| 47. |
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