Management of tethered spinal cord.
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Child↗
Biomedical subjects
J C Peter
Publications and source records attributed to J C Peter.
Intraoperative antibiotic prophylaxis.
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Anti-Bacterial Agents↗
Patients with retained transcranial knife blades: a high-risk group.
Sixty-six patients with transcranial stab wounds presenting to Groote Schuur Hospital over a 2-year period are reviewed. Two groups were identified, those with retained knife blades at presentation (Group A, 13 patients) and those without (Group B, 53 patients). An increased incidence of vascular complications was observed in Group A, (eight of 13 patients) compared with 11 of 53 patients in Group B (p < 0.01, chi-square test). The mortality rate was also higher in Group A, with deaths in three of 13 patients compared with four of 53 in Group B. Increased mortality was a result of vascular injury, and in two patients neurological deterioration occurred only after knife blade removal. Possible reasons for these findings are that retained blades tend to be deeply penetrating with a potential for more cerebral and vascular injury, and there is a higher incidence of petrous bone penetration that results in carotid artery injury.
Aneurysm, False↗
Health care concerns worldwide.
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Education, Medical↗
Carotid and vertebral artery occlusion after blunt cervical injury: the role of MR angiography in early diagnosis.
The early diagnosis of cervical vascular trauma is critical in the prevention of cerebral ischemia. Traumatic blunt carotid or vertebral artery dissection is rare and frequently associated with other injuries. Diagnosis is often delayed, limiting treatment options and contributing to a poor outcome. The clinical findings and investigation of 14 patients are presented with special reference to the last three who had magnetic resonance imaging angiography. Treatment options are discussed and it is suggested that with modern methods of investigation and management, the prognosis of this condition may be improved.
Adolescent↗
Extradural haematomas in children.
OBJECTIVE: To determine the cause, clinical presentation, radiological and computed tomography (CT) findings, anatomical position and post-surgical outcome of traumatic intracranial, extradural haemorrhage in children. DESIGN: Retrospective study, 1979-1994. SETTING: Neurosurgical referrals from the Trauma Unit at Red Cross War Memorial Children's Hospital, Cape Town. PARTICIPANTS: Forty-four children below the age of 12 years who had extradural haematomas surgically removed. RESULTS: Twenty-one extradural haematomas resulted from falls, 12 from motor vehicle accidents, and 6 from assaults; 1 was of unknown cause. Nineteen patients presented with persistent drowsiness (14/15 on the Glasgow Coma Scale), 17 had headache and vomiting, and 13 gave a history of initial loss of consciousness. Seventeen pre-operative neurological examinations were normal, 11 showed anisocoria, 10 hemiplegia, 4 ataxia, 1 nystagmus and 1 a full fontanelle. Cases of posterior fossa haematoma presented with headache and ataxia. Skull fractures were visible on radiographs in 26; computed tomographic diagnosis was made in all but 1. The site of extradural haematoma was parieto-occipital in 24, posterior fossa in 11, frontal in 6, and temporal in 3. Subdural haematomas occurred in 4 cases. Surgical treatment consisted of 41 craniotomies/craniectomies and 3 burr-holes. Postoperatively 36 patients were neurologically normal, 6 had neurological deficits, and 2 died. CONCLUSION: Intracranial extradural haemorrhage in children presents in an atypical manner when compared with adults. An initial loss of consciousness followed by a lucid interval and a progressive deteriorating level of consciousness is the exception rather than the rule. Timeous neurosurgical treatment resulted in an excellent outcome in 36 of the 44 children.
Child↗
Hydatid infestation of the brain: difficulties with computed tomography diagnosis and surgical treatment.
The radiological, surgical and pharmacological management of 11 children with cerebral hydatid disease is presented with special emphasis on the varying CT and MRI appearances and the surgical difficulties we have encountered. All but 2 had enhanced CT scanning and 2 had an MRI. The typical CT appearance of a large non-enhancing cyst of CSF density with minimal oedema was only seen in 3 children. Atypical appearances included irregularity of the cyst wall contour (2), enhancement of the surrounding rim (3), isodensity or heterogeneity of the cyst content (4), surrounding oedema (4) and globular as opposed to curvilinear calcification (2). Complete intact cyst removal was achieved in 3 patients. The reasons for puncturing the cysts or rupturing them at operation were failure to make a definitive pre-operative diagnosis (5), dense adhesions to the skull, dura or falx (3) and the misdiagnosis of an arachnoid cyst and the subsequent placement of a cystoperitoneal shunt (1). Pathological examination suggests that the degree of the inflammatory response to the ectocyst may determine the enhancement characteristics and the ease of surgical removal. There was 1 recurrence which responded well to four 28-day treatment cycles of albendazole.
Brain↗
Low-velocity penetrating craniocerebral injury in childhood.
Fifty-four children with low-velocity penetrating injury of the skull and brain are described. The incidence of septic complications was 43%, which is significantly higher than that seen in adults. Nine percent of children developed vascular complications. Due to the high septic complication rate, a more aggressive management protocol consisting of craniectomy and dural repair under antibiotic cover is suggested.
Adolescent↗
Selective posterior lumbosacral rhizotomy in teenagers and young adults with spastic cerebral palsy.
The outcome of 30 teenagers and young adults who have had selective posterior lumbosacral rhizotomy for cerebral palsy spasticity was analysed. This age group was selected because the full benefits of physiotherapy and maturation of the central nervous system would be likely to have accrued prior to rhizotomy and the post-operative function could be related more directly to the surgery per se. All 30 patients had satisfactory long-term tone reduction, sitting and standing were improved in 21 and 17, respectively, and walking patterns of the 25 of 26 spastic diplegic patients were improved. Five patients had dysaesthetic sensations in their legs and feet, and seven had patchy inconsistent areas of pin-prick loss which persisted for more than 2 years post-operatively. Touch was preserved in all cases and there were no patients with incontinence. Twenty-three patients were unequivocally positive about the benefits of this procedure.
Adolescent↗
Rhinogenic subdural empyema in older children and teenagers.
Forty-five patients under the age of 20 years with rhinogenic subdural empyema were treated at Groote Schuur Hospital and Red Cross War Memorial Children's Hospital between 1979 and 1991. Thirty-two were male and 13 female. The majority were between 13 and 19 years of age. Headache was the predominant symptom in 41 patients. Vomiting occurred in 15 and 21 presented with seizures, 2 in status epilepticus. Thirty had swinging pyrexias and 26 neck stiffness while only 14 had focal neurological signs. Swelling of the face or orbit was seen in 24. Twenty-two had depressed levels of consciousness and 7 had Glasgow Coma Scale (GCS) values below 11/15. White cell counts and erythrocyte sedimentation rates were raised in all cases. Twenty-three patients underwent lumbar punctures despite the inherent danger in this procedure. Cerebrospinal fluid analysis showed a pleocytosis in all cases; no organisms were cultured in any of the specimens. The diagnosis in all cases was made by contrast-enhanced computed tomography. Twenty-five patients underwent multiple burrholes, 9 small craniectomies and 11 craniotomies. Thirty-four patients made an excellent recovery. All of the 6 patients who died had GCS values below 11 at the time of their surgery.
Adolescent↗
Brain abscess in childhood. A 25-year experience.
The presentation, treatment and outcome of 98 children with brain abscesses at Red Cross War Memorial Children's Hospital, Cape Town, is reviewed. Middle ear disease and trauma were the commonest sources of infection in 60% of patients. The usual presentation was that of meningitis and it is recommended that computed tomography be performed before lumbar puncture in those patients with associated middle ear disease, trauma or sinusitis. With early treatment of both the abscess and the underlying source of infection, the mortality rate was 16%.
Adolescent↗
Spondylolysis and spondylolisthesis after five-level lumbosacral laminectomy for selective posterior rhizotomy in cerebral palsy.
Of 163 children who have undergone five-level lumbosacral laminectomies for selective posterior rhizotomy, 20% of those re-X-rayed post-operatively (19/99) have developed incidental isthmic spondylolysis or grade I spondylolisthesis. The majority of patients were ambulatory, active, spastic diplegics. There were five children with isthmic defects at L3-4, three at L4-5 and 11 at L5-S1. Six of the 19 children had grade I spondylolisthesis, but none were symptomatic nor has there been any evidence of further slipping to date. It is postulated that the laminectomy, associated lordosis and increased mobility after rhizotomy may be factors in the causation.
Adolescent↗
A study of African children with prolonged focal seizure and a specific CT scan finding.
A prospective study was carried out on 25 children who presented with a focal seizure and had CT scan appearances identified as tuberculoma. Thirteen were treated for tuberculosis. The other 12 received no anti-tuberculous drug therapy. Follow-up scans showed resolution of the radiological lesions in all cases. It is postulated that anti-tuberculous drugs may safely be withheld in cases of this nature when there is no other evidence of tuberculosis.
Antitubercular Agents↗
Subdural empyema: burr holes or craniotomy? A retrospective computerized tomography-era analysis of treatment in 90 cases.
Ninety patients with subdural empyema were treated in the period after computerized tomography (CT) became available (1979 to 1991). Males predominated by a ratio of 2:1, and 40 patients were between 11 and 20 years old. The site of origin was the paranasal air sinuses in 53 patients, the middle ear in 19, and a superficial infection in eight; the source of infection was not known in 10. The most common clinical presentation was headache, fever, neck stiffness, seizures, or periorbital swelling; only seven patients had status epilepticus. While the erythrocyte sedimentation rate and white blood cell count were invariably elevated, the cerebrospinal fluid showed nonspecific pleocytosis in the 60 patients who underwent lumbar puncture. The definitive preoperative diagnosis was made by contrast-enhanced CT in all cases. Surgical treatment was by multiple burr holes in 37 patients, burr holes and small craniectomies in 33, burr holes with catheter drainage in seven, and a large craniotomy in 12. One patient was treated without surgery. The mortality rate was 7.7%, with 86% making a good recovery. These results compare favorably with those reported in other studies using craniotomy alone, and suggest that burr holes should not be disregarded as a method of treating subdural empyema where contrast-enhanced CT facilities are available.
Adolescent↗
Selective posterior lumbosacral rhizotomy for the management of cerebral palsy spasticity. A 10-year experience.
One hundred and sixty-eight patients had selective lumbosacral posterior rhizotomies for the treatment of cerebral palsy spasticity at Red Cross War Memorial Children's Hospital and Groote Schuur Hospital during the 10-year period 1981-1991. There was no mortality and insignificant early postoperative morbidity. Long-term follow-up on 110 patients has revealed satisfactory tone reduction in 95% of cases. The majority showed improvement in standing, sitting and locomotion. Thirteen patients had minor persistent sensory disturbances and 20% have developed asymptomatic spondylolysis or grade I spondylolisthesis. Most therapists, patients and parents remain enthusiastic about the results of this procedure.
Adolescent↗
Traumatic subarachnoid-pleural fistula: case report and review of the literature.
Subarachnoid-pleural fistula is an unusual complication of spinal cord injury without radiologic abnormality (SCIWORA) and a rare cause of posttraumatic pleural effusion. The clinical presentation and surgical management of a child, the first with this complication seen at our institution, who sustained a T-6 SCIWORA and a cerebrospinal fluid-pleural effusion following a pedestrian-motor vehicle collision is discussed. Magnetic resonance imaging (MRI) proved superior to myelography in demonstrating the fistulous connection and associated cord damage. The fistula was successfully closed via a thoracotomy using a muscle and pleural plug.
Child, Preschool↗
Occult dysraphism of the spine. A retrospective analysis of 88 operative cases, 1979-1989.
Eighty-eight children under the age of 12 years with occult spinal dysraphism were operated on at Red Cross War Memorial Children's Hospital from 1979 to 1989. There were 56 lumbosacral lipomas, 18 dermal sinuses and cysts, 7 isolated thickened filum terminales and 7 diastematomyelias. The incidence of neurological abnormality was significantly higher in children operated on after 12 months of age (15% v. 60%). At surgery the commonest variant of the lumbosacral lipoma was the dorsal type. The incidence of postoperative complications was low (CSF leak 10%; superficial infection 6%). Three children improved neurologically, but the vast majority remained unchanged. The desirability and safety of early prophylactic surgery for occult spinal dysraphism is supported by this study.
Age Factors↗
Ascaris lumbricoides: an unusual cause of shunt infection.
Two cases of delayed shunt infection attributable to the abdominal complications of Ascaris lumbricoides infestation are reported. The first child presented with a peritoneal shunt catheter protruding through the anus and the second patient was found to have two live worms around the cephalic shunt tubing. Both had enteric shunt infections which responded well to therapy. The epidemiology and treatment of ascariasis are briefly discussed.
Animals↗