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Nathan R Selden

Publications and source records attributed to Nathan R Selden.

At least 19 recordsLinked to original sources
PubMed2005

CPP or ICP?

Explore the source record for details and available documents.

Brain Injuries↗
PubMed2005

Endovascular treatment of spinal arteriovenous fistula in a young child with hereditary hemorrhagic telangiectasia. Case report.

Hereditary hemorrhagic telangiectasia ([HHT] or Osler-Weber-Rendu syndrome) can manifest as sudden onset of epistaxis or neurological deficit in a child with characteristic mucocutaneous telangiectasias or as an asymptomatic bruit with or without overlying cutaneous vascular lesions. The authors present a case study of a pediatric patient with HHT in whom a screening computerized tomography (CT) scan of the chest revealed an asymptomatic arteriovenous malformation (AVM) of the spine. An 18-month-old child with a strong family history of HHT, including fatal central nervous system (CNS) hemorrhage and pulmonary AVMs, presented with a cutaneous telangiectasia of the pinna. The child was subsequently screened for potentially morbid pulmonary and CNS AVMs by using chest CT scanning and brain magnetic resonance (MR) imaging. A spinal MR image revealed a perimedullary macro-AVF (MAVF) resulting in a large venous varix within the parenchyma of the thoracic spinal cord. A transarterial embolization of the fistula was performed using N-butyl cyanoacrylate and ethiodol. Postembolization angiography confirmed obliteration of the fistula, and MR imaging revealed thrombosis and reduction in size of the venous varix. There were no neurological sequelae due to the treatment. In families with HHT and a high risk of sudden severe morbidity or death from undisclosed pulmonary or CNS AVMs, screening chest CT scanning and CNS MR imaging should be considered. Interdisciplinary teams of neurosurgery and interventional radiology specialists should evaluate and treat such patients by using diagnostic and therapeutic angiography and, if necessary, surgery.

Angiography↗
PubMed2004

Dura-splitting decompression of the craniocervical junction: reduced operative time, hospital stay, and cost with equivalent early outcome.

OBJECT: The choice of surgical technique for decompressive surgery in patients with Chiari I malformation is controversial. Good preliminary postoperative outcomes have been achieved in patients with Chiari I malformation (without syringomyelia) after using a dura-splitting technique. The authors evaluated safety, resource use, and early outcome after this surgery in patients without syringomyelia and compared the findings associated with duraplasty in patients with syringomyelia. METHODS: A prospective series of 24 patients with Chiari I malformation (12 with a syrinx) underwent decompression of the craniocervical junction (CCJ). An allograft-augmented duraplasty was performed in patients with syringomyelia. Intraoperative ultrasonography confirmed adequate tonsillar decompression after lysis of the periosteal bands at the foramen magnum and C-1 arch as well as partial resection of the outer leaf of the dura in patients without syringomyelia. Patients in each group were of similar mean age (syringomyelia 10.8 years and no syringomyelia 7.6 years old; p = 0.07) and functional status. The mean follow-up period was 15.3 months (range 3-30 months). Dura-splitting decompression required significantly less mean operative time (99 minutes compared with 169 minutes, respectively; p < 0.001), total operating room time (166 minutes compared with 249 minutes, respectively; p < 0.001), duration of hospitalization (3 days compared with 3.75 days, respectively; p < 0.05), perioperative charges ($3615 compared with $5538, respectively; p < 0.001), and overall hospital charges ($7705 compared with $9759, respectively; p < 0.001) than the duraplasty. Mean clinical outcome scores were similar (syringomyelia 1.53 of 2; no syringomyelia 1.67 of 2; not statistically significant). CONCLUSIONS: Dura-splitting CCJ decompression in pediatric patients with Chiari I malformation and without syringomyelia is safe, provides good early clinical results, and significantly reduces resource use. A randomized controlled trial of dura-splitting decompression in a uniform population of patients with Chiari I malformation is indicated.

Adolescent↗
PubMed2003

A single-pass tunneling technique for CSF shunting procedures.

Implantation of ventriculoperitoneal shunts in the precoronal position is generally accomplished using a retroauricular incision for subcutaneous tunneling. Retroauricular incisions can be associated with complications, including cerebrospinal fluid leak and shunt infection. We describe a technique for 'single-pass' shunt tunneling from frontal to abdominal incisions and our initial results in a consecutive, prospective series of 15 children (age 2 days to 5 years). Eleven patients presented with congenital hydrocephalus (including 5 with myelomeningocele and 3 with posthemorrhagic hydrocephalus) and 4 with hydrocephalus secondary to central nervous system (CNS) tumors. The average length of clinical follow-up was 6 months (range 1-13 months). There were no perioperative or long-term complications of the single-pass technique. Nine of the 11 patients with congenital hydrocephalus are currently well without any further medical or surgical intervention. Two underwent shunt revision for proximal obstruction, with an intact distal system. Three of the 4 patients with hydrocephalus secondary to CNS tumor suffered secondary shunt complications during periods of severe neutropenia resulting from chemotherapy (6 weeks to 6 months after shunt insertion). For primary ventriculoperitoneal shunt insertion in infants and young children, the single-pass tunneling technique is safe and avoids one source of complications.

Antineoplastic Combined Chemotherapy Protocols↗