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Cerebrospinal Fluid Diversion Procedures in the Pediatric Population

Hydrocephalus Definition The term hydrocephalus represents a condition defined as an imbalance between the production and absorption of the cerebrospinal fluid (CSF), resulting in increased intracranial pressure (ICP). Ventricular dilation may or may not occur, because ventriculomegaly can be present without signs of elevated ICP (i.e., without hydrocephalus). Congenital hydrocephalus is a term referring to hydrocephalus that is associated with congenital malformations such as myelomeningocele or…

Methods of Cranial Vault Reconstruction for Craniosynostosis

Cranial sutures are essential components in the development of the skull. Nonfunctional sutures during the evolution of the cranial vault and the skull base lead to evolving deformities that may end in neurologic sequel. Although the term craniosynostosis was first used by Bertolotti in 1914, referring to the premature closure of a cranial suture, it was Sommerring who described in 1791 the anatomy of the suture…

Instrumentation and Stabilization of the Pediatric Spine : Technical Nuances and Age-Specific Considerations

Introduction A wide variety of congenital, developmental, and acquired abnormalities may affect the pediatric spine. The decision for surgical intervention must be tailored to the disease pathology as well as each patient’s clinical situation. Spinal instability may be iatrogenic or caused by the disease process, requiring installation of spinal instrumentation. Placing instrumentation in the pediatric spine is challenging given the small anatomy of a child, lack…

Selective Dorsal Rhizotomy Surgery for the Treatment of Pediatric Spastic Cerebral Palsy

∗Portions of this section on the “History of Selective Posterior Rhizotomy” have been reproduced from the previous Schmidek and Sweet SDR chapter by Drazin et al. Cerebral palsy (CP) is the most common motor disability in children, occurring in 1.5 to 4 per 1000 live births in the United States. The incidence is rising as a result of increasing survival rates of very-low-birth-weight premature infants, the population…

Management of Pediatric Severe Traumatic Brain Injury

Acknowledgment Medical illustrations were drafted and refined by Dr. Shih Liu, USF Department of Neurosurgery. Introduction Worldwide, more than 50 million suffer traumatic brain injury (TBI) each year, and it is estimated that about half the world’s population will have one or more TBIs over their lifetime. Today, TBI still remains a leading cause of injury-related morbidity and mortality among the pediatric population. The impact on…

Revascularization Techniques in Pediatric Cerebrovascular Disorders

This chapter focuses on brain revascularization techniques used for the treatment of pediatric cerebrovascular disease. Although a wide variety of clinical scenarios might warrant surgical revascularization of the brain, the three most commonly encountered by neurosurgeons include atherosclerotic carotid disease, intracranial aneurysms, and moyamoya syndrome. This chapter will focus primarily on surgical revascularization in the setting of treating children with moyamoya syndrome. Moyamoya Syndrome Moyamoya syndrome…

Surgical Management of Spinal Dysraphism

The term spinal dysraphism describes many different forms of congenital malformations of the neural tube. Table 74.1 classifies dysraphic malformations according to accepted theories of embryogenesis and conveniently divides most of them into primary and secondary neurulation lesions, plus an additional class of preneurulation malformations whose basic error of embryogenesis probably occurred before primary neurulation. The surgical repair of these malformations varies as widely as their…

Fetal Surgery for Open Neural Tube Defects

The goal of fetal surgery is to prevent or reduce the adverse consequences of a congenital disorder without increasing the risks for the fetus and mother. A number of diseases, such as congenital diaphragmatic hernia and sacrococcygeal teratoma, can be treated by surgical procedures performed directly on the fetus prior to the anticipated delivery date. An open neural tube defect, or myelomeningocele, is different in that…

Surgical Decision-Making and Treatment Options for Chiari Malformations in Children

Introduction The Chiari malformations encompass a range of hindbrain anomalies. Classically, four subtypes were described ( Table 72.1 ). Chiari 1 malformations are characterized by cerebellar tonsillar herniation through the foramen magnum, and may be congenital or acquired. Patients with Chiari I malformations may develop hydrocephalus, syringomyelia, and/or scoliosis. , Chiari 2 malformations feature herniation of the cerebellar vermis, medulla, and fourth ventricle through the foramen…

Mapping, Disconnection, and Resective Surgery in Pediatric Epilepsy

Children present many unique challenges to the epilepsy surgeon necessitating the use of special techniques and equipment. A large portion of adult epilepsy surgery treats mesial temporal sclerosis (MTS), while in children, extratemporal epilepsy is more common and developmental lesions are frequently encountered. The scope of surgical treatment of pediatric epilepsy may involve mapping the site of seizure onset and surrounding essential brain functions, resection of…

Pediatric Brain Stem Tumors

Introduction Primary brainstem tumors represent 10% to 20% of all pediatric central nervous system (CNS) neoplasms and 20% to 30% of posterior fossa lesions, where their incidence is surpassed by cerebellar pilocytic astrocytoma (PA), medulloblastoma, and ependymoma. The overwhelming majority of these brainstem tumors are what was until recently known as diffuse intrinsic pontine gliomas (DIPG) , which account for up to 80% of pediatric brainstem…

Supratentorial Tumors in the Pediatric Population: Multidisciplinary Management

The most common pediatric supratentorial tumors include low-grade glioma, high-grade glioma (HGG), pineal region tumors, germ cell tumors, and intraventricular tumors. In this chapter, we examine the epidemiology, diagnosis, treatment, and relevant operative approaches for these lesions. Epidemiology Primary brain and other central nervous system (CNS) tumors are the most common solid tumors in pediatric patients and are the leading cause of cancer-related mortality in patients…

Posterior Fossa Tumors in the Pediatric Population: Multidisciplinary Management

Introduction Brain tumors are the most common solid pediatric cancer and constitute the most frequent cause of cancer-related death in children. Pediatric brain tumors are most often located in the posterior fossa (PF). They include medulloblastoma, ependymoma, and cerebellar astrocytoma, but also less common tumors such as atypical teratoid rhabdoid tumor (ATRT), (epi)dermoid cysts, and choroid plexus papilloma. In this chapter we will discuss the clinical…

Imaging Evaluation and Endovascular Treatment of Vasospasm

The first angiographic description of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) was provided in the 1950s by Ecker and Riemenschneider. and substantial contributions have been made in subsequent decades to the clinical and pathophysiologic understanding of this debilitating condition. The traditional belief has been that subarachnoid blood products trigger vasospasm of the proximal, large-caliber cerebral vessels, which consequently leads to impaired cerebral perfusion and eventual…

Endovascular Treatment of Head and Neck Bleeding

The role of endovascular therapy in the treatment of neurologic disease has had a relatively short history. Since its initial introduction by Luessenhop and Spence in 1960, the technological improvements and subsequent indications for the use of endovascular techniques have evolved dramatically. Advances in polymer science, device design, and technique development have resulted in the maturation of this specialty and its integration into neurosurgical management. Indeed,…

Endovascular Management of Spinal Vascular Malformations

Our knowledge of spinal vascular malformations has advanced significantly over the past several decades, and with this increased understanding of the anatomy and pathophysiology of this diverse group of lesions has come the advent of new classification schemes accompanied by a trend toward a greater role for neurosurgeons and enhanced outcomes. Significant advances in spinal arteriography pioneered in the 1960s first allowed the detailed classification of…

Endovascular Management of Dural Arteriovenous Fistulas

Introduction Dural arteriovenous fistulas (DAVFs), also sometimes referred to as dural arteriovenous malformations, represent approximately 10% to 15% of all intracranial arteriovenous malformations. These lesions are characterized by abnormal arteriovenous shunts located within dural leaflets. Cranial DAVFs are most commonly located near dural venous sinuses and spinal DAVFs in the region where the radiculomedullary artery enters the dural root sleeve. The etiology of DAVFs is unknown,…

Embolization of Tumors: Brain, Head, Neck, and Spine

Acknowledgments The authors thank the staff of Neuroscience Publications at Barrow Neurological Institute for assistance with manuscript preparation. Hypervascular neoplasms of the central nervous system can be formidable surgical challenges associated with significant morbidity and mortality, with excessive intraoperative blood loss prompting termination of the surgery before achieving its goals. Multiple reports have suggested preoperative embolization reduces intraoperative blood loss, the need for transfusions, operative time,…

Endovascular Treatment of Extracranial Occlusive Disease

Introduction Ischemic stroke is among the leading causes of morbidity and mortality in the United States. Carotid stenosis is the underlying pathology for 25% of an estimated 800,000 annual strokes. The prevalence of carotid disease is age dependent, with a prevalence of 0.5% after age 60 and up to 10% in the population older than 80 years. There is a direct correlation between the degree of…

Endovascular Treatment of Intracranial Occlusive Disease

Introduction Atherosclerosis and moyamoya disease (MMD) are the two most common forms of intracranial occlusive disease. In this chapter, we discuss endovascular options for the treatment of intracranial atherosclerotic disease (ICAD) and MMD. Approximately 8% to 10% of ischemic strokes in the United States are attributed to ICAD. , This accounts for 70,000 to 90,000 new strokes each year. Nearly 25% of strokes occurring in ethnic…