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Metopic Craniosynostosis

Introduction Although the metopic suture is the only calvarial suture to completely close and disappear in humans, premature closure in utero or soon after birth can lead to major cranial and facial deformities. Amongst these are trigonocephaly, hypotelorism, and a narrow face and forehead, as well as prominent and wide parietal eminences. If the suture closes after 3 or 6 months, the only significant clinical presentation…

Unicoronal Craniosynostosis

Introduction Unilateral nonsyndromic coronal craniosynostosis is a challenging condition for the treating surgical team given all of the deformational changes associated with this condition. Unlike other single suture closures, unicoronal stenosis leads to a combination of skull base, calvarial, and facial deformities. It is a well-known fact that the phenotypic presentation includes the following prominent features: (1) ipsilateral vertical dystopia ( Fig. 9.1 ); (2) ipsilateral…

Sagittal Craniosynostosis

Introduction Sagittal suture craniosynostosis is the most common type of sutural stenosis and affects males more than females at a rate of 3.5:1. , It is a genetic condition with which a number of genes have been associated, and they include: ALX₄ ; BBS9 ; BPM2 ; ERF ; FGR1 ; FGFR2 ; nonetheless, most patients presenting with isolated single suture synostosis are completely normal otherwise…

Ophthalmic Complications of Craniosynostosis and the Impact of Endoscopic Repair

Acknowledgment None Funding: Children’s Hospital Ophthalmology Foundation Chair Funds Introduction Craniosynostosis often affects the growth and development of the orbit resulting in morphologic changes of the orbital rim, the trajectory of the orbit, and internal volumetric proportions. , As such, there are a many ways that vision and ocular alignment are threatened. Ophthalmic abnormalities commonly associated with craniosynostosis include ptosis, exposure keratopathy, astigmatism, amblyopia, papilledema and…

Anesthesia Management

Introduction Craniosynostosis surgery presents a unique set of challenges to the anesthesiology team caring for the patient, particularly when surgery is done on young infants. Amongst a number of potential problems and concerns, the two most prominent are extensive blood losses and venous air emboli (VAE). As each child is different and presents with unique characteristics and concerns, the preoperative assessment needs to be tailored to…

The Role of the Nurse in Endoscopic Craniosynostosis Surgery

Introduction The role of the nurse in endoscopic craniosynostosis surgery began in 1996, after the first surgery was performed at the University of Missouri-Columbia. The role involved not only patient care and family communication, but also coordinating a new type of program. Many of the lessons learned during the early years of program development are still applicable today. The role of the Advanced Practice Registered Nurse…

Perioperative Logistics

Introduction As with any other surgical operation, adequate preparation and planning prior to performing the procedure are crucial and paramount to obtaining an excellent result and minimizing complications. In the case of minimally invasive procedures with small incisions and narrow working corridors, said planning and preparation play an even more important role. This chapter will detail a number of principles that are common to all of…

Background and Management Principles

Craniosynostosis, defined as the untimely and premature closure of a calvarial suture in an infant, leads to well-defined and described phenotypic deformational changes of the neocranium, endocranium, or both. The first recorded description in modern times is ascribed to Otto in 1830. Twenty-one years later, Rudolf Virchow, a German pathologist, developed a classification system for the phenotypes of deformities associated with craniosynostosis. The underlying principle in…

The Evaluation, Correction, and Prevention of Pathologic Facial Development Secondary to Craniosynostosis

Pathogenesis of Abnormal Facial Development Rapid brain growth in the first few months of life results in a rapidly expanding cranium and associated facial changes. The multiple sutures of the skull are critical during this time in allowing the healthy and normal growth of the human brain and face. When one of these sutures prematurely fuses, it can lead to abnormal growth which has been shown…

The History and Evolution of Craniosynostosis Surgery

Early Descriptions of Cranial Morphology and Cranial Sutures The first documented report describing the diversity of cranial morphology dates to 440 BCE in Herodotus’ work, The Histories ( Ἱστορίαι Historíai ). Herodotus (484–425 BCE), an ancient Greek historian, hypothesized through a study that environmental factors contributed to the observed variation in cranial thickness between different human populations. Hippocrates of Kos (460–370 BCE), the Greek physician who…

Intramedullary Spinal Cord Tumor

Indications Intramedullary spinal cord tumor (IMSCT) on magnetic resonance imaging (MRI) in the setting of neurologic symptoms (pain, sensory disturbances, motor weakness, nonspecific complaints). IMSCT, associated cyst, or syringomyelia that has progressed on follow-up MRI. IMSCT on MRI that is of unclear etiology, warranting a need for tissue diagnosis. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become…

Intradural Tumor—Meningioma

Indications Symptomatic patients: intradural meningioma (IM) causing pain or neurologic deficit. Incidental finding: IM causing mass effect on the spinal cord or associated nerve roots. Surgery should be considered for these lesions because of the slowly progressive growth pattern and likelihood of neurologic deterioration in the future. In the case of multiple lesions, it is better to wait for symptoms before resecting a specific lesion. In…

Intradural Nerve Sheath Tumors

Indications An intradural extramedullary lesion causing neurologic symptoms, including weakness, sensory deficits, or pain, is an indication for surgery. Early and aggressive surgical resection, with the aim of gross total resection, is associated with the best outcomes. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Brachial Plexus Injury Nerve Grafting and Transfers

Indications Obstetric brachial plexus palsy (OBPP) has a high percentage of injuries achieve complete recovery spontaneously, yet this does not occur in roughly 30% of patients. For OBPP, the typical lesion in infants is a neuroma-in-continuity, incomplete stretching that allows for some axon fibers to grow through and reach distal targets. Typical signs and symptoms are relevant to the roots and nerves involved in the injury…

Open Carpal Tunnel Release

Indications Clinical symptoms of carpal tunnel syndrome (CTS) include numbness and paresthesias or pain in the median nerve distribution of the hand and fingers. Weakness, stiffness, or clumsiness of the hand also is seen. The major disability the patients report is in regard to thumb movement. Atrophy of the thenar eminence may be seen with chronic CTS. Symptoms may be provoked by tapping or applying pressure…

Ulnar Nerve Release

Indications Progressive clinical symptoms of cubital tunnel syndrome include numbness and paresthesias or pain in the ulnar nerve distribution of the hand, primarily the little finger and ring finger. Sensory symptoms are usually exacerbated by activities that require prolonged elbow flexion, such as holding a telephone or prolonged pressure on the elbow (e.g., long hours working on the computer or flexing the elbow against table while…

Exploration for Injury to an Infant’s Brachial Plexus

Indications Obstetric brachial plexus palsy (OBPP) has a high percentage of injuries that achieve complete recovery spontaneously, yet this does not occur in roughly 30% of patients. Usually stretching injury of the brachial plexus components. Preganglionic avulsion injury is less common. Mixed injuries are fairly common. For OBPP, the typical lesion in infants is a neuroma- in-continuity, incomplete stretching that allows for some axon fibers to…

Tethered Cord Release

Indications Tethered cord on magnetic resonance imaging (MRI) (myelomeningocele, lipomyelomeningocele [LMMC], myelocystocele, spinal cord adhesions, thickened fatty filum, dermal sinus tract, diastematomyelia, tumors, epidermoid/dermoid/neurenteric cysts) with progressive clinical symptoms such as pain, sensory impairment, weakness, spasticity, urinary/bowel dysfunction, foot deformity, and scoliosis that can be correlated with the spinal cord anomaly. Asymptomatic patients, with the type of tethered cord that has a high risk of deterioration…

Primary Myelomeningocele Closure

Indications Newborns with an open dysraphism should undergo operative closure within 24 to 48 hours of delivery, as closure after 72 hours carries a significant risk of meningitis and ventriculitis, decrease of motor function, and an increase in neurologic deficits. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Perspective on How to Build a Neuromodulation Practice

Introduction by Elliot Krames, Editor, Neuromodulation, 2nd Edition Creating a medical practice around the field of neuromodulation, whether you are a neurosurgeon, an anesthesia pain doctor, a urologist, or some other specialist of medicine interested in the field of neuromodulation is not easy in today’s medical world of increasing economic scrutiny and report burden. However, if you do want to create a neuromodulation practice around your…