C. Zaccone

Intracranial pressure monitoring in children: comparison of external ventricular device with the fiberoptic system.

Several intracranial pressure monitoring devices have been developed in the past several years. We have recently adopted the Camino fiberoptic device that permits subdural, intraparenchymal, and intraventricular monitoring. In this report we compare experiences in monitoring a group of pediatric patients with severe craniocerebral trauma and coma, grouped according to severity of Glasgow Coma Scale score. Patient age ranged from 2 to 16 years. Twelve patients were monitored by a ventricular catheter and 37, treated more recently, by a Camino fiberoptic device. The study demonstrated that the fiberoptic device and the ventricular catheter have the same accuracy and reliability. The fiberoptic method correlates very closely with the ventriculostomy method, but the pressure values are always 3±2 mmHg lower than those obtained with the conventional pressure transducer system, especially in more critically ill patients. This new technique is also easier to implant, safer to use, has minimal drift, and is minimally invasive, which particularly speaks for its use in pediatric patients.

Intracranial solitary-type infantile myofibromatosis

An unusual case of infantile myofibromatosis of the solitary type occurring in an intracranial location in a 48-day-old female infant is presented. To our knowledge, there are no other descriptions in the literature of infantile myofibromatosis with exclusively intracranial involvement. The immunohistochemical and electron microscopic findings confirm the myofibroblastic origin of the proliferation.

Spinal cord compression in homozygous beta-thalassemia intermedia

Symptomatic spinal cord compression caused by an epidural mass of extramedullary hematopoietic tissue in patients with beta-thalassemia is a rare occurrence, that becomes exceptional in childhood and adolescence. The literature is not uniform about the optimal treatment of these patients and different modes of therapy have been proposed so far, including surgical excision or decompressing laminectomy followed by local irradiation and/or hypertransfusional regimens. We report the successful treatment of such a complication in an adolescent with homozygous beta-thalassemia by surgery followed by repeated blood transfusions aimed at maintaining hematocrit at normal levels.

Intraoperative monitoring of cerebral blood flow during ventricular shunting in hydrocephalic pediatric patients

Several studies have demonstrated lowered cerebral blood flow (CBF) in patients with hydrocephalus and symptoms of raised intracranial pressure. Ventricular shunting in such cases permits a sudden increase in CBF. The pathophysiology of functional brain deficit secondary to hydrocephalus is little understood. Improvement of the patients clinical status after drainage of CSF suggests that cerebral dysfunction is not necessarily due to permanent brain damage. In fact, it improves rapidly after ventricular taps. In view of this it would be helpful to monitor cerebral perfusion. The transcranial Doppler (TCD) ultrasonography technique allows real-time monitoring of the intracranial circulation and makes it possible to evaluate the physiopathological correlation between ventricular dilatation and CBF. Continuous monitoring of the middle cerebral artery (MCA) by TCD was performed in three hydrocephalic children (2 months, 14 months, and 8 years old) during a ventricular-peritoneal shunt operative procedure. A TC-2000S device provided by an IMP-F fixed probe was utilized. In all patients, when the lateral ventricle was shunted and the CSF could flow away, a clear and sudden increase of flow velocity above 30% was detected. The pulsatility index (PI) was also pathologically increased in all patients. A gradual normalization of this index was revealed after the shunting procedure. Our experience has to be considered preliminary, but nonetheless, it suggests a clear correlation between hydrocephalic disease and concomitant CBF alterations. A more consistent number of monitoring performances by TCD during operative procedures will improve our understanding of the role of CBF in the development of functional deficits in hydrocephalic disease.

Outcome of craniocerebral trauma in infants and children

The authors examined 927 patients affected by craniocerebral trauma and analyzed the neurological complications that occurred most frequently. The study confirmed that the percentage of craniocerebral trauma, gravity, and complications were different in relation to the sex and age of the patients. Based on this analysis, a correlation was made between the traumatic pathologies and socioeconomic-environmental conditions.