Emilia Nowosławska

Neuroendoscopic techniques in the treatment of arachnoid cysts in children and comparison with other operative methods

Objective: The authors intended to evaluate the application of neuroendoscopic techniques for the treatment of arachnoid cysts in children and compare it with other operative methods. Methods: The analysis covered the results of treatment of 44 children with arachnoid cysts who were subjected to neuroendoscopic procedures and 62 patients who underwent other operations. Results: The neuroendoscopic treatment of arachnoid cysts was very effective because of low rate of reoperative treatment (six out of 44 patients), no need to change the operative method (40 effective out of total 44 operative procedures), and low rate of persistent worsening (none of 44 patients worsened). Conclusions: Summing up all the mentioned aspects of neuroendoscopic techniques, the neuroendoscopic techniques were the most suitable operative procedures in the treatment of arachnoid cysts in the presented group of patients, providing that the connection between the lumen of the arachnoid cyst and the cerebrospinal fluid cisterns was of good quality.

Effectiveness of neuroendoscopic procedures in the treatment of complex compartmentalized hydrocephalus in children

ObjectiveThe main object of the work is to assess the suitability of neuroendoscopic techniques for the treatment of complex compartmentalized hydrocephalus.MethodsFor this purpose the authors compared two groups of children treated in the Research Institute of the Polish Mothers Memorial Hospital from March 1997 to January 2002. The first group of 47 children, treated using neuroendoscopic procedures, was compared with the second, which comprised 80 children treated conventionally by complicated shunt implantations.ResultsThe children treated neuroendoscopically needed on average 1.7660 procedures during the entire therapy, and 1.0232 operations a year. The same parameters in the conventionally-treated group were as follows: the total number of procedures was 7.050, and the rate of reoperation was 3.949 procedures a year. The proportion of patients who suffered from complications connected with operative treatment and who had a bad outcome was higher in the conventionally-treated group than in the neuroendoscopic one.

Assessment of hydrocephalus in children based on digital image processing and analysis

Abstract Hydrocephalus is a pathological condition of the central nervous system which often affects neonates and young children. It manifests itself as an abnormal accumulation of cerebrospinal fluid within the ventricular system of the brain with its subsequent progression. One of the most important diagnostic methods of identifying hydrocephalus is Computer Tomography (CT). The enlarged ventricular system is clearly visible on CT scans. However, the assessment of the disease progress usually relies on the radiologist’s judgment and manual measurements, which are subjective, cumbersome and have limited accuracy. Therefore, this paper regards the problem of semi-automatic assessment of hydrocephalus using image processing and analysis algorithms. In particular, automated determination of popular indices of the disease progress is considered. Algorithms for the detection, semi-automatic segmentation and numerical description of the lesion are proposed. Specifically, the disease progress is determined using shape analysis algorithms. Numerical results provided by the introduced methods are presented and compared with those calculated manually by a radiologist and a trained operator. The comparison proves the correctness of the introduced approach.

Automatic Assessment of Skull Circumference in Craniosynostosis

The premature fusion of one or more calvarias sutures of the infant’s skull causes a common pediatric disease called craniosynostosis. This condition causes a serious deformation of the head shape and may produce a noticeable disorder in the neuropsychological development of a child and can be treated only by a surgery. The fused sutures are typically confirmed by the computed tomography (CT) imaging. The surgical outcome and overall progress of the treatment is assessed based on a clinical judgment and an additional manual measurement of the head circumference (HC) index. The research presented in this paper considered the problem of an automatic calculation of the HC index based on CT scans. In particular, algorithms for the skull segmentation, determination of the head central sagittal plane and skull landmarks used for the calculation of the HC indices are introduced.

Unexpected eosinophilia in children affected by hydrocephalus accompanied with shunt infection

PurposeThe aim of the article is to describe an immunological reaction to shunt infection in children with hydrocephalus. The main cause of shunt infection involves methicillin resistant Staphylococcus epidermidis (Bhatia et al. Indian J Med Microbiol 35:120–123, 2017; Hayhurst et al. Childs Nerv Syst 24:557–562, 2008; Martínez-Lage et al. Childs Nerv Syst 26: 1795–1798, 2010; Simon et al. PLoS One, 2014; Snowden et al. PLoS One 8:e84089, 2013; Turgut et al. Pediatr Neurosurg 41:131–136, 2005), a bacterial strain which is responsible for the formation of biofilm on contaminated catheters (Snowden et al. PLoS One 8:e84089, 2013; Stevens et al. Br J of Neurosurg 26: 792–797, 2012).MethodsThe study group involved 30 children with congenital hydrocephalus after shunt system implantation, whose procedures were complicated by S. epidermidis implant infection. Thirty children with congenital hydrocephalus awaiting their first-time shunt implantation formed the control group. The level of eosinophils in peripheral blood was assessed in both groups. Cerebrospinal fluid (CSF) was examined for protein level, pleocytosis, interleukins, CCL26/Eotaxin-3, IL-5, IL-6, CCL11/Eotaxin-1, CCL3/MIP-1a, and MBP. Three measurements were performed in the study group. The first measurement was obtained at the time of shunt infection diagnosis, the second one at the time of the first sterile shunt, and the third one at the time of shunt reimplantation. In the control group, blood and CSF samples were taken once, at the time of shunt implantation.ResultsIn the clinical material, the highest values of eosinophils in peripheral blood and CSF pleocytosis were observed in the second measurement. It was accompanied by an increase in the majority of analyzed CSF interleukins.ConclusionCSF pleocytosis observed in the study group shortly after CSF sterilization is presumably related to an allergic reaction to Staphylococcus epidermidis, the causative agent of ventriculoperitoneal shunt infection.

The oscillatory flow of the cerebrospinal fluid in the Sylvian aqueduct and the prepontine cistern measured with phase contrast MRI in children with hydrocephalus—a preliminary report

IntroductionRecognizing patients with ventriculomegaly who are at risk of developing acute hydrocephalus presents a challenge for the clinician. The association between disturbed cerebrospinal fluid flow (CSF) and impaired brain compliance may play a role in the pathogenesis of hydrocephalus. Phase contrast MRI is a noninvasive technique which can be used to assess CSF parameters. The aim of the work is to evaluate the effectiveness of phase contrast MRI in recognizing patients at risk of acute hydrocephalus, based on measuring the pulsatile CSF flow parameters in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly.AimThe aim of the work is to characterize the parameters of cerebrospinal fluid (CSF) flow in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly with regard to patient age and symptoms. We hypothesize that the relationship between CSF flow parameters in these two regions will vary according to analyzed factors and it will allow to recognize children at risk of hydrocephalus.Materials and methodsA group of 26 children with ventriculomegaly (five girls and 21 boys) underwent phase contrast MRI examinations (Philips 3T Achieva with Q-flow integral application). Amplitudes of average and peak velocities of the CSF flow through the Sylvian aqueduct and prepontine cistern were used to calculate ratios of oscillation and peak velocities, respectively. The relationship between the oscillation coefficient, the peak velocity coefficient, and stroke volume was then assessed in accordance with age and clinical symptoms.ResultsThe peak velocity coefficient was significantly higher in patients with hyper-oscillating flow through the Sylvian aqueduct (3.04 ± 3.37 vs. 0.54 ± 0.28; p = 0.0094). Moreover, these patients tended to develop symptoms more often (p = 0.0612). No significant age-related changes were observed in CSF flow parameters.ConclusionPhase contrast MRI is a useful tool for noninvasive assessment of CSF flow parameters. The application of coefficients instead of direct values seems to better represent hemodynamic conditions in the ventricular system. However, further studies are required to evaluate their clinical significance and normal limits.

Early Vertebrectomy (Performed in First 72 Hours after Delivery) as a Treatment Method of Vertebral Column Deformation in Patients with MMC

Introduction 8–12% of all dysraphic defects are accompanied by vertebral column deformations like gibbus, that makes a skin closure a very complicated procedure. The presence of lumbar kyphosis in children who suffered from myelomeningocele increases thread of wound dehiscence, large skin necrosis, CNS infections, decubitus ulcer etc. Operative treatment of vertebral column deformations comprise reduction of pathological curvature to: reach a physiological balance of acting forces on vertebral column axis during upright position of a body, reduce a rate of vertebral column kyphosis increasing, minimize a skin tension over a gibbus, increase abdomen cavum capacity and improve breathing 72 hours after delivery is concerned as a critical moment of surgical management, that should not be exceeded. The main goal of the work is to asses efficiency of an early vertebrectomy performed during surgical management of dysraphic defect that makes possible: prevention from mentioned above complications, avoiding further surgical management and spine stabilization in the future. Material and Methods In Polish Mothers Memorial Hospital (PMMH) 572 surgical managements of dysraphic defects were performed between year 1992 and 2015. In 89 (15,6%) cases coexistence of pathological spine kyphosis was diagnosed. Myelomeningocele aperta was found to be most common type of DD in our material. All our procedures were performed in first 48 hours after delivery. In 15 cases it was in first 24 hours and in 16 it was in second 24 hours of living. During surgical management of Dysraphic Defect form 1 to 3 vertebral bodied were removed. Spine kyphosis side angle and height were measured. Height of gibbus was measured according to K-C straight and side angle was measured with Cobb-4 method Results After such a surgical management we achieve possibility to close skin defect with possible low tension and reduction of pathological spine kyphosis without any foreign material stabilization of the spine. By our surgical management we managed to reduce in average the side angle of the kyphosis by 52,4% and reduce the height in average by 48,06%. Height reduction of pathological spine kyphosis depends on height of pathological spine kyphosis before the surgical management. Side angle quantity of pathological spine kyphosis before the surgical management has statistically significant influence both on height of pathological spine kyphosis and quantity of height reduction after surgical management. Trophic disorders of postoperative wound right after surgery occurred in 12,9% of cases (4 patients) In all catamnesis period it occurred only in 7 cases that was 22,6% of all patients. Conclusion Early performed vertebrectomy with gibbus reduction in first 48 hour after delivery allow to: (1) Close dysraphic defect with coexisting large skin loss; (2) Reduce possibility of recurrent postoperative wound trophic disorders; (3) Reduce the growth rate of pathological spine kyphosis during child genesis. The severity of pathological spine kyphosis and occurrence of early postoperative wound trophic defects are predictors in dysraphic patients.