Tymon Skadorwa

Pediatric arrowshot injury to cervical spinal cord-sagittal cord transection with no neurological deficit and good outcome: case report and review of literature

BackgroundPenetrating spinal cord injuries (PSCI) in cervical region are extremely rare in children. They mostly occur in a mechanism of a gunshot or a stab injury with the use of sharp objects. Gunshot injuries are usually fatal or end up with tetraplegia. Stab wounds may be less severe and result in partial neurological syndrome. In the management of PSCI in children, reliable diagnostics and history of the patient are the most valuable for further decisions, which include early or delayed exploration either nonsurgical treatment. There exist no clear algorithm for antibiotic use in pediatric population—it depends on the site of an injury, presence of pathological secretion from the wound, and nature of the trauma. The use of steroids is controversial. The most common complications related to surgery include infections, edema, and hemorrhage. They may also be associated with the migration of small residual microtraumatizing agent. The literature lacks algorithms for management in children.DiscussionIn this paper, an unusual case of almost total sagittal cervical cord transection is reported. The patient had no neurological symptoms and recovered with no complications. Diagnostic imaging on admission included X-ray and computed tomography. The patient underwent early surgical intervention with removal of foreign body from the cord and subsequent dural suturing. In the paper, the role of detailed history taking, adequate imaging, and drugs administration is discussed. The choice of distinct strategies is analyzed, and a revised literature review is presented in order to unify the management algorithm for pediatric PSCI.

Clinical Characteristics of Benign Pediatric Cranial Vault Tumors: Surgical Considerations Based on 100 Cases.

Background/Aims: Tumors of the cranial vault occur at every age of childhood. Although they are mostly benign lesions, their symptomatology is variable and requires extended diagnostics. The choice of therapeutic strategy strongly depends on histopathological diagnosis, and therefore surgical excision is the elective treatment in such cases. Despite several published papers, the literature still lacks reliable clinical characteristics regarding this heterogeneous group of lesions in pediatric patients. Methods: We present a series of 100 children (55 male, 45 female) with scalp and cranial vault masses (average age: 3.6 years; range: 1 month to 17 years). Eighty-three (83%) patients underwent surgical excision. Demographic data, clinical presentation, diagnostic studies, choice of therapy, and the results of treatment were evaluated. Results: All removed tumors were benign pathologies: pilar cysts (30%), epidermoid/dermoid cysts (21%), vascular malformations (11%), inflammatory tumors (5%), and dysraphic remnants (2%). However, underlying bone destruction was observed in 61% of cases. Cranial extension occurred in 34%. Recurrence was noted in 1 case. Conclusions: Cranial vault tumors are characterized by constant growth and may penetrate the cranial cavity. Delayed surgery increases the risk of intracranial complications. Surgical problems include inappropriate planning, higher risk of intraoperative bleeding, and the need for subsequent cranioplasty.

A case of symmetric retrograde thromboembolic cerebral infarction in an 8-year-old child due to arterial thoracic outlet syndrome

Arterial type of thoracic outlet syndrome belongs to the most unusual mechanisms of stroke in children in the first decade of life. We present a case diagnosed for bilateral and symmetric changes due to retrograde thromboembolic phenomenon. Regarding the age of the patient, the appropriate diagnostics and management are still a matter of debate in pediatric and neurological literature.

Patterns of intrahemispheric propagation in pediatric photoparoxysmal response

PURPOSE The photoparoxysmal response (PPR) is the most important EEG indication of photosensitivity (PS). It may be elicited by intermittent photic stimulation (IPS). PS mostly affects young individuals, with adolescent females at greatest risk. The diagnosis of PS is based on visual EEG assessment. To date, no objective test of PS has been established. METHOD Here we describe 89 individuals of both sexes, aged 5-18 years, epileptic and non-epileptic, in whom a PPR was elicited by IPS during a standard EEG procedure. The distribution of amplitude and intrahemispheric coherence indices were analyzed and, in each case, revealed a unique pattern of PPR propagation. RESULTS A lateral (occipito-temporo-frontal) track was found in 52% of recordings, and 55% of individuals tested showed symmetric patterns. A bilateral pattern dominated in all age groups, all grades of PS, and across epileptic and non-epileptic groups. CONCLUSION A symmetric, bilateral pattern is the most common type of PPR across genders and all ages, regardless of grade of PS and the presence of epilepsy. The results of this study show the current PPR classification in a new light and provide a basis for the concept of PPR lateralization based on objective, quantitative findings.

Traumatic intracranial displacement of the ventriculoperitoneal valve chamber in a child—a report of 2 cases

We present two cases of traumatic intracranial migration of the ventriculoperitoneal (VPS) valve chamber without malfunction of the system. In both patients, a shunt reservoir was surgically repositioned without a burr hole expansion and with no implantation of a new VPS system. We discuss a role of a head trauma and repeated valve palpation in this rare complication.

How does Adamkiewicz artery influence blood supply to the fetal spinal cord

Adamkiewicz artery became important in clinical practice since it was noticed that its damage during aorta aneurysm repair surgery can sometimes lead to distal spinal cord ischemia. The complexity of anatomical variations can be related to the development of spinal cord arteries. The aim was to describe topography of Adamkiewicz artery and its relations to the anterior spinal artery in fetuses. The study was carried on 4 Batsons resin corrosion casts and 24 formalin-fixed fetuses injected with dyed gelatin or latex aged 15-24 weeks gestational age. In fixed specimens vertebral canals were dissected, the anterior spinal artery was traced and Adamkiewicz artery localized. Arteries were photographed and digitally measured. Data were afterwards statistically analyzed. Anterior spinal artery was duplicated in 3/28 cases. There were from 1 to 3 Adamkiewicz arteries per specimen, mean 1.71. No relation was found between the number of Adamkiewicz artery and age. In 37/48 cases Adamkiewicz artery emptied into the anterior spinal artery on the left side. Mean degree of narrowing in anterior spinal artery (diameter of the anterior spinal artery above junction with Adamkiewicz artery divided by its diameter under that junction) was 76.74%. The diameter of Adamkiewicz artery was also correlated linearly with the degree of narrowing of anterior spinal artery (r=0.68; p<0.05). The arteries of the anterior aspect of thoracolumbar spinal cord in the 2nd trimester of pregnancy represent the adult pattern. A potentially great impact of Adamkiewicz artery on the distal spinal cord circulation may be postulated on the basis of these morphological data.

Distinct Strategies in the Treatment of Epidural Hematoma in Children: Clinical Considerations

Background: Epidural hematoma (EDH) is the most common form of intracranial bleeding following head trauma in pediatric patients. It may develop into a life-threatening pathology, requiring an immediate neurosurgical intervention. However, due to an increasing number of posttrauma CT scans most pediatric EDH patients can be treated conservatively, because of minor dimensions of the clot and the possibility of quick control scanning. Aim: Evaluation of distinct strategies in the treatment of EDH patients in our department between January 2007 and December 2012. Results: During this period a total number of 221 patients with EDH were enrolled in the study. Seventy-seven of them (35%) underwent surgical procedures. One hundred and forty-four patients (65%) were treated conservatively. The dominating age group among nonsurgical patients was 0-4 years (85 cases, 61% of the nonsurgical group). In most of these cases a small epidural blood collection with inconsiderable dynamics was observed. Twenty-one patients from this age group (20%) were treated operatively. Among older children (5-18 years) surgical treatment was implemented in 56 (49%) cases. Conclusions: (1) EDH may be successfully treated conservatively with the use of control CT scans. (2) Smaller blood clots dominate in younger patients. (3) Surgical intervention is required more commonly in older patients.

Urazy głowy u dzieci

Summary In his study authors summarise current treatment of the head injury in children basing mainly on own experience. Bogdanowicz Memorial Hospital is the only multitrauma trauma center for children in Masovia region. The emergency department in this hospital is the only one which is supported by full spectrum of specialities. Yearly there is diagnosed about 20000 trauma cases with 5000 head trauma. About 500 is admited to the neurosurgical department and 100 needs surgical intervention. In 2012 next set of guidelines for treatment of sever brain injury in children was edited. However there is lack of enough number of randomized trials to obtain evident recommendations. Problem of Head trauma is wider than only brain injury. In this area guidelines are even less evident.