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Goyal-Honavar A, Markose AP, Gupta A, Manesh A, Varghese GM, Rose W, Jonathan GE, Prabhu K, Chacko AG. Distinct patterns of postoperative fever in paediatric neurosurgery patients. Childs Nerv Syst 2024; 40:1849-1858. [PMID: 38472391 DOI: 10.1007/s00381-024-06355-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Postoperative fever is a common problem following neurosurgery but data on the causes among paediatric patients is sparse. In this report, we determined the incidence, causes, and outcomes of postoperative fever in paediatric neurosurgical patients (< 18 years), and contrasted the findings with an adult cohort published recently from our unit. METHODS We recruited 61 patients who underwent 73 surgeries for non-traumatic neurosurgical indications over 12 months. A standard protocol was followed for the evaluation and management of postoperative fever. We prospectively collected data pertaining to operative details, daily maximal temperature, clinical features, and use of surgical drains, urinary catheters, and other adjuncts. Elevated body temperature of > 99.9 °F or 37.7 °C for > 48 h or associated with clinical deterioration or localising features was considered as "fever"; elevated temperature not meeting these criteria was classified as transient elevation in temperature (TET). RESULTS Twenty-six patients (35.6%) had postoperative fever, more frequent than in adult patients. TET occurred in 12 patients (16.4%). The most common causes of fever were aseptic meningitis (34.6%), followed by urinary tract infections (15.4%), pyogenic meningitis, COVID-19, and wound infections. Postoperative fever was associated with significantly longer duration of hospital admission and was the commonest cause of readmission. CONCLUSION In contrast to adults, early temperature elevations in paediatric patients may portend infectious and serious non-infectious causes of fever, including delayed presentation with aseptic meningitis, a novel association among paediatric patients. Investigation guided by clinical assessment and conservative antibiotic policy in keeping with the institutional microbiological profile provides the most appropriate strategy in managing paediatric postoperative fever.
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Affiliation(s)
- Abhijit Goyal-Honavar
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Annsmol P Markose
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Ankush Gupta
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Winsley Rose
- Department of Paediatric Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gandham Edmond Jonathan
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Krishna Prabhu
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - Ari G Chacko
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India
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Shibukawa S, Konta N, Niwa T, Miyati T, Yonemochi T, Yoshimaru D, Horie T, Kuroda K, Sorimachi T. Temperature measurement of intracranial cerebrospinal fluid using diffusion tensor imaging after revascularization surgery in Moyamoya disease. Magn Reson Imaging 2023; 99:1-6. [PMID: 36608908 DOI: 10.1016/j.mri.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Brain temperature monitoring using a catheter thermometer has been reported to be a useful technique to predict prognosis in neurosurgery. To investigate the possibility of measuring intracranial cerebrospinal fluid temperature for postoperative monitoring in patients with Moyamoya disease (MMD) after bypass surgery. MATERIALS AND METHODS This study evaluated fifteen patients with MMD who were indicated for bypass surgery. Diffusion tensor imaging for brain thermometry were performed on a 1.5-T MR scanner. Intracranial cerebrospinal fluid temperature with/without considering the fractional anisotropy component, body temperature, C-reactive protein levels, white blood cell count, and cerebral blood flow measured by 123I-IMP single-photon emission computed tomography were obtained before surgery and 1-3 days after surgery. Pixel values considered to be signal outliers in fractional anisotropy processing were defined as cerebrospinal fluid noise index and calculated. Wilcoxon signed-rank test and effect size were performed to compare the changes before and after revascularization. Spearman's rho correlation coefficient was used to analyze the correlations between each parameter. Statistical significance was defined as p < 0.05. RESULTS All parameter values became significantly higher compared to those measured before revascularization (p < 0.01 in all cases). The effect sizes were largest for the cerebrospinal fluid temperature with fractional anisotropy processing and for C-reactive protein levels (Rank-biserial correlation = 1.0). The cerebrospinal fluid noise index and cerebrospinal fluid temperatures with fractional anisotropy processing (r = 0.84, p < 0.0001) or without fractional anisotropy processing (r = 0.95, p < 0.0001) showed highly significant positive correlations. Although no significant correlation was observed, cerebrospinal fluid temperatures with fractional anisotropy had small or moderately positive correlations with cerebral blood flow, body temperature, C-reactive protein levels, and white blood cell count (r = 0.37, 0.42, 0.41, and 0.44, respectively; p > 0.05). CONCLUSION Our findings suggest the possibility of postoperative monitoring for MMD patients by measuring intracranial cerebrospinal fluid temperature with fractional anisotropy processing. Intracranial cerebrospinal fluid temperature might be considered as combined response since cerebrospinal fluid, body temperature, and inflammation are equally correlated.
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Affiliation(s)
- Shuhei Shibukawa
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Bunkyo-Ku, Tokyo, Japan; Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan; Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, Meguro-ku, Tokyo, Japan; Department of Radiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
| | - Natsuo Konta
- Department of Radiology, Tokai University Hospital, Isehara, Kanagawa, Japan
| | - Tetsu Niwa
- Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Tosiaki Miyati
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takuya Yonemochi
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Daisuke Yoshimaru
- Department of Radiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan; Jikei University School of Medicine, Division of Regenerative Medicine
| | - Tomohiko Horie
- Department of Radiology, Tokai University Hospital, Isehara, Kanagawa, Japan
| | - Kagayaki Kuroda
- Course of Electrical and Electronic Engineering, Graduate School of Engineering, Tokai University
| | - Takatoshi Sorimachi
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Goyal-Honavar A, Gupta A, Manesh A, Varghese GM, Edmond Jonathan G, Prabhu K, Chacko AG. A prospective evaluation of postoperative fever in adult neurosurgery patients in the COVID-19 era. J Clin Neurosci 2022; 103:26-33. [PMID: 35809454 PMCID: PMC9250895 DOI: 10.1016/j.jocn.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/04/2022] [Accepted: 06/27/2022] [Indexed: 11/20/2022]
Abstract
Postoperative fever is mostly transient and inconsequential but may portend a serious postoperative infection requiring a thorough evaluation, especially during the recent COVID-19 pandemic. We aimed to determine the incidence, causes and outcomes of postoperative fever in neurosurgical patients, as well as to evaluate a protocol for management of postoperative fever. We conducted a prospective study over 12 months, recruiting 425 adult patients operated for non-traumatic neurosurgical indications. We followed a standard protocol for the evaluation and management of postoperative fever collecting data regarding operative details, daily maximal temperature, clinical features, as well as use of surgical drains, urinary catheters, and other invasive adjuncts. Elevated body temperature of > 99.9°F or 37.7 °C for over 48 h or associated with clinical deterioration or localising features was considered as “fever” and was evaluated according to our protocol. We classified elevated temperature not meeting this criterion as a transient elevation in temperature (TET). Sixty-five patients (13.5%) had postoperative fever. Transient elevation of temperature, occurring in 40 patients (8.8%) was most common in the first 48 h after surgery. The most common causes of fever were urinary tract infections (13.7%), followed by aseptic meningitis (10.8%), wound infections and pneumonia. Various aetiologies of fever followed distinct patterns, with COVID-19 and meningitis causing high-grade, prolonged fever. Multivariate analysis revealed cranial surgery, prolonged duration of surgery, urinary catheters and wound drains retained beyond POD 3 to predict fever. Postoperative fever was associated with significantly longer duration of hospital admission. COVID-19 had a high mortality rate in the early postoperative period.
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Affiliation(s)
- Abhijit Goyal-Honavar
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ankush Gupta
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gandham Edmond Jonathan
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Krishna Prabhu
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ari G Chacko
- Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, India.
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Farag AA, Asiri FA, Khoudir MA, Ismaeel M, Hamouda W, Alaghory IM, Moshref RH. Endoscopic third ventriculostomy complications: avoidance and management in a stepwise manner. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00166-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Various complications of endoscopic third ventriculostomy (ETV) have been described. One has to recognize these complications and learn how to avoid them.
Methods
We performed a literature review regarding the reported complications of ETV procedures discussed in a correlated manner with the surgical steps. Furthermore, we reviewed the technical notes described by experienced neuroendoscopists, including surgical indications, choice of the endoscopic entry point and trajectory, anatomic orientation, proper bleeding control and tight closure, to prevent and deal with such complications.
Results and conclusion
A lesson learned that comprehensive knowledge of ventricular anatomy with proper orientation by studying the preoperative images is mandatory and one should be aware of all complication types and rates.
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Wang Y, Li Z, Cao X, Zhou C, Jin Y. Postoperative antibiotic management strategy for febrile patient with posterior cranial fossa tumor resection: Retrospective clinical study. J Clin Neurosci 2020; 80:80-86. [PMID: 33099373 DOI: 10.1016/j.jocn.2020.07.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/21/2020] [Accepted: 07/27/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Postoperative fever (POF), associated with posterior cranial fossa (PCF) surgery, occurs commonly and is a potential intracranial infection indicator of perioperative antibiotics prolongation and advancement. The existing prophylactic approaches to balancing the risk between intracranial infection and antibiotics abuse are debatable. METHODS We retrospectively assessed 100 patients subjected to PCF tumor resection between December 2015 and December 2018 at a single institution. Forty febrile patients were selected for further analysis. Of them, 16 received basic and 24 advanced antibiotics and were subjected to prophylactic antibiotic assessment. RESULTS The total POF rate of PCF tumor resection was 49.4%. POF occurred from day 1 to day 5, along with the abnormalities of cerebrospinal fluid (CSF) profiles and the mild meningeal irritation symptom. CSF cultures of all selected patients were negative. In the comparison between the basic and advanced antibiotic therapy, we found no statistically significant differences in the results of the average and dynamic analysis of the body temperature and CSF profiles. Negative results of outcome studies were also obtained in the duration of fever, duration of hospitalization, and total hospitalization expenses. However, the expenses were substantially increased in the advanced antibiotic treatment. CONCLUSIONS Although POF is a common symptom after PCF tumor resection, definite intracranial infection is rare. A high body temperature and significant abnormal CSF profiles at an early stage may not be a specific and sufficient indicator of intracranial infection to upgrade antibiotics therapy when standard prophylactic protocols have been accurately achieved.
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Affiliation(s)
- Yida Wang
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Zhen Li
- Department of Neurosurgery, Jingjiang People's Hospital, Jingjiang, Jiangsu 214500, China
| | - Xiangyuan Cao
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Chengcheng Zhou
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Yi Jin
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
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The Incidence of and Risk Factors for Postoperative Fever after Cleft Repair Surgery in Children. J Pediatr Nurs 2019; 45:e89-e94. [PMID: 30738633 DOI: 10.1016/j.pedn.2019.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/17/2019] [Accepted: 01/20/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE The characteristics of postoperative fever after cleft repair surgery in children are unknown. Thus, the purpose of this study was to determine the incidence of and risk factors for postoperative fever. DESIGN AND METHODS We retrospectively assessed 328 children who underwent cleft surgery at our hospital between March 2016 and April 2017 and were followed up for at least 3 days postoperatively. Fever was defined as a body temperature ≥38.0 °C. RESULTS Seventy-one percent (n = 233) of patients developed fever within 72 h postoperatively, and most cases of postoperative fever were benign. Patients most frequently developed fever within 24 h postoperatively, and the occurrence of fever significantly decreased between 24 and 72 h postoperatively (p < 0.001). The incidence of fever with temperatures between 38.0 °C and 39.0 °C was higher than that of fever with temperatures ≥39.0 °C (p < 0.001). The mean duration of an episode of fever was 4 h. The type of surgery, method of anesthesia, and duration of anesthesia and surgery were found to be correlated with postoperative fever after cleft surgery. CONCLUSIONS Most cases of postoperative fever after cleft surgery were benign occurrences. Postoperative fever after cleft repair surgery was characterized by a low grade, an early onset and a short duration in children. The method of anesthesia, duration of surgery and duration of anesthesia were risk factors for postoperative fever. PRACTICE IMPLICATIONS Our results could help healthcare providers to gain increased knowledge of the risk factors for fever and when and how to treat postoperative fever.
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Pitfalls of Neuroendoscopic Biopsy of Intraventricular Germ Cell Tumors. World Neurosurg 2017; 106:430-434. [PMID: 28711530 DOI: 10.1016/j.wneu.2017.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE A neuroendoscopic biopsy has become common for the diagnosis of ventricular tumors. However, its utility in patients with germ cell tumors (GCTs) has not been well discussed. We examined the usefulness and pitfalls of neuroendoscopic biopsies of intraventricular GCTs at a single institution. METHODS We retrospectively studied 21 consecutive patients diagnosed with GCTs by a neuroendoscopic biopsy of the ventricular region via the lateral ventricle. We examined the localization of tumors, histologic diagnoses using biopsies, surgical complications, and consistency of the diagnosis at the latest follow-up. RESULTS Tumor specimens were obtained from a pineal lesion (n = 20), neurohypophysial lesion (n = 5), and lateral ventricular wall lesion (n = 2). In 5 patients, the specimens were obtained from multiple areas. The initial diagnoses were pure germinoma (n = 16), immature teratoma (n = 1), yolk sac tumor (n = 1), and mixed GCT (n = 3). Six of 21 patients needed a second transcranial removal of enhanced residual lesions in the course of the treatment. A discrepancy in the histologic diagnosis between 2 surgeries occurred in 3 patients: All 3 patients had a new diagnosis of teratoma component following transcranial surgery. No postoperative mortality or permanent morbidity related to the neuroendoscopic procedures was noted. CONCLUSION Neuroendoscopic biopsies are safe and useful for obtaining reliable histologic diagnoses in the management of GCTs. However, for GCTs with mixed histology, biopsies are susceptible to diagnostic errors, especially missing detecting a component of teratoma.
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8
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Jung TY, Chong S, Kim IY, Lee JY, Phi JH, Kim SK, Kim JH, Wang KC. Prevention of Complications in Endoscopic Third Ventriculostomy. J Korean Neurosurg Soc 2017; 60:282-288. [PMID: 28490153 PMCID: PMC5426448 DOI: 10.3340/jkns.2017.0101.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 02/19/2017] [Accepted: 02/21/2017] [Indexed: 11/27/2022] Open
Abstract
A variety of complications in endoscopic third ventriculostomy have been reported, including neurovascular injury, hemodynamic alterations, endocrinologic abnormalities, electrolyte imbalances, cerebrospinal fluid leakage, fever and infection. Even though most complications are transient, the overall rate of permanent morbidity is 2.38% and the overall mortality rate is 0.28%. To avoid these serious complications, we should keep in mind potential complications and how to prevent them. Proper decisions with regard to surgical indication, choice of endoscopic entry and trajectory, careful endoscopic procedures with anatomic orientation, bleeding control and tight closure are emphasized for the prevention of complications.
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Affiliation(s)
- Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Sangjoon Chong
- Division of Pediatric Neurosurgery and Clinical Pediatric Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - In-Young Kim
- Department of Neurosurgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery and Clinical Pediatric Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea.,Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery and Clinical Pediatric Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery and Clinical Pediatric Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Jae-Hyoo Kim
- Department of Neurosurgery, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Kyu-Chang Wang
- Division of Pediatric Neurosurgery and Clinical Pediatric Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
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de Kunder SL, Ter Laak-Poort MP, Nicolai J, Vles JSH, Cornips EMJ. Fever after intraventricular neuroendoscopic procedures in children. Childs Nerv Syst 2016; 32:1049-55. [PMID: 27080093 PMCID: PMC4882356 DOI: 10.1007/s00381-016-3085-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/06/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this paper was to study the incidence and clinical significance of fever after intraventricular neuroendoscopic procedures in children. METHODS We retrospectively assessed all children subjected to an intraventricular neuroendoscopic procedure between 2004 and 2015. Body temperature 6 days postoperatively, symptoms and signs, and eventual cerebrospinal fluid analysis were evaluated. Fever was defined as temperature above 38 °C. RESULTS Fifty-five children (mean age 4.8 years) had 67 procedures. Forty-three children (47 procedures, 70 %) developed fever, mostly the day of surgery (n = 17; 25 %) or the next day (n = 33; 49 %). All children who were clinically ill (n = 9, including 7 with fever) suffered serious illness, as opposed to none of the children with fever without being clinically ill (n = 36). Fever was unrelated to gender, indication for, and type of procedure and did not influence ETV success rate at 3 months. Children under 1 year less frequently developed fever (p = 0.032). CONCLUSIONS Fever frequently develops after intraventricular neuroendoscopic procedures in children and follows a rather predictable course, peaking the day of surgery and/or the next day, and rapidly subsiding thereafter. Fever is not a cardinal symptom except when combined with other symptoms in children who are clinically ill (which most of them are not). Close observation avoiding invasive diagnostic tests may suffice for those who are not clinically ill, while extra attention should be paid to those whose temperature rises after day 2 especially when clinically ill, as they likely suffer serious illness. We recommend to closely observe children after any intraventricular neuroendoscopic procedure for at least 5 days.
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Affiliation(s)
- S L de Kunder
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M P Ter Laak-Poort
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J Nicolai
- Department of Child Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J S H Vles
- Department of Child Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E M J Cornips
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.
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Niccolini M, Castelli V, Diversi C, Kang B, Mussa F, Sinibaldi E. Development and preliminary assessment of a robotic platform for neuroendoscopy based on a lightweight robot. Int J Med Robot 2015; 12:4-17. [PMID: 25600885 DOI: 10.1002/rcs.1638] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Ventriculostomy is a widely performed neurosurgical procedure; some risk factors can be mitigated by computer/robot-assisted approaches. Platforms fostering synergistic robot-surgeon integration are pursued, for which lightweight robots with compliant controlled joints must be assessed (because compliance hampers accuracy). METHODS We developed a platform encompassing, in particular, a lightweight robot and an optical tracker also used to enhance robot accuracy. Based on specifications by neurosurgeons, we designed a neuroendoscope-handling interface and assessed targeting accuracy in a model ventriculostomy where the robot was operated both autonomously and in hands-on (i.e. co-operative) mode. RESULTS Targeting errors were systematically below the procedure accuracy threshold (1 mm); the rms targeting errors were 0.51 and 0.54 mm for autonomous and hands-on control, respectively. No significant difference was observed between the considered control modes. Very positive feedback was gathered from neurosurgeons. CONCLUSIONS Accurate tool targeting under both autonomous and hands-on control was achieved.
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Affiliation(s)
- Marta Niccolini
- Center for Micro-BioRobotics@SSSA, Istituto Italiano di Tecnologia, Viale Rinaldo Piaggio 34, 56025, Pontedera, Italy
| | - Virginia Castelli
- Center for Micro-BioRobotics@SSSA, Istituto Italiano di Tecnologia, Viale Rinaldo Piaggio 34, 56025, Pontedera, Italy
| | - Costanza Diversi
- Center for Micro-BioRobotics@SSSA, Istituto Italiano di Tecnologia, Viale Rinaldo Piaggio 34, 56025, Pontedera, Italy
| | - Byungjeon Kang
- Center for Micro-BioRobotics@SSSA, Istituto Italiano di Tecnologia, Viale Rinaldo Piaggio 34, 56025, Pontedera, Italy.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera, Italy
| | - Federico Mussa
- Neurosurgery Department, Meyer Pediatric Hospital, Viale Pieraccini 24, 50139, Firenze, Italy
| | - Edoardo Sinibaldi
- Center for Micro-BioRobotics@SSSA, Istituto Italiano di Tecnologia, Viale Rinaldo Piaggio 34, 56025, Pontedera, Italy
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