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Lonfat E, La Scala GC. Postoperative Dysnatremia in Pediatric Patients Undergoing Palatoplasty. J Craniofac Surg 2023; 34:1942-1947. [PMID: 37226304 PMCID: PMC10521787 DOI: 10.1097/scs.0000000000009345] [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: 12/15/2022] [Accepted: 03/30/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE Identifying predisposing factors to dysnatremia to improve perioperative care after cleft surgery. DESIGN Retrospective case series. Patient data were obtained through the electronic medical records of the hospital. SETTING Tertiary care university hospital. PATIENTS The inclusion criterion was the measurement of an abnormal natremia value, defined as Na >150 or <130 mmol/l after a cleft lip or cleft palate repair procedure. The exclusion criterion was natremia between 131 and 149 mmol/l. RESULTS Natremia measurements were available for 215 patients born between 1995 and 2018. Five patients presented with postoperative dysnatremia. Several predisposing factors to dysnatremia have been identified: drugs, infection, administration of intravenous fluids, and postoperative syndrome of inappropriate antidiuretic hormone secretion. Although the hospital environment contributes to dysnatremia development, the fact that only patients undergoing cleft palate repair develop natremia anomalies suggests that this surgery may be itself a risk factor. CONCLUSION Children undergoing palatoplasty may be at higher risk to develop postoperative dysnatremia. Early recognition of symptoms and risk factors, postoperative monitoring, and prompt treatment of dysnatremia diminish the risk of neurological complications.
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Massimi L, Frassanito P, Bianchi F, Fiorillo L, Battaglia DI, Tamburrini G. Postoperative Epileptic Seizures in Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101465. [PMID: 36291401 PMCID: PMC9600932 DOI: 10.3390/children9101465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/22/2022]
Abstract
Background: Postoperative seizures (PS) occur in 10−15% of patients. This study aims to provide an update on the role of surgery in PS. Methods: All children undergoing a craniotomy for supratentorial lesions in the last 10 years were considered except those with preoperative seizures, perioperative antiepileptic drugs prophylaxis, head-injury and infections, repeated surgery, or preoperative hyponatremia. Children undergoing surgery for intra-axial lesions (Group 1, 74 cases) were compared with those harboring extra-axial lesions (Group 2, 91 cases). Results: PS occurred in 9% of 165 cases and epilepsy in 3% of 165 cases (mean follow-up: 5.7 years). There was no difference between the two study groups with regard to demographic data or tumor size. Group 1 showed a higher rate of gross total tumor resection (p = 0.002), while Group 2 had a higher rate of postoperative hyponatremia (p < 0.0001). There were no differences between the two groups in the occurrence of seizures (6.7% vs. 11%) or epilepsy (2.7% vs. 3.2%). No correlations were found between seizures and age, tumor location, histotype, tumor size, or the extent of tumor resection. Hyponatremia affected the risk of PS in Group 2 (p = 0.02). Conclusions: This study shows a lower rate of PS and epilepsy than series including children with preoperative seizures. Hyponatremia has a significant role. Neurosurgery is safe but surgical complications may cause late epilepsy.
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Affiliation(s)
- Luca Massimi
- Neuroscience Department, Catholic University Medical School, 00168 Rome, Italy
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-3397584217
| | - Paolo Frassanito
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Federico Bianchi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Luigi Fiorillo
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Domenica Immacolata Battaglia
- Neuroscience Department, Catholic University Medical School, 00168 Rome, Italy
- Pediatric Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gianpiero Tamburrini
- Neuroscience Department, Catholic University Medical School, 00168 Rome, Italy
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Gopalakrishna KN, Chakrabarti D, Sadashiva N, Bharadwaj S, Bhat R, Sudhir V. Perioperative Factors Affecting Neurologic Outcome in Infants Undergoing Surgery for Intracranial Lesion: A Retrospective Study. World Neurosurg 2019; 130:e702-e708. [PMID: 31279108 DOI: 10.1016/j.wneu.2019.06.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The short-term neurologic outcome of infants undergoing brain tumor surgery depends on various perioperative factors. This study was undertaken to analyze the effects of perioperative variables on the postoperative neurologic outcome in infants undergoing brain tumor surgery. METHODS We retrospectively reviewed the chart of infants undergoing craniotomy for brain tumor removal from 2000 to 2017. The data related to preoperative variables, intraoperative management details, and postoperative factors were collected and analyzed. The primary outcome measure was occurrence of new postoperative neurologic deficit (POND) and the secondary outcome measure was length of hospital stay (LOHS). RESULTS Complete data were available for 40 infants undergoing craniotomy for excision of intracranial tumor. New-onset POND was found in 14 infants (35%). Based on logistic regression analysis, POND was associated with use of mannitol and massive blood transfusion (MBT) trended toward significance. Based on linear regression analysis, the risk factor associated with prolonged LOHS was reintubation and POND trended toward significance. CONCLUSIONS In this study, factors associated with new POND were mannitol use and to a certain extent MBT. The variables associated with prolonged LOHS were reintubation and to a certain extent POND. The anesthetic technique, location of tumor, tumor histology, and extent of tumor resection did not influence the occurrence of new POND or prolonged LOHS in infantile intracranial tumor surgery. Further prospective studies with larger samples are required for confirmation of these findings and identification of new perioperative risk factors.
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Affiliation(s)
| | - Dhritiman Chakrabarti
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Suparna Bharadwaj
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | | | - Venkataramaiah Sudhir
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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Massimi L, Battaglia D, Bianchi F, Peraio S, Peppucci E, Di Rocco C. Postoperative Epileptic Seizures in Children: Is the Brain Incision a Risk Factor? Neurosurgery 2018; 82:465-472. [PMID: 28973391 DOI: 10.1093/neuros/nyx221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 06/28/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Postoperative seizures (PSs) after neurosurgical operations are common but little is known about the role of surgical brain incision on their genesis. This topic has not been addressed so far. OBJECTIVE To verify if the corticotomy affects the risk of PSs and postoperative epilepsy (PE) in children. METHODS One hundred forty-three consecutive pediatric cases operated on for supratentorial lesions at the same institution in the last 15 yr have been retrospectively reviewed by dividing them into group A, 68 children who required brain corticotomy mainly for hemispheric tumors, and group B, 75 children treated through extracortical approaches mainly for suprasellar and optic tumors. Patients with possible "epileptic" biases, like preoperative seizures, were excluded. RESULTS No significant differences have been found between group A and B as far as incidence of PSs (11.7% vs 14.5%) and PE (4.5% vs 6.5%), timing, and type of seizures are concerned after a mean 6.8 yr follow-up. The size of corticotomy in group A (<3 cm2 vs >3 cm2) had no impact on epileptogenesis as well as the other variables considered in both groups (age, sex, extent of lesion resection). CONCLUSION This study shows that the surgical cortical "trauma" would not represent a risk factor for PSs and PE. According to the present analysis and the literature, other causes seem to be involved (namely, electrolytic imbalance and brain gliosis). This information is important for preoperative surgical planning and postoperative management. A validation by both adult series and prospective studies is needed.
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Affiliation(s)
- Luca Massimi
- Department of Pediatric Neurosurgery, A. Gemelli Hospital, Rome, Italy
| | | | - Federico Bianchi
- Department of Pediatric Neurosurgery, A. Gemelli Hospital, Rome, Italy
| | - Simone Peraio
- Department of Pediatric Neurosurgery, A. Gemelli Hospital, Rome, Italy
| | | | - Concezio Di Rocco
- Pediatric Neuro-surgery, International Neuroscience Insti-tute, Hannover, Germany
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Teixeira JFC, dos Santos Maia‐Lemos P, Cypriano MDS, Pisani LP. The influence of antineoplastic treatment on the weight of survivors of childhood cancer. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2016.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Teixeira JFC, Maia-Lemos PDS, Cypriano MDS, Pisani LP. The influence of antineoplastic treatment on the weight of survivors of childhood cancer. J Pediatr (Rio J) 2016; 92:559-566. [PMID: 27327565 DOI: 10.1016/j.jped.2016.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/23/2016] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Obesity is a late effect in survivors of childhood cancer and correlates with chronic complications. Survivors of leukemia, brain tumors, and hematopoietic stem cell transplantation are more likely to develop obesity resulting from treatment modalities such as radiotherapy and glucocorticoids. This paper analyzes and integrates the current data available to health professionals in order to clarify strategies that can be used to treat and prevent obesity in childhood cancer survivors. SOURCES This is a literature review from on scientifically reliable electronic databases. We selected articles published in the last five years and earlier articles of great scientific importance. DATA SYNTHESIS The mechanisms involved in the pathophysiology of obesity in cancer survivors are not completely understood, but it is believed that damage to the hypothalamus and endocrine disorders such as insulin resistance, leptin resistance, and hormone deficiency may be involved. The body composition of this group includes a predominance of adipose tissue, especially in those undergoing hematopoietic stem cell transplant and total body irradiation. The use of body mass index in these patients may lead to an underestimation of individuals' risk for metabolic complications. CONCLUSION Early identification of groups using accurate anthropometric assessments, interventional treatment, and/or preventative measures and counseling is essential to minimize the adverse effects of treatment. Physical activity and healthy eating to promote adequacy of weight in the whole population should be encouraged.
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Affiliation(s)
| | - Priscila Dos Santos Maia-Lemos
- Instituto de Oncologia Pediátrica/Grupo de Apoio ao Adolescente e à Criança com Câncer (IOP/GRAACC), São Paulo, SP, Brazil
| | - Mônica Dos Santos Cypriano
- Instituto de Oncologia Pediátrica/Grupo de Apoio ao Adolescente e à Criança com Câncer (IOP/GRAACC), São Paulo, SP, Brazil
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de Magalhães KCSF, Vaz JPM, Gontijo PAM, de Carvalho GTC, Christo PP, Simões RT, da Silva KR. Profile of patients with brain tumors and the role of nursing care. Rev Bras Enferm 2016; 69:138-43. [PMID: 26871228 DOI: 10.1590/0034-7167.2016690120i] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 11/01/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to describe the profile of 200 patients with central nervous system tumors (CNST), and the role of the nursing care. METHOD prospective, quantitative and descriptive analysis of medical records of 200 patients with TSNC. RESULTS a total of 61% of our patients had benign CNST and 39% had malignant tumors. The extent of patient dependence, according to the Karnofsky Performance Status scale, was significantly greater for patients with malignant CNST (p < .05), indicating that these patients needed more support with their activities of daily living. CONCLUSION patients with CNST need specialized care, with specific guidance regarding their disease and aspects of daily living after treatment. Thus, the nurse can function as a key element for the effectiveness of care provided to patients and family members with the aim of enhancing the quality of life of all those affected, directly or indirectly, by the disease.
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Affiliation(s)
| | | | | | | | - Paulo Pereira Christo
- Institute of Education and Research, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Renata Toscano Simões
- Institute of Education and Research, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Karla Rona da Silva
- Institute of Education and Research, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
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van Lindert EJ, Delye H, Leonardo J. Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates. J Neurosurg Pediatr 2014; 13:107-13. [PMID: 24236448 DOI: 10.3171/2013.9.peds13222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors conducted a study to compare the complication rate (CR) of pediatric neurosurgical procedures in a general neurosurgery department to the CRs that are reported in the literature and to establish a baseline of CR for further targeted improvement of quality neurosurgical care. METHODS The authors analyzed the prospectively collected data from a complication registration of 1000 consecutive pediatric neurosurgical procedures in 581 patients from the beginning of the registration in January 2004 through August 2008. A pediatric neurosurgeon was involved in 50.5% of the procedures. All adverse events (AEs) from induction of anesthesia until 30 days postoperatively were recorded. RESULTS Overall, 229 complications were counted in 202 procedures. The overall CR was 20.2%, with a 2.7% intraoperative CR and a 17.5% postoperative CR. Tumor surgery was associated with the highest CR (32.7%), followed by CSF disorders (21.8%). The mortality rate was 0.3%. An unplanned return to the operating room in relation to an AE happened in 10.5% of all procedures and in 52% of procedures associated with AEs, the majority of which were related to CSF disorders. CONCLUSIONS The CR in pediatric neurosurgical procedures was significant, and more than half of the patients with an AE required a repeat surgical procedure. Analysis of CRs should be a prerequisite for the prevention of complications and for the development of targeted interventions to reduce the CR (for example, infection rates).
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Affiliation(s)
- Erik J van Lindert
- Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and
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