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Nazwar TA, Bal’afif F, Wardhana DW, Masyhudi ANF, Panjaitan C. Transmastoid pediatric penetrating brain injury, interdisciplinary, and tailored patient's treatment. Surg Neurol Int 2024; 15:85. [PMID: 38628538 PMCID: PMC11021077 DOI: 10.25259/sni_18_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/21/2024] [Indexed: 04/19/2024] Open
Abstract
Background Pediatric penetrating brain injuries (PBIs) are rare but critical traumatic events, often involving foreign objects. This report will emphasize the clinical presentation, diagnosis, and treatment strategies for pediatric PBI cases. Case Description This report presents a case of a 7-year-old male patient with a PBI resulting from a nail that penetrated the left mastoid region following a fall from a tree. On admission, the patient maintained consciousness, displayed stable vital signs, and showed no neurological deficits. Crucial radiological examinations, including skull X-rays and head computed tomography (CT) scans, revealed a 6.5 mm caliber nail penetrating 5.5 cm into the brain, with intraventricular hemorrhage filling the bilateral posterior horns of the lateral ventricles. In addition, the CT angiography (CTA) of the head provided a visual of the internal carotid arteries and the vertebrobasilar artery system, obscured by metal artifacts but showing no evidence of thrombus, aneurysm, or vascular malformation. The patient underwent an urgent mastoidectomy and retro sigmoid craniotomy to remove a foreign object, involving a multidisciplinary team. Subsequent to the intervention, the patient sustained full consciousness without neurological impairments and received intensive care. Conclusion Radiological tools, notably skull X-rays and head CT scans, are pivotal for the precise diagnosis of pediatric PBI. The combined mastoidectomy and retro sigmoid craniotomy approach offers a safe and efficient means of foreign body removal. Tailoring treatments to individual patient needs enhances outcomes.
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Affiliation(s)
- Tommy Alfandy Nazwar
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Universitas Brawijaya/Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Farhad Bal’afif
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Universitas Brawijaya/Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Donny Wisnu Wardhana
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Universitas Brawijaya/Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | | | - Christin Panjaitan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Universitas Brawijaya/Dr. Saiful Anwar General Hospital, Malang, Indonesia
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Pramodana B, Fachniadin A, Priyambodo A, Pribadi RH, Wibowo N, Luoma V. Role of hybrid operating room in management of low-velocity penetrating brain injury. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lewit RA, Veras LV, Kocak M, Nouer SS, Gosain A. Pediatric traumatic brain injury: Resource utilization and outcomes at adult versus pediatric trauma centers. Surg Open Sci 2022; 7:68-73. [PMID: 35141513 PMCID: PMC8814818 DOI: 10.1016/j.sopen.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Traumatic brain injury is the leading cause of trauma-related death in children. We hypothesized that children with isolated traumatic brain injury would experience differential outcomes when treated at pediatric versus adult or combined trauma centers. Methods After institutional review board approval, the 2015 National Trauma Data Bank was queried for children up to age 16 years with isolated traumatic brain injury. Demographics and clinical outcomes were collected. Univariable and multivariable analyses were conducted to assess for predictors of in-hospital mortality and complications. Kaplan–Meier survival analysis was conducted. Results A total of 3,766 children with isolated traumatic brain injury were identified; 1,060 (28%) were treated at pediatric trauma centers, 1,909 (51%) at adult trauma centers, and 797 (21%) at combined trauma centers. Subjects were 5 years old (median, interquartile range 1–12 years), 63% male, and 64% white. Higher blood pressure and lower injury severity score were associated with reduced mortality (P < .05). Increasing injury severity score was associated with higher mortality by multivariable logistic regression (odds ratio 1.57, P < .0001). There were no survival differences among hospital types (P = .88). Conclusion Outcomes for children with isolated traumatic brain injury appear equal across different types of designated trauma centers. These findings may have implications for prehospital transport and triage guidelines. Traumatic brain injury (TBI) is the leading cause of trauma-related death in children. Children with TBI are treated at pediatric trauma centers (PTCs), adult TCs (ATCs), and combined TCs (CTCs). We utilized the ACS NTDB to evaluate outcomes for children with TBI at these centers. Ventilator use and intensive care unit utilization were lowest at PTCs. The 30-day mortality rates for children with isolated TBI were equal at PTCs, CTCs, and ATCs.
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Affiliation(s)
- Ruth A. Lewit
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Laura V. Veras
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Simmone S. Nouer
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Ankush Gosain
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
- Children’s Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
- Corresponding author at: Children’s Foundation Research Institute, 50 N Dunlap St, Suite 320, Memphis, TN 38105. Tel.: + 1 901-287-6219; fax: + 1 901-287-4434.
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Wu Y, Chen TG, Chen SM, Zhou L, Yuan M, Wang L, Liu ZY, Bi CL, Luo XY, Lan S, Liu JF. Trans-base and trans-vault low-velocity penetrating brain injury: A retrospective comparative study of characteristics, treatment, and outcomes. Chin J Traumatol 2021; 24:273-279. [PMID: 34016503 PMCID: PMC8563840 DOI: 10.1016/j.cjtee.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/20/2020] [Accepted: 02/15/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Low-velocity penetrating brain injury (LVPBI) caused by foreign bodies can pose life-threatening emergencies. Their complexity and lack of validated classification data have prevented standardization of clinical management. We aimed to compare the trans-base and trans-vault phenotypes of LVPBI to help provide guidance for clinical decision-making of such injury type. METHODS A retrospective study on LVPBI patients managed at our institution from November 2013 to March 2020 was conducted. We included LVPBI patients admitted for the first time for surgery, and excluded those with multiple injuries, gunshot wounds, pregnancy, severe blunt head trauma, etc. Patients were categorized into trans-base and trans-vault LVPBI groups based on the penetration pathway. Discharged patients were followed up by outpatient visit or telephone. The data were entered into the Electronic Medical Record system by clinicians, and subsequently derived by researchers. The demography and injury characteristics, treatment protocols, complications, and outcomes were analyzed and compared between the two groups. A t-test was used for analysis of normally distributed data, and a Mann-Whitney U test for non-parametric data. A generalized linear model was further established to determine whether the factors length of stay and performance scale score were influenced by each factor. RESULTS A total of 27 LVPBI patients were included in this analysis, comprised of 13 (48.1%) trans-base cases and 14 (51.9%) trans-vault cases. Statistical analyses suggested that trans-base LVPBI was correlated with deeper wounds; while the trans-vault phenotype was correlated with injury by metal foreign bodies. There was no difference in Glasgow Coma Scale score and the risk of intracranial hemorrhage between the two groups. Surgical approaches in the trans-base LVPBI group included subfrontal (n = 5, 38.5%), subtemporal (n = 5, 38.5%), lateral fissure (n = 2, 15.4%), and distal lateral (n = 1, 7.7%). All patients in the trans-vault group underwent a brain convex approach using the foreign body as reference (n = 14, 100%). Moreover, the two groups differed in application prerequisites for intracranial pressure monitoring and vessel-related treatment. Trans-base LVPBI was associated with higher rates of cranial nerve and major vessel injuries; in contrast, trans-vault LVPBI was associated with lower functional outcome scores. CONCLUSION Our findings suggest that trans-base and trans-vault LVPBIs differ in terms of characteristics, treatment, and outcomes. Further understanding of these differences may help guide clinical decisions and contribute to a better management of LVPBIs.
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Affiliation(s)
- Yun Wu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Tian-Ge Chen
- National Clinical Medical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Si-Ming Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Liang Zhou
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Meng Yuan
- Center for Experimental Medicine, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Lei Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Zi-Yuan Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Chang-Long Bi
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Xiang-Ying Luo
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Song Lan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Jin-Fang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China.
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Wu Y, Chen T, Yuan M, Mzimbiri JM, Liu Z, Chen Y, Luo X, Chen F, Liu J. Orbitocranial Penetrating Injury With Multiple Vessel Invasion in an Infant: A Case Report and Literature Review. Front Neurol 2020; 11:591431. [PMID: 33281731 PMCID: PMC7689382 DOI: 10.3389/fneur.2020.591431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/19/2020] [Indexed: 01/17/2023] Open
Abstract
Orbitocranial penetrating injury (OPI) with multiple vascular invasions is a rare occurrence. To our knowledge, experience with its clinical treatment is rather limited, especially for infants. This case report describes an infant who fell from a 0.5 m high bed and landed on a toy with a keen-edged plastic rod. The fractured end of the rod was noted at the medial aspect of the left eyelid, and she was experiencing impaired consciousness. Computed tomography showed that the foreign body penetrated the cavernous sinus with internal carotid artery involvement, and compressed the transverse sinus through the cerebellum. Emergency surgery was performed with temporal occlusion of the left common carotid artery. The rod was removed from the orbital side, and bleeding from cavernous sinus region was effectively controlled under direct inspection via a sub-temporal approach. The patient was successfully treated and recovered consciousness after 17 days. This is the first report of successful management of OPI combined with multiple vascular injury in an infant. Herein, we highlight the anatomical imaging features of the injuries and also the individualized strategy concerning vascular invasion.
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Affiliation(s)
- Yun Wu
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Tiange Chen
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Meng Yuan
- Center for Experimental Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | | | - Ziyuan Liu
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Yilei Chen
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Xiangying Luo
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Fenghua Chen
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Jinfang Liu
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
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Duda T, Sharma A, Ellenbogen Y, Martyniuk A, Kasper E, Engels PT, Sharma S. Outcomes of civilian pediatric craniocerebral gunshot wounds: A systematic review. J Trauma Acute Care Surg 2020; 89:1239-1247. [PMID: 32756261 DOI: 10.1097/ta.0000000000002900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pediatric craniocerebral gunshot injuries (CGIs) occur both in the context of accidental and intentional trauma. The incidence and physiology of pediatric CGIs merit reexamination of prognostic factors and treatment priorities. This study characterizes the current understanding of mortality and prognostic factors in this patient population. METHODS A systematic search was conducted. Selection criteria included all studies published since 2000, which described civilian isolated CGIs in pediatric patients. Data were analyzed qualitatively and quantitatively to identify factors prognostic for the primary outcome of mortality. Secondary outcomes included functional outcome status, requirement for surgery, and injury complications. Study quality was assessed with the Newcastle-Ottawa Scale. This study was registered with PROSPERO (CRD42019134231). RESULTS Initial search revealed 349 unique studies. Forty underwent full text screening, and eight studies were included in the final synthesis. The overall mortality rate was 44.8%. Most CGIs occurred in older teenagers. Aggressive surgical treatment was recommended by one author, while remaining studies emphasized clinical judgment. Reported prognostic factors include initial Glasgow Coma Scale, pupil reactivity, involvement of multiple lobes or deep nuclei, and bihemispheric injuries. Reported complications from CGIs included seizure, meningitis, abscess, cerebrospinal fluid leak, bullet migration, focal neurological deficits, endocrine abnormalities, cognitive deficits, and neuropsychological deficits. The Glasgow Outcome Scale was the predominant measure of function and demonstrated a moderate recovery in 17.4% and a good recovery in 27.3% of patients. CONCLUSION This systematic review analyzed the existing evidence for prognostic factors in the context of pediatric CGIs. Significant long-term clinical improvement is possible with interventions including urgent surgical therapy. Fixed bilateral pupils and low initial Glasgow Coma Scale correlate with mortality but do not predict all patient outcomes. Patients younger than 15 years are underreported and may have differences in outcome. The literature on pediatric CGIs is limited and requires further characterization. LEVEL OF EVIDENCE Systematic Review, level IV.
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Affiliation(s)
- Taylor Duda
- From the Division of Neurosurgery, McMaster University, Ontario, Canada
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Kacheris BN, Jallo G, Crooms JW, Oliver TA, Lawson MF, Beaty N. Penetrating intracranial trauma of two minors treated with endovascular technique with the use of temporary balloon occlusion for proximal arterial control. BMJ Case Rep 2019; 12:12/4/e227915. [PMID: 31040138 DOI: 10.1136/bcr-2018-227915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present two children treated with endovascular techniques to gain proximal arterial control of the internal carotid and vertebral artery prior to removal of penetrating objects from the skull base. Both siblings (8-month-old and 22-month-old boys) were injured by different sharp objects (knife and scissor) by a guardian. They were transported to the emergency room where vascular control, including coil embolisation and internal carotid balloon occlusion, was performed in the neuroendovascular suite for safe removal of penetrating objects. Both minors recovered and were discharged home without any focal neurological deficits. In two children with scissor and knife stab with intracranial penetration, endovascular technique allowed safe removal of objects and ensured proximal arterial control was maintained to control for possible extravasation of blood on removal from the skull base.
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Affiliation(s)
- Brian Nicholas Kacheris
- Florida State University College of Medicine, Tallahassee, Florida, USA.,Department of Neurosurgery, Tallahassee Neurological Clinic, Tallahassee, Florida, USA
| | - George Jallo
- Institute of Brain Protection Sciences, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - T Adam Oliver
- Department of Neurosurgery, Tallahassee Neurological Clinic, Tallahassee, Florida, USA
| | - Matthew F Lawson
- Department of Neurosurgery, Tallahassee Neurological Clinic, Tallahassee, Florida, USA
| | - Narlin Beaty
- Department of Neurosurgery, Tallahassee Neurological Clinic, Tallahassee, Florida, USA.,Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
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