1
|
Khurana E, Orth J, Pletcher B, Turbin RE, Mazzola CA. Management of an older Marshall-Smith syndrome patient: a review of literature of MSS and craniosynostosis. Childs Nerv Syst 2024:10.1007/s00381-024-06415-7. [PMID: 38647663 DOI: 10.1007/s00381-024-06415-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
Marshall-Smith Syndrome (MSS) is a rare progressive developmental disorder that severely impairs a patient's intellectual development and physical health. The only known cause for MSS is a mutation in the nuclear factor 1 X (NFIX) gene. This mutation affects neuronal development and protein transcription. Historically, most patients with MSS do not survive beyond 3 years of age. Reports of ocular findings are limited. We report a case of a 9-year-old MSS patient with progressive craniosynostosis, elevated intracranial pressure, and catastrophic ocular complications. A comprehensive PubMed literature search from 2018 to August 2022 updating a previous review of older literature produced 72 articles relating to MSS, which are reviewed.
Collapse
Affiliation(s)
- Eeshan Khurana
- Department of Neurosurgery, New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA.
| | - Jennifer Orth
- Department of Neurosurgery, New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA
| | - Beth Pletcher
- Department of Pediatrics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Roger E Turbin
- Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Catherine A Mazzola
- Department of Neurosurgery, New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA
| |
Collapse
|
2
|
Cazorla-Morales IJ, Chan AW, Mikhail MM, Fu A, Koutsouras GW, Heary RF, Mazzola CA. The Accreditation Council for Graduate Medical Education 20-Year Trends in Diversity, Equity, and Inclusion in the United States: How Does Neurological Surgery Compare? World Neurosurg 2024:S1878-8750(24)00382-6. [PMID: 38458250 DOI: 10.1016/j.wneu.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Within the current medical workforce, diversity is limited among surgical specialties. However, diversity allows physicians to provide culturally competent care. This paper discusses the trends in racial, ethnic, and gender representation within different surgical subspecialties with an emphasis on neurosurgery over a 20-year time frame. METHODS A retrospective review of data collected by the Accreditation Council for Graduate Medical Education over the past twenty years, as reported in Journal of the American Medical Association, was conducted. Residents from 5 surgical specialties were evaluated based on gender, race, and ethnic identifications from 2002 to 2022. One-way analysis of variance was performed to compare the levels and retention rates of racial, ethnic, and gender diversity within these specialties. RESULTS Analysis of resident demographics of the 5 surgical specialties reveals an overall trend of increasing diversity over the study period. Over the past 20 years, neurosurgery had an overall increase in Asian (+5.1%), Hispanic (+3.0%), and female (+11.4%) residents, with a decrease in White residents by 2.1% and Black residents by 1.1%. Among the surgical specialties analyzed, otolaryngology had the greatest overall increase in minority residents. Notably, there has been an overall increase in female residents across all 5 surgical specialties, with the highest in otolaryngology (+20.3%) which was significantly more than neurosurgery (P < 0.001). CONCLUSIONS This chronological analysis spanning 20 years demonstrates that neurosurgery, like other specialties, has seen a growth in several racial and ethnic categories. Relative differences are notable in neurosurgery, including Black, Asian, Hispanic, and White ethnic categories, with growth in females, but at a significantly lesser pace than seen in otolaryngology and plastic surgery.
Collapse
Affiliation(s)
- Ilona J Cazorla-Morales
- Department of Neurological Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.
| | - Amber W Chan
- Department of Neurological Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Mirai M Mikhail
- Department of Neurological Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Allen Fu
- Department of Neurosurgery, New Jersey Pediatric Neuroscience Institute, Morristown, New Jersey, USA
| | - George W Koutsouras
- Department of Neurosurgery, SUNY Upstate University Hospital, Syracuse, New York, USA
| | - Robert F Heary
- Department of Neurological Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Catherine A Mazzola
- Department of Neurological Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Neurosurgery, New Jersey Pediatric Neuroscience Institute, Morristown, New Jersey, USA
| |
Collapse
|
3
|
Fu AY, Kavia J, Yadava Y, Srinivasan A, Hargwood P, Mazzola CA, Ammar A. Biopsy of diffuse midline glioma is safe and impacts targeted therapy: a systematic review and meta-analysis. Childs Nerv Syst 2024; 40:625-634. [PMID: 37980290 DOI: 10.1007/s00381-023-06208-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/28/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE To quantify the safety and utility of biopsy of pediatric diffuse midline glioma (DMG). METHODS This study was conducted in accordance with PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science were queried for relevant articles from inception until June 2023. Two reviewers identified all articles that included diagnostic yield, morbidity, and mortality rates for pediatric DMG patients. Studies that did not present original data or were not in English or peer-reviewed were excluded. Meta-analysis was conducted in R using Freeman-Tukey or logit transformation and DerSimonian-Laird random-effects models. The risk of bias was assessed using the Newcastle-Ottawa Scale. A protocol for this review was not registered. RESULTS We identified 381 patients from ten studies that met all criteria. DMG biopsy is safe overall (0% mortality, 95% CI: 0-0.6%; 11.0% morbidity, 95% CI: 4.8-18.9%) and has a high diagnostic yield (99.9%, 95% CI: 98.5-100%). The use of stereotactic biopsy is a significant moderator of morbidity (p = 0.0238). Molecular targets can be identified in approximately 53.4% of tumors (95% CI: 37.0-69.0%), although targeted therapies are only delivered in about 33.5% of all cases (95% CI: 24.4-44.1%). Heterogeneity was high for morbidity and identification of targets. The risk of bias was low for all studies. CONCLUSION We conducted the first meta-analysis of DMG biopsy to show that it is safe, effective, and able to identify relevant molecular targets that impact targeted therapy.
Collapse
Affiliation(s)
- Allen Y Fu
- Department of Cell Biology and Neuroscience, Rutgers University, New Brunswick, NJ, USA.
- Department of Neurosurgery, New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA.
| | - Jay Kavia
- Department of Public Health, Rutgers University, New Brunswick, NJ, USA
| | - Yug Yadava
- Department of Neurosurgery, New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA
- Department of Biology, Rowan University, Glassboro, NJ, USA
| | - Anisha Srinivasan
- Department of Cell Biology and Neuroscience, Rutgers University, New Brunswick, NJ, USA
| | - Pam Hargwood
- Robert Wood Johnson Library of the Health Sciences, The State University of New Jersey, RutgersNew Brunswick, NJ, USA
| | - Catherine A Mazzola
- Department of Neurosurgery, New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA
| | - Adam Ammar
- Department of Neurosurgery, New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA
| |
Collapse
|
4
|
Fu AY, Gutha A, Ammar A, Collins JJ, Mazzola CA. The landscape of current research on pediatric diffuse midline glioma: a quantitative analysis of shifts, leaders, and future avenues. Childs Nerv Syst 2024; 40:57-63. [PMID: 37855876 DOI: 10.1007/s00381-023-06178-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Diffuse midline glioma (DMG) has seen a surge of research interest in recent years with the growth in knowledge of new avenues for potential treatments. However, no bibliometric review of the field has been conducted to visualize the current state of the field. Here, we use bibliometric mapping to visualize the knowledge structure, collaborations, and trends in the field. METHODS A total of 1079 original and review articles from 1996 to 2023 on diffuse midline glioma were extracted from the Web of Science Core Collection on June 3, 2023. These files were analyzed with R and VOSviewer to construct bibliometric visualizations. RESULTS Research interest in DMG has continued to grow, driven by publications of original research. Molecular characterization of DMG has been a key focus of recent literature, and terms relating to novel small molecules, mutations, immunotherapy, the blood-brain barrier, and liquid biopsy may be areas for future growth in the literature. Collaborating nations have generally been the North American and European nations, but other nations have begun to make their mark in the field. Leading and rising institutions and journals are described. CONCLUSION Research in DMG may continue to focus on molecular characterization and new therapeutics based on this knowledge. Novel collaborations between rising nations and institutions in the field may aid in accelerating this research.
Collapse
Affiliation(s)
- Allen Y Fu
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, USA.
- New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA.
| | - Alaya Gutha
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, USA
| | - Adam Ammar
- New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Pediatric Neurosurgery, Johns Hopkins Children's Center, Baltimore, MD, USA
| | - John J Collins
- New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA
| | | |
Collapse
|
5
|
Block BR, Straka-DeMarco D, Demarest M, Mazzola CA. Congenital unilateral lower lip palsy: a case-based review. Childs Nerv Syst 2023; 39:35-40. [PMID: 36198892 DOI: 10.1007/s00381-022-05695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/27/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Congenital unilateral lower lip palsy (CULLP), also referred to as congenital asymmetric crying facies (ACF), is a rare condition that causes pronounced depression of the unaffected lower lip when crying, despite symmetric appearance of the mouth and lips at rest. Unlike the acquired form of ACF, CULLP is idiopathic and often involves permanent defect. METHODS AND RESULTS We present a case-based review of CULLP, including a thorough analysis of the relevant literature and a discussion of the exemplary case of 5-year-old patient presenting with unilateral facial asymmetry resulting from left-sided facial weakness. The patient was diagnosed with ACF at birth, and documentation from a previous neurologic consultation specifies the root cause of the asymmetry as developmental aplasia of the left depressor anguli oris muscle (DAOM). However, there is no record of electrodiagnostic testing or B-scan ultrasound imaging that would support this conclusion, and the patient's dysarthric speech may suggest lower motor neuron involvement. Botox chemodenervation of the right, unaffected side was recommended to deanimate the contralateral lower lip and achieve facial symmetry, in addition to potentially resolving some of the patient's speech difficulties. CONCLUSIONS There are several approaches, both surgical and non-surgical, to the management and correction of CULLP. These include weakening the muscles of the contralateral side or increasing muscular tension on the ipsilateral side, referred to as deanimation and reanimation procedures, respectively.
Collapse
Affiliation(s)
- Brandon R Block
- New Jersey Pediatric Neuroscience Institute, 131 Madison Ave 3rd Floor, Morristown, NJ, 07960, USA. .,Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Deborah Straka-DeMarco
- New Jersey Pediatric Neuroscience Institute, 131 Madison Ave 3rd Floor, Morristown, NJ, 07960, USA
| | | | - Catherine A Mazzola
- New Jersey Pediatric Neuroscience Institute, 131 Madison Ave 3rd Floor, Morristown, NJ, 07960, USA
| |
Collapse
|
6
|
Xu JC, Haider SA, Sharma A, Blumenfeld K, Cheng J, Mazzola CA, Orrico KO, Rosenow J, Stacy J, Stroink A, Tomei K, Tumialán LM, Veeravagu A, Linskey ME, Schwalb J. Telehealth in Neurosurgery: 2021 Council of State Neurosurgical Societies National Survey Results. World Neurosurg 2022; 168:e328-e335. [DOI: 10.1016/j.wneu.2022.09.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
|
7
|
Mazzola CA. Commentary: Intellectual Property Protection in Neurosurgery: An Overview. Neurosurgery 2022; 91:e124. [DOI: 10.1227/neu.0000000000002132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 11/19/2022] Open
|
8
|
Block BR, Collins JJ, Rios JC, Mazzola CA. Maternal Levothyroxine Treatment as an Etiologic Factor in the Development of Infantile Craniosynostosis. J Fetal Med 2022. [DOI: 10.1007/s40556-022-00337-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
9
|
Rahman RK, Majmundar N, Ghani H, San A, Koirala M, Gajjar AA, Pappert A, Mazzola CA. Neurosurgical management of patients with neurocutaneous melanosis: a systematic review. Neurosurg Focus 2022; 52:E8. [DOI: 10.3171/2022.2.focus21791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Neurocutaneous melanocytosis (NCM), also referred to as neurocutaneous melanosis, is a rare neurocutaneous disorder characterized by excess melanocytic proliferation in the skin, leptomeninges, and cranial parenchyma. NCM most often presents in pediatric patients within the first 2 years of life and is associated with high mortality due to proliferation of melanocytes in the brain. Prognosis is poor, as patients typically die within 3 years of symptom onset. Due to the rarity of NCM, there are no specific guidelines for management. The aims of this systematic review were to investigate approaches toward diagnosis and examine modern neurosurgical management of NCM.
METHODS
A systematic review was performed using the PubMed database between April and December 2021 to identify relevant articles using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search criteria were created and checked independently among the authors. Inclusion criteria specified unique studies and case reports of NCM patients in which relevant neurosurgical management was considered and/or applied. Exclusion criteria included studies that did not report associated neurological diagnoses and neuroimaging findings, clinical reports without novel observations, and those unavailable in the English language. All articles that met the study inclusion criteria were included and analyzed.
RESULTS
A total of 26 extracted articles met inclusion criteria and were used for quantitative analysis, yielding a cumulative of 74 patients with NCM. These included 21 case reports, 1 case series, 2 retrospective cohort studies, 1 prospective cohort study, and 1 review. The mean patient age was 16.66 years (range 0.25–67 years), and most were male (76%). Seizures were the most frequently reported symptom (55%, 41/74 cases). Neurological diagnoses associated with NCM included epilepsy (45%, 33/74 cases), hydrocephalus (24%, 18/74 cases), Dandy-Walker malformation (24%, 18/74 cases), and primary CNS melanocytic tumors (23%, 17/74 cases). The most common surgical technique was CSF shunting (43%, 24/56 operations), with tethered cord release (4%, 2/56 operations) being the least frequently performed.
CONCLUSIONS
Current management of NCM includes CSF shunting to reduce intracranial pressure, surgery, chemotherapy, radiotherapy, immunotherapy, and palliative care. Neurosurgical intervention can aid in the diagnosis of NCM through tissue biopsy and resection of lesions with surgical decompression. Further evidence is required to establish the clinical outcomes of this rare entity and to describe the diverse spectrum of intracranial and intraspinal abnormalities present.
Collapse
Affiliation(s)
- Raphia K. Rahman
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Neil Majmundar
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Hira Ghani
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, New York
| | - Ali San
- Kansas City University College of Osteopathic Medicine, Kansas City, Missouri
| | - Monika Koirala
- Kansas City University College of Osteopathic Medicine, Kansas City, Missouri
| | - Avi A. Gajjar
- Department of Chemistry, Union College, Schenectady, New York; and
| | - Amy Pappert
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Newark, New Jersey
| | - Catherine A. Mazzola
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| |
Collapse
|
10
|
Mazzola CA. Letter: United States Medicolegal Progress and Innovation in Telemedicine in the Age of COVID-19: A Primer for Neurosurgeons. Neurosurgery 2022; 90:e52. [PMID: 34995214 DOI: 10.1227/neu.0000000000001797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
|
11
|
Air EL, Orrico KO, Benzil DL, Scarrow AM, Bean JR, Mazzola CA, Liau LM, Rutka JT, Muraszko KM. Developing a Professionalism and Harassment Policy for Organized Neurosurgery. Neurosurgery 2021; 88:1038-1039. [PMID: 33755153 PMCID: PMC8046587 DOI: 10.1093/neuros/nyab051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/26/2020] [Indexed: 11/13/2022] Open
Abstract
Annual conferences, educational courses, and other meetings draw a diverse community of individuals, yet also create a unique environment without the traditional guard rails. Unlike events held at one's home institution, clear rules and jurisdiction have not been universally established. To promote the open exchange of ideas, as well as an environment conducive to professional growth of all participants, the leading neurosurgical professional organizations joined forces to delineate the expectations for anyone who participates in sponsored events. The One Neurosurgery Summit Taskforce on Professionalism and Harassment developed a foundational policy that establishes common expectations for behavior and a unified roadmap for the prompt response to untoward events. We hope that publishing this policy will inspire other medical organizations to establish their own meeting and conference policies. More importantly, we wish to bring greater attention to everyone's responsibility for ensuring a safe and respectful space for education, scientific debate, and networking during organized events.
Collapse
Affiliation(s)
- Ellen L Air
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Katie O Orrico
- Washington Office, American Association of Neurological Surgeons/ Congress of Neurological Surgeons, Washington, District of Columbia, USA
| | - Deborah L Benzil
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - James R Bean
- Baptist Health Lexington, Lexington, Kentucky, USA
| | | | - Linda M Liau
- Department of Neurosurgery, David Geffen School of Medicine, UCLA Health, University of California at Los Angeles, Los Angeles, California, USA
| | - James T Rutka
- Department of Neurosurgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada.,Chair of the Professionalism and Harassment Taskforce
| | - Karin M Muraszko
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.,Chair of the Professionalism and Harassment Taskforce
| |
Collapse
|
12
|
Mazzola CA. Commentary: The Role of Gender in Neurosurgical Residency Applicants' Letters of Recommendation. Neurosurgery 2021; 89:E155. [PMID: 34192741 DOI: 10.1093/neuros/nyab235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/23/2021] [Indexed: 11/14/2022] Open
|
13
|
Markosian C, Mazzola CA, Tomycz LD. Sodium Fluorescein-Guided Gross Total Resection of Pediatric Exophytic Brainstem Glioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E146-E147. [PMID: 33313758 DOI: 10.1093/ons/opaa357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/12/2020] [Indexed: 11/13/2022] Open
Abstract
Brainstem gliomas comprise 10% to 20% of pediatric intracranial tumors.1 Gross total resection is associated with the greatest long-term survival.1 However, due to the eloquence of surrounding brain tissue, an aggressive resection is not always achievable and can be associated with significant risk.2 Sodium fluorescein can be used to help differentiate between tumor and normal tissue.3,4 In this operative video, we demonstrate the step-by-step technique to utilize fluorescence in surgically resecting an exophytic glioma arising from the midbrain in a 16-yr-old male. Technical nuances are highlighted in this operative video, including the use of the YELLOW 560 (Zeiss) filter to differentiate fluorescent tumor from normal tissue as well as strategic splitting of the tentorium to expose the supratentorial component of the tumor. A decrease in motor potentials of the right leg during the case did not translate into neurological worsening postoperatively; at 3-mo follow-up, the patient attests to better strength and coordination on his affected side. In summary, sodium fluorescein can be used as a critical adjunctive tool for successful surgery in the case of a brainstem tumor. Alternatives to this procedure included gross total resection with 5-aminolevulinic acid, subtotal resection with chemotherapy, and active monitoring, but were not chosen due to their limitations in this clinical case.5-7 Appropriate patient consent was obtained to perform this procedure and present this clinical case and surgical video for academic purposes.
Collapse
Affiliation(s)
- Christopher Markosian
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Luke D Tomycz
- New Jersey Pediatric Neuroscience Institute, Morristown, New Jersey
| |
Collapse
|
14
|
Bertoli MJ, Parikh K, Klyde D, Mazzola CA, Pandya Shah S. Spinal arteriovenous malformation in a pediatric patient with a history of congenital syphilis: a case report. BMC Pediatr 2021; 21:242. [PMID: 34011293 PMCID: PMC8132029 DOI: 10.1186/s12887-021-02707-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 05/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background Spinal arteriovenous malformations in children are extremely rare and pose great risk for intraoperative hemorrhage. Congenital syphilis sometimes presents with vascular symptoms, however, there is little published on patients with a history of congenital syphilis presenting with spinal arteriovenous malformations. Case presentation A 15-month-old female with a history of congenital syphilis presented with urinary retention, fever, and subacute onset of paraplegia. MRI showed a lesion at T8-L1, angiogram was performed which confirmed the presence of a complex type IVc arteriovenous malformation and fistula from Artery of Adamkiewicz at L1-L2. It also showed peri medullary dilated veins and a pseudoaneurysm that compressed the spinal cord at T8-T10. Somatosensory evoked potentials and motor-evoked potentials were not recordable on the bilateral lower extremities prior to surgery. Once the patient was optimized for surgery, osteoplastic laminotomies from T6-T12 were performed. The dura was opened and the intradural, intramesenchymal hematoma was evacuated. There were two episodes of brisk arterial bleeding with hypotension during resection of the hematoma. The patient was taken to the angiography suite from the OR to successfully coil the large aneurysm. Intraoperative spinal cord monitoring remained undetectable in the bilateral lower extremities. The patient’s paraplegia remained unchanged from preoperative presentation. Conclusion Congenital syphilis may present with vascular changes that might impact surgical approaches and treatment outcomes in patients with spinal arteriovenous malformations. Preparation for massive transfusion and intraoperative monitoring are imperative in ensuring a safe perioperative experience.
Collapse
Affiliation(s)
| | - Kruti Parikh
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - David Klyde
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Catherine A Mazzola
- Department of Neurosurgery, New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA
| | - Shridevi Pandya Shah
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA.
| |
Collapse
|
15
|
Cao M, Luo Y, Wu Z, Mazzola CA, Catania L, Alvarez TL, Halperin JM, Biswal B, Li X. Topological Aberrance of Structural Brain Network Provides Quantitative Substrates of Post-Traumatic Brain Injury Attention Deficits in Children. Brain Connect 2021; 11:651-662. [PMID: 33765837 DOI: 10.1089/brain.2020.0866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Traumatic brain injury (TBI)-induced attention deficits are among the most common long-term cognitive consequences in children. Most of the existing studies attempting to understand the neuropathological underpinnings of cognitive and behavioral impairments in TBI have utilized heterogeneous samples and resulted in inconsistent findings. The current research proposed to investigate topological properties of the structural brain network in children with TBI and their relationship with post-TBI attention problems in a more homogeneous subgroup of children who had severe post-TBI attention deficits (TBI-A). Materials and Methods: A total of 31 children with TBI-A and 35 group-matched controls were involved in the study. Diffusion tensor imaging-based probabilistic tractography and graph theoretical techniques were used to construct the structural brain network in each subject. Network topological properties were calculated in both global level and regional (nodal) level. Between-group comparisons among the topological network measures and analyses for searching brain-behavioral were all corrected for multiple comparisons using Bonferroni method. Results: Compared with controls, the TBI-A group showed significantly higher nodal local efficiency and nodal clustering coefficient in left inferior frontal gyrus and right transverse temporal gyrus, whereas significantly lower nodal clustering coefficient in left supramarginal gyrus and lower nodal local efficiency in left parahippocampal gyrus. The temporal lobe topological alterations were significantly associated with the post-TBI inattentive and hyperactive symptoms in the TBI-A group. Conclusion: The results suggest that TBI-related structural re-modularity in the white matter subnetworks associated with temporal lobe may play a critical role in the onset of severe post-TBI attention deficits in children. These findings provide valuable input for understanding the neurobiological substrates of post-TBI attention deficits, and have the potential to serve as quantitatively measurable criteria guiding the development of more timely and tailored strategies for diagnoses and treatments to the affected individuals. Impact statement This study provides a new insight into the neurobiological substrates associated with post-traumatic brain injury attention deficits (TBI-A) in children, by evaluating topological alterations of the structural brain network. The results demonstrated that relative to group-matched controls, the children with TBI-A had significantly altered nodal local efficiency and nodal clustering coefficient in temporal lobe, which strongly linked to elevated inattentive and hyperactive symptoms in the TBI-A group. These findings suggested that white matter structural re-modularity in subnetworks associated with temporal lobe may serve as quantitatively measurable biomarkers for early prediction and diagnosis of post-TBI attention deficits in children.
Collapse
Affiliation(s)
- Meng Cao
- Department of Biomedical Engineering and New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Yuyang Luo
- Department of Biomedical Engineering and New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Ziyan Wu
- Department of Electrical and Computer Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
| | | | - Lori Catania
- North Jersey Neurodevelopmental Center, North Haledon, New Jersey, USA
| | - Tara L Alvarez
- Department of Biomedical Engineering and New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Jeffrey M Halperin
- Department of Psychology, Queens College, City University of New York, New York, New York, USA
| | - Bharat Biswal
- Department of Biomedical Engineering and New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Xiaobo Li
- Department of Biomedical Engineering and New Jersey Institute of Technology, Newark, New Jersey, USA.,Department of Electrical and Computer Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
| |
Collapse
|
16
|
Erdman CM, Christie C, Iqbal MO, Mazzola CA, Tomycz L. The utilization of sodium fluorescein in pediatric brain stem gliomas: a case report and review of the literature. Childs Nerv Syst 2021; 37:1753-1758. [PMID: 32780271 DOI: 10.1007/s00381-020-04857-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/06/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION A major challenge in the surgical resection of brainstem tumors is distinguishing tumor from normal tissue. One approach for addressing this problem is the use of fluorescent tracers such as sodium fluorescein (NaFl). NaFl disseminates through a disruption in the blood-brain barrier (BBB) and accumulates in the extracellular space of brain tumors. Intraoperative fluorescence microscopy can be performed to identify tumor tissue and avoid damage to adjacent, normal tissue. Here, we present the case of a 16-year-old male who underwent a left retrosigmoid craniotomy with splitting of the tentorium to remove a large exophytic brainstem tumor involving the cerebellar peduncle and with superior extension into the midbrain and thalamus. OBJECTIVES The primary objective of this study was to investigate the effectiveness of sodium fluorescein as an intraoperative technique and evaluate its potential benefit for resection of tumors in eloquent regions in the pediatric population. To do so, we focused on a case study approach; however, we also performed a literature review and evaluated different intraoperative fluorescent techniques and their benefits for tumor resection. METHODS We performed a literature search using PubMed and Google Scholar by the key words "sodium fluorescein," "brain stem tumor," and "central nervous system neoplasms." Twenty-nine articles including both pediatric and adult populations were selected for analysis and qualitative review. RESULTS In this case study, sodium fluorescein helped the surgeons to identify and obtain a gross total resection of a large brainstem tumor. The marker was especially helpful for discerning the inferior pole of the tumor buried inconspicuously in cerebellar tissue. We evaluate different fluorescent tracers, 5-ALA and ICG, and discuss their application and benefits in tumor resection surgery. We present different cases that found sodium fluorescein to be helpful in achieving a gross total resection. CONCLUSION The application of sodium fluorescein proved to be a safe and effective technique for the resection of brain stem tumors as shown in this case study. It helped to expose concealed areas and illuminate the tumor capsule. Further studies should test the clinical use of sodium fluorescein on brain stem tumor resection.
Collapse
Affiliation(s)
- Cameron M Erdman
- Vassar College, 124 Raymond Avenue, Poughkeepsie, NY, 12603, USA
| | - Catherine Christie
- New Jersey Pediatric Neuroscience Institute, 131 Madison Avenue, Morristown, NJ, 07960, USA
| | - M Omar Iqbal
- Rutgers University, 90 Bergen Street, Newark, NJ, 07101, USA
| | - Catherine A Mazzola
- New Jersey Pediatric Neuroscience Institute, 131 Madison Avenue, Morristown, NJ, 07960, USA
| | - Luke Tomycz
- New Jersey Pediatric Neuroscience Institute, 131 Madison Avenue, Morristown, NJ, 07960, USA.
| |
Collapse
|
17
|
Affiliation(s)
| | - Ryan A Behmer Hansen
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christopher Markosian
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Catherine A Mazzola
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Antonios Mammis
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| |
Collapse
|
18
|
Franklin RC, Hansen RAB, Pierce JM, Tsitouras DJ, Mazzola CA. Reply to Oleske et al., Blood Lead Concentrations in Newark Children. Comment on "Franklin et al. Broken Promises to the People of Newark: A Historical Review of the Newark Uprising, the Newark Agreements, and Rutgers New Jersey Medical School's Commitments to Newark. Int. J. Environ. Res. Public Health 2021, 18, 2117". Int J Environ Res Public Health 2021; 18:ijerph18084215. [PMID: 33923403 PMCID: PMC8073492 DOI: 10.3390/ijerph18084215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022]
Abstract
We read, with tremendous gratitude, Dr. Oleske and Dr. Bogden's comment in the International Journal of Environmental Research and Public Health titled, "Blood Lead Concentrations in Newark Children" [...].
Collapse
Affiliation(s)
- Rosy C. Franklin
- New Jersey Pediatric Neuroscience Institute, Morristown, NJ 07960, USA; (R.C.F.); (R.A.B.H.)
| | - Ryan A. Behmer Hansen
- New Jersey Pediatric Neuroscience Institute, Morristown, NJ 07960, USA; (R.C.F.); (R.A.B.H.)
| | - Jean M. Pierce
- Health Professionals and Allied Employees, Emerson, NJ 07630, USA;
| | - Diomedes J. Tsitouras
- American Association of University Professors, Biomedical and Health Sciences of New Jersey, Newark, NJ 07103, USA;
| | - Catherine A. Mazzola
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
- Correspondence:
| |
Collapse
|
19
|
Bauer DF, Baird LC, Flannery AM, Klimo P, Tamber MS, Nikas DC, Mazzola CA, Rehring P. In Reply: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Treatment of Pediatric Hydrocephalus: Update of the 2014 Guidelines. Neurosurgery 2021; 89:E76-E77. [PMID: 33822192 DOI: 10.1093/neuros/nyab098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David F Bauer
- Department of Neurosurgery Texas Children's Hospital Pediatric Neurosurgery Baylor College of Medicine Houston, Texas, USA
| | - Lissa C Baird
- Department of Neurosurgery Boston Children's Hospital Harvard Medical School Boston, Massachusetts, USA
| | - Ann Marie Flannery
- Kids Specialty Center Women's & Children's Hospital Lafayette, Louisiana, USA
| | - Paul Klimo
- Semmes Murphey Department of Neurosurgery University of Tennessee Health Science Center Le Bonheur Children's Hospital Memphis, Tennessee, USA
| | - Mandeep S Tamber
- Division of Pediatric Neurosurgery British Columbia Children's Hospital University of British Columbia Vancouver, Canada
| | - Dimitrios C Nikas
- Division of Pediatric Neurosurgery Advocate Children's Hospital Oak Lawn, Illinois, USA
| | | | | |
Collapse
|
20
|
Air EL, Orrico KO, Benzil DL, Scarrow AM, Bean JR, Mazzola CA, Liau LM, Rutka JT, Muraszko KM. Developing a professionalism and harassment policy for organized neurosurgery. J Neurosurg 2021; 134:1355-1356. [PMID: 33761456 DOI: 10.3171/2021.1.jns218000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Annual conferences, educational courses, and other meetings draw a diverse community of individuals, yet also create a unique environment without the traditional guard rails. Unlike events held at one's home institution, clear rules and jurisdiction have not been universally established. To promote the open exchange of ideas, as well as an environment conducive to professional growth of all participants, the leading neurosurgical professional organizations joined to delineate the expectations for anyone who participates in sponsored events. The One Neurosurgery Summit Taskforce on Professionalism and Harassment developed a foundational policy that establishes common expectations for behavior and a unified roadmap for the prompt response to untoward events. We hope that publishing this policy will inspire other medical organizations to establish their own meeting and conference policies. More importantly, we wish to bring greater attention to everyone's responsibility for ensuring a safe and respectful space for education, scientific debate, and networking during organized events.
Collapse
Affiliation(s)
- Ellen L Air
- 1Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Katie O Orrico
- 2Washington Office, American Association of Neurological Surgeons/Congress of Neurological Surgeons, Washington, District of Columbia, USA
| | - Deborah L Benzil
- 3Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - James R Bean
- 5Baptist Health Lexington, Lexington, Kentucky, USA
| | | | - Linda M Liau
- 7Department of Neurosurgery, David Geffen School of Medicine, UCLA Health, University of California at Los Angeles, Los Angeles, California, USA
| | - James T Rutka
- 8Department of Neurosurgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada.,10Chair of the Professionalism and Harassment Taskforce
| | - Karin M Muraszko
- 9Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.,10Chair of the Professionalism and Harassment Taskforce
| |
Collapse
|
21
|
Snee IA, Mazzola CA, Sikorskyj T. Chiari I malformation with Klippel-Trenaunay syndrome: case report and review of the literature. Childs Nerv Syst 2021; 37:2369-2373. [PMID: 33492467 PMCID: PMC8263457 DOI: 10.1007/s00381-020-04992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/30/2020] [Indexed: 01/19/2023]
Abstract
We present a rare case of an 8-year-old male with Klippel-Trenaunay syndrome (KTS) and a Chiari I malformation (CIM). Magnetic resonance imaging (MRI) to investigate facial asymmetry and speech delay at age two revealed CIM with cerebellar tonsils 1.3 cm below the foramen magnum without syringomyelia. The patient underwent a craniectomy and posterior fossa decompression with C1 laminectomy. While gene sequencing determined the patient was negative for the PIK3CA gene mutation, the patient's clinical history strongly suggests KTS. He has hemihypertrophy, leg length discrepancy, hemangiomas and pigmentary mosaicism along the upper and lower extremities, heart murmur, chronic low heart rate, recurrent hip pain, and mild scoliosis. Neurodevelopmental concerns include difficulty reading, attention deficit hyperactivity disorder (ADHD), anxiety, and difficulty running and going downstairs. His most recent MRI shows good decompression at the cervicomedullary junction, global cerebrospinal fluid (CSF) flow, and less peg-like cerebellar tonsils. Also noted were two intravertebral hemangiomas at T5 and T6. While the patient's speech has improved, there is still difficulty with the expressive language. He still has mild delays, runs slowly, and does not alternate feet when climbing stairs. The patient is being followed by multiple specialists including neurology, hematology-oncology, genetics, orthopedic surgery, and developmental pediatrics.
Collapse
Affiliation(s)
- Isabel A. Snee
- The University of Notre Dame, Notre Dame, IN USA ,The New Jersey Pediatric Neuroscience Institute, Morristown, NJ USA
| | | | | |
Collapse
|
22
|
Guthikonda B, Mazzola CA, Steinmetz MP, Cheng JS, Stacy JD, Falavigna A, Wohns RNW. Introduction. The importance of understanding the medicolegal climate in neurosurgery. Neurosurg Focus 2020; 49:E1. [PMID: 33130622 DOI: 10.3171/2020.8.focus20765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Bharat Guthikonda
- 1Department of Neurosurgery, LSU Health Sciences Center, Shreveport, Louisiana
| | | | | | - Joseph S Cheng
- 4Department of Neurosurgery, University of Cincinnati, Ohio
| | - Jason D Stacy
- 5Department of Neurosurgery, North Mississippi Medical Center, Tupelo, Mississippi
| | | | | |
Collapse
|
23
|
Bauer DF, Baird LC, Klimo P, Mazzola CA, Nikas DC, Tamber MS, Flannery AM. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Treatment of Pediatric Hydrocephalus: Update of the 2014 Guidelines. Neurosurgery 2020; 87:1071-1075. [DOI: 10.1093/neuros/nyaa434] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
BACKGROUND
The Congress of Neurological Surgeons reviews its guidelines according to the Institute of Medicine's recommended best practice of reviewing guidelines every 5 yrs. The authors performed a planned 5-yr review of the medical literature used to develop the “Pediatric hydrocephalus: systematic literature review and evidence-based guidelines” and determined the need for an update to the original guideline based on new available evidence.
OBJECTIVE
To perform an update to include the current medical literature for the “Pediatric hydrocephalus: systematic literature review and evidence-based guidelines”, originally published in 2014.
METHODS
The Guidelines Task Force used the search terms and strategies consistent with the original guidelines to search PubMed and Cochrane Central for relevant literature published between March 2012 and November 2019. The same inclusion/exclusion criteria were also used to screen abstracts and to perform the full-text review. Full text articles were then reviewed and when appropriate, included as evidence and recommendations were added or changed accordingly.
RESULTS
A total of 41 studies yielded by the updated search met inclusion criteria and were included in this update.
CONCLUSION
New literature resulting from the update yielded a new recommendation in Part 2, which states that neuro-endoscopic lavage is a feasible and safe option for the removal of intraventricular clots and may lower the rate of shunt placement (Level III). Additionally a recommendation in part 7 of the guideline now states that antibiotic-impregnated shunt tubing reduces the risk of shunt infection compared with conventional silicone hardware and should be used for children who require placement of a shunt (Level I). <https://www.cns.org/guidelines/browse-guidelines-detail/pediatric-hydrocephalus-guideline>
Collapse
Affiliation(s)
- David F Bauer
- Department of Neurosurgery, Texas Children's Hospital, Pediatric Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Lissa C Baird
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul Klimo
- Semmes Murphey Department of Neurosurgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Catherine A Mazzola
- Goryeb Children’s Hospital, Morristown, New Jersey, Rutgers Department of Neurological Surgery, Newark, New Jersey
| | - Dimitrios C Nikas
- Division of Pediatric Neurosurgery, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Mandeep S Tamber
- Division of Pediatric Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ann Marie Flannery
- Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana
| |
Collapse
|
24
|
Silva NA, Cerasiello SY, Herendeen JS, Sotayo A, Say I, Mazzola CA, Liu JK, Eloy JA. Gender differences in NIH grant funding in neurological surgery. J Clin Neurosci 2020; 80:43-49. [DOI: 10.1016/j.jocn.2020.07.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/23/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022]
|
25
|
A. Mazzola C, Iqbal H, A. Mazzola C. Recurrent Torticollis and Cervical Subluxation in a Pediatric Patient. Surg Case Rep 2020. [DOI: 10.31487/j.scr.2020.08.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Atlantoaxial subluxation (AAS), also referred to as C1-C2 subluxation, is a misalignment of
the first two vertebrae of the cervical spine. AAS typically presents with a head tilt (torticollis) with limited
range of motion (ROM). Torticollis is quite common in infants, but in older children, torticollis may be an
indication of AAS.
Method: In this retrospective case study, the clinical history of a female pediatric patient diagnosed with
atlantoaxial subluxation presenting with recurrent torticollis is reviewed.
Result: The patient was initially diagnosed with torticollis during infancy; torticollis partially resolved.
However, after an ear infection, the child again developed torticollis secondary to Grisel’s Syndrome.
Despite undergoing physical therapy treatments, torticollis persisted. The patient was referred to
neurosurgery at age nine. AAS was diagnosed after a three-dimensional (3D) computed tomography (CT)
scan. The child was subsequently placed in halo-traction to reduce the C1-C2 subluxation. Once the
alignment was acceptable, the child was placed in a halo vest. However, even after several months of noninvasive cervical spine immobilization with a halo vest and hard cervical collar, the head tilt and cervical
subluxation recurred due to bone remodeling.
Conclusion: The diagnosis of AAS requires both a comprehensive physical examination and imaging
following presentation of torticollis. Understanding the etiology of the torticollis early on is critical in
preventing the occurrence of AAS after treatment.
Collapse
|
26
|
Snee I, Snee I, A. Mazzola C. C1-C2 Subluxation after Mild Cervical Spine Trauma in a Child. Surg Case Rep 2020. [DOI: 10.31487/j.scr.2020.07.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We report a case of a seven-year-old girl who presented with a “Cock-Robin” head tilt and cervical spine
injury after falling from her bed. Initial cervical spine X-ray reported a fractured clavicle. However, almost
four weeks later, the torticollis had not resolved. Computerized tomography (CT) of the cervical spine
revealed subluxation of the atlanto-axial joint at C1-C2. Cervical spine magnetic resonance imaging (MRI)
did not show any spinal cord injury. Manual reduction and hard collar placement were attempted, yet C1-
C2 subluxation recurred. The child was placed into halo traction and then into a halo vest. CT scan showed
near complete resolution of C1-C2 subluxation. Three months later the halo device was removed, and the
patient was placed in a hard cervical collar then transitioned into a soft collar over a four month period.
During this time, the patient received physical therapy. Final cervical spine radiographs revealed proper
cervical spine alignment and resolution of C1-C2 subluxation.
Collapse
|
27
|
Tamber MS, Flannery AM, McClung-Smith C, Assassi N, Bauer DF, Beier AD, Blount JP, Durham SR, Klimo P, Nikas DC, Rehring P, Tyagi R, Mazzola CA. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Shunt-Dependent Hydrocephalus in Infants With Myelomeningocele After Prenatal Versus Postnatal Repair. Neurosurgery 2020; 85:E405-E408. [PMID: 31418039 DOI: 10.1093/neuros/nyz262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/11/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Myelomeningocele (MM) is a condition that is responsible for considerable morbidity in the pediatric population. A significant proportion of the morbidity related to MM is attributable to hydrocephalus and the surgical management thereof. Postnatal repair remains the most common form of treatment; however, increased rates of prenatal diagnosis, advances in fetal surgery, and a hypothesis that neural injury continues in utero until the MM defect is repaired have led to the development and evaluation of prenatal surgery as a means to improve outcomes in afflicted infants. OBJECTIVE The objective of this guideline is to systematically evaluate the literature to determine whether there is a difference in the proportion of patients who develop shunt-dependent hydrocephalus in infants who underwent prenatal MM repair compared to infants who had postnatal repair. METHODS The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used to screen abstracts and to develop a list of relevant articles for full-text review. Full-text articles were then reviewed, and when appropriate, included as evidence. RESULTS A total of 87 abstracts were identified and reviewed by 3 independent reviewers. Thirty-nine full-text articles were selected for analysis. Three studies met selection criteria and were included in the evidence table. CONCLUSION Class I evidence from 1 study and class III evidence from 2 studies suggest that, in comparison to postnatal repair, prenatal surgery for MM reduces the risk of developing shunt-dependent hydrocephalus. Therefore, prenatal repair of MM is recommended for those fetuses who meet specific criteria for prenatal surgery to reduce the risk of developing shunt-dependent hydrocephalus (level I). Differences between prenatal and postnatal repair with respect to the requirement for permanent cerebrospinal fluid diversion should be considered alongside other relevant maternal and fetal factors when deciding upon a preferred method of MM closure. The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-2.
Collapse
Affiliation(s)
- Mandeep S Tamber
- Division of Pediatric Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Ann Marie Flannery
- Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana
| | - Catherine McClung-Smith
- Department of Neurological Surgery, Palmetto Health USC Medical Group, Columbia, South Carolina
| | - Nadege Assassi
- Department of Surgery, Division of Neurosurgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - David F Bauer
- Department of Surgery, Division of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Alexandra D Beier
- Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama
| | - Susan R Durham
- The University of Vermont Medical Center, Burlington, Vermont
| | - Paul Klimo
- Semmes Murphey, Memphis, Tennessee
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Dimitrios C Nikas
- Division of Pediatric Neurosurgery, Advocate Children's Hospital, Oak Lawn, Illinois
| | | | - Rachana Tyagi
- Department of Neurosurgery, Mercer University Medical School, Macon, Georgia
| | - Catherine A Mazzola
- Goryeb Children's Hospital, Morristown, NJ; Rutgers Department of Neurological Surgery, Newark, New Jersey
| |
Collapse
|
28
|
Mazzola CA, Tyagi R, Assassi N, Bauer DF, Beier AD, Blount JP, Durham SR, Flannery AM, Klimo P, McClung-Smith C, Nikas DC, Rehring P, Tamber MS. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Tethered Cord Syndrome in Infants With Myelomeningocele With Prenatal Versus Postnatal Repair. Neurosurgery 2020; 85:E417-E419. [PMID: 31418037 DOI: 10.1093/neuros/nyz266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/11/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The incidence of spina bifida (SB) is higher in the developing world as compared to the United States because of folic acid deficiency during pregnancy. Advances in technology have made prenatal repair of myelomeningocele (MM) possible. OBJECTIVE The objective of this guideline was to determine if there is a difference in the rate of development of tethered cord syndrome (TCS) in infants who had prenatal closure compared to infants who had MM repair after birth. METHODS The Guidelines Task Force developed search terms and strategies to search PubMed and Embase for the relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used. Full text articles were reviewed and, when appropriate, included as evidence. RESULTS A total of 261 abstracts were reviewed. Fifty-four full-text articles were selected for further analysis. Three studies met inclusion criteria. CONCLUSION There was Class II evidence from 1 study and Class III evidence from another 2 studies demonstrating that TCS develops in infants with prenatal MM closure at an equal or higher rate than with postnatal closure. There was an increased risk of development of inclusion cysts in infants who underwent in utero closure. Continued surveillance for TCS and/or the development of inclusion cysts in children with prenatal and postnatal closure of MM is indicated (Level II). Differences between prenatal and postnatal repair with respect to the development of TCS and/or inclusion cysts should be considered alongside other relevant maternal and fetal outcomes when deciding upon a preferred method for MM closure.The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-6.
Collapse
Affiliation(s)
- Catherine A Mazzola
- Goryeb Children's Hospital, Morristown, New Jersey.,Rutgers Department of Neurological Surgery, Newark, New Jersey
| | - Rachana Tyagi
- Department of Neurosurgery, Mercer University Medical School, Macon, Georgia
| | - Nadege Assassi
- Department of Surgery, Division of Neurosurgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - David F Bauer
- Department of Surgery, Division of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Alexandra D Beier
- Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama
| | - Susan R Durham
- Division of Neurosurgery, University of Vermont Medical Center, Burlington, Vermont
| | - Ann Marie Flannery
- Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana
| | - Paul Klimo
- Semmes Murphey, Memphis, Tennessee.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Catherine McClung-Smith
- Department of Neurological Surgery, Palmetto Health USC Medical Group, Columbia, South Carolina
| | - Dimitrios C Nikas
- Division of Pediatric Neurosurgery, Advocate Children's Hospital, Oak Lawn, Illinois
| | | | - Mandeep S Tamber
- Division of Pediatric Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| |
Collapse
|
29
|
Bauer DF, Beier AD, Nikas DC, Assassi N, Blount J, Durham SR, Flannery AM, Klimo P, McClung-Smith C, Rehring P, Tamber MS, Tyagi R, Mazzola CA. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Myelomeningocele: Whether Prenatal or Postnatal Closure Affects Future Ambulatory Status. Neurosurgery 2020; 85:E409-E411. [PMID: 31418040 DOI: 10.1093/neuros/nyz263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/11/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Myelomeningocele (MM) is an open neural tube defect treated by pediatric neurosurgeons with prenatal or postnatal closure. OBJECTIVE The objective of this systematic review was to answer the question: What is the evidence for the effectiveness of prenatal vs postnatal closure of MM regarding short and long-term ambulatory status? Treatment recommendations were provided based on the available evidence. METHODS The National Library of Medicine PubMed database and Embase were queried using MeSH headings and keywords relevant to ambulatory status after prenatal or postnatal closure of MM. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidence table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). RESULTS One randomized controlled trial (Class II) and 3 retrospective cohort studies (Class III) were included as evidence. Initial ambulatory status depended on anatomic level of the neural tube defect. In the short term, prenatal closure may improve ambulatory status compared to postnatal closure. Spinal cord tethering or dermoid inclusion cyst has been associated with neurologic deterioration in infants closed in utero and after birth. Ambulation may cease in both groups over time. No long-term studies evaluated whether there is a difference in the ability to ambulate upon reaching adulthood. CONCLUSION Prenatal closure of MM may improve ambulatory status in the short term (Level II). Spinal cord tethering in both groups caused deterioration in the ability to walk. Evaluation and treatment of spinal cord tethering may help maintain ambulatory status (Level III). No studies evaluate whether prenatal or postnatal repair provides improved ability to ambulate upon reaching adulthood.The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-3.
Collapse
Affiliation(s)
- David F Bauer
- Department of Surgery, Division of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Alexandra D Beier
- Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida
| | - Dimitrios C Nikas
- Division of Pediatric Neurosurgery, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Nadege Assassi
- Department of Surgery, Division of Neurosurgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jeffrey Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama
| | - Susan R Durham
- Division of Neurosurgery, University of Vermont, Burlington, Vermont
| | - Ann Marie Flannery
- Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana
| | - Paul Klimo
- Semmes Murphey, Memphis, Tennessee.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Catherine McClung-Smith
- Department of Neurological Surgery, Palmetto Health USC Medical Group, Columbia, South Carolina
| | | | - Mandeep S Tamber
- Division of Pediatric Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Rachana Tyagi
- Department of Neurosurgery, Mercer University Medical School, Macon, Georgia
| | - Catherine A Mazzola
- Goryeb Children's Hospital, Morristown, New Jersey; Rutgers Department of Neurological Surgery, Newark, New Jersey
| |
Collapse
|
30
|
Beier AD, Nikas DC, Assassi N, Bauer DF, Blount JP, Durham SR, Flannery AM, Klimo P, McClung-Smith C, Rehring P, Tamber MS, Tyagi R, Mazzola CA. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Closure of Myelomeningocele Within 48 Hours to Decrease Infection Risk. Neurosurgery 2020; 85:E412-E413. [PMID: 31418041 DOI: 10.1093/neuros/nyz264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/11/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Appropriate timing for closure of myelomeningocele (MM) varies in the literature. Older studies present 48 h as the timeframe after which infection complication rates rise. OBJECTIVE The objective of this guideline is to determine if closing the MM within 48 h decreases the risk of wound infection or ventriculitis. METHODS The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used to screen abstracts and to develop a list of relevant articles for full-text review. Full text articles were then reviewed and when appropriate, included in the evidentiary table. The class of evidence was evaluated, discussed, and assigned to each study that met inclusion criteria. RESULTS A total of 148 abstracts were identified and reviewed. A total of 31 articles were selected for full text analysis. Only 4 of these studies met inclusion criteria. CONCLUSION There is insufficient evidence that operating within 48 h decreases risk of wound infection or ventriculitis in 1 Class III study. There is 1 Class III study that provides evidence of global increase in postoperative infection after 48 h, but is not specific to wound infection or ventriculitis. There is 1 Class III study that provides evidence if surgery is going to be delayed greater than 48 h, antibiotics should be given.The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-4.
Collapse
Affiliation(s)
- Alexandra D Beier
- Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida
| | - Dimitrios C Nikas
- Division of Pediatric Neurosurgery, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Nadege Assassi
- Department of Surgery, Division of Neurosurgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - David F Bauer
- Department of Surgery, Division of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham; Children's of Alabama, Birmingham, Alabama
| | - Susan R Durham
- The University of Vermont Medical Center, Burlington, Vermont
| | - Ann Marie Flannery
- Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana
| | - Paul Klimo
- Semmes-Murphey, Memphis, Tennessee.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Catherine McClung-Smith
- Department of Neurological Surgery, Palmetto Health USC Medical Group, Columbia, South Carolina
| | | | - Mandeep S Tamber
- Division of Pediatric Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Rachana Tyagi
- Department of Neurosurgery, Mercer University Medical School, Macon, Georgia
| | - Catherine A Mazzola
- Goryeb Children's Hospital, Morristown, NJ; Rutgers Department of Neurological Surgery, Newark, New Jersey
| |
Collapse
|
31
|
Blount JP, Durham SR, Klimo P, Assassi N, Bauer DF, Beier AD, Flannery AM, McClung-Smith C, Nikas DC, Rehring P, Tamber MS, Tyagi R, Mazzola CA. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Myelomeningocele: Whether Persistent Ventriculomegaly Adversely Impacts Neurocognitive Development. Neurosurgery 2020; 85:E414-E416. [PMID: 31418036 DOI: 10.1093/neuros/nyz265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/11/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Myelomeningocele (MM) is the most common congenital anomaly to affect the nervous system and affects 1500-2000 newborn infants per year in the United States. It is accompanied by symptomatic hydrocephalus in approximately 70%-80% of patients. Different treatment strategies for hydrocephalus characteristically result in different effects on the size of the ventricles. OBJECTIVE The objective of this systematic review was to determine whether persistent ventricular enlargement adversely impacts neurocognitive development in patients with MM. METHODS The PubMed National Library of Medicine Medline database and Embase were queried using MeSH headings and keywords relevant to neurocognitive or intellectual development and ventricular size or morphology. Abstracts were reviewed by the authors to identify which studies met strict inclusion criteria. An evidence table was constructed that summarized the included studies and reflected the quality of evidence (Classes I-III) that each represented. A recommendation was made that is based on the quality of the evidence. RESULTS An initial abstract review utilizing strict inclusion/exclusion criteria yielded 48 studies, 9 of which underwent full-text review. There is limited and conflicting Class III evidence from 2 studies. CONCLUSION Currently, there is insufficient data to conclude that ventricular size and morphology impact neurocognitive development.The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-5.
Collapse
Affiliation(s)
- Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama
| | - Susan R Durham
- Division of Neurosurgery, University of Vermont, Burlington, Vermont
| | - Paul Klimo
- Semmes Murphey, Memphis, Tennesse.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennesse.,Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Nadege Assassi
- Department of Surgery, Division of Neurosurgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - David F Bauer
- Department of Surgery, Division of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshirt
| | - Alexandra D Beier
- Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida
| | - Ann Marie Flannery
- Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana
| | - Catherine McClung-Smith
- Department of Neurological Surgery, Palmetto Health USC Medical Group, Columbia, South Carolina
| | - Dimitrios C Nikas
- Division of Pediatric Neurosurgery, Advocate Children's Hospital, Oak Lawn, Illinois
| | | | - Mandeep S Tamber
- Division of Pediatric Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Rachana Tyagi
- Department of Neurosurgery, Mercer University Medical School, Macon, Georgia
| | - Catherine A Mazzola
- Goryeb Children's Hospital, Morristown, New Jersey.,Rutgers Department of Neurological Surgery, Newark, New Jersey
| |
Collapse
|
32
|
Mazzola CA, Assassi N, Baird LC, Bauer DF, Beier AD, Blount JP, Durham SR, Flannery AM, Klimo P, McClung-Smith C, Nikas DC, Rehring P, Tamber MS, Tyagi R. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Pediatric Myelomeningocele: Executive Summary. Neurosurgery 2020; 85:299-301. [PMID: 31418038 DOI: 10.1093/neuros/nyz261] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The incidence of spina bifida (SB) in the developing world is higher than in the United States because of malnutrition and folic acid deficiency during pregnancy. Advances in technology have made prenatal repair of myelomeningocele (MM) possible. OBJECTIVE The objective of the guidelines are, (1) To create clinical recommendations for best practices, based on a systematic review and analysis of available literature, (2) to obtain multi-disciplinary endorsement of these guidelines from relevant organizations, and (3) to disseminate the educational content to physicians to improve the care of infants with MM. METHODS The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used to screen abstracts and to develop a list of relevant articles for full-text review. RESULTS Guidelines authors aimed to systematically review the literature and make evidence based recommendations about the timing of closure after birth, hydrocephalus, the impact of prenatal closure, and the effect of prenatal closure on ambulation ability and tethered spinal cord. Evidence concerning persistent ventriculomegaly and cognitive impairment was also evaluated. Hundreds of abstracts were identified and reviewed for each of the 5 topics. A total of 14 studies met stringent inclusion criteria. CONCLUSION Based on a comprehensive systematic review, a total of 5 clinical practice recommendations were developed, with 1 Level I, 2 Level II and 2 Level III recommendations.The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-1.
Collapse
Affiliation(s)
- Catherine A Mazzola
- Goryeb Children's Hospital, Morristown, New Jersey.,Department of Neurological Surgery, Rutgers, Newark, New Jersey
| | - Nadege Assassi
- Department of Surgery, Division of Neurosurgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Lissa C Baird
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon
| | - David F Bauer
- Department of Surgery, Division of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Alexandra D Beier
- Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama
| | - Susan R Durham
- Division of Neurosurgery, University of Vermont, Burlington, Vermont
| | - Ann Marie Flannery
- Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana
| | - Paul Klimo
- Semmes Murphey, Memphis, Tennessee.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Catherine McClung-Smith
- Department of Neurological Surgery, Palmetto Health USC Medical Group, Columbia, South Carolina
| | - Dimitrios C Nikas
- Division of Pediatric Neurosurgery, Advocate Children's Hospital, Oak Lawn, Illinois
| | | | - Mandeep S Tamber
- Division of Pediatric Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Rachana Tyagi
- Department of Neurosurgery, Mercer University Medical School, Macon, Georgia
| |
Collapse
|
33
|
Agarwal N, Agarwal P, Taylor TM, Mortimer AR, Stacy JD, Spatola M, Mazzola CA, Orrico KO, Heary RF. Contributions to the Neurosurgery Political Action Committee (NeurosurgeryPAC): A Historical Perspective. World Neurosurg 2020; 135:273-279. [DOI: 10.1016/j.wneu.2019.12.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 11/26/2022]
|
34
|
Waldron MA, Halpern SL, Sikorskyj T, Mazzola CA. Stage IV Neuroblastoma with Metastatic Spread to the Mandible in a Young Child: Case Report and Review of the Literature. World Neurosurg 2019; 129:349-353. [PMID: 31203066 DOI: 10.1016/j.wneu.2019.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Infants and young children with neuroblastoma (NB) may present with metastases. The primary tumor most commonly originates in the abdomen and metastasizes to lymph nodes, liver, and bone marrow. Infants and young children presenting with multiple skull metastases are rare. METHODS We present a rare case of a 20-month-old child who presented with metastatic neuroblastoma and multiple skull lesions. The child responded well to induction chemotherapy followed by myeloablative busulfan/melphalan consolidation. RESULTS The child had substantial tumor reduction after chemotherapy was started. There was a significant decrease in tumor sizes and uptake, as seen in the metaiodobenzylguanidine study. The 6-month follow-up examination showed complete remission, and the remission continues. CONCLUSIONS Infants and young children with neuroblastoma rarely present with metastatic lesions to the skull. Even large lesions involving the skull base may be successfully treated with chemotherapy. The use of myeloablative busulfan/melphalan consolidation after induction chemotherapy can decrease the overall metastatic tumor burden. Craniofacial specialists should be aware of treatment options for these young children.
Collapse
Affiliation(s)
- Madison A Waldron
- Atlantic Health Systems-Goryeb Children's Hospital, Morristown, New Jersey, USA.
| | - Steven L Halpern
- Atlantic Health Systems-Goryeb Children's Hospital, Morristown, New Jersey, USA
| | - Tatiana Sikorskyj
- Atlantic Health Systems-Goryeb Children's Hospital, Morristown, New Jersey, USA
| | - Catherine A Mazzola
- Atlantic Health Systems-Goryeb Children's Hospital, Morristown, New Jersey, USA
| |
Collapse
|
35
|
Mazzola CA. Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Treatment Options for Adults With Multiple Metastatic Brain Tumors. Neurosurgery 2019; 84:E183-E184. [PMID: 30629217 DOI: 10.1093/neuros/nyy556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/08/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Catherine A Mazzola
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| |
Collapse
|
36
|
Mazzola CA. Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Whole Brain Radiation Therapy in Adults With Newly Diagnosed Metastatic Brain Tumors. Neurosurgery 2019; 84:E164-E165. [PMID: 30629226 DOI: 10.1093/neuros/nyy555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/07/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Catherine A Mazzola
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| |
Collapse
|
37
|
Mazzola CA. Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Steroids in the Treatment of Adults With Metastatic Brain Tumors. Neurosurgery 2019; 84:E193-E194. [PMID: 30629213 DOI: 10.1093/neuros/nyy560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/07/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Catherine A Mazzola
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| |
Collapse
|
38
|
Houston R, Gagliardo C, Vassallo S, Wynne PJ, Mazzola CA. Spinal Epidural Abscess in Children: Case Report and Review of the Literature. World Neurosurg 2019; 126:453-460. [PMID: 30797918 DOI: 10.1016/j.wneu.2019.01.294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Spinal epidural abscess (SEA) is a rare but serious infection in the epidural space along the spinal cord. SEA should be considered in patients with backache, fever, neurological deficits and/or spinal tenderness. Early diagnosis is imperative to prevent permanent neurological sequelae. CASE DESCRIPTION We report a case of lumbar SEA in a 13-year-old girl who was immunocompetent and presented with spinal tenderness, back pain and 4 days of fever. A lumbar magnetic resonance imaging demonstrated an epidural abscess from L3-S1. She had emergent surgical intervention. Cultures grew methicillin-susceptible Staphylococcus aureus. She was also given long-term systemic antibiotics and she made a complete recovery within 2 months. CONCLUSIONS SEA in an immunocompetent pediatric without risk factors is an extremely rare condition. In the English-language literature, there are only 30 reported cases in the past 19 years; our case brings the total to 31. Non-surgical treatment has been successful in both adult and pediatric patients under certain conditions. Still, there exists a risk of deterioration with non-surgical management, even in patients for whom treatment is begun in the absence of neurologic deficits. Tracking neurological deficits in children can be challenging, particularly in young children who are non-verbal and not yet ambulating, and a reliable neurologic examination is a critical component of non-surgical care. In consideration of these facts and the accelerated time frame of deterioration, once neurologic deficits are present, surgery plus systemic antibiotics remains the standard of care for pediatric SEA patients, with each individual case meriting review of the full clinical picture.
Collapse
Affiliation(s)
- Rebecca Houston
- Rowan University School of Medicine (UMDNJ), Stratford, New Jersey, USA.
| | - Christina Gagliardo
- Division of Pediatric Infectious Diseases, Goryeb Children's Hospital, Atlantic Health System, Morristown, New Jersey, USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sheryl Vassallo
- Division of Pediatric Infectious Diseases, Goryeb Children's Hospital, Atlantic Health System, Morristown, New Jersey, USA
| | - Peter J Wynne
- Department of Radiology, Morristown Medical Center, Morristown, New Jersey, USA
| | - Catherine A Mazzola
- Division of Pediatric Infectious Diseases, Goryeb Children's Hospital, Atlantic Health System, Morristown, New Jersey, USA
| |
Collapse
|
39
|
Wu Z, Mazzola CA, Catania L, Owoeye O, Yaramothu C, Alvarez T, Gao Y, Li X. Altered cortical activation and connectivity patterns for visual attention processing in young adults post-traumatic brain injury: A functional near infrared spectroscopy study. CNS Neurosci Ther 2018; 24:539-548. [PMID: 29359534 PMCID: PMC6490005 DOI: 10.1111/cns.12811] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 11/29/2022] Open
Abstract
AIMS This study aimed at understanding the neurobiological mechanisms associated with inattention induced by traumatic brain injury (TBI). To eliminate the potential confounding caused by the heterogeneity of TBI, we focused on young adults postsports-related concussion (SRC). METHODS Functional near-infrared spectroscopy (fNIRS) data were collected from 27 young adults post-SRC and 27 group-matched normal controls (NCs), while performing a visual sustained attention task. Task responsive cortical activation maps and pairwise functional connectivity among six regions of interest were constructed for each subject. Correlations among the brain imaging measures and clinical measures of attention were calculated in each group. RESULTS Compared to the NCs, the SRC group showed significantly increased brain activation in left middle frontal gyrus (MFG) and increased functional connectivity between right inferior occipital cortex (IOC) bilateral calcarine gyri (CG). The left MFG activation magnitude was significantly negatively correlated with the hyperactive/impulsive symptom severity measure in the NCs, but not in the patients. The right hemisphere CG-IOC functional connectivity showed a significant positive correlation with the hyperactive/impulsive symptom severity measure in patients, but not in NCs. CONCLUSION The current data suggest that abnormal left MFG activation and hyper-communications between right IOC and bilateral CG during visual attention processing may significantly contribute to behavioral manifestations of attention deficits in patients with TBI.
Collapse
Affiliation(s)
- Ziyan Wu
- Department of Electrical and Computer EngineeringNew Jersey Institute of TechnologyNewarkNJUSA
| | | | - Lori Catania
- North Jersey Neurodevelopmental CenterNorth HaledonNJUSA
| | - Oyindamola Owoeye
- Department of Biomedical EngineeringNew Jersey Institute of TechnologyNewarkNJUSA
| | - Chang Yaramothu
- Department of Biomedical EngineeringNew Jersey Institute of TechnologyNewarkNJUSA
| | - Tara Alvarez
- Department of Biomedical EngineeringNew Jersey Institute of TechnologyNewarkNJUSA
| | - Yu Gao
- Department of PsychologyBrooklyn College and the Graduate Center of the City University of New YorkBrooklynNYUSA
| | - Xiaobo Li
- Department of Electrical and Computer EngineeringNew Jersey Institute of TechnologyNewarkNJUSA
- Department of Biomedical EngineeringNew Jersey Institute of TechnologyNewarkNJUSA
| |
Collapse
|
40
|
Servatius RJ, Spiegler KM, Handy JD, Pang KC, Tsao JW, Mazzola CA. Neurocognitive and Fine Motor Deficits in Asymptomatic Adolescents during the Subacute Period after Concussion. J Neurotrauma 2018; 35:1008-1014. [DOI: 10.1089/neu.2017.5314] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Richard J. Servatius
- Rutgers Biomedical Health Sciences, Pharmacology, Physiology, and Neuroscience, Rutgers University, Newark, New Jersey
- Graduate School of Biomedical Sciences, Rutgers University, Newark, New Jersey
- State University of New York Upstate Medical University, Syracuse, New York
| | - Kevin M. Spiegler
- Graduate School of Biomedical Sciences, Rutgers University, Newark, New Jersey
| | - Justin D. Handy
- Rutgers Biomedical Health Sciences, Pharmacology, Physiology, and Neuroscience, Rutgers University, Newark, New Jersey
- Central New York Research Corporation, Syracuse, New York
| | - Kevin C.H. Pang
- Rutgers Biomedical Health Sciences, Pharmacology, Physiology, and Neuroscience, Rutgers University, Newark, New Jersey
- Graduate School of Biomedical Sciences, Rutgers University, Newark, New Jersey
| | - Jack W. Tsao
- University of Tennessee Health Science Center, Memphis, Tennessee
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Catherine A. Mazzola
- Rutgers Biomedical Health Sciences, Pharmacology, Physiology, and Neuroscience, Rutgers University, Newark, New Jersey
- Morristown Medical Center, Morristown, New Jersey
| |
Collapse
|
41
|
Kahn EN, La Marca F, Mazzola CA. Neurosurgery and Telemedicine in the United States: Assessment of the Risks and Opportunities. World Neurosurg 2016; 89:133-8. [DOI: 10.1016/j.wneu.2016.01.075] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/26/2016] [Accepted: 01/27/2016] [Indexed: 12/21/2022]
|
42
|
Mazzola CA, Choudhri AF, Auguste KI, Limbrick DD, Rogido M, Mitchell L, Flannery AM. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants. J Neurosurg Pediatr 2014; 14 Suppl 1:8-23. [PMID: 25988778 DOI: 10.3171/2014.7.peds14322] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The objective of this systematic review and analysis was to answer the following question: What are the optimal treatment strategies for posthemorrhagic hydrocephalus (PHH) in premature infants? METHODS Both the US National Library of Medicine and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words relevant to PHH. Two hundred thirteen abstracts were reviewed, after which 98 full-text publications that met inclusion criteria that had been determined a priori were selected and reviewed. RESULTS Following a review process and an evidentiary analysis, 68 full-text articles were accepted for the evidentiary table and 30 publications were rejected. The evidentiary table was assembled linking recommendations to strength of evidence (Classes I-III). CONCLUSIONS There are 7 recommendations for the management of PHH in infants. Three recommendations reached Level I strength, which represents the highest degree of clinical certainty. There were two Level II and two Level III recommendations for the management of PHH. Recommendation Concerning Surgical Temporizing Measures: I. Ventricular access devices (VADs), external ventricular drains (EVDs), ventriculosubgaleal (VSG) shunts, or lumbar punctures (LPs) are treatment options in the management of PHH. Clinical judgment is required. STRENGTH OF RECOMMENDATION Level II, moderate degree of clinical certainty. Recommendation Concerning Surgical Temporizing Measures: II. The evidence demonstrates that VSG shunts reduce the need for daily CSF aspiration compared with VADs. STRENGTH OF RECOMMENDATION Level II, moderate degree of clinical certainty. Recommendation Concerning Routine Use of Serial Lumbar Puncture: The routine use of serial lumbar puncture is not recommended to reduce the need for shunt placement or to avoid the progression of hydrocephalus in premature infants. STRENGTH OF RECOMMENDATION Level I, high clinical certainty. Recommendation Concerning Nonsurgical Temporizing Agents: I. Intraventricular thrombolytic agents including tissue plasminogen activator (tPA), urokinase, or streptokinase are not recommended as methods to reduce the need for shunt placement in premature infants with PHH. STRENGTH OF RECOMMENDATION Level I, high clinical certainty. Recommendation Concerning Nonsurgical Temporizing Agents. II. Acetazolamide and furosemide are not recommended as methods to reduce the need for shunt placement in premature infants with PHH. STRENGTH OF RECOMMENDATION Level I, high clinical certainty. Recommendation Concerning Timing of Shunt Placement: There is insufficient evidence to recommend a specific weight or CSF parameter to direct the timing of shunt placement in premature infants with PHH. Clinical judgment is required. STRENGTH OF RECOMMENDATION Level III, unclear clinical certainty. Recommendation Concerning Endoscopic Third Ventriculostomy: There is insufficient evidence to recommend the use of endoscopic third ventriculostomy (ETV) in premature infants with posthemorrhagic hydrocephalus. STRENGTH OF RECOMMENDATION Level III, unclear clinical certainty.
Collapse
Affiliation(s)
- Catherine A Mazzola
- Division of Pediatric Neurological Surgery, Goryeb Children's Hospital, Morristown, New Jersey
| | - Asim F Choudhri
- Departments of Radiology and Neurosurgery, University of Tennessee Health Science Center,3Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | | | - David D Limbrick
- Division of Pediatric Neurosurgery, St. Louis Children's Hospital, St. Louis, Missouri
| | - Marta Rogido
- Division of Neonatology, Department of Pediatrics, Goryeb Children's Hospital, Morristown and Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Ann Marie Flannery
- Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri
| | | |
Collapse
|
43
|
Flannery AM, Mazzola CA, Klimo P, Duhaime AC, Baird LC, Tamber MS, Limbrick DD, Nikas DC, Kemp J, Post AF, Auguste KI, Choudhri AF, Mitchell LS, Buffa D. Foreword: Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. J Neurosurg Pediatr 2014; 14 Suppl 1:1-2. [PMID: 25988776 DOI: 10.3171/2014.8.peds14426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ann Marie Flannery
- 1Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri
| | - Catherine A Mazzola
- 2Division of Pediatric Neurological Surgery, Goryeb Children's Hospital, Morristown, New Jersey
| | - Paul Klimo
- 3Department of Neurosurgery, University of Tennessee Health Science Center, and.,4Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Ann-Christine Duhaime
- 5Department of Pediatric Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Mandeep S Tamber
- 7Department of Pediatric Neurological Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David D Limbrick
- 8Division of Pediatric Neurosurgery, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Dimitrios C Nikas
- 9Department of Neurosurgery, University of Illinois at Chicago, Chicago, and Advocate Children's Hospital, Oak Lawn, Illinois
| | - Joanna Kemp
- 1Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri
| | - Alexander F Post
- 10Division of Pediatric Neurological Surgery, Department of Neurosciences and Pediatrics, Goryeb Children's Hospital-Morristown Medical Center, Morristown, New Jersey
| | - Kurtis I Auguste
- 11Department of Neurosurgery, University of California, San Francisco, California
| | - Asim F Choudhri
- 12Departments of Radiology, Ophthalmology, and Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, and Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Laura S Mitchell
- 13Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; and
| | - Debby Buffa
- 14Hydrocephalus Association, Bethesda, Maryland
| |
Collapse
|
44
|
Baird LC, Mazzola CA, Auguste KI, Klimo P, Flannery AM. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 5: Effect of valve type on cerebrospinal fluid shunt efficacy. J Neurosurg Pediatr 2014; 14 Suppl 1:35-43. [PMID: 25988781 DOI: 10.3171/2014.7.peds14325] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The objective of this systematic review was to examine the existing literature to compare differing shunt components used to treat hydrocephalus in children, find whether there is a superior shunt design for the treatment of pediatric hydrocephalus, and make evidence-based recommendations for the selection of shunt implants when placing shunts. METHODS Both the US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words chosen to identify publications comparing the use of shunt implant components. Abstracts of these publications were reviewed, after which studies meeting the inclusion criteria were selected. An evidentiary table was compiled summarizing the selected articles and quality of evidence. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider evidence-based treatment recommendations. RESULTS Two hundred sixty-nine articles were identified using the search parameters, and 43 articles were recalled for full-text review. Of these, 22 papers met the study criteria for a comparison of shunt components and were included in the evidentiary table. The included studies consisted of 1 Class I study, 11 Class II studies, and 10 Class III studies. The remaining 21 articles were excluded. CONCLUSIONS An analysis of the evidence did not demonstrate a clear advantage for any specific shunt component, mechanism, or valve design over another. RECOMMENDATION There is insufficient evidence to demonstrate an advantage for one shunt hardware design over another in the treatment of pediatric hydrocephalus. Current designs described in the evidentiary tables are all treatment options. STRENGTH OF RECOMMENDATION Level I, high degree of clinical certainty. RECOMMENDATION There is insufficient evidence to recommend the use of a programmable valve versus a nonprogrammable valve. Programmable and nonprogrammable valves are both options for the treatment of pediatric hydrocephalus. STRENGTH OF RECOMMENDATION Level II, moderate degree of clinical certainty.
Collapse
Affiliation(s)
| | - Catherine A Mazzola
- Division of Pediatric Neurological Surgery, Goryeb Children's Hospital, Morristown, New Jersey
| | - Kurtis I Auguste
- Department of Neurosurgery, University of California, San Francisco, California
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center,6Le Bonheur Children's Hospital, Memphis, Tennessee; and
| | - Ann Marie Flannery
- Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri
| | | |
Collapse
|
45
|
Nikas DC, Post AF, Choudhri AF, Mazzola CA, Mitchell L, Flannery AM. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 10: Change in ventricle size as a measurement of effective treatment of hydrocephalus. J Neurosurg Pediatr 2014; 14 Suppl 1:77-81. [PMID: 25988786 DOI: 10.3171/2014.7.peds14330] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The objective of this systematic review is to answer the following question: Does ventricle size after treatment have a predictive value in determining the effectiveness of surgical intervention in pediatric hydrocephalus? METHODS The US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were searched using MeSH headings and key words relevant to change in ventricle size after surgical intervention for hydrocephalus in children. An evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). RESULTS Six articles satisfied inclusion criteria for the evidentiary tables for this part of the guidelines. All were Class III retrospective studies. CONCLUSIONS/RECOMMENDATIon: There is insufficient evidence to recommend a specific change in ventricle size as a measurement of the effective treatment of hydrocephalus and as a measurement of the timing and effectiveness of treatments including ventriculoperitoneal shunts and third ventriculostomies. STRENGTH OF RECOMMENDATION Level III, unclear clinical certainty.
Collapse
Affiliation(s)
- Dimitrios C Nikas
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois,2Advocate Children's Hospital, Oak Lawn, Illinois
| | - Alexander F Post
- Division of Pediatric Neurological Surgery, Department of Neurosciences and Pediatrics, Goryeb Children's Hospital-Morristown Medical Center, Morristown, New Jersey
| | - Asim F Choudhri
- Departments of Radiology, Ophthalmology, and Neurosurgery, University of Tennessee Health Science Center,5Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Catherine A Mazzola
- Division of Pediatric Neurological Surgery, Goryeb Children's Hospital, Morristown, New Jersey
| | | | - Ann Marie Flannery
- Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri
| | | |
Collapse
|
46
|
Tamber MS, Klimo P, Mazzola CA, Flannery AM. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 8: Management of cerebrospinal fluid shunt infection. J Neurosurg Pediatr 2014; 14 Suppl 1:60-71. [PMID: 25988784 DOI: 10.3171/2014.7.peds14328] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The objective of this systematic review was to answer the following question: What is the optimal treatment strategy for CSF shunt infection in pediatric patients with hydrocephalus? METHODS The US National Library of Medicine and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words relevant to the objective of this systematic review. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected and graded according to their quality of evidence (Classes I-III). Evidentiary tables were constructed that summarized pertinent study results, and based on the quality of the literature, recommendations were made (Levels I-III). RESULTS A review and critical appraisal of 27 studies that met the inclusion criteria allowed for a recommendation for supplementation of antibiotic treatment using partial (externalization) or complete shunt hardware removal, with a moderate degree of clinical certainty. However, a recommendation regarding whether complete shunt removal is favored over partial shunt removal (that is, externalization) could not be made owing to severe methodological deficiencies in the existing literature. There is insufficient evidence to recommend the use of intrathecal antibiotic therapy as an adjunct to systemic antibiotic therapy in the management of routine CSF shunt infections. This also holds true for other clinical scenarios such as when an infected CSF shunt cannot be completely removed, when a shunt must be removed and immediately replaced in the face of ongoing CSF infection, or when the setting is ventricular shunt infection caused by specific organisms (for example, gram-negative bacteria). CONCLUSIONS Supplementation of antibiotic treatment with partial (externalization) or complete shunt hardware removal are options in the management of CSF shunt infection. There is insufficient evidence to recommend either shunt externalization or complete shunt removal as the preferred surgical strategy for the management of CSF shunt infection. Therefore, clinical judgment is required. In addition, there is insufficient evidence to recommend the combination of intrathecal and systemic antibiotics for patients with CSF shunt infection when the infected shunt hardware cannot be fully removed, when the shunt must be removed and immediately replaced, or when the CSF shunt infection is caused by specific organisms. The potential neurotoxicity of intrathecal antibiotic therapy may limit its routine use. RECOMMENDATION Supplementation of antibiotic treatment with partial (externalization) or with complete shunt hardware removal is an option in the management of CSF shunt infection. STRENGTH OF RECOMMENDATION Level II, moderate degree of clinical certainty. RECOMMENDATION There is insufficient evidence to recommend either shunt externalization or complete shunt removal as a preferred surgical strategy for the management of CSF shunt infection. Therefore, clinical judgment is required. STRENGTH OF RECOMMENDATION Level III, unclear degree of clinical certainty. RECOMMENDATION There is insufficient evidence to recommend the combination of intrathecal and systemic antibiotics for patients with CSF shunt infection in whom the infected shunt hardware cannot be fully removed or must be removed and immediately replaced, or when the CSF shunt infection is caused by specific organisms. The potential neurotoxicity of intrathecal antibiotic therapy may limit its routine use. STRENGTH OF RECOMMENDATION Level III, unclear degree of clinical certainty.
Collapse
Affiliation(s)
- Mandeep S Tamber
- Department of Pediatric Neurological Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis,3Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Catherine A Mazzola
- Division of Pediatric Neurological Surgery, Goryeb Children's Hospital, Morristown, New Jersey
| | - Ann Marie Flannery
- Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri
| | | |
Collapse
|
47
|
|
48
|
Mazzola CA, Lobel DA, Krishnamurthy S, Bloomgarden GM, Benzil DL. Efficacy of Neurosurgery Resident Education in the New Millennium. Neurosurgery 2010; 67:225-32; discussion 232-3. [DOI: 10.1227/01.neu.0000372206.41812.23] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Catherine A. Mazzola
- Department of Neurosciences and Pediatrics, Atlantic Health System-Goryeb Children's Hospital, Morristown, New Jersey
| | - Darlene A. Lobel
- Department of Neurosurgery, University of Florida, Jacksonville, Florida
| | | | | | - Deborah L. Benzil
- Department of Neurosurgery, Westchester Brain and Spine Surgery, Hartsdale, New York
| |
Collapse
|
49
|
Lobel DA, Mazzola CA, Krishnamurthy S, Benzil DL, Bloomgarden GM. Post-Residency Survey Reveals Critical Education Issues. Neurosurgery 2009. [DOI: 10.1227/01.neu.0000358672.43606.a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
50
|
Abstract
Chiari malformations comprise four different hindbrain anomalies originally described by Hans Chiari, a professor of pathology at the German University in Prague. There are four basic Chiari malformations. The reasons for revision of Chiari malformation decompression may be for conservative or inadequate initial decompression or the development of postoperative complications. Another reason involves cases of both hindbrain herniation and syringomyelia in patients who have undergone adequate posterior fossa decompression without resolution of symptoms, signs, or radiological appearance of their syrinx cavity. Additionally, symptom recurrence has been reported in association with various types of dural grafts. Reoperation or revision surgery for patients with Chiari malformations is common and may not be due to technical error or inadequate decompression. The types of revision surgeries, their indications, and initial presentations will be reviewed.
Collapse
Affiliation(s)
- Catherine A Mazzola
- Department of Neurosurgery, Pediatric Neurosciences Institute, Hackensack University Medica Center, Hackensack, New Jersey 07601, USA.
| | | |
Collapse
|