Common Neurosurgical Conditions in the Pediatric Practice

 

Description:

This unique title is designed to illustrate and foster how a closer working relationship between pediatricians and subspecialists can make childhood medicine work more seamlessly. Despite the common lack of training for pediatricians in pediatric neurosurgery, they are challenged almost daily with caring for children with neurologic conditions. Common Neurological Conditions in the Pediatric Practice is replete with a wide range of instructional case vignettes and is organized into sections that loosely approximate the neurologic development of a child and address issues that are commonly encountered. The first section reviews neurologic development and birth related trauma commonly seen in the neonatal intensive care unit. The second part addresses findings commonly encountered by a pediatrician in a child’s first month of life. The third section is a comprehensive review of hydrocephalus. Part four describes state of the art imaging techniques for the central nervous system in children, from pre-natal ultrasound through MRI and CT; and the fifth part consists of individual explorations of common neurosurgical conditions that many pediatricians are uncomfortable managing, including brain tumors, spasticity, and vascular lesions to use as a reference tool when caring for a complex neurosurgical patient. Finally a series of chapters related to head trauma, including sections on non-accidental trauma and concussion management, completes the text.

 

 

Table of Contents:

 

Part I: Development of the Brain and Spine

1: Normal Development of the Skull and Brain

Introduction

Normal Skull Development

Normal Development of the Brain

Abnormal Head Size

Evaluation of the Head Circumference

Macrocephaly

Microcephaly

Abnormal Head Shape

Craniosynostosis

References

2: The Neurologic Exam in Neonates and Toddlers

Introduction

The History

Birth History

Developmental History

The General Exam

The Head

The Face

The Neck

Cardiovascular and Abdomen

The Skin

The Spine and Back

The Neurologic Exam

Mental Status

Cranial Nerves

I: Olfactory Nerve

II: The Optic Nerve

III/IV/VI: The Oculomotor Nerve, the Trochlear Nerve, and the Abducens Nerve

V: The Trigeminal Nerve

VII: The Facial Nerve

VIII: The Vestibulocochlear Nerve

IX and X: The Glossopharyngeal Nerve and Vagus Nerves

XI: The Spinal Accessory Nerve

XII: The Hypoglossal Nerve

Motor Examination

Sensory Examination

Reflex Examination

Developmental Reflexes

Coordination

Gait

Conclusion

Clinical Pearls and Red Flags

Suggested Reading�

Part II: Newborn Through Infancy

3: Birth Trauma to the Scalp and Skull

Introduction

Extracranial (Scalp) Hematoma

Caput Succedaneum

Subgaleal Hemamtoma

Cephalohematoma

Intracranial Hematomas

Skull Fractures

Conclusion

Pediatrician’s Perspective

References

Evidence-Based Medicine Resources

4: Brachial Plexus Injuries During Birth

Anatomy and Mechanisms of Injury

Epidemiology

Presentation and Natural History

Evaluation

Management

Conclusion

References

5: Neonatal Brain Injury

Brain Injuries Affecting Term and Preterm Infants

Hypoxic-Ischemic Encephalopathy

Clinical Presentation

Diagnosis

Management

Long-Term Outcomes

Neonatal Stroke

Clinical Presentation

Diagnosis

Management

Long-Term Outcomes and Rehabilitation

Brain Injuries Affecting Preterm Infants

Hemorrhagic Injuries

Clinical Presentation

Diagnosis

Management

Outcomes

White Matter Injuries

Clinical Presentation

Diagnosis

Management

Outcomes

Prematurity

Clinical Presentation

Diagnosis

Management

Outcomes

Conclusion

Bibliography

6: Evaluation of Head Shape in the Pediatric Practice: Plagiocephaly vs. Craniosynostosis

Anatomy of the Infant Skull

The Anterior Fontanel

The Posterior Fontanel

Plagiocephaly

Deformational Plagiocephaly

Diagnosis: Clinical Signs

Scaphocephaly: Sagittal Synostosis

Trigonocephaly: Metopic Synostosis

Unilateral Coronal Synostosis (UCS): Premature Closure of the Coronal Suture

Lambdoid Synostosis: Premature Closure of the Lambdoid Suture

Deformational Brachycephaly

Synostotic Brachycephaly: Bilateral Coronal Synostosis

Deformational Scaphocephaly (DS)

Imaging

Pediatrician’s Perspective

References

7: Neurocutaneous Disorders

Introduction

Neurofibromatosis Type 1

Overview

Diagnosis

Clinical Manifestations

Cutaneous

Nerve Sheath Tumors

Central Nervous System (CNS) Tumors

Other CNS Manifestations

Other Malignancies

Ophthalmologic

Skeletal

Cardiovascular

Management Considerations

Neurofibromatosis Type 2

Overview

Diagnosis

Clinical Manifestations

Cutaneous

Schwannomas

Other Nervous System Tumors

Ophthalmologic

Other Nervous System Manifestations

Management Considerations

Tuberous Sclerosis Complex

Overview

Diagnosis

Clinical Manifestations

Cutaneous

CNS Tumors

Other Nervous System Manifestations

Ophthalmologic

Cardiac

Renal

Pulmonary

Management Considerations

Sturge-Weber Syndrome

Overview

Diagnosis

Clinical Manifestations

Cutaneous

Nervous System

Ophthalmologic

Management Considerations

Von Hippel-Lindau

Overview

Diagnosis

Clinical Manifestations

Management Considerations

Neurocutaneous Melanosis

Overview

Diagnosis

Clinical Manifestations

Cutaneous

Nervous System

Management Considerations

Incontinentia Pigmenti

Overview

Diagnosis

Clinical Manifestations

Cutaneous

Nervous System

Other Organ Systems

Management Considerations

Hypomelanosis of Ito

Overview

Diagnosis

Clinical Manifestations

Cutaneous

Nervous System

Other Organ Systems

Management Considerations

Ataxia-Telangiectasia

Overview

Diagnosis

Clinical Manifestations

Cutaneous

Nervous System

Other Organ Systems

Management Considerations

Pediatricians’ Perspective

Bibliography

8: Cutaneous Markers of Spinal Dysraphism

Definition

Epidemiology

Risk Factors

Classification of Spinal Dysraphism [8, 9]

Clinical Presentation

Cutaneous Manifestations

The Predictive Value of the Skin Lesions

Is Radiological Screening Warranted in Presence of Skin Lesions?

Which Method to Use for Screening?

References

9: Tethered Cord

Introduction

History

Pathophysiology

Thickened Filum or Fatty Filum Terminale

Clinical Presentation and Diagnosis

Imaging

Pediatrician’s Perspective

References

10: Lumps and Bumps: Scalp and Skull Lesions

Clinical Presentation and Evaluation

Imaging

Scalp Lesions

Congenital Lesions

Dermoid and Epidermoid Cysts

Encephaloceles and Atretic cephaloceles

Aplasia Cutis Congenita of the Scalp

Traumatic Lesions

Cephalohematoma, Caput Succedaneum, Subgaleal Hematoma

Vascular Lesions

Sinus Pericranii

Hemangiomas

AVMs and Venous Malformations of the Scalp

Subcutaneous Nodules

Necrobiotic Granulomas and Subcutaneous Granuloma Annulare

Neurofibromas

Infantile Myofibroma and Primary Fibrosarcomas of the Scalp

Cranial Fasciitis

Skull Lesions

Langerhans Cell Histiocytosis

Enlarged Parietal Foramina

Primary Bone Tumors

Intraosseous Hemangioma

Aneurysmal Bone Cyst

Fibrous Dysplasia

Metastases

Pediatrician’s Perspective

References

Part III: Hydrocephalus Primer

11: Intraventricular Hemorrhage in the Premature Infant

Background

Neuropathology

Importance of the Germinal Matrix

Grading the Hemorrhage

Pathogenesis of IVH

Cerebral Autoregulation and Pressure-Passive Circulation

Intravascular Perturbations

Periventricular White Matter Injury (WMI) Associated with IVH

Case Continued

Linking Systemic and Cerebral Vascular Perturbations in Infants with Respiratory Distress Syndro

Perturbations on the Arterial Side

Perturbations in Venous Pressure

Hypercarbia and Intraventricular Hemorrhage

Surfactant Administration and PV-IVH

Post-hemorrhagic Hydrocephalus (PHH)

Clinical Manifestations of Hemorrhage

Strategies to Prevent Severe IVH

General Considerations

Perinatal Glucocorticoid Administration

Postnatal Strategies

Outcomes

Future Directions

Pediatrician’s Perspective

References

12: Neuro-Ophthalmic Presentation of Neurosurgical Disease in Children

Assessment of Visual Function

Visual Acuity

Color Testing

Visual Field Testing

Pupillary Testing

Funduscopy

Efferent Testing

Papilledema and Disorders of Elevated Intracranial Pressure

Visual Function in Papilledema

Causes of Papilledema in Children

Aqueductal Stenosis

Mass Lesions

MRI Findings Associated with Papilledema

Idiopathic Intracranial Hypertension

Treatment of IIH

Venous Sinus Thrombosis

Craniosynostosis

Unilateral Papillitis

Visual Field Defects

Dorsal Midbrain (Parinaud) Syndrome

Diplopia and Gaze Palsies

Abducens Palsies

Trochlear (Fourth Cranial) Nerve Palsies

Oculomotor Nerve Palsies

Cavernous Sinus Syndrome and Orbital Apex Syndrome

Skew Deviation

Nystagmus and Saccadic Intrusions

Nystagmus

Vestibular Nystagmus

Relevant Anatomy

Patterns of Peripheral Vestibular Nystagmus

Patterns of Central Vestibular Nystagmus

Downbeat Nystagmus

See-Saw Nystagmus

Ocular Flutter and Opsoclonus

Anisocoria

Horner Syndrome

Pediatrician’s Perspective

References

13: Hydrocephalus and Ventriculomegaly

Introduction

Classification of Hydrocephalus

External Hydrocephalus

Benign Subdural Collections of Infancy

Symptomatic Extra-Axial Fluid Collections in Children

Hydranencephaly

Trapped Fourth Ventricle and Multiloculated Hydrocephalus

Dandy-Walker Malformation (DWM)

Pathophysiology of DWM-­Associated Hydrocephalus

Neonatal Posthemorrhagic Hydrocephalus

Neurodevelopmental Pathophysiology

Papile et al. Classification of Germinal Matrix Hemorrhage [50]

Normal Volume Hydrocephalus

Post-traumatic Hydrocephalus

Radiologic Recognition and Definition of Hydrocephalus

Clinical Presentation of Hydrocephalus

Neonates and Infants

Children and Young Adults

Hydrocephalus Associated with Chiari Malformations

Aqueductal Stenosis

X-Linked Hydrocephalus

Idiopathic Intracranial Hypertension

Hydrocephalus with Brain Tumors

Pediatrician’s Perspective

References

14: Neurosurgical Considerations in Macrocephaly

Epidemiology

Etiology

Presentation

Evaluation

Treatment and Management

Shunting

Endoscopic Third Ventri-�� culostomy (ETV)

Goals of Treatment

Medical Management

Follow-Up and Indications for Re-evaluation

Conclusion

Pediatrician’s Perspective

References

15: Evaluation and Classification of Pediatric Headache

Identification and Classification of Headache

Primary Versus Secondary Headache

Headache History

Headache Questions

Headache Characteristics and Most Likely Diagnosis

Common Red Flags in Headache History for Children

Pediatric Physical and Neurological Examination

Physical Examination

Discussion

Evaluation and Management

Physical Examination

Discussion

Evaluation and Management

Discussion

Evaluation and Management

Discussion

Pediatrician’s Perspective

References

Part IV: Imaging of the Pediatric Brain and Spine

16: Imaging of the Fetal Brain and Spine

Prenatal Imaging

Indications for Fetal MR

Safety of Fetal MR Imaging

Imaging Techniques: US

Imaging Techniques: MR

Normal Fetal CNS Anatomy and Development—US

Ventricles

Midline Structures

Parenchyma

Sulcation

Posterior Fossa

Skull

Spine

Normal Fetal CNS Anatomy and Development—MR

Ventricles and Subarachnoid Spaces

Midline Structures

Brain Parenchyma

Sulcation

Posterior Fossa

Biometrics

Spine

Pathology of the Fetal CNS

Ventriculomegaly

Aqueductal Stenosis

Dorsal Induction Malformations/Neural Tube Defects

Anencephaly

Cephalocele

Chiari II

Ventral (Forebrain) Induction Malformations

Holoprosencephaly

Corpus Callosum Abnormalities

Posterior Fossa Anomalies

Dandy–Walker Continuum

Malformations of Cortical Development (MCD)

Monochorionic Twin Pregnancies

Conclusion

References

17: Prenatal Counseling for Fetal Diagnoses

Ascertainment Bias

Fetal Behavior

MRI

Genetics

Timing of Prenatal Diagnosis

Patient Counseling

Ventriculomegaly

Workup

Counseling

Posterior Fossa Abnormalities

Diagnosis

Dandy–Walker Malformation and Inferior Vermian Agenesis

Workup

Prognosis

Cerebellar Hypoplasia

Cephaloceles

Workup

Counseling

Chiari II Malformation

Workup

Counseling

Agenesis of the Corpus Callosum

Workup

Counseling

Microcephaly

Workup

Counseling

Pediatrician’s Perspective

References

18: Imaging of the Pediatric Brain

Introduction

Neuroimaging Techniques

Neuroimaging Indications

Practical Neuroimaging

Imaging Findings

Benign Incidental Findings on Imaging

Developmental Venous Anomalies

Capillary Telangiectasias

Pineal Cysts

Arachnoid Cysts

Sinusitis

Persistent Congenital Vascular Anastomoses

Arachnoid Granulations

Benign Enlargement of the Subarachnoid Spaces of Infancy

Imaging Findings Necessitating Neurological Workup

Arterial Dissections

Meningitis and Brain Abscess

Congenital Neuronal Migration Anomalies

Pediatric White Matter Disease

Vasculopathies

Phakomatoses

Dandy–Walker Spectrum

Idiopathic Intracranial Hypertension

Dural Venous Sinus Thrombosis

Non-accidental Trauma

Imaging Finding Necessitating Neurosurgical Workup

Congenital Vascular Malformations

Moyamoya Disease

Chiari Malformations

Intracranial Mass Lesions

Infratentorial Neoplasms

Supratentorial Neoplasms

Conclusion

References

19: Radiographic Evaluation of Suspected Scoliosis

Introduction

Definition

Non-idiopathic Scoliosis

Radiographic Evaluation

Specific Orthopedic Manifestations of Pediatric Neurologic Disease

Pediatrician’s Perspective

Bibliography for Pediatric Scoliosis

20: Image Gently: Minimizing Radiation Exposure in Children

History of Radiation

Radiobiology

Radiation Dose Simplified

Radiation Risk in Children

Radiation Dose Reduction and Alternative CNS Imaging

Pediatricians’ Responsibility

Radiologists’ Responsibility

Indications for Pediatric Head CT

Imaging Algorithms for Common Neurologic Pediatric Conditions

Head Trauma

Cervical Spine Trauma

Headache

Seizures

Developmental Delay

Head Enlargement

Head Lumps and Bumps

Possible Spinal Dysraphism

Take-Home Messages

References

Part V: Beyond Hydrocephalus: What Pediatric Neurosurgeons Treat Most

21: Chiari Malformation

Clinical Vignettes

A Nonoperative Case

An Operative Case

Classification

Pathophysiology

Epidemiology

Presentation

Chiari 0, 1, and 1.5

Specific Patient Populations

Patients Younger Than 6 Years

Craniosynostosis

Idiopathic Intracranial Hypertension

Postradiation Therapy Chiari

Acquired Chiari

Tethered Cord Syndrome

Chiari Associated with Hydrocephalus

Chiari Associated with Growth Hormone Disorders

Chiari 2

Imaging

Natural History

Treatment

Management-Indications for surgery

Conservative

Surgical

Treatment of Chiari 2

Complications

Follow-Up

Outcome

Conclusion

Key Points

Pediatrician’s Perspective

References

22: Pediatric Brain Tumors

Introduction

Epidemiology and Classification

Clinical Presentation

Specific and Nonspecific Symptoms

Pediatrician’s Perspective

Key Points

Suggested Reading�

23: Pediatric Neurovascular Disease

Introduction

Aneurysms

Epidemiology

Presentation and Clinical Features

Subarachnoid Hemorrhage

Focal Neurologic Findings

Seizures

Giant Aneurysms and Mass Effect

Hydrocephalus

Vasospasm

Genetics and Associated Syndromes

Polycystic Kidney Disease

Tuberous Sclerosis

Coarctation of the Aorta

Ehlers–Danlos and Marfan Syndromes

Pathophysiology

Idiopathic Aneurysms

Traumatic Aneurysms

Giant Aneurysms

Infectious Aneurysms

Diagnosis

Screening and Implications for Family

When to Refer to a Neurosurgeon

Treatment, Outcomes, and Prognosis

Unruptured Aneurysms

Ruptured Aneurysms

Cavernous Malformations

Definition

Epidemiology

Clinical Presentation

Diagnosis

Pathophysiology

When to Refer to a Neurosurgeon

MRI Screening for Family Members in Familial Cavernous Malformations

Treatment

Prognosis and Outcome

Cerebral Venous Malformations (Venous Angiomas and Developmental Venous Anomalies)

Definition

Epidemiology

Clinical Presentation and Diagnosis

Pathophysiology

When to Refer to a Neurosurgeon

Treatment

Arteriovenous Malformations

Definition

Epidemiology

Presenting Clinical Features

Pathophysiology

Diagnosis and Imaging

Natural History

When to Refer to a Neurosurgeon

Treatment

Prognosis and Outcome

Ischemic Stroke

Definition and Classification

Epidemiology

Clinical Presentation

Diagnosis

Pathophysiology

Treatment of Pediatric Ischemic Stroke

When to Refer to a Neurosurgeon

Prognosis and Outcome

Vein of Galen Malformations

Definition and Classification

Epidemiology

Clinical Presentation

Diagnosis

Pathophysiology

When to Refer to a Neurosurgeon

Treatment

Prognosis and Outcome

Spinal Vascular Malformations

Definitions and Classification

Epidemiology

Presenting Clinical Features

Genetics and Associated Clinical Syndromes

Diagnosis and Evaluation

When to Refer to a Neurosurgeon

Treatment, Prognosis, and Long-Term Outcome

Key Points

Pediatrician’s Perspective

References

24: Pediatric Seizures

Seizure Semiology

Generalized Seizures

Generalized Tonic-Clonic Seizures

Myoclonic Seizures

Tonic Seizures

Atonic Seizures

Absence Seizures

Infantile or Epileptic Spasms

Focal Seizures

Temporal Lobe Seizures

Frontal Lobe Seizures

Occipital Lobe Seizures

Parietal Seizures

Vignette Continued [2]

Approach to the First Seizure

Febrile Seizures

Nonfebrile Seizures

Epilepsy Syndromes

Benign Childhood Epilepsy with Centrotemporal Spikes (Also Known as Rolandic Epilepsy or Benign Ro

Childhood Absence Epilepsy (CAE)

Juvenile Myoclonic Epilepsy (JME)

Lennox-Gastaut Syndrome (LGS)

West Syndrome (Also Known as Infantile Spasms or Epileptic Spasms)

Acute Seizure Management

General Seizure Precautions

Antiepileptic Choices

Nonpharmacologic Seizure Management

Vignette Continued [3]

Conclusion

References

25: Approach to Spasticity in the Pediatric Patient

Introduction

Examining a Child with Spasticity

Overview of Treatment Goals

Overview of Treatment Options

Nonsurgical Therapies

Surgical Therapies

Age-Based Guide to Approaching Families and Patients

Infant

Case Presentation 1

Two Years Old

Case Presentation

Three–Four Years Old

Case Presentation

Older Than Four Years

Case Presentation

Conclusion

Bibliography

26: Assessment and Management of Minor Head Injuries in Toddlers and Adolescents

Case Presentation

Introduction to Pediatric Head Injuries

Assessing the Patient

Imaging and Decision-Making

Recommendations for CT in Children Under 2 Years of Age Derived from PECARN

PECARN Recommendations for Obtaining a CT in Children 2 Years of Age and Older

What to Tell Parents

Prevention

Conclusion

Pediatrician’s Perspective

References

Evidence Based Medicine Resources

27: Non-accidental Head Trauma

History

Epidemiology: Incidence and Prevalence

Risk Factors

Biomechanics and Non-accidental Head Trauma

Clinical Presentation

Primary Traumatic Brain Injury

Secondary Traumatic Brain Injury

Diagnostic Evaluation

History Taking

History of Present Illness

Past Medical History

Social History

Family History

Physical Exam

Head and Neck

Skin

Abdomen

Genitals

Neurologic Exam

Neuroradiologic Evaluation

Computed Tomography

Magnetic Resonance Imaging

Ultrasound

Plain Radiographs

Laboratory Evaluation

Serum Brain Biomarkers

Ophthalmologic Exam

Prevention

Role of the Pediatrician

References

28: A Pediatrician’s Guide to Concussion Management

Epidemiology

Resolution of Concussion

Special Considerations in the Pediatric Population

Office Visit for Concussion

History of the Injury

Actual Injury

Retrograde Amnesia

Loss of Consciousness (LOC)

Posttraumatic Amnesia (PTA)

Test Results

Post-Concussion Signs and Symptoms

Physical and Neurologic Exam

Diagnosis and Feedback

Second Impact Syndrome

Chronic Traumatic Encephalopathy

Treatment Plan and Recommendations

When to Refer for an Emergent Neurosurgical Consultation

Recommendations for Return to School and to Sports

Medication

When to Refer for a Neuropsychological Consultation

The Pediatric Concussion Patient: Case Reports

Case Report 1: Sailing Injury

Case Report 2: Schoolyard Concussion

Case Report 3: Head-to-Head Collision

Case Report 4: Motor Vehicle Accident

Summary

References

29: Pathophysiology and Diagnosis of Concussion

Definition

Epidemiology

Concussion in Sports

Pathophysiology of Concussion

Biomechanics of Injury

Glutamate Release and Ionic Flux (Fig. 29.5)

Alterations to Brain Metabolism and Activation

Axonal Injury

Acute Response to Repeat Concussion and the “Second Impact Syndrome”

Special Considerations in the Pediatric Population

Evaluation of Concussion Patients

Clinical History and Exam

Sideline Testing

Neurocognitive Testing

Neuroimaging

Eye Tracking

Treatment of Concussion and Management of Symptoms

Pharmacologic Management of Symptoms

Post-Concussion Syndrome

Cumulative Effects of Concussion

Return to Play

Return to School

References

Index

 

An aparitie	2017
Autor	Greenfield
Dimensiuni	? 17.81 x 2.64 x 25.4 cm
Editura	Springer
Format	Softcover
ISBN	9781493938056
Limba	Engleza
Nr pag	459