First name
Jimmy
Middle name
W
Last name
Huh

Title

Urgent neurosurgical interventions in the COVID-19 positive pediatric population.

Year of Publication

2021

Date Published

2021 Oct 27

ISSN Number

1878-8769

Abstract

<p><strong>BACKGROUND: </strong>Urgent neurosurgical interventions in pediatric patients with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) are rare. These cases pose an additional stressor on a potentially vulnerable dysregulated inflammatory response which may put the child at risk for further clinical deterioration. Our aim was to describe the perioperative course of SARS-CoV-2 positive pediatric patients who required an urgent neurosurgical intervention.</p>

<p><strong>METHODS: </strong>We retrospectively analyzed pediatric patients ≤18 years of age admitted to a quaternary children's hospital with a positive PCR for SARS-CoV-2 virus from March 2020 to October 2021. Clinical characteristics, anesthetic and neurosurgical operative details, surgical outcomes, and non-neurological symptoms were collected and analyzed.</p>

<p><strong>RESULTS: </strong>Eight SARS-CoV-2 positive patients were identified with a mean age of 8.83 years (median 8.5 years; range 0.58 -18 years). 6 of the 8 patients were male. All children had mild disease or were asymptomatic with regards to COVID symptoms. The anesthetic and surgical courses for these patients were overall uncomplicated. All patients were admitted to a specialized isolation unit in the pediatric intensive care unit (PICU) for cardiopulmonary and neurologic monitoring. Increased protective personal equipment (PPE) during anesthesia and the operation did not impede a successful neurosurgical operation.</p>

<p><strong>CONCLUSIONS: </strong>SARS-CoV-2 positive pediatric patients with minimal COVID-related symptoms who require urgent neurosurgical interventions face unique challenges regarding their anesthetic status, operative delays due to SARS-CoV-2 PCR testing and additional PPE requirements. Despite these clinical challenges, the patients in our study had no adverse post-operative consequences and no healthcare professionals involved contracted the virus.</p>

DOI

10.1016/j.wneu.2021.10.155

Alternate Title

World Neurosurg

PMID

34718196

Title

Intracranial pressure and brain tissue oxygen neuromonitoring in pediatric cerebral malaria.

Year of Publication

2020

Date Published

2020 Jun 08

ISSN Number

1878-8769

Abstract

<p><strong>BACKGROUND: </strong>Pediatric cerebral malaria (CM) is a severe complication of Plasmodium falciparum that often leaves survivors with severe neurological impairment. Increased intracranial pressure (ICP) as a result of cerebral edema has been identified as a major predictor of morbidity and mortality in CM. Past studies have demonstrated that survivors are more likely to have resolution of elevated ICP and that efficient management of ICP crises may lead to better outcomes. However, data on invasive brain tissue oxygen monitoring is unknown.</p>

<p><strong>CASE DESCRIPTION: </strong>We report a case of a pediatric patient with cerebral malaria who developed encephalopathy and cerebral edema and describe the pathophysiology of this disease process with invasive ICP and brain tissue oxygen multimodality neuromonitoring. The utilization of both ICP and brain tissue oxygen monitoring allowed prompt diagnosis and successful treatment of severe intracranial hypertension and low brain tissue oxygenation crisis. The patient was discharged to home in good neurological condition.</p>

<p><strong>CONCLUSION: </strong>Multimodality neuromonitoring may be considered in pediatric patients who have cerebral edema and encephalopathy from CM.</p>

DOI

10.1016/j.wneu.2020.06.024

Alternate Title

World Neurosurg

PMID

32526359

Title

Reduced Radiation in Children Presenting to the ED With Suspected Ventricular Shunt Complication.

Year of Publication

2017

Date Published

2017 May

ISSN Number

1098-4275

Abstract

<p><strong>BACKGROUND: </strong>Ventricular shunt complications in children can be severe and life-threatening if not identified and treated in a timely manner. Evaluation for shunt obstruction is not without risk, including lifetime cumulative radiation as patients routinely receive computed tomography (CT) scans of the brain and shunt series (multiple radiographs of the skull, neck, chest, and abdomen).</p>

<p><strong>METHODS: </strong>A multidisciplinary team collaborated to develop a clinical pathway with the goal of standardizing the evaluation and management of patients with suspected shunt complication. The team implemented a low-dose CT scan, specifically tailored for the detection of hydrocephalus and discouraged routine use of shunt series with single-view radiographs used only when specifically indicated.</p>

<p><strong>RESULTS: </strong>There was a reduction in the average CT effective dose (millisievert) per emergency department (ED) encounter of 50.6% (confidence interval, 46.0-54.9; P ≤ .001) during the intervention period. There was a significant reduction in the number of shunt surveys obtained per ED encounter, from 62.4% to 5.32% (P &lt; .01). There was no significant change in the 72-hour ED revisit rate or CT scan utilization rate after hospital admission. There were no reports of inadequate patient evaluations or serious medical events.</p>

<p><strong>CONCLUSIONS: </strong>A new clinical pathway has rapidly reduced radiation exposure, both by reducing the radiation dose of CT scans and eliminating or reducing the number of radiographs obtained in the evaluation of patients with ventricular shunts without compromising clinical care.</p>

DOI

10.1542/peds.2016-2431

Alternate Title

Pediatrics

PMID

28557725

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