First name
Phillip
Middle name
B
Last name
Storm

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

Optical Detection of Intracranial Pressure and Perfusion Changes in Neonates With Hydrocephalus.

Year of Publication

2021

Date Published

2021 May 15

ISSN Number

1097-6833

Abstract

<p><strong>OBJECTIVE: </strong>To demonstrate that a novel non-invasive index of intracranial pressure (ICP) derived from diffuse optics-based techniques is associated with intracranial hypertension.</p>

<p><strong>STUDY DESIGN: </strong>We compared non-invasive and invasive ICP measurements in infants with hydrocephalus. Infants born term and preterm were eligible for inclusion if clinically determined to require cerebrospinal fluid (CSF) diversion. Ventricular size was assessed preoperatively via ultrasound measurement of the fronto-occipital (FOR) and fronto-temporal (FTHR) horn ratios. Invasive ICP was obtained at the time of surgical intervention with a manometer. Intracranial hypertension was defined as invasive ICP ≥15 mmHg. Diffuse optical measurements of cerebral perfusion, oxygen extraction, and non-invasive ICP were performed preoperatively, intraoperatively, and postoperatively. Optical and ultrasound measures were compared with invasive ICP measurements, and their change in values after CSF diversion were obtained.</p>

<p><strong>RESULTS: </strong>We included 39 infants; 23 had intracranial hypertension. No group difference in ventricular size was found by FOR (p=0.93) or FTHR (p=0.76). Infants with intracranial hypertension had significantly higher non-invasive ICP (p=0.02) and oxygen extraction fraction (p=0.01) compared with infants without intracranial hypertension. Increased cerebral blood flow (p=0.005) and improved oxygen extraction fraction (P &lt; .001) after CSF diversion were only observed in infants with intracranial hypertension.</p>

<p><strong>CONCLUSIONS: </strong>Non-invasive diffuse optical measures (including a non-invasive ICP index) were associated with intracranial hypertension. The findings suggest impaired perfusion from intracranial hypertension was independent of ventricular size. Hemodynamic evidence of the benefits of CSF diversion was seen in infants with intracranial hypertension. Non-invasive optical techniques hold promise for aiding the assessment of CSF diversion timing.</p>

DOI

10.1016/j.jpeds.2021.05.024

Alternate Title

J Pediatr

PMID

34004191

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

Development and Clinical Validation of a Large Fusion Gene Panel for Pediatric Cancers.

Year of Publication

2019

Date Published

2019 Jun 27

ISSN Number

1943-7811

Abstract

<p>Gene fusions are one of the most common genomic alterations in pediatric cancer. Many fusions encode oncogenic drivers and play important roles in cancer diagnosis, risk stratification, and treatment selection. We report the development and clinical validation of a large custom-designed RNA sequencing panel, CHOP Fusion panel, using anchored multiplex PCR technology. The panel interrogates 106 cancer genes known to be involved in nearly 600 different fusions reported in hematological malignancies and solid tumors. The panel works well with different types of samples including formalin-fixed, paraffin-embedded samples. The panel demonstrated excellent analytic accuracy with 100% sensitivity and specificity on 60 pediatric tumor validation samples. In addition to identifying all known fusions in the validation samples, three unrecognized yet clinically significant fusions were also detected. Two-hundred and sevety-six clinical cases were analyzed after the validation and 51 different fusions were identified in 104 cases. Of these, 16 fusions were not previously reported at the time of discovery. These fusions provided genomic information useful for clinical management. Our experience demonstrates that CHOP Fusion panel can detect the vast majority of known and certain novel clinically relevant fusion genes in pediatric cancers accurately, efficiently, and cost effectively, and provides an excellent tool for new fusion gene discovery.</p>

DOI

10.1016/j.jmoldx.2019.05.006

Alternate Title

J Mol Diagn

PMID

31255796

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