Pediatric Neurosurgery Board Review: A Comprehensive Guide

✍ Scribed by Nir Shimony, George Jallo

• Publisher: Springer
• Year: 2023
• Tongue: English
• Leaves: 361
• Category: Library

✦ Synopsis

This specialized textbook will be dedicated to the various disease topics of pediatric neurosurgery and management strategies. The text will cover the different aspects of the field of pediatric neurosurgery in a unique way by giving state of the art up-to-date synopsis with references to recent publications. More specifically, the whole book is dedicated to a comprehensive discussion of brainstem tumors and other lesions.  It will be composed of 20 chapters. The various chapters will start from updates regarding the development of the nervous system and the clinical differences in assessing the infant or a child in comparison to the adult patient. The book then will focus on  various pathologies starting with hydrocephalus, pediatric brain and spine tumors, congenital malformation, spasticity, epilepsy, and more. The proposed textbook will be enriched with diagnostic and surgical images, and illustrations that cover all types of pediatric neurosurgery pathologies, with an emphasis on evidence-based data that reflects the controversies and possible solutions. The main structure of each chapter will include a short synopsis of the topic at hand, questions and answers that will inspire the reader for better understanding, learning objectives, and key references for further reading. 
Written by experts in the field, Pediatric Neurosurgery Board Review serves as a valuable resource for neurosurgery residents and fellows studying for their neurosurgery exams, as well as an educational material for neurosurgery specialists after graduation by discussing pediatric neurosurgery in more convenient way to review and understand key information in this field.

✦ Table of Contents

Foreword
Preface
Acknowledgments
Contents
Contributors
1: The Neurological Assessment of Pediatric Patient and the Differences Across Different Age Groups
Introduction
Helpful Tools
Components of the Neurological Exam
Vital Signs
Anterior Fontanelle
General Appearance [5–8]
Head Shape
Cranial Sutures
Dysmorphic Features and Associated Conditions
Mental Status
Cranial Nerves [8]
Motor Exam
Reflexes
Primitive Reflexes: Full Description in Fig. 1.4 [5, 10]
Tone
Gait
Sensory
Cutaneous Exam
Brain Death Testing [11, 12]
Conclusion
References
Additional Suggested Readings and Resources
2: The Changes of the Nervous System from Fetal Stages to Early Adulthood, as Seen in Different Imaging Modalities
Introduction
Diagnostic Imaging Modalities for the Study of the Developing and Maturing Brain
Brain Ultrasound
Brain CT
Anatomical Brain MRI
Fetal MRI
Advanced Brain MR
Imaging of the Brain During Development
Imaging of the Fetus and Preterm Brain
Ultrasound
MRI
Normal Postnatal Brain Development
Neonatal MRI Brain Development
Myelination Milestones as Depicted by MRI
Diffusion Tensor Imaging and Tractography
References
3: Hydrocephalus and Surgical Solutions for It
Pathophysiology
Diagnostics
Neonatal IVH with Hydrocephalus
Infection and Hydrocephalus
Myelomeningocele
Other Congenital Hydrocephalus
CNS Tumors and Hydrocephalus
Therapy
Temporary Measures
Endoscopy
Shunt
Endoscopy in Combination with Shunt
Summary
References
4: Management of Arachnoid Cysts
Introduction
Intracranial Arachnoid Cysts
Etiology and Pathogenesis
Natural History
Clinical Presentation
Radiological Features
Effect of Arachnoid Cysts on Cerebral Perfusion and Metabolism
Effect of Arachnoid Cysts on Language Organization
Surgical Management of Intracranial Cysts
Surgical Techniques
Endoscopic Fenestration
Outcome of Endoscopic Treatment
Alternate Procedures
Microsurgery for Cyst Fenestration: Marsupialization
Cyst-Peritoneal Shunt
Overall Outcome Following Treatment
Spinal Arachnoid Cysts
Etiology and Pathogenesis
Clinical Presentation
Radiological Features
Surgical Management
Prognosis
References
Intracranial Arachnoid Cysts
Spinal Arachnoid Cysts
5: Management of Congenital Malformations (Cranial and Spinal)
Introduction
Cranial
Spinal
References
6: Management of Chiari Malformation
Introduction
Chiari Subtypes
Chiari 1
Chiari 2, 3, and 4
New Classification Schemes
Pathogenesis and Pathophysiology
Comorbidities and Associations
Syringomyelia
Scoliosis
Craniosynostosis
Hydrocephalus
Spinal Instability
Associated Syndromes
Diagnosis and Workup
Symptoms
Imaging
Complex Chiari Malformations
Sleep Studies
Ophthalmological Evaluation
Treatment
Posterior Fossa Decompression
Bone-Only vs Decompression with Duraplasty
Outcomes After Decompression
Endoscopic Third Ventriculostomies
Posterior Calvarial Distraction
Craniocervical Fusion
Conclusion
References
7: Management of Head Shape Deformity and Craniosynostosis
Introduction
Deformational Plagiocephaly
Introduction
Diagnosis
Therapy
Summary: Clinical Pearls for the Treatment of Deformational Plagiocephaly
Craniosynostosis
Introduction
Diagnosis
Clinical Exam in Craniosynostosis
Radiologic Studies in Craniosynostosis
Management
Operative Management: Open Approaches
Operative Management: Endoscopic Approaches
Operative Management: Flexible Springs and Distractor Devices
Measuring Clinical Outcomes in Craniosynostosis
Summary: Clinical Pearls for Craniosynostosis Repair
References
8: Pediatric Brain and Brainstem Tumors
Introduction
Main Players: Methylation, Histone Mutation, MEK/BRAF, FGFR, and Other Alterations
Medulloblastoma
What Is the Current Knowledge?
Role of Surgical Intervention
Management of Adjuvant Therapy
Low-Grade Gliomas
High-Grade Gliomas
Ependymomas
Glioneuronal and Neuronal Tumors
Craniopharyngiomas
Choroid Plexus Carcinoma/Papilloma
References
9: Pediatric Spine, Spinal Cord, and Peripheral Nervous System Tumors
Introduction
Intramedullary Spinal Cord Tumors
Epidemiology
Risk Factors
Clinical Presentation
Investigation
Learn to Know the “Tumor Fingerprint”
Astrocytoma
Ependymoma
ATRT
Hemangioblastoma
Management Paradigm for IMSCT
Extent of Resection for Pediatric IMSCT
Treatment Paradigm
Surgical Pearls for Intramedullary Tumors
Intradural Extramedullary Tumors
Meningiomas
Nerve Sheath Tumors
Myxopapillary Ependymomas
Conclusions
References
10: Pediatric Vascular Malformations
Arteriovenous Malformations (AVMs)
Background
Epidemiology
Natural History
Diagnosis
Genetics
Treatment
Outcomes
Arteriovenous Fistulas (AVFs)
Background
Classification
Genetics and Pathogenesis
Treatment
Outcomes and Follow-Up
Vein of Galen Malformations (VOGMs)
Background
Clinical Features
Presentation
Genetics
Treatment
Outcomes
Dural Sinus Malformations (DSMs)
Background
Clinical Characteristics
Treatment
Cerebral Proliferative Angiopathy (CPA)
Background
Imaging Characteristics
Clinical Features
Genetics and Pathophysiology
Treatment
Cerebral Cavernous Malformations (CCMs)
Background
Epidemiology
Presentation
Imaging Characteristics
Treatment
Outcomes
Developmental Venous Anomalies (DVAs)
Background
Imaging Characteristics
Clinical Characteristics
Spinal Cord Vascular Malformations (SCVM)
Background
Classification
Natural History
Conclusion
References
11: Pediatric Epilepsy Surgery
Introduction
Epilepsy Surgery in Children
Special Considerations for Pediatric Epilepsy Surgery
Special Epilepsy Syndromes of Childhood
Neuropathology of Pediatric Epilepsy
Preoperative Assessment
Neuroimaging Studies
Noninvasive Electrophysiological Techniques
Invasive Electrophysiological Techniques
Awake Surgery and Electrocorticography
Surgical Procedures
Resective Procedures
Disconnective Procedures
Neuromodulation and Ablation Procedures
Conclusion
References
12: Management of Pediatric Patient with Neurofibromatosis
Introduction
Neurofibromatosis Type 1
Diagnosis
Manifestations and Management by System
Cutaneous
Skeletal
Ophthalmologic
Vascular
Neurologic
Benign and Malignant Neoplasms of Neurofibromatosis Type 1
Plexiform Neurofibroma
Malignant Peripheral Nerve Sheath Tumors
Low Grade Glioma
High Grade Glioma
Screening of Patients with Neurofibromatosis Type 1
Neurofibromatosis Type 2
Diagnosis
Manifestations and Management by System
Dermatologic
Ophthalmologic
Neurologic
Benign and Malignant Neoplasms of Neurofibromatosis Type 2
Vestibular Schwannoma
Non-vestibular Schwannoma
Meningioma
Ependymoma
Screening for Patients with NF2
Summary
References
13: Management of Pediatric Patient with Non-NF Phakomatosis
Introduction
Tuberous Sclerosis Complex
Epidemiology and Etiology
Clinical Presentation
Investigation
Treatment Paradigm
Surveillance
Medical Management
Surgical Management of SEGAs
Surgical Management of Refractory Epilepsy
Other Treatment for Refractory Epilepsy
Multidisciplinary Approach
Von Hippel-Lindau Disease
Epidemiology and Etiology
Clinical Presentation
Investigation
Treatment
Surveillance
Medical Treatment
Surgical Treatment
Multidisciplinary Approach
Sturge-Weber Syndrome
Epidemiology and Etiology
Clinical Presentation
Investigation
Treatment Paradigm
Surveillance
Medical Treatment
Surgical Treatment
Multidisciplinary Approach
Conclusion
References
14: Management of Spasticity
What Is Spasticity?
Differentiating Spasticity and Dystonia
Cerebral Palsy and Spasticity: Classification
Etiologies of Spasticity
Epidemiology
Pathology/Pathophysiology
Clinical Features and Grading
Diagnostic Studies
Spasticity Treatment
Intrathecal Baclofen Pump
Selective Dorsal Rhizotomy
References
15: Management of Brachial Plexus Injury Across Different Age Groups
Introduction
Epidemiology and Pathophysiology
Classification and Functional Scoring of OBPP
Natural History of OBPP
Rates of Spontaneous Recovery
Prognostication
Initial Management and Workup
Initial Evaluation and Management of OBPP
Role for Imaging and Electrophysiology
Nerve Surgery for OBPP
General Principles
Surgical Criteria
Surgical Technique
Outcomes After Surgery
Secondary Surgery for OBPP
Summary
References
16: Management of Musculoskeletal Malformations
Introduction
Craniovertebral Junction Abnormalities
Embryology and Anatomy of the Craniovertebral Junction
Craniovertebral Junction Instability
Down Syndrome and CVJ Abnormalities
Os Odontoideum
Subaxial Cervical Spine and Klippel-Feil Syndrome
Embryology and Anatomy
Klippel-Feil Syndrome
Developmental and Congenital Spinal Stenosis and Achondroplasia
Transient Neurapraxia with Developmental Cervical Stenosis
Pediatric Degenerative Disc Disease and Disc Herniation
Spondylolisthesis and Spondylolysis
Conclusion
References
17: Traumatic Brain Injury
Introduction
Emergency Evaluation and Triage
Intubation, Ventilation, and Circulation
Intubation
Anesthesia
Neuromuscular Blockade
Postintubation Procedures and Mechanical Ventilation
Hyperventilation
Circulation
Detailed Neurologic Examination
Breathing Patterns
Ophthalmic Examination
Pupillary Evaluation
Ocular Responses
Fundus Examination
Motor Examination
Posttraumatic Seizures
Trauma-Specific Evaluation
Head Injury Patterns and Mechanisms
Development and Head Injury Patterns
Blunt Force Injury
Compression Injury
Sharp or Penetrating Injury
Penetrating Blast Injury
Types of Intracranial Injury
Extra-Axial Hemorrhage
Epidural Hematoma
Subdural Hematoma
Focal Hemorrhagic and Nonhemorrhagic Lesions
Traumatic Intraparenchymal Hemorrhage
Diffuse Traumatic Axonal Injury
Concussion (Mild TBI)
Secondary Injury
Early-Phase Edema
Posttraumatic Ischemia, Tissue Oxygenation, and Metabolism
Imaging
Indications for Imaging
Radiation Concerns in the Developing Brain
Plain Radiographs
Computed Tomography
CT Pan Scan
Magnetic Resonance Imaging
Ultrasound
CT Angiography
Intensive Care Management of Pediatric TBI Patients
Physiologic Differences Between Pediatric and Adult Patients
Intracranial Hypertension
Intracranial Monitoring Methods
Managing Elevated Intracranial Pressure
Baseline Care
Consensus and Guidelines-Based Algorithm for First- and Second-Tier Therapies to Manage Elevated Intracranial Hypertension [24]
Tier 1
Herniation Pathway
ICP and CPP Pathways
Brain Oxygenation Pathway
Tier 2
Repeat Imaging
Barbiturate Infusion
Late Moderate Hypothermia
Late Induced Hyperventilation
Hyperosmolar Therapy
Advanced Neuromonitoring
Surgical Decompression
Weaning of Therapies
Postacute Pathology
Posttraumatic Seizures and Anticonvulsants
Risk Factors
Prophylaxis
Medication Options
Continuous EEG
Temperature Management
Fever/Hyperthermia/Pyrexia
Meningitis
Malignant Cerebral Edema
Corticosteroids
Posttraumatic Hydrocephalus
Hypothalamic-Pituitary Dysfunction
Cortisol
Water Homeostasis
Hyponatremia: SIADH vs CSW
Hypernatremia: Diabetes Insipidus
Other Hormones
Venous Thromboembolism Prophylaxis
Nutrition
Fluids
Surgical Management of Pediatric Neurotrauma
Preoperative Considerations
Anesthesia Considerations
Surgical Preparation
Intraoperative Considerations
Decompressive Craniectomy
Cranial Reconstruction
Nonoperative Skull Fractures
Prognostication
Managing Discussions
Lethal and Fatal Injuries
Long-Term Sequelae and Outcomes
References
18: Traumatic Spine Injury
Cervical Spine Trauma
Epidemiology
Cervical Spinal Biomechanics and Stabilizing Structures
Imaging and Pediatric Cervical Spine Clearance
Patterns of Pediatric Cervical Spine Injury, Radiographic Correlates of Instability, and Surgical Management
Injuries to the Occiput-C1 Junction
Injuries to C2
Injuries to the Sub-Axial Cervical Spine
Thoracolumbar Trauma
Introduction and Epidemiology
Imaging
Injury Classifications
Specific Pathology
Compression Fractures
Burst Fractures
Flexion Distraction/Translational Injuries
Ring Apophyseal Fractures
Conclusion
References
19: Central Nervous System Infections and Their Management
Introduction
Bacterial and Viral Meningitis
Bacterial Meningitis
Viral Meningitis
Viral Encephalitis
Etiology
Clinical Presentation and Diagnosis
Treatment
Tuberculosis, Parasitic, and Fungal Infections
CNS Tuberculosis
Neurocysticercosis
Toxoplasmosis
Amebic Encephalitis
Fungal Infections
Abscesses and Empyemas
Pott’s Puffy Tumor
Epidural Abscess
Subdural Empyema
Intraparenchymal Brain Abscess
Special Considerations
Shunt Infections
Etiology
Risk Factors
Prevention
Clinical Presentation
Diagnosis
Treatment
Trauma
Penetrating Injuries
Open Depressed Skull Fractures
Neurological Implications of COVID-19
Conclusions
References
20: Pediatric Spinal Deformity
Scoliosis
Congenital Scoliosis
Neuromuscular Scoliosis
Idiopathic Scoliosis
Evaluation
Imaging
Treatment
Kyphosis
Surgery
References
Index