Pediatric Neurosurgery for Clinicians

✍ Scribed by Georgios Alexiou (editor), Neofytos Prodromou (editor)

• Publisher: Springer
• Year: 2022
• Tongue: English
• Leaves: 834
• Category: Library

✦ Synopsis

This book presents a detailed overview of a spectrum of pediatric neurosurgical conditions. It features detailed insight into the techniques available for examining abnormalities, hemorrhages and a variety of tumors. Relevant surgical methodologies are described in relation to a clinical problem or disorder, ensuring that the reader can systematically develop their knowledge of how to perform both routine and more-obscure procedures presently utilized to treat these conditions.

Pediatric Neurosurgery for Clinicians is a comprehensive guide detailing methodologies for applying a range of surgical techniques based upon a range of clinical questions. Therefore, it is a critical resource for all practicing and trainee physicians who encounter children with disorders affecting their neurological systems in disciplines within neurosurgery, neurology, radiology, oncology and pathology.

✦ Table of Contents

Preface
Contents
Part I: General Topics
Chapter 1: History of Pediatric Neurosurgery
1.1 The Evolution of Neurosurgery from Ancient Greece to Modern Times
1.2 The Evolution of Neurosurgery in Europe
1.3 Period 1840–1940: The Century of the Most Important Changes
1.4 Period 1940–1960
1.5 Period 1960–1980
1.6 Period 1980–present
References
Chapter 2: Neurological Examination
2.1 Neurological Examination of the Neonate
2.1.1 General Assessment
2.1.1.1 History
2.1.1.2 Assessment of Gestational Age
2.1.1.3 Physical Examination
2.1.2 Formal Neurological Examination
2.1.2.1 Level of Alertness
2.1.2.2 Cranial Nerves
Cranial Nerve I (Olfactory Nerve)
Cranial Nerve II (Optic Nerve)
Cranial Nerves III, IV and VI (Oculomotor, Trochlear, and Abducens Nerves)
Cranial Nerve V (Trigeminal Nerve)
Cranial Nerve VII (Facial Nerve)
Cranial Nerve VIII (Vestibulocochlear Nerve)
Cranial Nerves IX, X and XII (Glossopharyngeal, Vagus, and Hypoglossal Nerves)
Cranial Nerve XI (Spinal Accessory Nerve)
2.1.2.3 Motor Examination
Tone and Posture
Motility and Power
Tendon Reflexes and Plantar Response
Abnormalities of the Motor Examination
2.1.2.4 Primitive Neonatal Reflexes
2.1.2.5 Sensory Examination
2.2 Neurological Examination of the Infant and Child
2.2.1 History
2.2.2 Neurological Examination
2.2.2.1 Head
2.2.2.2 Face
2.2.2.3 Spine—Extremities
2.2.2.4 Mental Status
2.2.2.5 Cranial Nerves
Cranial Nerve I (Olfactory Nerve)
Cranial Nerve II (Optic Nerve)
Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens Nerves)
Cranial Nerve V (Trigeminal Nerve)
Cranial Nerve VII (Facial Nerve)
Cranial Nerve VIII (Vestibulocochlear Nerve)
Cranial Nerves IX and X (Glossopharyngeal and Vagus Nerves)
Cranial Nerve XI (Spinal Accessory Nerve)
Cranial Nerve XII (Hypoglossal Nerve)
2.2.2.6 Motor System
Bulk
Tone
Strength
Abnormal Movements
2.2.2.7 Reflexes
2.2.2.8 Sensory System
2.2.2.9 Coordination
2.2.2.10 Gait
2.3 Conclusions
References
Part II: Congenital and Developmental Cranial Anomalies
Chapter 3: Hydrocephalus
3.1 Introduction
3.2 History
3.3 Etiology
3.4 Clinical Manifestations
3.5 Imaging
3.6 Treatment
3.7 Conclusion
References
Chapter 4: Intraventricular Hemorrhage in the Newborn
4.1 Introduction
4.2 Pathogenesis of IVH
4.3 Definition of IVH Grading and PHH
4.4 Treatment Modalities for PHH
4.5 Prognosis
4.6 How to Reduce Periventricular White Matter Damage and Improve Neurodevelopmental Outcomes?
4.7 Future Directions
4.8 Conclusion
References
Chapter 5: Arachnoid Cysts
5.1 Introduction
5.2 Classification
5.2.1 Cranial ACs
5.2.2 Spinal ACs
5.3 Relation between Arachnoid Cysts and Hydrocephalus
5.4 Clinical Presentation
5.4.1 Cranial ACs
5.4.2 Cranial ACs and Cognitive Impairment
5.4.3 Spinal ACs
5.5 Diagnosis
5.5.1 Cranial ACs
5.5.2 Spinal ACs
5.6 Indications for Treatment
5.6.1 Cranial ACs
5.6.2 Spinal ACs
5.7 Operative Treatment
5.7.1 Cranial ACs
5.7.2 Spinal ACs
5.8 Postoperative Complications
References
Chapter 6: Dandy-Walker Malformation
6.1 Introduction
6.2 Etiology
6.3 Imaging Findings
6.4 Symptomatology
6.5 Central Nervous System Abnormalities
6.6 Non-CNS Abnormalities
6.7 Management
6.8 Prognosis
6.9 Conclusion
References
Chapter 7: Chiari Malformation
7.1 Classification
7.1.1 Chiari Malformation Type 0
7.1.2 Chiari Malformation Type 0.5
7.1.3 Chiari Malformation Type 1
7.1.4 Chiari Malformation Type 1.5
7.1.5 Chiari Malformation Type 2
7.1.6 Chiari Malformation Type 3
7.1.7 Chiari Malformation Type 4
7.1.8 Chiari Malformation Type 5
7.2 Embryology
7.3 Pathophysiology
7.3.1 Overcrowding Theory
7.3.2 Growth Abnormality Theory
7.3.3 Molecular Genetic Theory
7.3.4 Hydrodynamic Theory
7.3.5 Traction Theory
7.3.6 Unified Theory
7.4 Epidemiology
7.5 Signs and Symptoms
7.5.1 Signs and Symptoms Related to the CSF Flow Impairment
7.5.2 Signs and Symptoms Related to the Brainstem and Cerebellar Compression or Traction on the Cranial Nerves
7.5.3 Signs and Symptoms Related to the Spinal Cord Compression or Syringomyelia
7.6 Associated Disorders
7.7 Diagnostic Studies
7.7.1 Plain Radiography
7.7.2 Ultrasound Studies
7.7.3 Computed Tomography (CT)
7.7.4 Magnetic Resonance Imaging (MRI)
7.7.5 CSF Flow Studies
7.7.6 Electrophysiological Studies
7.8 Management
7.9 Complications
7.10 Outcomes and Prognosis
References
Chapter 8: Encephaloceles
8.1 Definition/Introduction
8.1.1 Prevalence and Inheritance
8.1.2 Sincipital Encephaloceles
8.1.3 Basal Encephalocele
8.1.4 Occipital Encephalocele
8.2 Embryology
8.2.1 Primary Defect at the Foramen Caecum
8.2.2 Secondary to Intracranial Abnormalities
8.3 Clinical Presentation
8.3.1 Frontoethmoidal Presentations
8.3.2 Summary of Key Anterior Presentations
8.3.3 Occipital Presentations
8.4 Diagnosis
8.5 Management
8.5.1 Sincipital and Basal Encephaloceles
8.5.2 Occipital Encephalocele
References
Chapter 9: Craniosynostosis
9.1 Introduction
9.2 Epidemiology
9.3 Clinical Features: Definitions
9.4 Genetics and Risk Factors
9.5 Clinical Evaluation
9.6 Imaging
9.7 Management
References
Chapter 10: Craniofacial Syndromes
10.1 Introduction
10.2 Epidemiology
10.3 Etiology-Genetics
10.4 Pathological and Imaging Findings
10.4.1 Crouzon Syndrome
10.4.2 Apert Syndrome
10.4.3 Pfeiffer Syndrome
10.4.4 Saethre-Chotzen Syndrome
10.4.5 Muenke Syndrome
10.5 Clinical Features
10.5.1 Crouzon Syndrome
10.5.2 Apert Syndrome
10.5.3 Pfeiffer Syndrome
10.5.4 Saethre-Chotzen Syndrome
10.5.5 Muenke Syndrome
10.6 Diagnosis
10.7 Management
10.8 Conclusion
References
Part III: Congenital and Developmental Spinal Anomalies
Chapter 11: Myelomeningocele-Lipomyelomeningocele
11.1 Introduction
11.2 Myelomeningocele
11.3 Lipomyelomeningocele
References
Chapter 12: Split Cord Malformations
12.1 Introduction
12.2 Embryology
12.3 Classification
12.4 Relation to Other Abnormalities
12.5 Clinical Presentation
12.6 Imaging
12.7 Management
12.8 Conclusion
References
Chapter 13: Myeloschisis
13.1 Definition
13.2 Epidemiology
13.3 Embryology
13.4 Folate and NTD
13.5 Prenatal Diagnosis
13.6 Prenatal Repair
13.7 Clinical Features
13.8 Investigations
13.9 Postnatal Management
13.10 Technique of Surgical Repair
13.11 Postoperatve Care
13.12 Complications
13.13 The Future
References
Chapter 14: Non-Dysraphic Spinal Lipomas
14.1 Introduction
14.2 Embryology of Non-Dysraphic Spinal Lipomas (NDSL)
14.3 Clinical Presentation
14.4 The Concept of Tethering of the Spinal Cord Due to Lipoma
14.5 Investigations and Diagnosis
14.6 Management of Non-Dysraphic Lipomas
14.7 Post-Operative Management
References
Part IV: Tumors
Chapter 15: Predisposing Syndromes
15.1 Introduction
15.2 Neurofibromatosis Type 1
15.2.1 Tumors of the Central Nervous System
15.3 Neurofibromatosis Type 2
15.3.1 Schwannomas (WHO, Grade I)
15.3.2 Meningioma
15.3.3 Ependymoma
15.3.4 Other Tumors
15.4 Tuberous Sclerosis Complex and Subependymal Giant Cell Astrocytoma
15.5 Cowden Disease
15.6 Li-Fraumeni Syndrome
15.7 Turcot Syndrome
15.8 Atypical Teratoid Rhabdoid Tumour / Rhabdoid Tumour Predisposition Syndrome [RTPS 1 and 2]
15.9 DICER1 Syndrome
15.10 Conclusion
References
Chapter 16: Scalp and Skull Tumors
16.1 Introduction
16.2 Diagnostic Procedures
16.3 Lesions of the Scalp
16.4 Lesions of the Skull
16.4.1 Epidermoid and Dermoid Cysts
16.4.2 Aneurysmal Bone Cyst
16.4.3 Langerhans Cell Histiocytosis
16.4.4 Osteoma
16.4.5 Fibrous Dysplasia
16.4.6 Osteosarcoma and Ewing Sarcoma
16.4.7 Metastatic Neuroblastoma
References
Chapter 17: Astrocytomas
17.1 Background
17.2 Pilocytic Astrocytoma (WHO Grade I)
17.2.1 Clinical History
17.2.2 Physical Examination and Imaging
17.2.3 Differential Diagnosis
17.2.4 Treatment Options
17.2.5 Complications
17.2.6 Pearls
17.3 Diffuse Astrocytoma (WHO Grade II and III)
17.3.1 Clinical History
17.3.2 Physical Examination and Imaging
17.3.3 Differential Diagnosis
17.3.4 Treatment Options
17.3.5 Complications
17.3.6 Pearls
17.4 Glioblastomas (WHO Grade IV)
17.4.1 Clinical History
17.4.2 Physical Examination and Imaging
17.4.3 Differential Diagnosis
17.4.4 Treatment Options
17.4.5 Complications
17.4.6 Pearls
References
Chapter 18: Embryonal Tumors
18.1 Introduction
18.2 Medulloblastoma
18.2.1 Epidemiology
18.2.2 Clinical Presentation
18.2.3 Radiographic Findings
18.2.4 Pathology
18.2.5 Management and Outcome
18.3 Atypical Teratoid and Rhabdoid Tumor (AT/RT)
18.3.1 Epidemiology
18.3.2 Clinical Presentation
18.3.3 Radiographic Findings
18.3.4 Pathology
18.3.5 Management and Outcome
18.4 Embryonal Tumor with Multilayered Rosettes (ETMR), C19MC-Altered
18.4.1 Epidemiology
18.4.2 Clinical Presentation
18.4.3 Radiographic Findings
18.4.4 Pathology
18.4.5 Management and Outcome
18.5 Other CNS Embryonal Tumors
18.6 Conclusion
References
Chapter 19: Ependymal Tumors
19.1 Introduction
19.2 Clinical Features
19.3 Pathological-Genetics Features
19.4 Imaging Features
19.5 Treatment
19.5.1 Surgery
19.5.2 Adjuvant Therapy
19.6 Prognosis—Future Perspective
References
Chapter 20: Neuronal and Mixed Neuronal-Glial Tumors
20.1 Introduction
20.2 Gangliogliomas and Gangliocytomas
20.2.1 General
20.2.2 Pathological Features
20.2.3 Clinical Manifestations
20.2.4 Imaging
20.2.5 Management/Prognosis
20.3 Dysembryoplastic Neuroepithelial Tumors
20.3.1 General
20.3.2 Pathological Features
20.3.3 Clinical Manifestations
20.3.4 Imaging
20.3.5 Management/Prognosis
20.4 Central and Extraventricular Neurocytoma
20.4.1 General
20.4.2 Pathological Features
20.4.3 Clinical Manifestations
20.4.4 Imaging
20.4.5 Management/Prognosis
20.5 Dysplastic Cerebellar Gangliocytoma (Lhermitte- Duclos Disease)
20.5.1 General
20.5.2 Pathological Features
20.5.3 Clinical Manifestations
20.5.4 Imaging
20.5.5 Management/Prognosis
20.6 Desmoplastic Infantile Astrocytoma and Desmoplastic Infantine Ganglioglioma
20.6.1 General
20.6.2 Pathological Features
20.6.3 Clinical Manifestations
20.6.4 Imaging
20.6.5 Management/Prognosis
20.7 Papillary Glioneuronal Tumor
20.7.1 General
20.7.2 Pathological Features
20.7.3 Clinical Manifestations
20.7.4 Imaging
20.7.5 Management/Prognosis
20.8 Cerebellar Liponeurocytoma
20.8.1 General
20.8.2 Pathological Features
20.8.3 Clinical Manifestations
20.8.4 Imaging
20.8.5 Management/Prognosis
20.9 Diffuse Leptomeningeal Glioneuronal Tumor
20.9.1 General
20.9.2 Pathological Features
20.9.3 Clinical Features
20.9.4 Imaging
20.9.5 Management/Prognosis
20.10 Rosette-Forming Glioneuronal Tumor
20.10.1 General
20.10.2 Pathological Features
20.10.3 Clinical Manifestations
20.10.4 Imaging
20.10.5 Management/Prognosis
20.11 Paragangliomas
20.11.1 General
20.11.2 Pathological Features
20.11.3 Clinical Manifestations
20.11.4 Imaging
20.11.5 Treatment/Prognosis
References
Chapter 21: Craniopharyngioma and Other Sellar Tumors
21.1 Pituitary Gland: Development, Anatomy and Function
21.2 Pituitary and Sellar Tumours
21.2.1 Craniopharyngiomas
21.2.1.1 Clinical Presentation
21.2.1.2 Diagnosis
21.2.1.3 Treatment
21.2.2 Pituitary Adenomas
21.3 Other Sellar Tumours
References
Chapter 22: Pediatric Brainstem Tumors
22.1 Introduction
22.2 Evolution of Surgical Intervention and Classification Schemes
22.3 Current Classification
22.3.1 Mesencephalic
22.3.1.1 Clinical Presentation
22.3.1.2 Radiographic Characteristics
22.3.1.3 Pathology
22.3.1.4 Prognosis and Treatment
22.3.2 Dorsal Exophytic
22.3.2.1 Radiographic Characteristics
22.3.2.2 Pathology
22.3.2.3 Prognosis/Treatment
22.3.3 Cervicomedullary
22.3.3.1 Radiographic Characteristics
22.3.3.2 Pathology
22.3.3.3 Prognosis/Treatment
22.3.4 Focal
22.3.4.1 Radiographic Characteristics
22.3.4.2 Pathology
22.3.4.3 Prognosis and Treatment
22.3.5 Diffuse Intrinsic
22.3.5.1 Radiographic Characteristics
22.3.5.2 Pathology
22.3.5.3 Prognosis and Treatment
22.4 Conclusion
References
Chapter 23: Pineal Region Tumors in Pediatric Patients
23.1 Introduction
23.2 Epidemiology
23.3 Clinical Presentation
23.4 Imaging
23.4.1 Germ Cell Tumor
23.4.2 Teratoma
23.4.3 Pineal Parenchymal Tumors
23.4.4 Gliomas
23.4.5 Tectal Tumors
23.4.6 Aqueductal Tumors
23.5 Molecular Findings and Tumor Microenvironment
23.6 Tumor Biomarkers
23.7 Treatment
23.7.1 Surgical Indications
23.7.2 Hydrocephalus Management
23.7.3 Radiotherapy
23.7.4 Chemotherapy
23.8 Long Term Outcomes
23.9 Future Perspectives
References
Chapter 24: Paediatric Brain Tumours: Rare Variants
24.1 Introduction
24.2 Atypical Teratoid/Rhabdoid Tumour (AT/RT)
24.2.1 Definition
24.2.2 Epidemiology
24.2.3 Histological and Molecular Classification
24.2.4 Associated Conditions/ Syndromes
24.2.4.1 Rhabdoid Tumour Predisposition Syndrome
24.2.5 Natural History and Prognosis
24.2.6 Clinical Presentation and Diagnosis
24.2.7 Radiological Features [25, 26]
24.2.8 Management
24.2.8.1 Surgery
24.2.8.2 Chemotherapy
24.2.8.3 Radiotherapy
24.2.9 Controversies and Current Advances
24.3 Embryonal Tumour with Multi-layered Rosettes, C19MC-Altered
24.3.1 Definition
24.3.2 Epidemiology
24.3.3 Histological and Molecular Classification
24.3.4 Natural History and Prognosis
24.3.5 Clinical Presentation and Radiological Features [25, 40]
24.3.6 Management
24.3.7 Controversies and Current Advances
24.4 Choroid Plexus Tumours
24.4.1 Definition
24.4.2 Epidemiology
24.4.3 Histological and Molecular Classification [2]
24.4.4 Associated Conditions/Syndromes
24.4.4.1 Li-Fraumeni Syndrome
24.4.5 Natural History and Prognosis
24.4.6 Clinical Presentation
24.4.7 Radiological Features [25, 69]
24.4.8 Management
24.4.8.1 Surveillance
24.4.8.2 Surgery
24.4.8.3 Preoperative Embolization
24.4.8.4 Chemotherapy and Radiotherapy
24.4.9 Radiation Therapy
24.5 Desmoplastic Infantile Astrocytoma and Ganglioglioma
24.5.1 Definition
24.5.2 Epidemiology
24.5.3 Histological and Molecular Classification
24.5.4 Natural History and Prognosis
24.5.5 Clinical Presentation and Radiological Features
24.5.6 Management
24.5.7 Controversies and Current Advances
References
Chapter 25: Spinal Tumors
25.1 Introduction
25.2 Clinical Features
25.2.1 Hydrocephalus in Patients with Primary SATs
25.3 Diagnosis-Imaging
25.4 Differential Diagnosis
25.4.1 Intradural Intramedullary Tumors
25.4.1.1 Astrocytoma
25.4.1.2 Ependymoma
25.4.1.3 Ganglioglioma
25.4.1.4 Hemangioblastoma
25.4.2 Other Intramedullary Tumors
25.5 Intradural Extramedullary Tumors
25.5.1 Dermoid and Epidermoid Tumors
25.5.2 Meningioma
25.5.3 Schwannoma/Neurofibroma
25.6 Atypical Teratoid Rhabdoid Tumors (AT/RT)
25.7 Primary Neuroectodermal Tumors (PNET)
25.8 Extradural Tumors
25.9 Osteoid Osteoma/Osteoblastoma
25.10 Neuroblastoma
25.11 Aneurysmal Bone Cysts
25.12 Ewing’s Sarcoma
References
Part V: Trauma
Chapter 26: Abusive Head Trauma
26.1 Introduction
26.1.1 Risk Factors
26.2 Clinical Presentation
26.3 Physical and Laboratory Evaluation
26.4 Imaging Findings
26.5 Treatment
26.6 Prognosis
References
Chapter 27: Pediatric Skull Fracture
27.1 Introduction
27.2 Imaging
27.3 Types of Skull Fracture
27.3.1 Linear Skull Fracture
27.3.2 Depressed Skull Fracture
27.3.3 Ping-pong Skull Fracture
27.3.4 Basilar Skull Fracture
References
Chapter 28: Epidural Hematoma
28.1 Introduction
28.2 Epidemiology
28.3 Symptomatology
28.4 Radiological Features
28.5 Treatment
28.6 Outcome
References
Chapter 29: Subdural Hematoma
29.1 Introduction
29.2 Epidemiology
29.2.1 Risk Factors
29.3 Pathogenesis
29.4 Diagnosis
29.4.1 Imaging
29.4.2 Clinical Findings
29.5 Mechanisms
29.5.1 Traumatic Etiology of SDH in Children
29.5.2 Non-accidental (Abusive Head Trauma)
29.5.3 Accidental (Falls from a Low Height)
29.6 Management
References
Chapter 30: Traumatic Axonal Injury - Intracerebral Hematoma
30.1 Introduction
30.2 Traumatic Axonal Injury
30.3 Neuroimaging in DAI
30.4 Biomarkers
30.5 Management
30.6 Intracerebral Hematoma
References
Chapter 31: Penetrating Head Trauma
31.1 Introduction
31.2 Mechanism of Trauma
31.3 Penetrating Objects
31.4 Clinical Evaluation and Injury Sites
31.5 Neuroimaging
31.6 Management
31.7 Complications
31.8 Prognosis
References
Chapter 32: Spine Trauma
32.1 Introduction
32.2 Epidemiology
32.3 Children Are Not Small Adults
32.4 Initial Management of Paediatric Trauma
32.4.1 Recent Developments in Early Management of Acute SCI
32.5 Cervical Radiology
32.6 Specific Cervical Spine Injuries
32.6.1 Atlanto Occipital Dislocations (AOD)
32.6.2 Atlas and Axis Fractures
32.6.3 Subaxial Fractures and Ligamentous Injuries
32.7 Lumbar Spine Injuries
32.7.1 Compression Fractures
32.7.2 Burst Fractures
32.7.3 Vertebral Apophysis Fracture
32.8 Spinal Orthoses and Surgical Considerations
32.9 Conclusions
References
Part VI: Cerebrovascular Disorders
Chapter 33: Arteriovenous Malformations
33.1 Introduction
33.2 Epidemiology of Pediatric Arteriovenous Malformations
33.3 Clinical Presentation of Pediatric Arteriovenous Malformations
33.3.1 Hemorrhagic Presentation
33.3.2 Seizure Presentation
33.4 Management of Ruptured Pediatric Arteriovenous Malformations
33.5 Management of Unruptured Pediatric Arteriovenous Malformations
33.5.1 Microsurgery for Unruptured Pediatric AVMs
33.5.2 Stereotactic Radiosurgery for Unruptured Pediatric AVMs
33.5.3 Endovascular Therapy for Unruptured Pediatric AVMs
33.5.4 Multimodality Treatment of Pediatric AVMs
33.6 Follow-Up of Pediatric Arteriovenous Malformations
33.7 Outcomes in Children with Cerebral Arteriovenous Malformations
33.7.1 Functional Outcomes in Children with Cerebral Arteriovenous Malformations
33.7.2 Seizures in Children with Cerebral Arteriovenous Malformations
33.8 Conclusion
References
Chapter 34: Cavernous Malformations
34.1 Introduction
34.2 Epidemiology
34.3 Diagnosis
34.3.1 Clinical Presentation
34.3.2 Pathophysiology
34.3.3 Imaging Findings
34.4 Pathology
34.5 Treatment
34.5.1 Nonsurgical Treatment
34.5.2 Surgical Indications
34.6 Conclusions
34.7 Cases
34.7.1 Case 1
34.7.2 Case 2
References
Chapter 35: Intracerebral Aneurysms
35.1 Introduction
35.2 Etiology and Epidemiology
35.3 Aneurysm Characteristics
35.4 Clinical Presentation
35.5 Evaluation
35.6 Treatment
35.6.1 Medical Management
35.6.2 Endovascular Treatment
35.6.3 Open Microsurgery
35.6.4 3D Modeling
35.7 Outcomes/Complications
35.8 Pearls
References
Chapter 36: Moya-Moya Disease
36.1 Epidemiology
36.2 Pathophysiology of Moyamoya Disease
36.3 Natural History
36.4 Clinical Presentation
36.5 Diagnosis of Moyamoya Disease
36.5.1 Head Computed Tomography
36.5.2 Magnetic Resonance Imaging/Angiography
36.5.3 Electroencephalography and Cerebral Blood Flow Studies
36.6 Treatment of Moyamoya
36.6.1 Medical Treatment
36.6.2 Surgical Treatment
36.6.2.1 Direct Bypass: Superficial Temporal Artery-to-Middle Cerebral Artery Bypass (STA-MCA)
36.6.2.2 Indirect Bypass
36.6.2.3 Encephalomyosynangiosis (EMS)
36.6.2.4 Encephaloduroarteriosynangiosis (EDAS), Encephalomyoarteriosynangiosis (EMAS), Pial Synangiosis, Encephaloduroarteriomyosynangiosis (EDAMS)
36.7 Familial Moyamoya Disease (FMMD)
36.8 Outcomes
References
Chapter 37: Vein of Galen Aneurysmal Malformations
37.1 Introduction
37.2 Classification
37.3 Etiology and Pathophysiology
37.4 Clinical Presentation
37.5 Diagnosis
37.6 Management
37.7 Conclusion
References
Part VII: Functional
Chapter 38: Temporal Lobe Epilepsy
38.1 Introduction
38.2 Epidemiology
38.3 Clinical Features: Presentation, Semiology, and Etiology
38.4 Histopathology
38.5 Natural History
38.6 Noninvasive Workup
38.7 Invasive Investigation
38.8 Functional Anatomy
38.9 Surgical Treatment: Options, Goals, and Outcome
38.10 Resective Surgical Approaches for Resection
38.10.1 Anterior Temporal Lobectomy: Indications and Technique
38.10.1.1 Technique
38.10.1.2 Intra-operative Electrocorticography
38.10.2 Open Selective Amygdalohippocampectomy: Indications, Technique, and Approaches
38.10.2.1 Comparison of Anterior Temporal Lobectomy and Selective Amygdalohippocampectomy
38.10.3 Lesionectomy
38.11 Alternatives to Standard Resective Surgery
38.11.1 Minimally Invasive Ablation: Laser Interstitial Thermal Therapy and Radiofrequency Ablation
38.11.2 Multiple Hippocampal Transections and Multiple Subpial Transection
38.12 Neuromodulation
38.12.1 Vagus Nerve Stimulation (VNS)
38.12.2 Deep Brain Stimulation
38.12.3 Responsive Neurostimulation
38.13 Conclusions
References
Chapter 39: Extratemporal Lobe Epilepsy
39.1 Introduction
39.2 Considerations in Pediatric Extratemporal Epilepsy Surgery
39.3 Pre-surgical Evaluation of Extratemporal Epilepsy
39.3.1 History and Examination
39.3.2 Video EEG (VEEG)
39.3.3 Magnetic Resonance Imaging (MRI)
39.3.4 FDG-PET (Positron Emission Tomography)
39.3.5 SPECT (Single-Positron Emission Computed Tomography)
39.3.6 MEG (Magnetoencephalography)
39.3.7 Neuropsychological Evaluation
39.4 Invasive EEG Studies
39.4.1 Subdural or Depth Electrodes
39.4.2 Functional Mapping
39.5 Surgery
39.5.1 Lesionectomy
39.5.2 Multilobe Resections
39.5.3 Hemispherectomy
39.5.4 Corpus Callosotomy
39.5.5 Vagal Nerve Stimulation (VNS)
39.6 Complications
39.7 Conclusions
39.8  Illustrative Case
References
Chapter 40: Hemispherectomy
40.1 Hemispherectomy
40.2 Patient Selection
40.2.1 Rasmussen’s Encephalitis
40.2.2 Sturge Weber
40.2.3 Peri-Natal Infarcts and Vascular Insults
40.2.4 Hemimegalencephaly
40.2.5 Malformations of Cortical Development (MCD)
40.2.6 Infantile Spasms
40.2.7 Hemiconvulsion-Hemiplegia-Epilepsy Syndrome (HHE)
40.2.8 Other Hemispheric Injury, Infarction or Hemorrhage
40.3 Pre-operative Evaluation
40.4 Surgical Options for Hemispherectomy or Hemispherotomy
40.4.1 Anatomic Hemispherectomy
40.4.2 Operative Notes
40.4.3 Hemidecortication
40.4.4 Functional Hemispherectomy and Variants
40.4.5 Disconnective Hemispherotomy
40.5 Outcomes
40.6 Clinical Pearls
References
Chapter 41: Deep Brain Stimulation for Pediatric Movement Disorders
41.1 Introduction
41.2 Basal Ganglia Anatomy
41.3 Classification of Dystonia in the Pediatric Age
41.4 Dystonia Assesment: The Burke-Fahn-Marsden Dystonia Rating Scale
41.5 Treatment of Dystonia
41.6 Efficacy of DBS in Dystonia
41.7 Cost Benefit
41.8 The Importance of Patient Selection
41.9 Surgical Technique
41.10 Neurostimulation
41.11 Early Postoperative Management and Initial Deep Brain Stimulation Programming
41.12 Long-Term Management of DBS in Dystonia
41.13 Adverse Events
41.14 Special Characteristics in Pediatric Patients
References
Chapter 42: Deep Brain Stimulation in the Management of Neuropsychiatric Conditions in Children
42.1 Introduction
42.2 Scientific Evidences
42.2.1 Gilles de la Tourette Syndrome
42.2.1.1 Background
42.2.1.2 Surgical Management
42.2.1.3 DBS for GTS in Paediatric Patients
42.2.2 Eating Disorders
42.2.2.1 Background
42.2.2.2 Surgical Management
42.2.2.3 DBS for Eating Disorders in Children
42.2.3 Aggressive Behaviour and Self-Harm
42.2.3.1 Background
42.2.3.2 Surgical Management
42.2.3.3 DBS for Aggressive Behaviour and Self-Harm in Children
42.2.4 Autism Spectrum Disorder
42.3 Complications
42.4 Perspectives and Challenges
42.5 Final Remarks
References
Chapter 43: Spasticity
43.1 Surgical Techniques
43.1.1 Intrathecal Baclofen Therapy
43.1.2 Dorsal Rhizotomies
43.2 Decision Making in Children
43.3 Conclusion
References
Part VIII: Infections
Chapter 44: Shunt Infection
44.1 Introduction
44.2 Definition
44.3 Epidemiology
44.4 Risk Factors
44.5 Pathogenesis
44.6 Clinical Characteristics
44.7 Diagnosis
44.8 Treatment
44.8.1 Surgical Management
44.8.2 Antibiotic Treatment
44.8.3 Duration of Antibiotic Therapy
44.8.4 New Shunt Reimplantation
References
Chapter 45: Epidural Abscess and Subdural Empyema
45.1 Introduction
45.2 Epidemiology
45.2.1 Epidural Abscess
45.2.2 Subdural Empyema
45.3 Microbiology
45.4 Clinical Presentation
45.4.1 Epidural Abscess
45.4.2 Subdural Empyema
45.5 Investigations
45.6 Treatment
45.6.1 Epidural Abscess
45.6.2 Subdural Empyema
45.7 Prognosis
45.8 Conclusion
References
Chapter 46: Brain Abscess in Children
46.1 Introduction
46.2 Epidemiology and Predisposing Factors
46.2.1 Incidence
46.2.2 Aetiopathogenesis
46.3 Pathology and its Treatment Implications
46.3.1 Stages of Cerebral Abscess
46.4 Microbiology
46.5 Management
46.5.1 Clinical Features
46.6 Evaluation
46.6.1 Evaluation for Infection
46.7 Imaging in Cerebral Abscess
46.8 Treatment
46.8.1 Decision-Making Algorithm
46.8.2 Principles of Medical Management
46.8.3 Surgical Options
46.8.3.1 Monitoring Treatment Response and Endpoint
46.8.3.2 Role of Steroids
46.8.3.3 Other Treatment Considerations
46.8.3.4 Timing of Management of Underlying Cardiac Physiology
46.8.3.5 Role of Hyperbaric Oxygen Therapy
46.8.3.6 Prognostic Factors
46.9 Summary
References
Chapter 47: Encephalitis
47.1 Introduction
47.2 Epidemiology
47.3 Aetiology
47.4 Clinical Manifestation
47.5 Diagnosis
47.6 Imaging
47.7 Treatment
47.8 Prognosis
References
Chapter 48: Spine Infection in Children
48.1 Introduction
48.2 Spondylodiscitis
48.2.1 Epidemiology
48.2.2 Pathogenesis and Etiology
48.2.3 Clinical Aspects
48.2.4 Neuroimaging
48.2.5 Laboratory Investigations
48.2.6 Treatment
48.2.7 Surgery
48.2.8 Outcome
48.3 Non-pyogenic Spondylodiscitis
48.3.1 Tuberculosis
48.3.2 Other Non-pyogenic Spondylodiscitis
48.4 Spinal Epidural Abscess
48.4.1 Clinical Aspects
48.4.2 Diagnosis
48.4.3 Management
48.5 Intradural Spinal Infection
48.5.1 Clinical Aspects
48.5.2 Diagnosis
48.5.3 Management
References
Part IX: Modern Concepts and Practices
Chapter 49: Advances in Pediatric MRI
49.1 Introduction
49.2 Diffusion
49.2.1 The Diffusion Ellipsoid
49.2.2 The Diffusion Metrics
49.2.3 Tractography
49.3 Perfusion
49.3.1 Dynamic Susceptibility Contrast (DSC)
49.3.2 Arterial Spin Labeling (ASL)
49.3.3 Pulsed ASL (PASL)
49.3.4 Pseudocontinuous ASL (pCASL)
49.4 Magnetic Resonance Spectroscopy (MRS)
49.4.1 The Brain Spectrum
49.4.2 Acquisition and Analysis
49.5 Susceptibility
49.6 Clinical Applications
References
Chapter 50: Molecular Imaging in Pediatric Brain Tumors
50.1 Introduction
50.2 SPECT
50.3 PET
50.3.1 Assessment of Tumor Grade
50.3.2 Differentiation of Treatment-Related Changes from Recurrent/Residual Tumor
50.3.3 Response to Therapy
50.3.4 Prognosis
50.3.5 Other Applications
50.4 Theranostics in Pediatric Brain Tumors
50.5 Conclusion
References
Chapter 51: Intraoperative Flow Cytometry in Pediatric Brain Tumors
51.1 Introduction
51.1.1 Flow Cytometry in Pediatric Brain Tumors
51.1.2 Fast Cell Cycle Analysis
51.2 Immunophenotypic Analysis
51.2.1 CD56
51.2.2 CD24
51.3 Central Nervous System Lymphoma
51.4 Conclusion
References
Chapter 52: Advances in Radiotherapy for Pediatric Brain Tumours
52.1 Introduction
52.2 Brief Overview of Radiation
52.3 Intensity Modulated Radiation Therapy (IMRT) and Image Guidance Radiation Therapy (IGRT)
52.4 Proton Beam Therapy
52.5 Medulloblastoma
52.5.1 Standard-risk Medulloblastoma
52.5.2 High-risk Medulloblastoma
52.5.3 Optimal Radiotherapy Technique for CSI
52.5.4 Proton Beam Therapy
52.6 Ependymoma (Intracranial)
52.6.1 Newly Diagnosed Non-metastatic Ependymoma
52.6.2 Newly Diagnosed Metastatic Ependymoma
52.6.3 Proton Beam Therapy
52.7 Low Grade Gliomas
52.7.1 Systemic Treatment
52.7.2 Radiotherapy
52.7.3 Treatment Response
52.7.4 Radiotherapy in Leptomeningeal Dissemination
52.7.5 Proton Beam Therapy
52.8 Intracranial Germ Cell Tumours
52.8.1 Germinomas
52.8.1.1 Localized Germinoma
52.8.2 Non-germinomatous Tumours
52.8.3 Proton Beam Treatment
52.9 Side Effects of the Radiotherapy
52.9.1 Neuro-cognition
52.9.2 Neuroendocrine Function
52.9.3 Hearing
52.9.4 Cerebrovascular Effects (Stroke)
52.9.5 Alopecia
52.9.6 Secondary Neoplasms
52.10 Paediatric Normal Tissue Effects in the Clinic (PENTEC)
52.11 Conclusion
References
Chapter 53: Rehabilitation of Children with Traumatic Brain Injury
53.1 Introduction
53.2 Rehabilitation
53.3 Neuropsychiatric Effects of TBI
53.4 Future Perspectives
References
Index