By A. Leland Albright, Ian Pollack
This atlas of pediatric neurosurgery describes and demonstrates the
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malformations, hydrocephalus, tumors, vascular and sensible problems, and
trauma. The chapters current state-of-the-art innovations and are written by way of
nationally famous professionals. The textual content serves as a better half to Principles
and perform of Pediatric Neurosurgery.
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Additional resources for Operative Techniques in Pediatric Neurosurgery
The assessment of ventral compression is done with sagittal MRIs. Flexion and extension MRIs can be obtained in the cooperative child but are technically difficult. Operative Planning As previously stated, hydrocephalus and raised ICP should be addressed before any consideration of surgery The Chiari Malformations for the posterior fossa pathology. Posterior fossa decompression in the presence of hydrocephalus is dangerous and has little likelihood of resolving the CSF flow problem and avoiding a shunt or third ventriculostomy.
Following the administration of general endotracheal anesthesia, the patient is positioned supine on the operating room table with the head placed in a cerebellar headrest. A small roll is placed beneath the shoulders to elevate the chest approximately 10 degrees. A strip shave of the hair is performed, and the head is prepared and draped in a standard fashion. The skin is incised, and a burr hole is created 6 cm from the midline and 2 cm anterior to the coronal suture (Fig. 2–14A). The dura and pia–arachnoid are incised and coagulated.
Patients with a shunt in place and “no change,” “stable,” or relatively small ventricles should have the shunt tapped, ICP monitored, or the system explored surgically before any consideration is given to a Chiari decompression. If the system is explored, it is insufficient to see some flow from the ventricular catheter and assume the system is functional. The catheter also must be free without intraventricular fixation. If the ventricular catheter is adherent, soft tissue must be present within it and will cause intermittent or partial obstruction.