Hydrocephalus
Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni in Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
The mainstay of hydrocephalus treatment for decades has been VP shunting. A cranial incision is made at the site for ventricular catheter insertion, either frontal or posterior depending on surgeon preference. A burr hole is made. In infants, the anterior fontanelle may be used as a site to enter the cranium without bony removal. A second incision is made in the abdomen, and the peritoneum is opened. A tunneling device is used to pass the distal catheter subcutaneously from the head to the abdomen. In the case of coronal placement, a small intervening incision is often required to complete the pass. Once the valve and distal catheter are in position, the dura is opened, and the ventricular catheter is passed into the ventricle. Endoscopy, ultrasound, and stereotactic techniques have all been used to guide placement of the ventricular catheter. Once the ventricular catheter is connected to the distal shunt system, the distal tubing is placed into the open peritoneum. All incisions are closed (Figure 35.5).
Paediatric neurosurgical disorders
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
From the list of options above, choose which is the most recommended method of treatment for each of the following scenarios. A 2-month-old baby born at 32 weeks had an intraventricular bleed that has now cleared. The baby has increasing head circumference. The anterior fontanelle is bulging and the baby is having episodes of downward gaze. CT scan of the head shows communicating hydrocephalus.A 6-year-old boy presents with sudden onset of headache. He is drowsy but obeying commands. A CT scan of his head shows blood in the ventricles with a small clot in the fourth ventricle and gross hydrocephalus.A 10-year-old girl presents with headaches since the age of 8, which are gradually getting worse. Her fundus examination shows early papilloedema. Her MRI scan shows hydrocephalus due to aqueductal stenosis.
Abnormal Labour
Sanjeewa Padumadasa, Malik Goonewardene in Obstetric Emergencies, 2021
The attitude of the fetal head refers to the degree of flexion or extension at the upper cervical spine. Different longitudinal diameters are presented to the pelvis depending on the fetal attitude. In a well-flexed head, the anterior fontanelle is not easily felt, and the presenting diameter is the suboccipito-bregmatic, which measures about 9.5 cm at term (Figure 8.5A). In OP and occipitotransverse (OT) positions, which are often associated with deflexion of the fetal head, the anterior fontanelle is felt at a lower plane and assumes a more medial position compared to the posterior fontanelle, and the presenting diameter is the occipito-frontal which measures about 10.5 cm at term (Figure 8.5B). The extension of the fetal head leads to brow and face presentations (Figures 8.5C and D).
Intracranial sewing needle – accidentally inserted from a traditional cap worn by infants
Published in British Journal of Neurosurgery, 2023
Oliyath Ali, Ishrit Yasin, Mohd Abbas, Mohd Hussain
As far as the cause of the foreign body in our case is concerned, it is highly likely that the needle must have been accidentally inserted from the skull cap with sewing needles holding the decorations the patients was wearing during her infancy as per part of the tradition her tribe follows. The location of the foreign body in the frontal lobe near the location of bregma in infancy suggested its insertion during infancy through the open anterior fontanel. There was no injury or bleeding from the scalp which might have suggested its insertion during the minor head trauma. There have been reports of voluntary infanticide earlier in literature inserting sewing needles in the brain through the open fontanels during infancy. The offending person is usually the stepmother, but psychopathic mother, aunt, stepsister, and baby sitter have also been mentioned as offenders.11,15 If the first homicide attempt were not successful, a second, third, or even more attempts might be performed to harm the victim.10 In our case there was no such history of any child abuse or any other history relating to the insertion of foreign body in her brain.
MicroRNA-185 activates PI3K/AKT signalling pathway to alleviate dopaminergic neuron damage via targeting IGF1 in Parkinson’s disease
Published in Journal of Drug Targeting, 2021
Xiaocui Qin, Xia Zhang, Pinyu Li, Min Wang, Li Yan, Peiling Pan, Hailing Zhang, Xuejun Hong, Muxi Liu, Zeqing Bao
Rats were anaesthetised with pentobarbital sodium (50 µg/kg, Chemical Reagents Shanghai Co., Ltd., Shanghai, China) and fixed in a prone position in a stereoscopic locator (RWD Life Science Co., Shenzhen, China). The skin on the head was sterilised with 75% ethanol and cut with a sharp knife to expose the skull. Started from the anterior fontanelle, two points of the medial forebrain bundle were drilled based on the Paxinos & Watson mode, one was located at 4.4 mm posterior to the anterior fontanelle, 1.2 mm to the right of the midline, and 7.8 mm below the skull, while the other one at 4.0 mm posterior to the anterior fontanelle, 0.8 mm to the right of the midline, and 8.0 mm below the inner skull. The injection doses of 6-OHDA (Sigma-Aldrich) were 2.25 µL and 2.7 µL, respectively, and rats were injected with 6-OHDA at 1 µL/min for 5 min. The rats were kept warm after the operation and raised in cages with sufficient food and water (20–25 °C, lighting time of 8.00am–8.00pm). Penicillin was used to prevent infection for 3 d at 200,000 U per day. In the same way, 2.25 µL and 2.7 µL of normal saline were injected into the medial forebrain bundle of rats as a sham control [21].
Medical devices and the pediatric population – a head-to-toe approach
Published in Expert Review of Medical Devices, 2019
Joy H. Samuels-Reid, Judith U. Cope
The head is large relative to the body in infants and young children. The skull is thinner and more flexible. This requires different types of considerations for the pediatric population and age-appropriate medical devices. Head circumference is a significant metric in assessing growth and development of the neonate and infant and is measured across the frontal-occipital prominence, the area of greatest diameter. While head circumference is an indicator for growth and development in the pediatric population, it is not in adults. It is tracked on growth charts during pediatric exams from birth through the first few years. Newborns have greater brain weights in proportion to body weight. The anterior and posterior fontanelles close at different times: the anterior fontanelle is the last to close between 1 to 3 years (the median time is about 13.8 months) and the posterior closes 2–3 months after birth. Depressed fontanelles may indicate dehydration, while bulging fontanelles may indicate swelling in the brain [6]. Early closure of fontanelles may lead to microcephaly, misshapen head and delay in closure may signal hydrocephalus. Cranial sutures close at different rates. It is important that use of devices take into consideration the status of cranial sutures and the stage of growth and development of the skull. If sutures close prematurely, they result in craniosynostosis [7]. Devices such as cranial helmets are often used to correct positional head deformity such as plagiocephaly.
Related Knowledge Centers
- Bregma
- Coronal Suture
- Dehydration
- Intracranial Pressure
- Fontanelle
- Sagittal Suture
- Frontal Suture
- Neonatal Meningitis