Neurosurgery in paediatric strokes

Paediatric strokes are a different entity owing to the difference in pathological entity causing the stroke as well as difficulty in treatment and management due to the presence of a growing brain and small vascular volume making surgery and endovascular intervention dangerous. Yet, the high neuronal plasticity coupled with unique surgical and endovascular procedures makes surgery in these conditions rewarding with improving morbidity and mortality statistics. The field is young and dynamic leading to constant change and updating. We attempt to review the current recommendations with our own experience in paediatric neurosurgery for paediatric strokes and present an overview of common conditions causing paediatric strokes. A brief review of the literature is also supplied for reference.

One Stage Reconstruction and Refinements for Frontonasal Encephalocele

Background: The successful correction of frontonasal encephaloceles was shown to depend on a detailed understanding of the pathological anatomy, careful planning of the bone movements to correct these deformities, and attention to detail regarding the placement of scars, positioning of the medial canthi and the nasal reconstruction. Objective: We reviewed our experience at the paediatric neurosurgery department of national institute of neurosciences, Dhaka, Bangladesh and discussed our evolution toward a definitive, single-stage correction, including refinements. Methodology: This was a clinical trial which was conducted in the Department of Paediatric neurosurgery at National institute of Neurosciences & Hospital, Dhaka, Bangladesh fromMay 2014 to April 2019 for a period of five (05) years. Paediatric patients with frontonasal encephalocele were operated. Post-operative outcomes were observed. Result: A total number of 6 patients were operated. All were under 1 year. 3 were male and 3 were female. We operated 6 cases of successful one stage operation for frontonasal encephalocele in very young children. A good cosmetic result had been achieved after operation. Conclusion: In conclusion, a one-stage repair with both a transcranial and external approach is effective surgical management for the frontonasal encephalocele paediatric patients. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 111-117

TP1-10 Non tumour brain biopsies in alder hey paediatric neurosurgery

ObjectivesTo review the utility of non-tumour brain biopsies in Alder Hey Children’s NHS Foundation Trust Paediatric Neurosurgery Department.MethodsOperative records were searched for ‘biopsy’. Case notes were reviewed for referral source, histology, surgical complication and outcome. Tumour, epilepsy and non-brain biopsy cases were excluded.Results83 ‘biopsy’ cases were identified between 2008 and 2017. 31 tumour, 5 epilepsy, 2 infections and 28 non brain/other biopsies were excluded. 17 brain biopsies for non-tumour causes were seen. 15 patients were referred by neurology, 2 by rheumatology. 14 underwent a craniotomy/mini-craniotomy, 3 had burrholes.4 biopsies were non diagnostic, 2 were abnormal but inconclusive for diagnosis. Diagnoses included: 3 demyelinating lesions, 2 normal brain tissue, 1 neurosarcoidosis, 1 autoimmune encephalitis, 1 definite Rasmussen’s Encephalitis, 1 possible Rasmussen’s Encephalitis, 1 systemic lupus erythematosus associated CNS vasculitis, 1 inflammatory infiltrate (secondary to hydrocephalus/ventriculitis), 1 patient developed a late wound infection. No other surgical morbidities/mortalities were recorded. 11 of these cases had a change in management or the treating team were reassured due to the result of the biopsy (i.e. were able to start immunomodulatory drugs in the absence of infection).Conclusions65% of brain biopsies were diagnostic. 71% of biopsies either changed management or reassured the treating team about a line of management. The procedure is low risk with 0.06% morbidity and 0% mortality.

Challenges in paediatric neurosurgery

Improvements in technique, knowledge and expertise have brought about rapid advances in the fields of paediatric neurosurgery and anaesthesia, and many procedures limited earlier to adults are now being increasingly attempted in neonates and small children, with good outcomes. This article highlights the challenges faced by the operating team while handling some of the technically complex procedures like awake craniotomy, interventional neuroradiology, minimally invasive neurosurgery, procedures in intraoperative magnetic resonance imaging suites, and neonatal emergencies in the paediatric population.