EVDs were placed for TBI, ventriculoperitoneal shunt failure and new-onset hydrocephalus. The overall complication rate was 26%. Complication rates were similar in TBI and hydrocephalus patients, and with EVDs inserted in either the PCCU or OR. Prophylactic antibiotics or antimicrobial-impregnated catheters directed against coagulase-negative Staphylococcus may reduce EVD infections.

Unilateral and bilateral thalamic tumors behave differently. Surgical resection is an appropriate treatment option in unilateral tumors, most of which are low grade, but outcome is not related to extent of resection (EOR). Bilateral thalamic tumors have a poorer prognosis, but the occasional patient does remarkably well. The efficacy of chemotherapy and radiotherapy has not been clearly demonstrated. Novel therapeutic approaches are required to improve the prognosis for malignant unilateral thalamic tumors and bilateral thalamic tumors.

Thrombocytopenia seems to be an important cause of intraparenchymal hemorrhage, and the use of forceps is more likely to be associated with subarachnoid and subdural hemorrhage.

OD and Maffucci syndrome differ with respect to the distribution of intracranial malignancies by histology, and geographical and age distribution of cases, with OD patients younger by approximately a decade, and Maffucci syndrome patients more likely to live in Asia or South America.

ABSTRACT:Objective: To determine physical and cognitive outcomes of full-term infants who suffered intracranial hemorrhage (ICH) at birth. Methods: A retrospective hospital-based, follow-up study of infants treated in London, Ontario between 1985 and 1996. Follow-up was conducted by telephone interviews and clinic visits. Outcome was measured according to physical and cognitive scales. Perinatal risk factors and hemorrhage characteristics were correlated with final outcome. Results: For this study 66 infants with ICH were identified, of which seven died during the first week of life. We obtained follow-up in all but ten cases (median = 3-years; range 1.0 to 10.9 years). Overall, 57% of infants had no physical or cognitive deficits at follow-up. Death occurred most frequently among those with primarily subarachnoid hemorrhage (19%) and the most favorable outcomes occurred among those with subdural hemorrhage (80% had no disability). In univariate models, thrombocytopenia (platelet count ≤ 70 x 10 9 /L), increasing overall hemorrhage severity, frontal location and spontaneous vaginal delivery as opposed to forceps-assisted delivery increased risk for poor outcome. In multivariate models, all these factors tended towards increased risk, but only thrombocytopenia remained significant for physical disability (OR = 7.6; 95% CI = 1.02 -56.6); thrombocytopenia was borderline significant in similar models for cognitive disability (OR = 4.6; 95% CI = 0.9 -23.9). Conclusion: Although forceps-assisted delivery may contribute to ICH occurrence, our study found better outcomes among these infants than those who had ICH following a spontaneous vaginal delivery. Hemorrhage in the frontal lobe was the most disabling hemorrhage location and if multiple compartments were involved, disability was also more likely to occur. However, in this report we found that the factor that was most likely to contribute to poor outcome was thrombocytopenia and this remained important in multivariate analysis. Nous avons obtenu des informations sur cinquante-six enfants (âge médian de 3 ans; écart de 1,0 à 10,9 ans). Au moment du suivi, 57% des enfants n'avaient pas de déficit physique ou cognitif. 19% des enfants ayant subi une hémorragie sous-arachnoïdienne sont morts. L'issue la plus favorable a été observée chez ceux qui avaient subi une hémorragie sous-durale (80% n'avaient pas de déficit). À l'analyse univariée, la thrombocytopénie (décompte plaquettaire ≤ 70 x 10 9 /L), la sévérité de l'hémorragie, la localisation frontale et un accouchement vaginal spontané plutôt qu'avec forceps augmentaient le risque d'une issue défavorable. À l'analyse multivariée, tous ces facteurs indiquaient un risque accru, mais seulement la thrombocytopénie demeurait un facteur significatif de l'invalidité physique (rapport de cotes 7,6 ; IC à 95% de 1,2 à 56,6) et était limite pour le déficit cognitif (rapport de cotes 4,6; IC à 95% de 0,9 à 23,9). Conclusion: Bien que l'accouchement avec forceps puisse contribuer à l'HIC, l'issue était meilleure chez ces nourriss...

PurposeIn children and adolescents, dysembryoplastic neuroepithelial tumors (DNETs) of the brain present with seizures almost 100 % of the time, potentially creating significant long-term morbidity and disability despite the generally indolent course of the lesion. These tumors also tend to be quite resistant to anti-epileptic drugs which, themselves, can be associated with long-term side effects and resultant disability. Many clinicians advocate early surgical resection of these lesions, but how effective this approach is, and how aggressive tumor removal should be, continues to be debated.MethodsWe performed a systematic review of the relevant literature to identify all reports of DNET resections in pediatric patients published over the past 20 years. In all, over 3000 MEDLINE abstracts were reviewed, ultimately resulting in 13 studies with 185 pediatric DNET patients to review.ResultsSurgical resection of the lesion was effective at improving seizures in over 98 % of patients and at achieving long-term seizure freedom in 86 %. Surgical resection of DNETs also appeared to be quite safe, with no reported perioperative deaths and an overall rate of postoperative complications of 12 %; the vast majority of these complications were transient.ConclusionsTotal gross resection of the lesion was the only factor statistically correlated with long-term seizure freedom (r = 0.63, p = 0.03). However, data remain lacking regarding whether this translates into more extensive procedures—like brain mapping and partial lobectomies—being any more effective than simple lesionectomies alone. Further research is clearly needed to address this and other crucial questions.

Type 2B von Willebrand disease (VWD) is a rare, inherited bleeding disorder resulting from a qualitative defect in von Willebrand factor (VWF). There is very little published information on how to quantify bleeding risk and manage haemostasis in type 2B VWD patients during pregnancy. This article presents the changes in VWF parameters and details of patient management and delivery outcomes for four pregnancies in three women with two different mutations causing type 2B VWD. We report an unexpected rise in the VWF:Ag at 37 weeks gestation in two sisters with R1306W associated with significant thrombocytopenia. These patients were supported with platelet transfusions as well as intermediate purity VWF-FVIII plasma concentrates during the peri- and postpartum periods. No thrombocytopenia was observed in our third case with a mutation encoding an R1308C substitution; haemostatic support was with intermediate purity VWF-FVIII plasma concentrates alone. No adverse bleeding events occurred and in all cases a live healthy infant was delivered. One patient was readmitted post partum with bleeding symptoms due to retained placenta; no further haemostatic support was given at this time. This case series is the first to detail the progression of laboratory parameters, management and outcomes of pregnancy in patients with type 2B VWD. The cases illustrate some of the challenges posed by the increased production of a VWF variant with a gain-of-function effect. The rapid coagulation changes observed in this series illustrate the need for continual monitoring of VWF parameters and platelet count throughout pregnancy in women with type 2B VWD.

When an infected cephalohematoma is suspected, aspiration of hematoma fluid should be performed for both diagnostic and therapeutic purposes. Infectious symptoms should warrant prompt investigation and treatment, which may include drainage, debridement, and antibiotics. This report demonstrates that the combination of an infected cephalohematoma and underlying osteomyelitis might not be as uncommon as previously believed.