clinical-indications-for-rapid-sequence-mri-pediatric-neurosurgical

Clinical Indications for Rapid Sequence MRI in Pediatric Neurosurgical Patients and the Limitations and Barriers to Implementation

Rapid and fast magnetic resonance imaging (MRI) protocols have become increasingly popular for pediatric neurosurgical patients as they are a great way to ...

University of North Carolina, Chapel Hill

University of North Carolina at Chapel Hill

Extraneural metastasis (ENM) of primary central nervous system (CNS) tumors is an uncommon occurrence. Case reports and case series describe ENM after shunting, but this phenomenon has not been well characterized. In this review we aim to better understand the risk factors and clinical implications of ENM associated with shunting. A literature search of cases of ENM related to shunt placement in patients with primary CNS tumors reported through January 2018 was performed using PubMed and Google Scholar. We identified 106 cases of ENM of primary CNS tumors related to shunt placement. The three most common tumor histologies resulting in ENM were germinoma (24%), medulloblastoma (21%), and glioblastoma (11%). Of the patients with ENM, 48% had leptomeningeal spread and 37% had brain or spinal cord metastasis. Mean survival time from shunt placement was 13 months. Ventriculoatrial-shunted cases had higher rates of widespread metastasis and shorter average survival time from shunt placement (2 months) than the average of all types of shunts. Given the known association with ENM, careful consideration should be given to shunt placement in patients with primary CNS tumors, especially germinomas, medulloblastomas, and glioblastomas. Appropriate surveillance should be instituted after shunt placement, and leptomeningeal or neural metastasis should prompt the consideration of potential ENM. When considering distal shunt options, our review suggests that ventriculoatrial shunts should be avoided if possible. For truly obstructive pathologies, the risk of ENM is a further indication to consider other treatment options such as endoscopic third ventriculostomy rather than shunt placement.

A systematic review of shunt-related extraneural metastases of primary central nervous system tumors.

Recent studies aim to reduce radiation exposure associated with computed tomography (CT) using rapid-sequence magnetic resonance imaging (MRI). We evaluated imaging modalities used for hydrocephalus and traumatic brain injury (TBI) to identify opportunities for further radiation exposure reduction.

Targeted head CT reduction for pediatric patients with hydrocephalus and traumatic brain injury: academic center institutional experience as an example of opportunities for further improvement.

Reduction in use of computed tomography (CT) in favor of rapid-sequence magnetic resonance imaging (MRI) to decrease pediatric radiation exposure has varied across institutions in the United States. The aims of this study were to understand national trends in CT and rapid-sequence MRI usage and identify variables affecting imaging practices and obstacles to CT reduction.

National Imaging Trends in Pediatric Traumatic Brain Injury and Hydrocephalus.

We present an 8-month old male status post simple tethered cord release with idiopathic intracranial hypertension.

Infantile idiopathic intracranial hypertension in the setting of recent laminectomy and filum lysis for tethered cord syndrome: a case report and literature review.

Cerebral aspergillosis carries a high mortality. Rapid diagnosis and treatment can increase survival, but symptoms and imaging findings are nonspecific. The literature on cerebral aspergillosis consists mostly of case reports and case series and lacks large-scale review of data.

Impact of Surgical and Medical Treatment on Survival of Patients with Cerebral Aspergillosis: Systematic Review of the Literature.

Suboptimal communication can lead to preventable preoperative delays. In our study, we aimed to identify factors delaying surgery in the immediate preoperative period. Our outcomes of interest were the anesthesia release to incision time (RIT) and preoperative expectations of neurosurgery and anesthesia providers. Additionally, we introduced new communication goals prior to induction, to examine the impact on preoperative efficiency.

Does communication between neurosurgeons and anesthesiologists improve preoperative efficiency?

Chiari malformation type I (CIM) diagnoses have increased in recent years. Controversy regarding the best operative management prompted a review of the literature to offer guidance on surgical interventions.

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Patients With Chiari Malformation: Surgical Interventions.

Chiari I malformation (CIM) is characterized by descent of the cerebellar tonsils through the foramen magnum, potentially causing symptoms from compression or obstruction of the flow of cerebrospinal fluid. Diagnosis and treatment of CIM is varied, and guidelines produced through systematic review may be helpful for clinicians.

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Patients With Chiari Malformation: Diagnosis.

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Patients With Chiari Malformation: Symptoms.

In Reply: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Patients With Chiari Malformation: Surgical Interventions.

Concussions incurred during high school athletics are a significant health concern, and studies examining concussions with symptom resolution time (SRT) of 15-28 days have been limited.

Concussion Symptomology By Symptom Resolution Time in US High School Athletes: Findings From The National Athletic Treatment, Injury and Outcomes Network (NATION) High School Surveillance Program.

Article	Year
A systematic review of shunt-related extraneural metastases of primary central nervous system tumors. Clinical neurology and neurosurgery\| PubMed ID: 30292900	2018
Targeted head CT reduction for pediatric patients with hydrocephalus and traumatic brain injury: academic center institutional experience as an example of opportunities for further improveme... Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery\| PubMed ID: 31696289	2020
National Imaging Trends in Pediatric Traumatic Brain Injury and Hydrocephalus. World neurosurgery\| PubMed ID: 32305606	2020
Infantile idiopathic intracranial hypertension in the setting of recent laminectomy and filum lysis for tethered cord syndrome: a case report and literature review. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery\| PubMed ID: 32748011	2021
Impact of Surgical and Medical Treatment on Survival of Patients with Cerebral Aspergillosis: Systematic Review of the Literature. World neurosurgery\| PubMed ID: 33482411	2021
Does communication between neurosurgeons and anesthesiologists improve preoperative efficiency? Clinical neurology and neurosurgery\| PubMed ID: 33508594	2021
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Patients With Chiari Malformation: Surgical Interventions. Neurosurgery\| PubMed ID: 37646504	2023
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Patients With Chiari Malformation: Diagnosis. Neurosurgery\| PubMed ID: 37646512	2023
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Patients With Chiari Malformation: Symptoms. Neurosurgery\| PubMed ID: 37646519	2023
In Reply: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Patients With Chiari Malformation: Surgical Interventions. Neurosurgery\| PubMed ID: 37962335	2023
Concussion Symptomology By Symptom Resolution Time in US High School Athletes: Findings From The National Athletic Treatment, Injury and Outcomes Network (NATION) High School Surveillance Pr... Journal of athletic training\| PubMed ID: 38014801	2023

Carolyn Quinsey

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