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Pediatric Epilepsy Surgery

Whereas there is no specific neurosurgical technique in pediatric epilepsy, the frequency of each type of surgery is very different from epilepsy surgery applied in adults, and reflects the underlying etiologies, which are much more diverse in children, with malformations of cortical development and tumors as the prevailing etiologies. Extensive resective or disconnective procedures for extratemporal epilepsy are more frequently performed in infants and younger children, whereas temporo-mesial resection is by far the most common surgical treatment for adults with epilepsy. More recently, less invasive techniques in children with an extensive epileptogenic zone, such as multilobar disconnection, hemispherotomy and other functional hemispherectomy variants, have been introduced in order to reduce duration of surgery, perioperative morbidity and length of hospital stay. Likewise, minimally invasive techniques are utilized, such as the endoscopic disconnection of hypothalamic hamartomas for gelastic epilepsy. This development has been encouraged with the introduction of image-guided navigation systems for the preoperative planning and during surgery. Historically, epilepsy surgery for children has been established much later than for adults. Apart from the particular aspects in perioperative management of younger infants, surgery-related morbidity as well as seizure outcome is in general similar to those in adults, depending rather on each type of surgery.

Cerebral Ischemia in Active Giant Cell Arteritis: Clinical and Diagnostic Aspects in 36 Patients

Abstract Background: Cerebral ischemia (CI) is an uncommon, sometimes life-threatening complication of active giant cell arteritis (aGCA) due to affection of the precerebral arteries. Aim of the Study: To analyze and describe clinical findings and results of multimodal vascular imaging of the craniocervical arteries. Patients and Methods: Out of 317 aGCA patients, 36 (11%) presented with CI. All patients underwent vascular imaging including ultrasonography (US) of the temporal arteries (TA) and precerebral arteries, biopsies were taken in 27, CTA/MRA were performed in 21 and FDG-PET in 18 patients. Results: In 72% of patients, CI was located in the posterior circulation and in14% of patients, it occurred after beginning of steroid therapy. TA were normal on clinical and US examination in 10 patients (with normal biopsies in 5) but PET demonstrated GCA of the precerebral arteries in 9 of them. Abnormalities of the precerebral arteries typical of GCA were demonstrated by US as halos in 67% (in 61% halos of the vertebral arteries), CTA/MRA in 43% and PET in 72% of patients. Concurrent etiologies for CI were evident in 19% of patients (including >50% ICA stenosis in 3 and atrial fibrillation in 4 patients). Conclusions: Awareness for GCA as a cause of CI requiring specific diagnostic and therapeutic steps is important. US, CTA, MRA and PET are valuable diagnostic tools for rapid detection of GCA involving the precerebral arteries in different stages of the disease even if the TA look normal.

Neurologisch-neurochirurgische Frührehabilitation an einem Akutkrankenhaus

BACKGROUND Rehabilitation of neurological / neurosurgical patients is usually provided by specialised units following the acute hospital treatment. We analysed the characteristics of patients who received early rehabilitation at the Knappschafts-Hospital Recklinghausen. METHODS Included were 541 cases treated from 2003 to 2008. All fulfilled the criteria of the German coding system for structural characteristics item 8-552. We analysed the parameters age, gender, length of stay, mortality, types of discharge, diagnoses, morbidity and functional deficits measured by the Barthel (BI) and early Barthel index (FRBI). RESULTS 81 % of patients (58 % men, median age 73 years) suffered from stroke (55 %) or intracranial haemorrhage (ICH 26 %). Median stay was 27 days. 36 % of patients were transferred to further rehabilitation if BI > 30 was reached. Severity of diseases was reflected by 6.5 % mortality, and a median of FRBI at admission of -50. FRBI at discharge improved by a median of 45 points. Women were significantly older in all groups. Although FRBIs at discharge were similar, men stayed significantly (p = 0.03) longer (median 28, compared to 26 days in women) and improved more than women (p = 0.009), in particular in ICH. CONCLUSIONS Qualified early rehabilitation was successfully performed according to OPS item 8-552 following acute hospital setting. Compared to otherwise published data by specialised rehabilitation institutes, our patients showed comparable demographic characteristics. A relevant improvement of functional deficits was achieved at a shorter length of stay compared to specialised rehabilitation institutes. However, compared to secondary specialised rehabilitation institutes the mortality was higher. Younger age and male gender were relevant parameters for improvement during a longer stay despite higher initial deficits. The main challenge of early rehabilitation remains the control of complicating diseases, in particular pneumonia and urinary tract infections.