Burying shunts in bone cavities to protect delicate scalp.

The authors describe a simple technique for protecting at-risk scalp overlying CSF shunt hardware. Patients with brain tumors commonly undergo radiation therapy and CSF diversion. Chronic radiation-induced changes in the skin can predispose patients to skin breakdown over the prominent shunt reservoir, which may lead to subsequent contamination of the shunt hardware. The technique described reduces the risk of hardware contamination while obviating the need for revision of the entire shunt system. By reducing the profile of the CSF shunt reservoir, this technique also reduces the risk of future skin ulceration.

Detection of important venous collaterals by computed tomography venogram in multisutural synostosis. Case report and review of the literature.

The authors describe the novel use of computed tomography (CT) venography in the preoperative evaluation of a child with Crouzon syndrome who was being considered for Chiari decompression. This 18-month-old girl presented with hydrocephalus (treated with a ventriculoperitoneal shunt) and persistent symptomatic Chiari malformation and associated syrinx. A CT venogram was obtained because of the well-described relationship between multisutural craniosynostosis and abnormal intracranial-to-extracranial venous drainage. The CT venogram showed widely dilated vertebral and paravertebral veins located in the paraspinous muscles of the craniocervical junction. Because of the risk of massive intraoperative blood loss and/or occlusion of important collateral draining veins leading to intracranial venous hypertension and intractably raised intracranial pressure, the planned posterior fossa decompression was not performed. Computed tomography venography is an easily obtained study that we recommend in the evaluation of children with multisutural craniosynostosis prior to cranial surgical interventions.

The history of neurosurgery at the Hospital for Sick Children in Toronto.

The tradition of selfless charity for children in Toronto was established by Elizabeth McMaster, founder of the Hospital for Sick Children, or "Sick Kids," in 1875. The tradition of fortitude and perseverance in trying to cure children who were deemed incurable by others was sealed into the history of the Hospital by early pioneering surgeons, including Drs. Clarence Starr, A.W. Farmer, and William Gallie. Dr. William Gallie recognized the importance of neurosurgery for the future of the Hospital and encouraged Dr. William Keith to acquire training in pediatric neurosurgery in Chicago and London. Dr. Keith began the practice of pediatric neurosurgery at Sick Kids in 1935 and worked in the primordial phase of the subspecialty for the next 20 years until he was joined by Dr. E. Bruce Hendrick in 1955. In time, Dr. Hendrick was joined by Drs. Harold Hoffman and Robin Humphreys who led a decidedly strong pediatric neurosurgery unit between 1975 and 1995. During this epoch, the pediatric neurosurgery service grew to become one of the busiest and most progressive units in the world. Over the years, numerous neurosurgery fellows and faculty from all over the world have trained at or have visited Sick Kids to learn how pediatric neurosurgery is practiced in Toronto. The purpose of this article is to review the history of the individuals who founded the Hospital for Sick Children and its Division of Neurosurgery.

Laparoscopy-assisted ventriculoperitoneal shunt surgery in children: a series of 11 cases.

OBJECT: The use of laparoscopy-assisted placement of the distal catheter of a ventriculoperitoneal (VP) shunt has been well described in the literature, and several advantages of laparoscopy over laparotomy have been documented. METHODS: The authors retrospectively reviewed the charts of 11 consecutive children with hydrocephalus of various origins who underwent surgery for initial VP shunt placement or for revision of an existing VP shunt system between July 1, 2006, and December 31, 2006. The peritoneal catheter in all of these cases was implanted using a laparoscopic procedure and with the aid of a pediatric general surgeon. Laparoscopy-assisted placement of the distal catheter was successful in all patients. There were no periprocedural complications. There was one complication, an incisional hernia, noted in the short-term follow-up period. CONCLUSIONS: The authors illustrate that laparoscopy-assisted implantation of a peritoneal catheter is a safe, effective, minimally invasive, and technically easy approach for VP shunt placement or revision in children. It allows accurate placement of the distal catheter in the peritoneal cavity, enables retrieval of fractured catheter segments, and allows confirmation of the patency of the shunt system.

Neurosurgical implications of neurofibromatosis Type I in children.

Neurofibromatosis Type 1 (NF1) is one of the most common inherited diseases in humans. It is caused by a mutation in the NF1 gene on chromosome 17, and is associated with numerous central and peripheral nervous system manifestations. Children with NF1 are at high risk of harboring numerous lesions that may require the attention of a neurosurgeon. Some of these include optic nerve gliomas, hydrocephalus, intraspinal tumors, and peripheral nerve tumors. Although most of the neoplasms that affect the brain, spine, and peripheral nerves of children are low-grade lesions, there is a small but real risk that some of these lesions may become high grade over time, requiring other forms of therapy than surgery alone. Other associated disorders that may result from NF1 in childhood include Chiari malformation Type I, scoliosis, and pulsating exophthalmos from the absence of the sphenoid wing. In this review, the major lesions that are found in children with NF1 are reviewed as well as the types of treatment that are offered by neurosurgeons and other members of the treating team. Today, optimum care of the child with NF1 is provided by a multidisciplinary team comprising neurosurgeons, neurologists, ophthalmologists, radiologists, orthopedic surgeons, and plastic surgeons.