ABSTRACT
In 1991, Biedermann coined the term "kinetic imbalance due to suboccipital strain" ("KiSS-syndrome"). He assumed a functional abnormality of the suboccipital-high cervical spine, resulting in positional preference of the infant;s head. A broad spectrum of symptoms and complaints have been attributed to "KiSS-Syndrome". Patients are advised to undergo manual therapy, with pressure applied locally in order to readjust the cervical spine. Life threatening side-effects have been published repeatedly. We present two infants with brain tumours who developed torticollis and further neurological findings such as ataxia and reflex differences. In both cases, symptoms caused by the tumour were interpreted as "KiSS-syndrome", and appropriate diagnostics and therapy were delayed for months. There is no scientific evidence for the actual existence of "KiSS-syndrome" as a clinical entity or for the positive effects of manual therapy. Approximately 12% of all infants <12 months show a positional preference of the head, about 8% present with body asymmetry. Whereas most cases are benign, there is a long list of serious differential diagnoses for torticollis in infants. We give an updated review of the literature regarding "KiSS-Syndrome" and discuss the differential diagnostics in infants with torticollis.
Subject(s)
Algorithms , Astrocytoma/diagnosis , Cerebellar Neoplasms/diagnosis , Cervical Vertebrae , Ganglioglioma/diagnosis , Magnetic Resonance Imaging , Neoplasms, Second Primary/diagnosis , Spinal Diseases/diagnosis , Torticollis/etiology , Astrocytoma/pathology , Astrocytoma/surgery , Cerebellar Neoplasms/pathology , Cerebellar Neoplasms/surgery , Child, Preschool , Diagnostic Errors , Gait Disorders, Neurologic/etiology , Ganglioglioma/pathology , Ganglioglioma/surgery , Humans , Infant , Male , Microsurgery , Neoplasm, Residual/diagnosis , Neoplasms, Second Primary/pathology , Neoplasms, Second Primary/surgery , Neurologic Examination , Postoperative Complications/diagnosis , Reoperation , SyndromeABSTRACT
BACKGROUND: The insertion of a ventriculoperitoneal shunt (VPS) is the treatment of choice in patients with hydrocephalus. However, VPS placement may be difficult in patients with extensive adhesions following prior abdominal interventions. Laparoscopic placement of the abdominal part of the VPS allows controlled adhesiolysis in combination with an optimal shunt placement in patients with a body weight above 5 kg. We investigated the feasibility and safety of laparoscopic VPS placement in young infants who had undergone abdominal operations. PATIENTS AND METHODS: In our institution, 6 children with prior laparotomies (range: 2-9; median 3) received a VPS catheter between 2004 and 2008. The median age was 9 months (range: 2 months-4 years) and the median body weight was 4.5 kg (3.5-8.2 kg). All procedures were laparoscopically assisted and performed simultaneously by an interdisciplinary neurosurgical and a pediatric surgical team. RESULTS: Median operating time was 63 min (35-100 min). In all cases, correct placement of the shunt with sufficient drainage was achieved. Enteral feeding was started on the day of operation in all patients. Median follow-up was 10 months (range: 2 months-3 years). There were no complications except in one patient, who developed shunt dysfunction 4 weeks postoperatively and underwent a laparoscopic shunt revision. CONCLUSION: In our series laparoscopically assisted VPS insertion in low-weight children who had undergone repeated prior abdominal surgery was feasible and had a low complication rate. We recommend laparoscopically assisted VPS insertion in small infants to avoid the complications of alternative techniques, such as open techniques or ventriculoatrial shunt.