Minimally invasive retrieval of a bullet settling into the thoracic spinal canal in a pediatric patient: A case report / Recuperación mínimamente invasiva de una bala que se asienta en el canal espinal torácico en un paciente pediátrico: reporte de un caso

A 10-year-old boy presented to neurosurgery department after a gunshot wound to the upper thoracic spine. The bullet entered through the right deltoid muscle and lodged inside the spinal canal at T1 level. The patient arrived conscious and obeying commands; however, he experienced a loss of sensation below T3 level, loss of reflexes below the injured T1 level, loss of anal sphincter tone and paraplegia in the lower limbs (American Spinal Injury Association grade-A). Imaging studies revealed an intra-canalicular metallic bullet at the T1 level. The patient underwent urgent operation using a tubular retractor system and the microscope. Subsequently, the bullet was successfully retrieved. Postoperatively, the patient made a significant recovery and by the end of the 6th month, he was able to walk independently despite some gait instability. A minimally invasive approach for intra-canalicular bullet removal in the thoracic region is a safe and effective technique in pediatric patients. (AU)

Un niño de 10 años se presentó al departamento de neurocirugía después de una herida de bala en la columna torácica superior. La bala entró por el músculo deltoides derecho y se alojó dentro del canal espinal a nivel T1. El paciente llegó consciente y obedeciendo órdenes; sin embargo, experimentó una pérdida de sensibilidad por debajo del nivel T3, pérdida de reflejos por debajo del nivel T1 lesionado, pérdida del tono del esfínter anal y paraplejía en las extremidades inferiores (American Spinal Injury Association grado-A). Los estudios de imagen revelaron una bala metálica intracanalicular a nivel T1. El paciente fue intervenido de urgencia mediante un sistema retractor tubular y el microscopio. Posteriormente, la bala se recuperó con éxito. En el postoperatorio, el paciente se recuperó significativamente y, al final del sexto mes, podía caminar de forma independiente a pesar de cierta inestabilidad en la marcha. Un enfoque mínimamente invasivo para la extracción de balas intracanaliculares en la región torácica es una técnica segura y eficaz en pacientes pediátricos. (AU)

Minimally invasive retrieval of a bullet settling into the thoracic spinal canal in a pediatric patient: A case report.

A 10-year-old boy presented to neurosurgery department after a gunshot wound to the upper thoracic spine. The bullet entered through the right deltoid muscle and lodged inside the spinal canal at T1 level. The patient arrived conscious and obeying commands; however, he experienced a loss of sensation below T3 level, loss of reflexes below the injured T1 level, loss of anal sphincter tone and paraplegia in the lower limbs (American Spinal Injury Association grade-A). Imaging studies revealed an intra-canalicular metallic bullet at the T1 level. The patient underwent urgent operation using a tubular retractor system and the microscope. Subsequently, the bullet was successfully retrieved. Postoperatively, the patient made a significant recovery and by the end of the 6th month, he was able to walk independently despite some gait instability. A minimally invasive approach for intra-canalicular bullet removal in the thoracic region is a safe and effective technique in pediatric patients.

External ventricular drainage: indications and outcome among Sudanese Children.

This study reflects our experience in managing Sudanese children with different cranial conditions through external ventricular drainage (EVD): indications for EVD, pathologies faced, and early outcome. A prospective review of cases operated at the National Center for Neurological Sciences was carried out during the period from February 2014 to February 2016. The patients were closely followed up till EVD removal and discharge. Thirty-five Sudanese children were included in the study (age range between 6 days and 7 years). Majority of the cases had posterior fossa tumor with obstructive hydrocephalus (n = 19, 54.3%). Twenty (57.1%) patients presented with a decreased level of consciousness, while 28 (80%) patients presented with symptoms and signs of raised intracranial pressure (ICP). The decision for EVD was made preoperatively based on positive cranial computed tomography/magnetic resonance imaging findings in 10 (28.6%) patients. Additionally, 28 (80%) patients responded to single injectable antibiotic therapy with an average duration of 22 days. Subsequently, 25 (71.4%) patients improved or got cured, 5 deteriorated, and 11 died. We conclude that EVD can be used for many indications, including obstructive, postinfectious, and postmeningitic hydrocephalus as well as intraventricular hemorrhage. Most patients may present with either deteriorating levels of consciousness or symptoms and signs of raised ICP, but few of them may have positive brain imaging findings and therefore the decision for EVD was made intraoperatively. The average duration for EVD use was 3 weeks with single antibiotic therapy use, which was found as effective as when combined with intraventricular therapy.

Thermodynamics of translational and rotational dynamics of C9 hydrocarbons in the pores of zeolite-beta.

There has been a growing interest in the separation of aromatic hydrocarbon molecules from the petroleum stream using zeolite-based technologies. This led to numerous experimental and molecular simulation studies of the structural and dynamical properties of aromatic hydrocarbons under the confinement of microporous materials like zeolites. The understanding of the behavior of the isomers of the trimethylbenzene under confinement is crucial for their separation and purification from industrial streams. Here, we investigate the translational and rotational dynamics and associated thermodynamics of three isomers of trimethyl benzene, namely, 1,2,3-trimethyl benzene (1,2,3-TMB), 1,2,4-trimethyl benzene (1,2,4-TMB), and 1,3,5-trimethylbenzene (1,3,5-TMB) under the confinement of zeolite-beta (BEA) using molecular dynamics (MD) simulations. The trends in the diffusion coefficients of the TMB isomers calculated from our MD simulation data are in good agreement with the data already available in the literature. Analysis of dynamics and associated thermodynamic properties indicate that 1,2,4-TMB is translationally more facile than the other two isomers. The rotational motion of TMB isomers is largely anisotropic and it is relatively more significant for both 1,2,4-TMB and 1,3,5-TMB. The thermodynamic properties reveal that the distinguishability in the dynamic properties among these three isomers is essentially caused by entropy. These results are not only critical to engineer the separation process of TMB isomers across the zeolite beds but also to understand the different catalytic processes such as trans-alkylation, conversion, cracking etc.

Brain abscess burr hole aspiration in children with congenital heart disease in low facility centers: case series.

This is a prospective cross-sectional study on brain abscess burr hole aspiration in children with congenital heart disease (CHD) performed from January 2018 to March 2019. All patients were operated on through a burr hole, and then received intravenous antibiotics for 6 weeks and orally for 2 weeks either empirically or according to the results of abscess culture, if positive. The follow-up of cranial computed tomography or brain magnetic resonance image with contrast was obtained after 2 months (post-operatively) to assess the effectiveness of the procedure and to look for any residual or recurrent abscesses. Data were collected in a designed data collection sheet and analysed using Statistical Package for the Social Sciences-20. Thirteen patients were found to satisfy inclusion criteria. The most common presenting symptoms were fever (n = 11/13, 84.6%), vomiting (n = 7/13, 53.8%), headache (n = 6/13, 46.2%), convulsions (n = 6/13, 46.2%), focal weakness (n = 3/13, 23.1%), and impaired level of consciousness (n = 1/13, 7.7%). No bacterial growth was detected in two-thirds of the cases (69.2%), while the culture was positive in the remaining one-third (30.8%). The follow-up images showed complete resolution of the abscesses except in one case (n = 1/13, 7.7%), which required a second session of aspiration. One patient died (n = 1/13, 7.7%) on the 19th post-operative day due to severe pneumonia. Aspiration of brain abscess in children with CHD through a burr hole is a safe and effective procedure in terms of operative time, duration of anaesthesia and postoperative complications.

Surgical Intervention for Unstable Craniovertebral Junction Anomalies with Narrow C2 Pedicle.

OBJECTIVE: We sought to investigate and report a novel surgical technique of screws insertion and posterior surgical reduction, as well as explore its clinical results. METHODS: From September 2008 to September 2012, we treated 41 cases of unstable craniovertebral junction anomalies with a narrow C2 pedicle at our department. All patients underwent "posterior reduction and internal fixation of the occipital bone with superior or inferior articular process of C2 and lateral mass of C3 on the narrowed C2 pedicle side-for non-narrowed C2 pedicle side, the screw was only inserted into C2 pedicle without extending the fixation to C3 vertebrae-using a titanium screw-rod (plate) fixation system." The preoperative and postoperative atlantodens interval, Chamberlain line, McRae line, and cervicomedullary angle were all measured. In addition, the preoperative and postoperative Japanese Orthopedic Association score was used to evaluate the cervical myelopathy. RESULTS: A total of 134 screws were inserted into the C2 pedicle (30 screws), superior (35 screws) or inferior (17 screws) articular process of C2, and lateral mass of C3 (52 screws). There was a significant statistical difference between the preoperative and postoperative results in the reduction of the odontoid process, decompression of the upper cervical spinal cord and medulla, as well as the improvement of neurologic functions (P < 0.05). All patients have exhibited a major neurologic improvement and solid bony fusion. CONCLUSION: This novel surgical technique is safe, feasible, and effective for the treatment of unstable craniovertebral junction anomalies with a narrow C2 pedicle.

Shunt tube calcification as a late complication of ventriculoperitoneal shunting.

Shunt calcification is a rare complication of ventriculoperitoneal shunting that occurs years later after the initial operation this condition is rarely reported in literature. Two patients with shunt calcifications were described. The first patient was 17-year-old lady who had congenital hydrocephalus and shunted in the early infancy, she was presented recently complaining of itching of the skin along the shunt track and limitation of neck movement. The patient was then operated with removal of the old peritoneal catheter and replacing it with a new one. The second patient was 17-year-old boy originally was a case of posterior fossa pilocytic astrocytoma associated with obstructive hydrocephalus, he was operated with both shunting for the hydrocephalus and tumor removal, 6 years later he presented with shunt exposure. Calcification of the shunt tube was discovered intraoperatively upon shunt removal. Shunt calcification has been observed mainly in barium-impregnated catheters. Introducing plain silicone-coated shunt tubing may reduce the rate of this condition. The usual complaints of the patients suffering from this condition are pain in the neck and chest wall along the shunt pathway and limitation of the neck movement due to shunt tube tethering, but features of shunt dysfunction and skin irritation above the shunt may be present. In this review, plain X-ray and operative findings showed that the most extensive calcification is present in the neck, where the catheters were subject to heavy mechanical stress. Disturbed calcium and phosphate metabolisms may be involved in this condition. Shunt calcification is a rare condition that occurs due to material aging presenting with features of shunt tethering, dysfunction or overlying skin irritation. Plain X-ray is needed to detect calcification while shunt removal, replacement or endoscopic third ventriculostomy may carry solution for this condition.

Brain abscess: Current management.

Brain abscess (BA) is defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis, which is subsequently converted into a collection of pus within a well-vascularized capsule. BA must be differentiated from parameningeal infections, including epidural abscess and subdural empyema. The BA is a challenge for the neurosurgeon because it is needed good clinical, pharmacological, and surgical skills for providing good clinical outcomes and prognosis to BA patients. Considered an infrequent brain infection, BA could be a devastator entity that easily left the patient into dead. The aim of this work is to review the current concepts regarding epidemiology, pathophysiology, etiology, clinical presentation, diagnosis, and management of BA.

Unusual surface and edge morphologies, sp2 to sp3 hybridized transformation and electronic damage after Ar+ ion irradiation of few-layer graphene surfaces.

Roughness and defects induced on few-layer graphene (FLG) irradiated by Ar+ ions at different energies were investigated using X-ray photoemission spectroscopy (XPS) and atomic force microscopy techniques. The results provide direct experimental evidence of ripple formation, sp2 to sp3 hybridized carbon transformation, electronic damage, Ar+ implantation, unusual defects and edge reconstructions in FLG, which depend on the irradiation energy. In addition, shadowing effects similar to those found in oblique-angle growth of thin films were seen. Reliable quantification of the transition from the sp2-bonding to sp3-hybridized state as a result of Ar+ ion irradiation is achieved from the deconvolution of the XPS C (1s) peak. Although the ion irradiation effect is demonstrated through the shape of the derivative of the Auger transition C KVV spectra, we show that the D parameter values obtained from these spectra which are normally used in the literature fail to account for the sp2 to sp3 hybridization transition. In contrast to what is known, it is revealed that using ion irradiation at large FLG sample tilt angles can lead to edge reconstructions. Furthermore, FLG irradiation by low energy of 0.25 keV can be a plausible way of peeling graphene layers without the need of Joule heating reported previously.