Seizure Outcome after Anterior versus Complete Corpus Callosotomy in Children: A Systematic Review with Meta-Analysis / Controle das crises epilépticas após calosotomia anterior versus completa em crianças: uma revisão sistemática com metanálise

Introduction Refractory epilepsy is a debilitating and challenging condition to manage. Corpus callosotomy (CC) seems to be an effective treatment option for patients with seizures not amenable to focal resection. The aim of the present study is to compare seizure outcome of pediatric patients following anterior CC, compared with complete CC. Method The authors performed a systematic review and meta-analysis of the English literature involving comparative studies. Results The present investigation includes four retrospective case-controlled studies and authors perform a pooled analysis of the surgical results. Seizure outcome presented favorable results in patients who underwent complete CC (Odds Ratio, M-H, Fixed, 95% CI: 3.02 [1.43, 6.387], p-value: 0.005). Clinical and neurological complications occurred independently when a complete or anterior CC was performed. Conclusion Complete CC seems to be the most effective treatment option to control intractable seizure in children not amenable to focal resection.

Introdução Epilepsia refratária é uma condição debilitante e desaadora para lidar. Calosotomia parece ser uma opção de tratamento ecaz para pacientes com convulsões não passíveis de ressecção focal. O objetivo do presente estudo é comparar o resultado de convulsões em pacientes pediátricos de acordo com calosotomia anterior e completa. Métodos Uma revisão sistemática e metanálise da literatura médica em inglês envolvendo estudos comparativos. Resultados Quatro casos retrospectivos foram incluídos na presente investigação e uma análise dos resultados cirúrgicos foi realizada. Convulsões decorrentes tiveram resultados favoráveis em pacientes submetidos a calosotomia complete (odds ratio, M-H, xo, 95% IC: 3,02 [1,43; 6,387], valor de p: 0,005). Complicações clínicas e neurológicas ocorreram independentemente de se calosotomia complete ou anterior. Conclusão Calosotomia completa parece ser a opção de tratamento mais ecaz para controlar convulsões não rastreáveis e não passíveis de ressecção focal em crianças.

Subdural hematoma in childhood. Considerations about twenty cases and review of the literature

Background: Subdural hematoma is defined as a clot between dura-mater and arachnoid spaces due to trauma, infectious diseases or bleeding disorders. In infancy, subdural hematoma is a clinical syndrome that, although relatively constant in its overall features, is often unrecognized with later diagnostic. The subdural hematoma in childhood is more commonly seen in the child of the three weeks of life or more. Clinical features depend on patient’s age, the hematoma’s site and its length. Computed tomography and magnetic resonance are the best methods. Aim: 1) to identify the sex, age, causes and computed tomography findings in patients with subdural hematoma; 2) to analyse the results of the treatment. Material and Methods: This study is retrospective. Twenty children under fifteen years old were studied at João Alves Filho Hospital (Aracaju – Sergipe – Brazil). The period was 1995, may to 2004, june. Results: Twelve (60 por ciento) children were male and eight (40 por ciento) female. Children’s age ranged from two days to fourteen years old. The most common causes were fall, car collision, trampling, delivery trauma and fight. Computed tomography was important for diagnosis and treatment. The clinical treatment was done in thirteen patients. Fifteen (67 por ciento) patients had good recovery and five (33 por ciento) died. Conclusion: 1) the male children were more affected; 2) the principal age was 6 to 12 years old; 3) the most common cause was fall; 4) the main localization in computed tomography was parieto-temporal and 5) 67 por ciento of the patients survived.

Migration of ventriculoperitoneal shunt catheter into the cranium - case report

Shunt migration into the cranium is an uncommon complication of surgical treatment for hydrocephalus. The authors report a case of a 4-months-male child that wanted a ventriculoperitoneal shunt catheter due to hydrocephalus. As a complication of the treatment, the catheter migrated into do cranium. The catheter was removed and a new catheter was fixed in other area. The child has been attended for one year with good development.