RESUMO
The authors describe an extremely unusual case of a giant hemicranial subdural empyema occurring nine years after insertion of a venticuloperitoneal shunt. Though the empyema was evacuated, the child suffered significant morbidity and remained hemiparetic. The present case highlights the delayed morbidity following a ventriculoperitoneal shunt insertion and the need of prolonged and regular follow up in children who have undergone this procedure.
Assuntos
Adolescente , Calcinose , Criança , Craniotomia , Drenagem , Empiema Subdural/epidemiologia , Empiema Subdural/etiologia , Empiema Subdural/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Morbidade , Paresia/epidemiologia , Paresia/etiologia , Complicações Pós-Operatórias , Fatores de Tempo , Resultado do Tratamento , Derivação Ventriculoperitoneal/efeitos adversosRESUMO
OBJECTIVES: To analyze the results after surgery for spinal cord lipomas. METHODS: The authors report their results of management of 63 non consecutive random children with spinal cord lipomas treated over a period from 2001 to 2005, at the All India Institute of Medical Sciences, New Delhi, India, a tertiary care neurosurgical centre. RESULTS: There were 63 cases consisting of 32 (52%) conus lipomas, 14 (22%) filum lipomas, 14 (22%) lipomeningomyelocele (lipoMMC), 2 (2.5%) cases of lipomyelocystocele and one (1.5%) case of mixed lipoma. None of the patients who were asymptomatic before surgery deteriorated neurologically, irrespective of the type of lipoma till the last follow up. In those patients with preexisting neurological deficits, the improvement in motor, sensory and bladder abnormalities was only to an extent of 15 %, 16 % and 21 % respectively. None of the children with preexisting neurological deficit regained overall normal function. Nevertheless, the improvement in symptoms after surgery made the patients lead a better social life. Only 6 % of patients developed deterioration in neurological function after surgery, all of them occurring in patients already having pre-operative deficits. CONCLUSIONS: The authors recommend prophylactic surgery which is safe and effective in preventing neurological deficits, irrespective of the type of lipoma. Most of the patients benefit only to some extent even after surgery, once they develop neurological dysfunction. A close long term follow up is recommended in order to detect neurological deterioration even in children operated prophylactically.