Patterns and prognosis of ventriculoperitoneal shunt malfunction among pediatrics in Saudi Arabia.

OBJECTIVE: To examine the predictors of pediatric ventriculoperitoneal (VP) shunt malfunction in a university hospital. METHODS: A retrospective cohort was conducted. Patients under 18 years old who underwent VP shunt revision at least once between 2016 and 2019 were included. Data were stratified based on age, gender, diagnosis, type of valve, valve position, cause of revision, and part revised. RESULTS: A total of 45 patients (64% males and 36% females) were included in this study. Eighty-two revision surgeries were identified. The most common revised part was the entire shunt system. The most common type of valve which required revision was the low-pressure valve (15.5%). Since a p-value of less than 0.05 was considered significant, no significant differences among the 4 groups for different points. CONCLUSION: Younger age at initial VP shunt insertion is associated with a higher rate of shunt malfunction. Valve mechanical failures followed by infections are the most common causes for the first 3 revisions. A prospective multi-center study to confirm the current findings is recommended.

Cerebrospinal fluid leakage after turbinate submucosal diathermy: an unusual complication.

Submucosal diathermy of the inferior turbinate (SMDIT) is a generally safe procedure to control inferior turbinate hypertrophy. We present a case of a cerebrospinal fluid (CSF) leak at the craniocervical junction after SMDIT done in another institution. A 27-year-old man presented 3 weeks after undergoing SMDIT with signs and symptoms of meningitis and postnasal rhinorrhea. Nasal endoscopy and imaging revealed a nasopharyngeal CSF fistula at the craniocervical junction. Transnasal endoscopic repair and reconstruction was performed with no recurrence on repeat imaging and clinical follow up. We describe the first reported case in the literature of an iatrogenic CSF fistula caused by SMDIT, an unusual and potentially fatal complication, and its surgical management. SIMILAR CASES PUBLISHED: 0 CONFLICT OF INTEREST: None.

Atlas instrumentation guided by the medial edge of the posterior arch: An anatomic and radiologic study.

STUDY DESIGN: This was an interventional human cadaver study and radiological study. OBJECTIVES: Atlas instrumentation is frequently involved in fusion procedures involving the craniocervical junction area. Identification of the entry point at the center of atlas lateral mass (ALM) is challenging because of its rounded posterior surface and the surrounding venous plexus. This report examines using the medial edge of atlas posterior arch (MEC1) as a fixed and reliable anatomic reference to guide the entry point of ALM screws. METHODS: Fifty, normal, cervical spine computed tomography studies were reviewed. ALM screw trajectories were planned at one point along MEC1 and another point 2 mm lateral to MEC1. Free-hand ALM instrumentation was performed in ten fresh human cadavers using the 2 mm entry point, with a sagittal trajectory parallel to atlas inferior arch (IAC1); three-dimensional imaging was then performed to confirm instrumentation accuracy. RESULTS: The average ALM diameter was 12.35 mm. Inserting a screw using the entry point 2 mm lateral to MEC1 was closer to ALM midpoint than using the entry point along MEC1 (P < 0.0001). Twenty ALM screws were successfully inserted in the ten cadavers. No encroachments into the spinal canal or foramen transversarium occurred. However, two screws were superiorly directed and violated the occipitocervical joint; they were not parallel to IAC1. CONCLUSION: MEC1 provides a fixed and reliable landmark for ALM instrumentation. An entry point 2 mm point lateral to MEC1 is close to ALM midpoint. IAC1 also provides a guide for the sagittal trajectory. Attention to anatomic landmarks may help reduce complications associated with atlas instrumentation but should be verified in future clinical studies.

Large primary leiomyoma causing progressive cervical deformity.

Leiomyomas are benign smooth tumors that rarely affect the neck area. Complete surgical resection is the treatment of choice. Here, we describe a 13-year-old girl with a large leiomyoma of the neck, which increased in size after incomplete resection. The tumor caused progressive cervical kyphotic deformity, difficulty breathing and severe malnourishment. The tumor was resected successfully in a second surgery, and the patient is stable after 3 years of follow-up. Histopathologically, the tumor was consistent with leiomyoma and showed strong reactivity to specific smooth muscle markers, such as desmin and caldesmon. This is the second reported case demonstrating massive growth of a leiomyoma, with emphasis on complete resection from the beginning.

Traumatic retropulsion of T10 vertebra in a 5-year-old boy with involvement of neurocentral synchondrosis: a case report and review of the literature.

STUDY DESIGN: This is a case report of a traumatic retropulsion of the T10 vertebral body in a 5-year-old boy. OBJECTIVES: This paper aims to describe a rare pediatric fracture where there was involvement of the neurocentral synchondrosis (NCS) and to evaluate the characteristics of this type of fractures in children. SUMMARY OF BACKGROUND DATA: The NCS is the junction between the vertebral body and the pedicle bilaterally where the vertebra grows horizontally. It closes between 11 and 16 years. It is a known location for spine fracture. However, it was mainly reported in children less than 2 years of age secondary to nontraumatic injury and at the junction levels of the spine. This is the first case of a fracture involving the NCS in a child older than 2 years, due to trauma, and in a non-junctional area of the spine. METHODS: This 5-year-old boy was involved in a motor vehicle collision where he was ejected from the car. He had bilateral lower limb paresthesia and weakness. The fracture involved the neurocentral synchondrosis on the left side and impacted the vertebral body into the pedicle on the right side. Additionally, there was posterior vertebral element injury. He was treated with wide laminectomy and posterior pedicle screw instrumentation. RESULTS: At 18 months of follow-up, the patient showed a normal neurologic status and a normal alignment of the spine. CONCLUSION: Traumatic retropulsion of the thoracic spine with involvement of the NCS is possible in young age when exposed to a significant trauma. Restoration of spine alignment and normal neurological function could be achieved with a single posterior approach. KEY POINTS: - Pediatric fractures are uncommon and tend to affect junction areas. - A fracture through the neurocentral synchondrosis is possible before the age of closure (11-16 years) with forcible trauma. - Single posterior decompression and instrumented fusion is sufficient to restore alignment and neurological function.

Socio-demographic determinants of antibiotic misuse in children. A survey from the central region of Saudi Arabia.

OBJECTIVE: To investigate knowledge, beliefs, and practices associated with parental antibiotic misuse. METHODS: This cross-sectional study included parents visiting 4 malls in Riyadh, Saudi Arabia. The study took place at the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia between June and December 2010. Self-prescription of antibiotic for a child in the past year was defined as antibiotic misuse. RESULTS: From 610 parents (60.5% mothers and 39.5% fathers), 11.6% reported self-prescription. Responding parents differed by age, education, number of children, and profession. Overall, parents responded that antibiotics are required in children with runny nose or cough or sore throat or fever (50%); to reduce symptom severity and duration (57.7%), are effective against viruses (68.6%), can be stopped on clinical improvement (28.7%), and it used by another family member can be used in children (20.1%). Determinants of misuse in a multivariable model were income, number of children, type of infection treated last year, knowledge of illness requiring antibiotic or being unsure, using antibiotics used by an other family member in children, unsure of such use, and adjusting for the type of responding parent. CONCLUSION: Parents with low income, more than 2 children, lack of knowledge, inappropriate beliefs and practices are vulnerable for misusing antibiotics in children.