The Use of Middle Meningeal Artery Embolization to Treat Chronic Subdural Hematoma in the Pediatric Population: A Review of the Literature.

Chronic subdural hematoma (cSDH) is rare in the pediatric population and typically arises from various causes. These include trauma (accidental, non-accidental, or birth-related injuries), coagulopathies (such as hemophilia or von Willebrand disease), vascular malformations (such as arteriovenous malformations), and complications from previous surgeries. These diverse etiologies contribute to the complexity of managing this condition. Although middle meningeal artery (MMA) embolization is proven effective in adults, limited studies have investigated its applicability in pediatrics. This study aims to assess the efficacy, safety, and outcomes of MMA embolization in the pediatric age group, guiding future research and treatment strategies. A systematic review of the literature was conducted using PubMed, Web of Science, and Embase. No restrictions were applied regarding publication status or follow-up duration. The inclusion criteria were studies that integrated MMA embolization as a treatment for cSDH in pediatric patients. Data extracted included patient sample and characteristics, cSDH etiology and characteristics, prior intervention, procedural technique and indication, and clinical and radiological outcomes. Twelve studies were included in the review, comprising a total of 14 patients. There were no randomized clinical trials or large-scale cohort studies. The included literature consisted of 11 case reports and one case series, and the results described a clinical and radiological outcome in a varied mix of patients with different characteristics and backgrounds for cSDH. No neurological complications attributed to MMA embolization were reported. Follow-up showed resolved or decreased size of cSDH in all patients except for one, who experienced hematoma expansion despite treatment. MMA embolization may be considered a primary or adjuvant treatment modality for cSDH in the pediatric population. However, further research is needed to investigate the impact of different etiologies on outcomes and to highlight long-term complications and results.

Medical management for cerebellar mutism syndrome following posterior fossa surgery: A systematic review.

INTRODUCTION: Cerebellar mutism syndrome (CMS) is a serious complication of posterior fossa surgeries affecting mainly pediatric age group. The pathophysiology is still not fully understood. It adversely affects the recovery of patients. There is no definitive and standardized management for CMS. However pharmacological therapy has been used in reported cases with variable effectiveness. We aim through this review to summarize the available evidence on pharmacological agents used to treat CMS. METHOD: A thorough systematic review until December 2022, was conducted using PubMed Central, Embase, and Web of Science, databases to identify case reports and case series of CMS patients who underwent posterior fossa surgery and received pharmacological treatment. Patients with pathologies other than posterior fossa lesions were excluded from the study. RESULTS: Of 592 initial studies, 8 studies met our eligibility criteria for inclusion, with 3 more studies were added through manual search; reporting on 13 patients. The median age of 13 years (Standard deviation SD=10.60). The most frequent agent used was Bromocriptine. Other agents were fluoxetine, midazolam, zolpidem, and arpiprazole. Most patients recovered within 48 hours of initiating medical therapy. The median follow-up period was 4 months (SD=13.8). All patients showed complete recovery at the end of follow-up period. CONCLUSION: Cerebellar mutism syndrome is reported after posterior fossa surgeries, despite attempts to identify risk factors, pathophysiology, and management of CMS, it remains a challenging condition with significant morbidity. Different Pharmacological treatments have been proposed with promising results. Further studies and formalized clinical trials are needed to evaluate available options and their effectiveness.

A Comparative Analysis of Complication Rates in Arthroscopic Repair of the Lateral Ankle Ligament and the Brostrom-Gould Technique: A Systematic Review.

Injury to the lateral ligament is the most common cause of chronic lateral ankle instability. Lateral ankle instability is usually managed through conservative management, but surgery is indicated if this fails to relieve the symptoms. Surgical repair of the lateral ligament involves many surgical techniques including the arthroscopic repair technique and the modified Brostrom-Gould technique. Due to the minimal research on the complication rates of both techniques, this systematic review aims to establish the complication rates. To obtain articles, a detailed systematic search of MEDLINE, PubMed, Embase, Web of Science, and Cochrane Library was performed. The articles found using the keywords "arthroscopic," "Brostrom," and "Brostrom-Gould" were reviewed by two independent authors. The authors then selected the articles according to our predetermined eligibility criteria. The articles that met our inclusion were then chosen for data extraction. Specific details obtained from the study included the author's details, the setting of the study, and the complications of the study. The online search yielded 975 articles, but only 44 met our inclusion criteria and were included in the review. The total sample size for the review was 2041 patients, the modified Brostrom technique was performed on 760 patients while on the remaining 1281 patients, arthroscopic repair was performed. On the characteristics of the sample, the age of the samples ranged from eight years to 83 years, while the mean BMI ranged from 21.0 kg/m² to 25.3 kg/m². The various complication rates included superficial peroneal nerve injury (2.3% in arthroscopic Brostrom and 0.65% in the Brostrom-Gould), wound infections (1.3% in arthroscopic Brostrom and 1.8% in the Brostrom-Gould), persistent pain (1.5% in the arthroscopic Brostrom and 1.1% in the Brostrom-Gould), and lastly recurrent instability (0.31% in arthroscopic Brostrom and 3.0% in the Brostrom-Gould). Overall, the complication rates of the arthroscopic repair were 11.00%, while those of the modified Brostrom-Gould were 10.65%. The study demonstrated that although the arthroscopic technique had higher complication rates than the modified Brostrom technique, the difference was insignificant. Therefore, we concluded that surgeons performing the arthroscopic Brostrom technique should have good arthroscopic skills to minimize complications.

An Overview of Developmental Dysplasia of the Hip and Its Management Timing and Approaches.

Developmental dysplasia of the hip (DDH), if uncorrected, can result in several chronic abnormalities, including chronic hip pain, degenerative arthritis, and gait abnormalities. The outcome of DDH generally depends on the age of presentation; a worse prognosis is linked to a higher age of presentation. Although treatment continues to be a challenge, recent advancements in the field have improved our understanding of the disease, which has resulted in advancements in DDH surveillance during infancy and the reduction of complications with early intervention. The databases used for this overview include Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library, MEDLINE, and EMBASE. These databases were used to search for ongoing trials related to the management and diagnosis of DDH.

Outcomes of Endoscopic Resection in Pediatric Skull Base Chordoma: A Systematic Review.

The endoscopic approach has been recommended as a primary option for treating chordomas, and it is associated with better resection rates and fewer surgical complications than transcranial surgery. This review aimed to assess the long-term consequences and evidence in the current literature regarding the endoscopic approach's efficacy in treating skull-base chordoma in children. A systematic review was conducted based on the PubMed, Web of Science, and EMBASE databases to examine the clinical outcomes of endoscopic endonasal surgery for pediatric skull base chordoma tumors. The review included studies published in English that employed specific research designs and reported on pediatric patients with skull base chordoma. Of the 268 studies initially considered, 25 met our eligibility criteria and were included in the final analysis. The average age of the patients was 11.5 years, with approximately equal number of males and females. The endoscopic endonasal approach (EEA) was the most commonly used modality. Gross total resection (GTR) was achieved in 62.7% of patients, while 18.09% had a subtotal resection (STR), and 13.83% had near-total resection only. Most patients showed significant to moderate improvement from their baseline condition and had no recurrence during their follow-up. Our findings further endorse that the endoscopic approach is a viable primary treatment option for pediatric skull base chordoma.

The Effectiveness of Anti-Interleukin-17A Treatment for Pityriasis Rubra Pilaris: A Systematic Review.

Anti-interleukin-17A (anti-IL-17A) therapy has been increasingly employed as a treatment option for pityriasis rubra pilaris (PRP). In this study, we reviewed all available studies on this topic in the literature to evaluate the efficacy and safety of anti-IL-17A. Our main objective was to assess the current evidence on the efficacy and safety of anti-IL-17A therapy in the management of PRP. We searched for relevant articles on PubMed, MEDLINE, Ovid, Embase, and the Web of Science electronic databases from inception until 2022. Our inclusion criteria were as follows: randomized controlled trials (RCTs), quasi-randomized trials, or prospective observational studies that include PRP patients treated with biological treatments; studies that report clinical outcomes; and studies that compare the treatment modalities, including anti-IL-17, in the English language. A total of 19 articles involving 77 cases were reviewed after applying the inclusion criteria and removing duplicates. We found that type 1 PRP was the most common condition irrespective of gender, and the trunk was the most affected area. The study showed that IL-17 inhibitors had a significant impact on the patients. However, higher-level studies are required to further evaluate the therapeutic and safety effects of the treatment.

A Systemic Review of Spinal Needles Broken During Neuraxial Anesthesia.

Needle breakage during spinal anesthesia occurs infrequently and represents a serious complication with potentially adverse effects. The objective of this systemic review was to look at the incidence, risk factors, and preventative measures for broken spinal needles. A search of the literature on PubMed, Web of Science, and Embase databases and a manual web search was performed, with no filters and up to April 2023 from inception. Out of the 43 potential studies, 23 were included. The search terms for the full article reading were broken needle, spinal anesthesia, humans, and post-operative, and the exclusion criteria were systematic reviews, conference presentations, and non-full articles. A review of the 23 studies (24 cases) suggests an association between specific risk factors such as obesity and needle size and breaks. Identifying the risks and complications of needle breaks could help physicians modify their practice and inform their patients of any increased risks applicable to them.

Successful Management of a Broken Spinal Needle During Difficult Spinal Anesthesia: A Case Report.

Spinal anesthesia is the most common mode of anesthesia utilized during caesarian sections worldwide. Despite its many advantages over general anesthesia in the pregnant cohort, uncommon and even catastrophic complications could occur due to patient-related, equipment-related, and procedure-related complications. One such uncommon event of a broken spinal needle during failed spinal anesthesia for a caesarian section and subsequent successful management is described here.

Dermatofibrosarcoma Protuberans of the Scalp Mimicking Trichilemmal Cyst: A Case Report.

We present a case of a 47-year-old female with a swelling on her scalp that was at first thought to be trichilemmal cysts. After two years, she returned to her general practitioner with a larger scalp mass. Following a biopsy, histological analysis revealed dermatofibrosarcoma protuberans (DFSP). She then had the tumor completely removed, resulting in clean margins.

Anterior Cervical Huge Osteophyte Causing Dysphagia: A Case Report.

The prevalence of anterior cervical osteophyte among elderly patients is high due to many causes such as trauma, degenerative changes, and diffuse idiopathic skeletal hyperostosis. Severe dysphagia is one of the main presenting symptoms for anterior cervical osteophytes. We describe a case of a patient with anterior cervical osteophyte with severe dysphagia and quadriparesis. The 83-year-old man presented to the emergency department following the incident of falling on his face. CT and X-ray were done in the emergency department, which showed huge anterior osteophytes at the level of C3-4 compressing the esophagus. The patient's consent was taken and shifted to the operation room and surgery was done. Anterior cervical osteophyte was removed, a discectomy was performed, and a peek cage and screws were inserted for fusion. In many cases of anterior cervical osteophyte, surgery is considered the ultimate treatment for patients to relieve symptoms, improve quality of life, and decrease mortality.