ABSTRACT
BACKGROUND: Macrocephaly is present in 2.3% of children with important neurosurgical conditions in the differential diagnosis. The objective of this study was to identify clinical associations with actionable imaging findings among children with head imaging for macrocephaly. METHODS: We conducted a case-control study of head imaging studies ordered for macrocephaly among children 24 months and younger in a multistate children's health system. Four neurosurgeons reviewed the images, determining cases to be a 'concern' if neurosurgical follow-up or intervention was indicated. Electronic health records were reviewed to collect patient-level data and to determine if surgery was performed. Controls were matched 3:1 to cases of 'concern' in a multivariate model using conditional logistic regression. RESULTS: In the study sample (n = 1293), 46 (4%) were concern cases, with 15 (1%) requiring surgery. Significant clinical factors associated with neurosurgical concern were bulging fontanel [aOR 7.47, (95% CI: 2.28-24.44), P < 0.001], prematurity [aOR 21.26, (95% CI: 3.76-120.21), P < 0.001], any delay [aOR 2.67, (95% CI: 1.13-6.27), P = 0.03], and head-weight Z-score difference (W_diff, defined as the difference between the Z-scores of head circumference and weight) [aOR 1.70, (95% CI: 1.22-2.37), P = 0.002]. CONCLUSIONS: Head imaging for macrocephaly identified few patients with findings of concern and fewer requiring surgery. A greater head-weight Z-score difference appears to represent a novel risk factor for neurosurgical follow-up or intervention.
Subject(s)
Megalencephaly , Humans , Child , Child, Preschool , Case-Control Studies , Megalencephaly/diagnostic imaging , Megalencephaly/surgery , Tomography, X-Ray Computed , Risk Factors , CephalometryABSTRACT
Ventriculoperitoneal (VP) shunts are frequently placed for the treatment of hydrocephalus. Shunt complications are a common occurrence typically involving infection, disconnections, or blockages. Abdominal complications involving the intraperitoneal portion of the catheter are rare. Spontaneous peritoneal knot formation involving the bowel with subsequent obstruction is even rarer. Spontaneous knot formation of a VP shunt is also not commonly seen in the adult population. In this report, we present the case of an 18-year-old male with cerebral palsy and hydrocephalus requiring VP shunt placement who developed a spontaneous knot leading to bowel obstruction requiring emergency laparoscopic surgery.
Subject(s)
Cranial Sutures/surgery , Craniosynostoses/diagnosis , Craniosynostoses/surgery , Craniotomy/methods , Age Factors , Craniosynostoses/classification , Craniosynostoses/complications , Diagnosis, Differential , Endoscopy , Humans , Hydrocephalus/etiology , Hydrocephalus/surgery , Infant , Optic Atrophy/etiology , Optic Atrophy/prevention & control , Plagiocephaly, Nonsynostotic/diagnosis , Plastic Surgery Procedures/methods , Ventriculoperitoneal ShuntABSTRACT
INTRODUCTION: We report a case of shunt malfunction after a child was subjected to G forces during a roller coaster ride. DISCUSSION: The temporal sequence of events suggests proximal catheter obstruction with subsequent symptoms of raised intracranial pressure immediately after experience with a G force ride. A shunt revision with catheter change led to resolution of symptoms, and findings were consistent with hemorrhage within the catheter. CONCLUSION: This case illustrates the risks of such an experience on children with shunts and the implications for patient counseling.
