Glass foreign body in the spinal canal of a child: case report and review of the literature.

Retained foreign bodies pose a risk to the patient from the perspective of potential morbidity. We describe a previously healthy 8-year-old boy with head and back trauma from a glass picture frame that fell off the wall. He sustained a closed head injury and a back laceration several centimeters lateral to the spine. A persistent drainage from the back laceration contained glucose and protein levels consistent with cerebral spinal fluid. A foreign body was easily visible on subsequent plain radiograph. The glass foreign body was removed by neurosurgeons after computed tomography and magnetic resonance imaging clarified the exact location of the glass fragment. Physicians should have a low threshold for obtaining plain radiographs in patients with glass foreign bodies and consider that projectiles may rest some distance from the laceration site.

Chiari Type II malformation: past, present, and future.

OBJECT: The Chiari Type II malformation (CM II) is a unique hindbrain herniation found only in patients with myelomeningocele and is the leading cause of death in these individuals younger than 2 years of age. Several theories exist as to its embryological evolution and recently new theories are emerging as to its treatment and possible prevention. A thorough understanding of the embryology, anatomy, symptomatology, and surgical treatment is necessary to care optimally for children with myelomeningocele and prevent significant morbidity and mortality. METHODS: A review of the literature was used to summarize the clinically pertinent features of the CM II, with particular attention to pitfalls in diagnosis and surgical treatment. CONCLUSIONS: Any child with CM II can present as a neurosurgical emergency. Expeditious and knowledgeable evaluation and prompt surgical decompression of the hindbrain can prevent serious morbidity and mortality in the patient with myelomeningocele, especially those younger than 2 years old. Symptomatic CM II in the older child often presents with more subtle findings but rarely in acute crisis. Understanding of CM II continues to change as innovative techniques are applied to this challenging patient population.

Neurointensive care of the nonaccidentally injured child.

Childhood victims of NAT with severe brain injury require a multidisciplinary approach to their management if a good outcome is to occur. Despite the grave prognosis of these patients, an initial aggressive treatment strategy is warranted, because enough children go on to a meaningful life. A vigilant evaluation for multisystem injuries and vigorous resuscitation should be followed by prompt surgical intervention as indicated. Most NAT victims do not require surgical treatment of their brain injury, but do require ICP monitoring. A stepwise approach to the treatment of elevated ICP optimizes CPP, minimizes secondary brain injury, and increases the chances of a meaningful recovery. The future holds promise for these patients because a concerted effort is underway to understand pediatric TBI on a molecular level, and targeted therapies based on current basic research will certainly improve the neurointensive care, and eventual neurologic outcomes, of these children.

Delayed intracranial migration of cervical sublaminar and interspinous wires and subsequent cerebellar abscess. Case report.

Delayed complications associated with sublaminar and interspinous wiring in the pediatric cervical spine are rare. The authors present a case of delayed complication in which a cervical fusion wire migrated into the cerebellum, causing subsequent cerebellar abscess 2 years after posterior cervical arthrodesis. A craniotomy was required to remove the wire and drain the abscess. Despite their history of safety and successful fusion, procedures involving sublaminar and interspinous wiring carry a risk of neurological injury secondary to wire migration. A thorough neuroimaging evaluation is required in patients who have undergone fusion and who have neurological complaints to detect late instrumentation-related sequelae.