Biomedical subjects

Francesco T Mangano

Publications and source records attributed to Francesco T Mangano.

3 recordsLinked to original sources

PubMed2006

Simultaneous image-guided and endoscopic navigation without rigid cranial fixation: application in infants: technical case report.

OBJECTIVE AND IMPORTANCE: Infants and young children demonstrate a variety of intraventricular and periventricular lesions. Endoscopy has proven useful in the treatment of many of these lesions, but its benefit is limited if it is applied to complex loculated cysts or if the disease is concealed by normal ependymal boundaries. In adults and older children, endoscopy can be augmented by the simultaneous use of frameless stereotaxy, but this combined modality has not been possible in infants and young children without rigid cranial fixation. We describe a method of achieving simultaneous stereotactic and endoscopic navigation in infants and young children by using a pinless, frameless stereotactic assembly. CLINICAL PRESENTATION: The first patient was a 6-week-old boy with macrocephaly and a bulging fontanelle. Computed tomographic and magnetic resonance imaging revealed a complex arachnoid cyst and obstructive hydrocephalus. The second patient was a 7-month-old, ex-premature (27-wk gestational age) boy who developed posthemorrhagic hydrocephalus. He underwent multiple shunt revisions, one of which was complicated by enterococcal ventriculitis. Despite bilateral ventriculoperitoneal shunts, he developed increasing head circumference, listlessness, and irritability. Imaging revealed an enlarged, multiloculated, and asymmetric ventricular system. INTERVENTION: Simultaneous image-guided and endoscopic neuronavigation was implemented in both patients. Before the procedure, a cranial reference arc was secured to the outer table of the cranium through a small incision adjacent to the operative field. After the stereotactic apparatus was registered, the software was used to plan a trajectory for the approach. A burr hole was then made, and a rigid 6-mm endoscope was inserted for direct visualization. Once advanced past the endoscopic port tip, the electromagnetic coil stylet was used to stereotactically track position and identify areas for fenestration, biopsy, and catheter insertion. CONCLUSION: Endoscopic views of complex hydrocephalus and arachnoid cysts alone are often difficult to interpret. Simultaneous image-guided and endoscopic neuronavigation may be advantageous in the management of complex cases that are anatomically related to the ventricular system in infants for whom rigid cranial fixation could lead to increased procedure-related morbidity.

Brain Diseases↗

PubMed2006

Pediatric neurosurgical injuries associated with all-terrain vehicle accidents: a 10-year experience at St. Louis Children's Hospital.

OBJECT: All-terrain vehicles (ATVs) have been characterized as inherently unstable and are associated with significant pediatric injuries in the US. The authors performed a study to analyze data obtained in pediatric patients who had sustained neurological injuries in ATV-related accidents, identify potential risk factors, and propose preventive measures. The study is based on a 10-year experience at the St. Louis Children's Hospital. METHODS: The authors retrospectively analyzed data obtained in all patients admitted to the St. Louis Children's Hospital between 1993 and 2003, limiting their focus to pediatric cases involving ATV-related accidents. A total of 185 patients were admitted with these criteria. Sixty-two patients (33.5%) suffered neurological injuries; there were 42 male and 20 female patients whose age ranged from 2 to 17 years. The most common injuries included skull fracture (37 cases) and closed head injury (30 cases). There were 39 cases of intracranial hemorrhage and 11 of spinal fracture. A total of 15 types of neurosurgical procedure were performed: six craniotomies for hematoma drainage, five craniotomies for elevation of depressed fractures, two procedures to allow placement of an intracranial pressure monitor, one to allow placement of an external ventricular drain, and one to allow the insertion of a ventriculoperitoneal shunt. Two patients had sustained spinal cord injury, and three procedures were performed for spinal decompression or stabilization. The duration of hospital stay ranged from 1 to 143 days (mean 6.6 days). Fifty-seven patients (30.8%) were eventually discharged from the hospital, three (1.6%) were transferred to another hospital, two (1.1%) died, and 123 (66.4%) required in-patient rehabilitation. CONCLUSIONS: Children suffered significant injuries due to ATV accidents. In passengers there was a statistically significant increased risk of neurological injury. The relative risk of neurological injury in patients not wearing helmets was higher than that in those who wore helmets, but the difference did not reach statistical significance. Further efforts must be made to improve the proper operation and safety of ATVs, both through the education of parents and children and through the creation of legislation requiring stricter laws concerning ATV use.

Adolescent↗

PubMed2005

Early programmable valve malfunctions in pediatric hydrocephalus.

OBJECT: The use of adjustable differential pressure valves has been recommended to improve ventriculoperitoneal (VP) shunt performance in selected patients; however, published data are scarce regarding their clinical reliability. Recently, the identification of a number of malfunctioning programmable valves during shunt revision surgery in children prompted a retrospective review of valve performance in this patient cohort. METHODS: The authors performed a retrospective chart analysis of 100 patients with programmable valve shunts and 89 patients with nonprogrammable valve shunts implanted at the St. Louis Children's Hospital between April 2002 and June 2004. They noted the cause of hydrocephalus, the type of shunt malfunction, and cerebrospinal fluid (CSF) protein levels. Regular clinical follow up ranged from 1 to 26 months, with a mean follow-up time of 9.75 months for patients with programmable valves and 10.4 months for patients with nonprogrammable valves. Patient ages ranged from 2 weeks to 18 years. One hundred patients had 117 programmable valves implanted, and 35 of these patients (35%) underwent shunt revision because of malfunction. The programmable valve itself malfunctioned in nine patients who had undergone shunt revision (11.1%/year of follow up). The nonprogrammable valve group had no valve malfunctions. The overall VP shunt revision rate in the nonprogrammable valve group was 20.2%. No significant differences were identified when CSF protein levels and specific malfunction types were compared within the programmable valve and nonprogrammable valve groups. CONCLUSIONS: In this study the authors demonstrated an annualized intrinsic programmable valve malfunction rate of 11.1%, whereas during the same period no intrinsic valve malfunctions were noted with nonprogrammable valve systems for similar causes of hydrocephalus. The CSF protein levels did not correlate with observed valve malfunction rates. Further evaluation in a prospective, randomized fashion will elucidate specific indications for programmable valve systems and better determine the reliability of these valves in the pediatric population.

Adolescent↗