Abstract Study Objective To describe our 10 years of experience with childhood choroid plexus tumors (CPTs). Design Retrospective chart analysis. Setting Operating room and pediatric intensive care ...unit (PICU) of a university hospital. Patients 18 infants and children undergoing CPT surgery from 1995 to 2004, 11 of whom were younger than 12 months. Measurements Perioperative hematologic and coagulation data were measured as well as estimated red cell volume variations (as a reliable index of blood loss) in the perioperative period, together with coagulation parameters. Results Greater blood loss was recorded in the infant group vs older children (percentage of estimated red cell volume loss, 1.31 ± 1.79% vs 0.20 ± 0.17% P < 0.01 and 1.50 ± 1.86% vs 0.29 ± 0.21% P < 0.01 on PICU admission and after 72 hours, respectively). Platelet count decrease was similarly noted (51.60 ± 28.06 vs 27.57 ± 11.98, P < 0.05, as percentage of preoperative count). Patients operated on in the neonatal period showed the highest blood loss and related coagulation impairment. Conclusion Younger CPT surgery patients present an increased risk versus their older counterparts of massive bleeding resulting in hemodynamic instability and coagulative impairment.
Abstract Background Single suture craniosynostoses were long considered a benign condition with little risk of complications. In many cases, parents may forgo surgical correction because of the ...inherent risks of surgical intervention. Case Description We report 2 cases of uncorrected sagittal synostosis associated with the development of Chiari malformations with syringomyelia later in life. To our knowledge, this is the first report of symptomatic Chiari malformations associated with uncorrected sagittal synostosis. We discuss mode of presentation and management in each case. We propose that these patients either have a pathophysiological predisposition to Chiari malformations based on the compensatory bone growth pattern in sagittal synostosis resulting in craniocephalic disproportion or that there may be an underlying genetic alteration accounting for the association of the 2 processes. Conclusions Further investigations are warranted to investigate whether the incidence of Chiari malformations is decreased in patients who have undergone early correction of an isolated sagittal synostosis. We conclude that patients with sagittal synostosis should be evaluated for Chiari malformations before being discharged permanently from a neurosurgical practice.
