Journal of Pediatric Neuroradiology - Volume 3, issue 4

Authors: Raets, M.M.A. | Govaert, P. | Goos, T.G. | Reiss, I.K.M. | de Jonge, R.C.J. | Dudink, J.

Article Type: Research Article

Abstract: AIM: Pilot study to explore feasibility of a color Doppler technique for monitoring cerebral perfusion at the level of microvessels. METHODS: Between March 1st, 2011, and January 30th, 2013, all admitted infants born before 29 weeks of gestation were eligible for Doppler imaging. Perfusion images were acquired in a standard coronal plane. Image quality was assessed by two authors (MR, PG). The region of interest (ROI) was manually selected. A segmentation tool was developed to separate color data from the greyscale 2D images, leading to a percentage and number of color pixels in the image (Doppler color index; DCI). Intra- …and inter-observer agreement was analyzed. RESULTS: Intra- and inter-observer agreement for placement of ROIs was good (bias −0.24 resp. −0.74 percentage points). Color Doppler was able to depict microvessels in cortex, white matter and deep grey matter. The median DCI in a region of cortex-white matter was 7.8% with a wide range (1.4%–25.6%). There was no significant difference between the left and right hemisphere (Mann-Whitney U, P-value 0.61). Clinically relevant observations were tabulated, e.g. distant effect of germinal matrix hemorrhage (GMH) on regional perfusion. CONCLUSION: Sonographic small vessel visualisation may help understand pathogenetic mechanisms related to perfusion and is valuable to monitor effects of treatment. Show more

Keywords: Preterm infant, microcirculation, cerebral, color Doppler imaging

DOI: 10.3233/PNR-14190

Citation: Journal of Pediatric Neuroradiology, vol. 3, no. 4, pp. 155-160, 2014

Authors: Sahni, Deshdeepak | Prasad, Prashant | Hadley, Caroline | Tran, Brandon H. | Fulkerson, Daniel H. | Hwang, Steven W. | Jea, Andrew

Article Type: Research Article

Abstract: Though pedicle screws are widely used in spinal stabilization, studies evaluating the variables affecting placement accuracy and effects of accuracy on outcome are limited. Using computed tomography (CT), we evaluated the accuracy of pedicle screw placement in pediatric and transitional patient populations. We evaluated screw placement in a series of 276 thoracic, lumbar, and sacral pedicle screws implanted in 41 patients with the assistance of fluoroscopy by a single surgeon at a single institution from September 1, 2007 to December 31, 2012. Postoperative CT was performed and each screw was graded based on relation to neurologic, osseous, and intra thoracic …and intra-abdominal landmarks by an independent neuro radiologist: Grade I, entirely intra pedicular; Grade II, violates lateral pedicle but screw tip entirely within the vertebral body; Grade III, tip penetrates the anterior or lateral vertebral body; Grade IV, breaches medial or inferior pedicle; and Grade V, violates pedicle or vertebral body and threatens spinal cord, nerve root, or great vessels, requires immediate revision or removal. The accuracy rate (Grades I and II) was lower than expected (76.8%). Screw misplacements (Grades III, IV, and V) were numerous (23.2%), although the overall complication rate remained low. There was no statistically significant difference in pedicle screw accuracy as a function of surgeon experience, patient age, or patient diagnosis. This suggests the need for advanced intraoperative imaging, such as neuronavigation or CT, to aid placement of spinal instrumentation in the pediatric and transitional patient population. While postoperative CT should be considered gold standard for evaluating pedicle screw placement, further study is warranted to evaluate overall accuracy and assess the need for more extensive intraoperative imaging to improve accuracy. Show more

Keywords: Pedicle screw, pediatric spine, computed tomography, pedicle screw accuracy

DOI: 10.3233/PNR-14193

Citation: Journal of Pediatric Neuroradiology, vol. 3, no. 4, pp. 161-169, 2014

Authors: Singh, Vineeta | Neil, Terry | Hetts, Steven W. | English, Joey D.

Article Type: Research Article

Abstract: Dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous shunts that occur in the dura of the central nervous system. Multiple DAVFs present in a nine year old girl with Cowden Syndrome (CS) diagnosis is presented in this article.

Keywords: DAVF, Cowden Syndrome, Vascular malformations

DOI: 10.3233/PNR-14187

Citation: Journal of Pediatric Neuroradiology, vol. 3, no. 4, pp. 171-174, 2014

Authors: Franceschi, Roberto | Agarwal, Nivedita | Savona, Valentina | Maines, Evelina | Bellizzi, Maria | Di Palma, Annunziata

Article Type: Research Article

Abstract: Grisel's syndrome (GS) is defined as a non-traumatic subluxation of the atlanto-axial joint and is considered a rare complication of infectious or inflammatory processes of the head and neck region due to upper respiratory tract infections or following surgical otolaryngeal interventions. The etiopathogenesis of this clinical entity is not yet clear. Early recognition of pediatric atlanto-axial subluxation (AAS) is essential to avoid permanent damage and requires a combination of clinical assessment and appropriate radiologic imaging. Computed tomography (CT) is considered gold standard in the diagnosis of GS. We report a case of a young child who presented with torticollis and …acute otitis media and discuss the potential role of magnetic resonance imaging (MRI) in first suggesting the diagnosis. A brief review of the literature is presented. Conclusion: radiologists should first consider MRI of the atlanto-axial joint in young patients with torticollis with a recent history of infection in the head and neck region. Show more

Keywords: Grisel syndrome, torticollis, non-traumatic atlanto-axial subluxation, magnetic resonance imaging, pediatric

DOI: 10.3233/PNR-14189

Citation: Journal of Pediatric Neuroradiology, vol. 3, no. 4, pp. 175-180, 2014

Authors: Chow, Maggie | Cooke, Daniel | Fullerton, Heather | Amans, Matthew | Narvid, Jared | Dowd, Christopher | Higashida, Randall | Halbach, Van | Hetts, Steven

Article Type: Research Article

Abstract: PURPOSE: Vein of Galen Malformations (VOGMs) are rare congenital arteriovenous fistulas that were previously associated with high mortality and morbidity prior to the advent of endovascular treatment approaches. The long-term functional outcome and quality of life of infants and children treated with these approaches, however, are not well characterized. METHODS: The long-term outcomes of a cohort of pediatric patients treated at University of California at San Francisco from 1986–2013 (N = 39) for their VOGMs were assessed using a self-report survey-based approach. The Pediatric Quality of life Inventory (PedsQL), the Functional Disability Inventory (FDI) and the World Health Organization Disability …Assessment Schedule 2.0 (WHODAS 2.0) were employed. The results of the surveys were analyzed. RESULTS: We received six surveys from three male and three female patients with a median age of 17.5 years (range 7–22 years). The median length of follow-up since first treatment was 17 years (range 5–19 years). The PedsQL summary scores of the patients in our sample were only slightly lower than norms from healthy controls (78.4 vs. 83.0). The cases in our sample were on an average mildly affected in the domains of physical health, emotional health, social functioning and school functioning. The FDI and WHODAS results revealed that survey respondents had minimal or no disability. CONCLUSION: The long-term neurodevelopmental outcomes of children with VOGM may be good following endovascular treatment. Better long-term follow up is needed, as evidenced by the low rate of survey response. Show more

Keywords: Vein of Galen Malformation, endovascular intervention

DOI: 10.3233/PNR-14191

Citation: Journal of Pediatric Neuroradiology, vol. 3, no. 4, pp. 181-189, 2014

Authors: Cohen, Harris L. | Choudhri, Asim F. | Raju, Anand D. | Samson, Jacques | Mabry, Lisa M. | Thompson, Jerome W.

Article Type: Research Article

Abstract: A lingual ranula is a rare cystic lesion of the tongue. Ranulas are typically sublingual mucoceles. We report perhaps the first lingual ranula identified in a fetus. It was identified by ultrasound and confirmed by magnetic resonance imaging. Knowledge of the presence of such a large intraoral mass antenatally allows diagnosis, monitoring, assessment of potential airway compromise and delivery planning. The possibility of impending airway compromise caused the planning of an ex-utero intrapartum treatment (EXIT) procedure performed at delivery. Identification of tongue tissue below a cystic intraoral mass suggests a lingual rather than a sublingual origin, a finding which helps …stratify the differential diagnosis. Show more

Keywords: Ranula, fetal, magnetic resonance, ultrasound, tongue

DOI: 10.3233/PNR-14192

Citation: Journal of Pediatric Neuroradiology, vol. 3, no. 4, pp. 191-195, 2014

Authors: Berry, Kristen | Shuh, Kevin | Blackmon, Karen | Devinsky, Orrin | Carlson, Chad | Kuzniecky, Ruben | Doyle, Werner | Thesen, Thomas

Article Type: Research Article

Abstract: We present a case of functional reorganization of the somatosensory system in a 15 year-old female with a history of perinatal stroke of the middle cerebral artery. The patient presented with hemiparesis and epilepsy and underwent comprehensive pre-surgical evaluation for epilepsy surgery, including mapping of somatosensory function with functional magnetic resonance imaging (fMRI). The fMRI results indicated inter-hemispheric reorganization of somatosensory function from the left to the right hemisphere, and showed no residual somatosensory function in the peri-lesional area of the affected left hemisphere. However, following implantation of subdural electroencephalography (EEG) electrodes, recordings from left hemisphere lesional and peri-lesional areas …showed evoked electrophysiological responses to tactile stimulation. Bedside and intra-operative stimulation mapping confirmed multiple somatosensory responsive sites in the left hemisphere in or near the lesion, in contradiction of the fMRI results. Since the BOLD signal is a measure of the local ratio of oxygenated to deoxygenated blood, fMRI represents only an indirect measure of neuronal activity. Modeling of fMRI activation depends on intact neurovascular coupling and adequate signal to noise ratios, which may be altered in the presence of a vascular lesion. Our results suggest that pre-surgical mapping of cortical function with fMRI can be unreliable in the presence of a vascular lesion and can lead to false-negative results. In such cases, direct measures of electrophysiological activity, such as electrocorticography, scalp EEG and MEG should be preferred. Show more

Keywords: Functional imaging, stroke, electrical stimulation, epilepsy surgery, evoked potentials

DOI: 10.3233/PNR-14188

Citation: Journal of Pediatric Neuroradiology, vol. 3, no. 4, pp. 197-202, 2014

Article Type: Other

Citation: Journal of Pediatric Neuroradiology, vol. 3, no. 4, pp. 203-205, 2014

Article Type: Other

Citation: Journal of Pediatric Neuroradiology, vol. 3, no. 4, pp. 207-208, 2014