Pre- Versus Post-Tonsillectomy Intraoperative Bupivacaine Injection in the Pediatric Population: An Age- and Surgical Indication-Stratified Analysis.

gnorimies20.15 shared this article with you from Inoreader Pre- Versus Post-Tonsillectomy Intraoperative Bupivacaine Injection in the Pediatric Population: An Age- and Surgical Indication-Stratified Analysis. Via pubmed: "ear nose throat j"[... Pre- Versus Post-Tonsillectomy Intraoperative Bupivacaine Injection in the Pediatric Population: An Age- and Surgical Indication-Stratified Analysis. Ear Nose Throat J. 2020 Oct 23;:145561320968926 Authors: Ji KSY, Greene NH, Eapen RJ, Commesso E, Raynor EM Abstract OBJECTIVES: Postoperative respiratory depression is of concern in children undergoing adenotonsillectomy receiving postoperative opioids and may be mitigated with intraoperative bupivacaine. This study aims to compare the impact of bupivacaine on postoperative pain and sedation in various pediatric age and surgical indication subgroups. METHODS: This is a case series with chart review of 181 patients <18 years old undergoing adenotonsillectomy at a tertiary care center (2013-2016). Postoperative outcomes were compared between those who received intraoperative bupivacaine before (pre-tonsillectomy) or after (post-tonsillectomy) tonsil removal and those who did not (none) using χ2 test and analysis of variance. Subanalysis was performed after stratifying into age and surgical indication subgroups. RESULTS: Ninety-eight patients were included in the pre-tonsillectomy group, 47 in the post-tonsillectomy group, and 36 in the none group. The number of postanesthesia care unit opioid doses (P = .159) and pain scores at arrival (P = .362) or discharge (P = .255) were not significantly different between treatment groups overall. Among 0- to 5-year-olds, pre-tonsillectomy injection was associated with lowest mean (SD) discharge pain score of 0.55 (1.29) pre-tonsillectomy versus 0.71 (1.37) post-tonsillectomy versus 2 (1.63) none group (P = .004). Among 12- to 17-year-olds, no injection was associated with lowest mean (SD) discharge pain score of 2.33 (0.52) pre-tonsillectomy versus 5 (2.65) post-tonsillectomy versus 1.63 (1.60) none group (P = .020). Injection in patients with obstructive sleep apnea and/or sleep-disordered breathing did not improve postoperative outcomes. CONCLUSION: Intraoperative bupivacaine may improve pain scores in younger pediatric populations, though it may not impact the amount of postoperative opioid use. Prospective analysis with a larger sample size is warranted to better outline opioid usage and pain control in this group. PMID: 33095665 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Traumatic Stapediovestibular Dislocation With Intact Stapes: Report and Review.

gnorimies20.15 shared this article with you from Inoreader Traumatic Stapediovestibular Dislocation With Intact Stapes: Report and Review. Via pubmed: "ear nose throat j"[... Traumatic Stapediovestibular Dislocation With Intact Stapes: Report and Review. Ear Nose Throat J. 2020 Oct 23;:145561320968925 Authors: Ren Q, Su J, Si J, Li Y, Ding X Abstract Stapediovestibular dislocation is a rare disorder as a result of traumatic injury to the structures in the middle ear. We described a case of a 60-year-old female with stapediovestibular dislocation with associated perilymph fistula. She presented with symptoms including hearing loss, vertigo, and tinnitus after a penetrating injury by an ear pick. After 4 months of conservative management, her symptoms failed to improve. Therefore, she underwent surgery which resolved completely her vestibular symptoms and her hearing loss had partially improved. The restoration of the stapes to its normal anatomical position coupled with ossiculoplasty and closure of the tympanic membrane are effective in patients with stapediovestibular dislocation. PMID: 33095666 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pneumocephalus causing oculomotor nerve palsy: A case report.

gnorimies20.15 shared this article with you from Inoreader Pneumocephalus causing oculomotor nerve palsy: A case report. Via leak of cerebrospinal fluid Pneumocephalus causing oculomotor nerve palsy: A case report. Surg Neurol Int. 2020;11:302 Authors: Goodrich ME, Wolberg AM, Kashyap S, Podkovik S, Bernstein J, Iv JW, Sweiss R Abstract Background: Pneumocephalus, the presence of gas or air within the intracranial cavity, is a common finding after cranial procedures, though patients often remain asymptomatic. Rare cases of cranial nerve palsies in patients with pneumocephalus have been previously reported. However, only two prior reports document direct unilateral compression of the third cranial nerve secondary to pneumocephalus, resulting in an isolated deficit. Case Description: A 26-year-old male developed a unilateral oculomotor (III) nerve palsy after repair of a cerebrospinal fluid leak. The pneumocephalus was treated with a combination of an epidural drain, external ventricular drain (EVD), and high-flow oxygen. Following treatment, repeat computed tomography imaging of the head demonstrated that the pneumocephalus was progressively resorbed and the patient's deficit resolved. Conclusion: In rare cases, isolated cranial nerve palsies, specifically of the third cranial nerve, can result from pneumocephalus following cranial procedures. Acute cranial nerve palsy secondary to pneumocephalus will often resolve without intervention as the air is resorbed, but direct decompression with an epidural drain and an EVD may expedite the resolution of deficits. PMID: 33093979 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Acute subdural hematoma recurrence during drain removal associated with spontaneous intracranial hypotension - A non-reported complication.

gnorimies20.15 shared this article with you from Inoreader Acute subdural hematoma recurrence during drain removal associated with spontaneous intracranial hypotension - A non-reported complication. Via leak of cerebrospinal fluid Acute subdural hematoma recurrence during drain removal associated with spontaneous intracranial hypotension - A non-reported complication. Surg Neurol Int. 2020;11:316 Authors: Perez-Vega C, Robles-Lomelin P, Robles-Lomelin I, Diaz-Alba A, Navarro VG Abstract Background: Spontaneous intracranial hypotension (SIH) is an uncommon, benign, and generally self-limiting condition caused by low cerebrospinal fluid (CSF) volume and pressure usually caused by a CSF leak. Patients with SIH have an increased incidence of subdural hematomas (SDH), which may be bilateral and recurrent. Case Description: We report a unique case of a man presenting with SIH and bilateral SDH that were drained with bilateral craniotomies. During drain removal, the patient had an acute neurological deterioration and a CT scan showed SDH recurrence. The patient had two new recurrent SDH afterwards. After the third surgical intervention, the drain was removed in the OR with concomitant subdural saline infusion, there was no recurrence of SDH after that and the patient has had no further complications after a 2-year follow-up. Conclusion: Patients with intracranial hypotension are predisposed to form SDH. In this case, drain removal caused further decrease in intracranial pressure and triggered a new SDH formation, subdural saline irrigation masked atmospheric pressure and prevented this complication from happening again. PMID: 33093993 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cervical meningioma resection including the inner dura through an open-door laminoplasty using hydroxyapatite spacers: A case report.

gnorimies20.15 shared this article with you from Inoreader Cervical meningioma resection including the inner dura through an open-door laminoplasty using hydroxyapatite spacers: A case report. Via leak of cerebrospinal fluid Cervical meningioma resection including the inner dura through an open-door laminoplasty using hydroxyapatite spacers: A case report. Surg Neurol Int. 2020;11:317 Authors: Miyakoshi N, Hongo M, Kasukawa Y, Ishikawa Y, Kudo D, Shimada Y Abstract Background: The ideal surgery for spinal cord tumors is complete resection to prevent recurrence. However, it should be accomplished safely/effectively without risking increased morbidity. Here, we report a cervical meningioma that was totally resected, including the inner dura, through a laminoplasty performed with hydroxyapatite (HA) spacers. Case Description: A 61-year-old Asian male presented with a symptomatic intradural extramedullary C4-C6 cervical meningioma. At surgery, this required resection of the inner dural layer through an open-door laminoplasty. Preservation of the outer dural layer facilitated a watertight closure and the avoidance of a postoperative cerebrospinal fluid (CSF) fistula. Notably, the laminoplasty utilized HA spacers which were magnetic resonance (MR) compatible allowing for future follow-up studies to evaluate for tumor recurrence. At 5-year follow-up, the tumor had not recurred, the patient was asymptomatic, and alignment was maintained. Conclusion: Gross total resection of an intradural extramedullary C4-C6 cervical meningioma was performed with removal of just the inner dural layer. Preservation of the outer dural layer allowed for a watertight closure and the avoidance of a postoperative CSF leak. Further, laminoplasty using HA spacers allowed for successful tumor resection, adequate fusion/stabilization, while not interfering with future MR studies (e.g., HA MR compatible). PMID: 33093994 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intracranial Hypotension in the Setting of Post-Concussion Headache: A Case Series.

gnorimies20.15 shared this article with you from Inoreader Intracranial Hypotension in the Setting of Post-Concussion Headache: A Case Series. Via leak of cerebrospinal fluid Intracranial Hypotension in the Setting of Post-Concussion Headache: A Case Series. Cureus. 2020 Sep 18;12(9):e10526 Authors: Pettyjohn EW, Donlan RM, Breck J, Clugston JR Abstract Intracranial hypotension can be a common sequela of a cerebrospinal fluid (CSF) leak. However, evidence of such a condition related to an injury in American football is currently lacking in the literature. While a positional or orthostatic headache is the most classic symptom of headaches due to intracranial hypotension, a variety of nonspecific symptoms such as neck pain, nausea, vomiting, photophobia, phonophobia, and visual changes can also be present. We present two cases where collegiate American football players developed protracted headaches after a concussive injury and were subsequently diagnosed with intracranial hypotension thought secondary to spinal CSF leaks.  Both players underwent multiple procedures of fluoroscopic-guided autologous blood patching, with improvement in their headaches. Recovery varied between the athletes. Case 1 achieved full resolution of his headaches and returned to full activity. Case 2 continued to have intermittent headaches a fter blood patching, but the positional nature had resolved and he was cleared for full participation in football and was closely followed during the remainder of his collegiate career. Both these cases emphasize the importance of including CSF leak as a cause of post-traumatic headache in an American football player. PMID: 33094067 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Changes in auditory function in premature children: A prospective cohort study.

gnorimies20.15 shared this article with you from Inoreader Changes in auditory function in premature children: A prospective cohort study. Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Changes in auditory function in premature children: A prospective cohort study. Int J Pediatr Otorhinolaryngol. 2020 Oct 17;139:110456 Authors: Savenko IV, Garbaruk ES, Krasovskaya EA Abstract OBJECTIVES: To analyze the age-specific pattern of auditory function in preterm children as a function of their gestational age at birth. STUDY DESIGN: longitudinal cohort study. METHODS: a prospective cohort study involved 271 preterm children aged from 6 months to 15 years old. Children were divided into two groups: 70 children with a gestational age at birth of 32-36 weeks (Group 1) and 201 children with a gestational age of 22-31 weeks (Group 2). Hearing was assessed by ABR, ASSR, OAE, behavioral audiometry, and pure tone audiometry. Additionally, for some children, CT, MRI, and GBJ2 evaluations were performed. Assessments of hearing impaired children were performed 3-4 times a year for children under 2 years of age; 2-3 times a year for children from 2 to 5 years of age; and 1-2 times a year for children over 5 years of age. Infants without any hearing problems were examined 2-3 times during their first year of life, followed by annual examinations as they aged. RESULTS: The initial hearing examination identified SNHL and ANSD in 18 children (25.7%) and 64 children (31.8%) in Group 1 and Group 2, respectively. No significant difference in the occurrence of auditory impairment in the two groups was found at the initial assessment (p > 0.05). Further long-term follow-up revealed changes in hearing in 16 children: 15 from Group 2 and only one child from Group 1. Four different kinds of hearing changes were noted: hearing recovery to normal levels in children with ANSD; late onset hearing loss; the transformation of ANSD to SNHL, and vice versa. The age, factors, and possible mechanisms of such changes are discussed in the article. CONCLUSION: The auditory function in prematurely born children tends to be unstable, especially at a very early age. In very preterm infants, it may either deteriorate or improve. Infants born before 31 weeks' gestation require long-term follow-up at least until they are 3-4 years of age. Caution is advised regarding very early cochlear implantation for children born before 32 weeks of gestation age. PMID: 33096380 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.