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Pediatric Neurosurgery - part 5

Trẻ em cho thấy ít hoặc không phục hồi tự phát của 3 tháng tuổi nên trải qua EMG nghiên cứu thần kinh dẫn truyền và hình ảnh sống-kênh MRI hay CT chụp tuỷ. Sau đó là hữu ích để xác định pseduomeningoceles tại trang web của sự nhổ lên rễ thần kinh. Thăm dò đám rối cánh tay được thực hiện với thử nghiệm dẫn truyền thần kinh intraoperative EMG | 94 Pediatric Neurosurgery Erb-Duchenne-Klumpke Paralysis Total brachial plexus injury results in flail arm. Prognosis for recovery is relatively poor. 3 Management Children showing little or no spontaneous recovery by the age of 3 months should undergo EMG nerve-conduction studies and spinal-canal imaging by MRI or CT myelography. The latter is useful to identify pseduomeningoceles at the site of nerve root avulsion. Brachial plexus exploration is undertaken with intraoperative EMG nerve-conduction testing. Involved brachial plexus elements may be surgically treated with neurolysis neuroma excision and nerve grafting as indicated. Eighty percent to 90 of children with Erb s palsy will attain good or excellent functional shoulder recovery with expectant and or operative management. Conclusions Although potentially devastating nervous system trauma in children should be aggressively and wisely managed with the hope of attaining an excellent outcome. While there are many similarities between the management of adult and pediatric neurotrauma physiological sociological and psychological differences must be recognized and expert pediatric neurosurgical care made available. Care of the neuro-logically injured child also poses dramatic ethical challenges. Excellent communication between doctor patient family and all members of the trauma-care team will contribute to optimal outcome. Suggested Readings 1. Adelson PD Bratton SL Carney NA et al. Guidelines for the acute medical management of severe traumatic brain injury in infants children and adolescents. Pediatr Crit Care Med 2003 4 3 Suppl . 2. Carney N and the committee for Traumatic Brain Injury Outcomes Research Oregon Health Sciences University 1999 . Rehabilitation for traumatic brain injury in children and adolescents. Agency for Health Care Policy and Research. Washington D.C. 3. Committee for Severe Head Injury Guidelines of the Brain Trauma Foundation AANS and Joint Section on Neurotrauma and Critical Care 1995 .