Objective To investigate the clinical features of acute traumatic subdural hematomas (SDH) in infants and discuss the treatment methods. Methods The clinical features of 48 infants under three years old with acute traumatic SDH admitted from 2002 to 2008 were retrospectively analyzed.Results There were 31 infants under one year old (65%). The most popular injury cause was accidental fall in 37 patients (77%). Of all patients, 12 patients (25%) had disturbance of consciousness,eight ( 17% ) had convulsion and eight ( 17% ) were combined with skull fractures. The treatment methods included craniotomy and evacuation of the blood clot in 18 patients ( including 13 patients underwent instant operation after admission ), burr hole craniotomy and external drainage of the chronic subdural hematoma in seven and conservative management in 23 with small subdural hematomas. All patients obtained good outcome except that two patients had motor dysfunction and one death. Conclusions The incidence of acute traumatic SDH in infants is high, especially in infants under one year old. It is easy to be disregarded at early stage and may deteriorate to chronic subdural hematoma or hydropsy. Early diagnosis and active surgical treatment may attain sound prognosis.

Objective To explore the clinical characteristics of posttraumatic cerebral massive infarction in children. Methods 68 cases were reviewed. Results There were 43 cases complicated with subarachnoid hemorrhage, 37 with brain contusion, 48 with fracture of skull,and the hematoma was subdural in 29 cases, epidural in 16 cases, and intracerebral in 14 cases. Other complications included fracture of limbs (24/68), thoracic or abdominal injury (15/68), and hemorrhagic shock (30/68). The infarction were found mostly in the first 7 d (range 2 h~13 d), and 32 cases within 4~7 d after the trauma. The outcome when discharged (according to the Glasgow outcome scale) was good recovery in 32 cases, moderate disability in 15 cases, severe disability in 9 cases, vegetative state in 4 cases, and 8 cases died. Conclusion The feature of the posttraumatic cerebral massive infarction in children is usually concealed by primary injury. CT and MRI are the bases for diagnosis.The outcome may be better than in the adults when early diagnosis and intervention has been produced.

OBJECTIVETo explore the management of obstructive hydrocephalus caused by posterior fossa tumors before tumor resection in children.

METHODSThe clinical data were reviewed of 162 pediatric patients of posterior fossa tumors with obstructive hydrocephalus undergoing surgical tumor removal between January 2008 and June 2012. Ninety children received preoperative Ommaya external drainage (group A) and 72 underwent preoperative ventriculo-peritoneal shunting (V-Ps) (group B). The therapeutic effects were evaluated and compared between the two groups.

RESULTSPostoperative complications found in a total of 67 cases including infection (27), shunt blockage (19), subdural hematoma or effusion (16), ventricle fissure syndrome (5), and tumor hernia (4). Significant differences were found in the incidences of shunt blockage (P=0.047) and subdural hematoma or effusion (P=0.039) but not in the incidences of intracranial infection (P=0.478) or tumor hernia (P=0.462) between the two groups.

CONCLUSIONOmmaya reservoir can produce good results through simple surgical procedures for treatment of acute hydrocephalus in children with posterior fossa tumors and is associated less trauma and complications.

Adolescent ; Astrocytoma ; complications ; surgery ; Brain Diseases ; etiology ; Child ; Child, Preschool ; Drainage ; adverse effects ; methods ; Female ; Hematoma, Subdural ; etiology ; Humans ; Hydrocephalus ; etiology ; surgery ; Infant ; Infection ; etiology ; Infratentorial Neoplasms ; complications ; surgery ; Male ; Medulloblastoma ; complications ; surgery ; Preoperative Period ; Retrospective Studies ; Ventriculoperitoneal Shunt ; adverse effects