Objective To investigate the diagnosis,treatment and prognosis of isolated epidural hematoma (EDH) in children.Methods Clinical data of 83 children,45 males and 38 females (at age of 0.7-14 years),with EDH treated between January 2012 and October 2014 were retrospectively reviewed.Slipping and falling were the most commonly causes of injury.While motor-vehicle accident was noted with increased age.In 16 patients lesion of hematoma was frontal,in 28 patients temporal,in 13 patients parietal,in 9 patients occipital and in 17 patients posterior fossa.Results Of the 28 patients treated surgically,the outcome evaluated using the Glasgow Outcome Score (GOS) was good in 22 patients,mild disability in 2,moderate and severe disability in 1 and death in 3 (one died of venous sinus rupture and one large area infarction).Of the 55 patients treated conservatively,the outcome was good in 52 patients,mild disability in 1,and death in 2 (both presented with bilateral cerebral hernia on admission and one of them was unable to breath spontaneously).Conclusions Overall prognosis of the patients with isolated EDH in children is excellent.Complications of venous sinus rupture,foramen magnum hernia and large area cerebral infarction may contribute to poor prognosis.

Objective To analyze the clinical characteristics of children massive cerebral infarction after traumatic brain injury. Methods The clinical data of 33 children with massive cerebral infarction after traumatic brain injury were retrospectively analyzed. Results Among the 33 children, 24 cases suffered from falling, 10 cases were involved in traffic accidents, 1 case suffered from violence and 1 case was hit by falling object. The massive cerebral infarction occurred in all objects: 9 cases in 1 day after head trauma, 14 cases in 1 - 3 days, 7 cases in 4 - 7 days, and 3 cases after 7 days. Eighteen patients were performed operation to evacuate the intracranial hematoma and decompression. Antiplatelet agents, calcium antagonist and low molecular dextran were administered in all patients after exclusion of bleeding tendency. The follow-up period of all children ranged from 6 months to 24 months. According to Glasgow outcome score (GOS):18 cases showed a good outcome, 6 cases were moderately disabled, 1 case was severely disabled, 1 case survived in a permanent vegetative state and 7 cases died. Conclusions The main causes of children massive cerebral infarction with traumatic brain injury are falling and traffic accident. With proactive treatment, the prognosis of children survivors is acceptable.

ObjectiveTo evaluate the mortality and morbility of children with severe traumatic brain injury (sTBI) following treatment with decompressive craniectomy and further analyze its long-term outcomes.Methods Seventeen children with sTBI undergone decompressive craniectomy between 2004 and 2010 were retrospectively studied.Quality of life of the patients who survived the operation was assessed by using the King' s outcome scale for childhood head injury (KOSCHI).ResultsOf 17 children with sTBI,the mean preoperative Glasgow Coma Scale (GCS) score was 5.27.Five children (29％) died postoperatively,of whom three children were died of cerebral infarction.Twelve children who survived the operation were followed up for average 4.6 years,which showed the mean KOSCHI score of 4.75.Among the 12 survivors,five patients (42％) experienced posttraumatic shunt-dependent hydrocephalus and four (33％) suffered ipsilateral and/or contralateral hygroma.ConclusionsAlthough a high mortality rate is observed in the children with sTBI after decompressive craniectomy,the survived patients have satisfactory outcomes. Posttraumatic hydrocephalus and hygroma are two common complications after decompressive craniectomy for children with sTBI.

Objective: To summarize the mid-term effect of modified extended Morrow procedure in patients with hypertrophic obstructive cardiomyopathy (HOCM) combining sub aortic valve obstruction and mid left ventricular obstruction. Methods: We studied 34 consecutive HOCM patients with sub aortic and midventricular obstruction who received modiifed extended Morrow procedure with extracorporeal circulation in our hospital from 1996-11 to 2015-01. Transthoracic echocardiography was conducted at pre-, post-operation and follow-up period to evaluate the changes of mid-ventricular gradient, subarctic gradient and each heart valve function. Results: The average follow-up time was (25.7 ± 14.9) months, 2 patients lost contact and no death occurred. In rest 32 patients, the mid ventricular gradient decreased from (60.3 ± 29.4) mmHg to (21.0 ± 19.8) mmHg, subaortic valve gradient decreased from (77.9 ± 26.2) mmHg to (11.6 ± 6.5) mmHg, the maximum ventricular septal thickness dropped from (25.2 ± 4.9) mm to (17.9 ± 7.2) mm, left atrial diameter reduced from (41.1 ± 7.8) mm to (37.6 ± 6.4) mm, left ventricular end-diastolic diameter increased from (39.8 ± 5.1) mm to (42.2 ± 4.3) mm, allP<0.05; there were 5 patients without obviously improved mid ventricular gradient because of insufifcient resection of septal myocardium in mid-ventricle. The post-operative NYHA classiifcation was improved,P<0.01, mitral valve regurgitation degree was decreased,P<0.01 and SAM phenomenon was disappeared. Complications included 3 (8.8%) patients of III atrio-ventricular block, 1 (2.9%) patient of re-admission due to poorly healed sternum combining pneumonia Conclusion: Modified extended Morrow procedure may relieve sub aortic valve and mid ventricular obstruction, therefore improve left ventricular diastolic function and prognosis in relevant patients.

Objective: To discuss the etiology, pathogenesis, clinical manifestation, diagnosis and therapy of sphenoid wing dysplasia(SWD) associated with neurofibromatosis type Ⅰ(NF-Ⅰ). Methods: We retrospectively reviewed its clinical manifestations, imaging, surgical treatment, complications and postoperative outcome of one NF-Ⅰ patient with SWD. Results: A 14 years-old girl presented with pulsating exophthalmos, loss of vision and café au lait spots. Radiological studies showed right-side orbital enlargement and complete absence of the greater wing of the sphenoid. Titanium mesh was tailored intraoperatively to close the defect as a barrier between the orbital cavity and the cranium and then covered by periosteum.The patient developed postoperative infectious which was controlled by after antibiotic treatment and proper drainage. Proptosis improved significantly after surgery within a month. Ocular pulsation subsided and clinical symptoms improved at 28-month follow-up. Conclusions Sphenoid greater wing dysplasia associated with neurofibromatosis type Ⅰ is a rare inherited autosomal dominant disorders. The treatment should be customized to each patient. Titanium mesh reconstruction is patients with symptomatic sphenoid dysplasia. It can correct the proptosis and pulsating exophthalmos without the risk of bone resorption and recurrence.However, high risk of infection is associated with the procedure.

OBJECTIVE: Epidural haematoma (EDH) most commonly occurs in the supratentorial area, particularly in the temporal region, of the brain. Posterior fossa epidural haematoma (PFEDH) is less frequently observed, accounting for only 1.2% to 12.9% of all EDH cases. Because of the non-specific symptoms and the potential for rapid and fatal deterioration in children, an early computed tomography (CT) scanning is necessary for all suspicious cases. The aim of the present study was to share the experience of 48 cases and review the literature concerning PFEDH.METHODS: A retrospective analysis was conducted for 48 paediatric cases diagnosed with PFEDH and admitted to Yuying Children’s Hospital of Wenzhou Medical University from January 2010 to August 2015. The clinical features and outcomes were analyzed and compared with previous literature.RESULTS: Seventeen patients were surgically treated in this series and 31 patients received non-operative treatment. The outcomes were good in 46 patients, evaluated using the Glasgow outcome score (GOS), while mild disability was observed in one patient, and only one case showed severe disability. There were no cases of mortality in this series.CONCLUSION: Posterior fossa epidural haematoma is relatively rare compared with supratentorial epidural haematoma. Early and serial CT scans should be performed for all suspicious cases. The criteria for the surgical treatment of paediatric patients with PFEDH were concluded. The overall prognosis was excellent in paediatric patients.
Brain ; Child ; Hematoma ; Humans ; Mortality ; Prognosis ; Retrospective Studies ; Temporal Lobe ; Tomography, X-Ray Computed

Objective To evaluate the value of CT plus CTA in emergency surgical treatment of spontaneous intracerebral hemorrhage caused by brain arteriovenous malformations(AVM). Methods A total of 15 cases diagnosed with spontaneous intracerebral hemorrhage by emergent CT examination in the Second Affiliated Hospital of Wenzhou Medical University were retrospectively reviewed from May 2015 to June 2018, and subsequent emergent CTA examination was adopted to verify whether the patients had brain AVM that was responsible for the hemorrhage. After diagnosis, emergency surgical resection of the brain AVM and evacuation of hematoma were performed. Glasgow outcome score (GOS) was used to evaluated the outcome. A secondary DSA or CTA was performed from 2 weeks to 6 months post the operation. Results All 15 cases exanimated by emergent CT plus CTA were demonstrated to have brain AVM and intracranial hematoma. All the patients received emergency brain AVM resection and hematoma evacuation. The surgical finding during operation was in line with what was seen on emergent CT plus CTA, and all cases got total hematoma evacuation. Twelve cases received total brain AVM resection, and the other 3 cases received partial resection because the residual AVM foci existed in deep brain structures . After the operation, none had rebleeding at the surgical site. Follow-up DSA or CTA confirmed the 12 cases had total resection and the other 3 cases had partial resection. All patients were alive after the surgery and GOS scores during the follow-up time, from 2 weeks to 6 months after emergency surgery, were: 5 in 6 patients, 4 in 4 patients, 3 in 4 patients and 2 in 1 patient. Conclusions CT plus CTA can better show the relationship between vascular malformation, hematoma, and the adjacent anatomical structure, and therefore may contribute to intraoperative judgment and complete resection of vascular malformation. It is a practical imaging tool for the preoperative evaluation and emergency surgical treatment of spontaneous intracerebral hemorrhage caused by brain AVM.

Objective:To explore the clinical features and treatment efficiencies of pediatric giant posterior fossa tumors.Methods:A retrospective analysis was performed. The clinical data of 18 children with giant posterior fossa tumors, whose maximum diameter of any section was over 5 cm, admitted to our hospital from January 2015 to June 2020, were collected. The surgical treatment results were analyzed.Results:The tumor volume of 18 children was (63.9±20.7) mL (33.2-116.2 mL). Sixteen children had different degrees of preoperative obstructive hydrocephalus; ommaya capsule implantation was performed in 2, ventriculoperitoneal shunt was performed in one, and external ventricular drainage was performed in one before surgery; intraoperative external ventricle drainage was performed in 5; and the left 7 had postoperative self-healing. Tumor resection was performed in 17 children, including 10 with total resection and 7 with subtotal resection. The postoperative pathological results indicated medulloblastoma in 10 patients, ependymoma in 3 patients, pilocytic astrocytoma in 2 patients, oligodendroglioma in 1 patient, and yolk sac tumor in 1 patient;12 patients were treated with chemotherapy and 9 with radiotherapy. Postoperative persistent hydrocephalus was noted in 2 patients, cerebellar mutism in 2 patients, and subarachnoid hemorrhage combined with ventricular hematocele in 1 patient. The follow-up period ranged from 3 to 67 months: 13 children survived for more than one year (10 lived without tumor recurrence); 8 of the 10 patients with total tumor resection had progression-free survival for more than 1 year (the other 2 patients were lost of follow-up), while 3 of the 7 patients with subtotal resection had progression-free survival for more than 1 year.Conclusion:Pediatric giant posterior fossa tumors have high complication rate, high recurrence rate and poor prognosis; symptomatic treatment, total resection of the tumors, and adjuvant radiotherapy/ chemotherapy are effective treatment methods.

Objective     To evaluate a score system to allow stratification of complexity in degenerative mitral valve repair. Methods     We retrospectively reviewed the clinical data of 312 consecutive patients who underwent surgery for mitral valve repair and whose preoperative echocardiography was referable in our hospital from January 2012 to December 2013. A scoring system for surgical complexity was used based mainly on the preoperative echocardiography findings. Complexity of mitral valve repair was scored as 1 to 9, and patients were categorized into 3 groups based on the score for surgical complexity: a simple group (1 point), an intermediate group (2-4 points) and a complex group (≥5 points). There were 86 males and 35 females in the simple group (n=121) with an average age of 51.6±12.6 years, 105 males and 53 females in the intermediate group (n=158) with an average age of 51.1±12.8 years and 25 males and 8 females in the complex group (n=33) with an average age of 49.3±13.0 years. Results     There was significant difference in surgical complexity in different groups. In the simple, intermediate and complex groups, the mean cardiopulmonary bypass time was 111.7±45.5 min, 117.7±40.4 min and 153.4±74.2 min (P<0.001), the mean cross-clamping time was 77.5±33.8 min, 83.2±29.9 min and 108.8±56.2 min (P<0.001), and the mean number of repair techniques utilized was 2.1±0.4, 2.4±0.6 and 2.8±0.8 (P<0.001). However, there was no significant difference in the early and late outcomes in different groups. Conclusion     It is feasible to use echocardiography to quantitatively evaluate the difficulty of mitral valvuloplasty.

Objective    To evaluate the long-term clinical effect and risk factors of tricuspid valve replacement (TVR) as a relief treatment for adult patients with congenitally corrected transposition of the great artery (CCTGA). Method     We retrospectively analyzed the clinical data of 47 adult patients with CCTGA who underwent tricuspid valve replacement in Fuwai Hospital between 2000 and 2017 year. There were 27 males and 20 females with operation age of 14–62 (38.8±13.5) years. Preoperative echocardiography showed moderate or more tricuspid regurgitation in all patients. The basic data of patients before and during operation were recorded. Survival was followed up by telephone and ultrasound report. Results    The average follow-up time was 6.5±3.7 years. The 1-year, 5-year and 10-year survival rate or the incidence of heart transplant-free was 94.6%, 90.5% and 61.7%, respectively. During the follow-up period, the long-term right ventricular ejection fraction of most patients (>90%) was still greater than or equal to 40%. Increased preoperative right ventricular end diastolic diameter (RVEDD) was a risk factor for death or heart transplantation (risk ratio 1∶11, P=0.04). The survival rate of patients with RVEDD (>60 mm) before operation was significantly reduced (P=0.032). Conclusion    TVP is a feasible treatment for adult patients with CCTGA. The increase of preoperative RVEDD is a risk factor for long-term mortality.