Spasticity and movement disorders in cerebral palsy.

Purpose: To review the neurosurgical treatments of children with movement disorders associated with cerebral palsy (CP) during the previous decades, up to the present day.

Methods: An extensive literature review was undertaken to identify important publications about this subject. My experience treating children with these disorders over the past three decades was included in the individual sections.

Hydranencephaly treatments: retrospective case series and review of the literature.

Objective: The objective of this study was to review treatment options for infants with hydranencephaly and to consider the pros and cons of each treatment modality.

Methods: This paper is a review of hydranencephaly as well as a retrospective analysis evaluating the outcomes of 52 infants with hydranencephaly who were treated at the Kijabe Hospital, Kijabe, Kenya, in one of four ways: ventriculoperitoneal shunt (VPS) insertion, endoscopic choroid plexus coagulation (CPC), open choroid plexectomy (CPlx), and palliative care. The primary outcome measure was control of head size, with the aim of improving patient care.

Pediatric Ventriculoperitoneal Shunts Revision Rate and Costs in High-Volume sub-Saharan Department.

Background: Ventriculoperitoneal shunt (VPS) placement is one of the most common neurosurgical procedures. VPSs are associated with high costs, which predominantly arise from relatively high complication and revision rates. It is reasonable to assume that revision rates in developing countries would be higher.

Ventriculoperitoneal shunt perforations of the gastrointestinal tract.

OBJECT The purposes of this study were to evaluate the frequency with which children presented with ventriculoperitoneal (VP) shunt perforations of the gastrointestinal (GI) tract, to determine the type of shunts that caused the perforations, and to compare the stiffness of perforating catheters with the stiffness of catheters from other manufacturers. METHODS Medical records were reviewed of 197 children who were admitted with VP shunt malfunction. Catheter stiffness was evaluated by measuring relative resistance to cross-sectional compression, resistance to column buckling, and elasticity in longitudinal bending.

Sources of delayed provision of neurosurgical care in a rural kenyan setting.

Background: Delay to neurosurgical care can result in significant morbidity and mortality. In this study, we aim to identify and quantify the sources of delay to neurosurgical consultation and care at a rural setting in Kenya.

Methods: A mixed-methods, cross-sectional analysis of all patients admitted to the neurosurgical department at Kijabe Hospital (KH) was conducted: A retrospective analysis of admissions from October 1 to December 31, 2013 and a prospective analysis from June 2 to June 20, 2014.

Bacteria causing ventriculoperitoneal shunt infections in a Kenyan population.

Object: Ventriculoperitoneal shunt (VPS) infections are a major cause of morbidity and mortality in patients with hydrocephalus. Most data about these infections come from the Western literature. Few data about infecting organisms in Africa are available, yet knowledge of these organisms is important for the prevention and treatment of infectious complications.

Distal spinal cord stimulation in infants with myelomeningoceles: preliminary study.

Object: The purpose of this study of infants with myelomeningoceles was to evaluate the effect of stimulation of the distal spinal cord, proximal to the neural placode, on functioning lower-extremity muscles distal to the placode.

Methods: In 13 infants with lumbosacral myelomeningoceles, the lateral spinal cord was stimulated, with a monopolar probe, between its exit from the spinal canal and the neural placode. Responses of functional muscles in the lower extremities were monitored with a neural integrity monitor.

Enterocutaneous fistula in the setting of ventriculoperitoneal shunt extrusion through the skin and perforation through the small bowel.

The authors report a case of a 2-year-old boy with postinfectious hydrocephalus, managed with a ventriculoperitoneal (VP) shunt and complicated by shunt extrusion through the cranial skin. The shunt was removed due to concern for infection, and the child was found to have an enterocutaneous fistula (ECF) communicating along the shunt track between the small bowel and a clavicular sinus. Self-closure of the ECF was anticipated.

Choroid plexus coagulation in infants with extreme hydrocephalus or hydranencephaly.

Unlabelled: OBJECT.: Severe hydrocephalus and hydranencephaly are common congenital conditions in Kenya. In patients with these conditions, ventriculoperitoneal (VP) shunts are associated with appreciable complications and endoscopic third ventriculostomies (ETVs) have limited success.

Assessing the prevalence of spina bifida and encephalocele in a Kenyan hospital from 2005-2010: implications for a neural tube defects surveillance system.

Introduction: Neural tube defects such as anencephaly, spina bifida, and encephalocele are congenital anomalies of the central nervous system. Data on the prevalence of neural tube defects in Kenya are limited. This study characterizes and estimates the prevalence of spina bifida and encephalocele reported in a referral hospital in Kenya from 2005-2010.

Distal cordectomies as treatment for lumbosacral myelomeningoceles.

Object: The purpose of this study was to evaluate the effect of distal cordectomies on motor function in the lower extremities of infants with lumbosacral myelomeningoceles.

Methods: Medical records were reviewed in 32 infants with lumbosacral myelomeningoceles who were 1 day to 7 months old, who had some lower-extremity function preoperatively, and who were treated by distal cordectomies, dividing the cord between its exit from the intact spinal canal and the neural placode. Neurological function was evaluated before and after operation by therapists who were unaware of the surgical technique.

Cerebrospinal fluid white blood cell counts in infants with myelomeningoceles.

Object: The authors undertook this study to determine white blood cell (WBC) counts in CSF obtained from lateral ventricles and myelomeningoceles (MMCs) in infants in a developing country at the time of their initial presentation for medical evaluation.

Methods: CSF was aspirated from the lateral ventricles and from MMC sacs of 100 consecutive infants at Kijabe Hospital, Kijabe, Kenya. Peripheral blood WBC counts and CSF WBC counts were determined in the laboratory.

Tethered cord syndrome secondary to the unusual constellation of a split cord malformation, lumbar myelomeningocele, and coexisting neurenteric cyst.

We describe a seminal case report of a child with a tethered cord syndrome secondary to the unusual constellation of a split cord malformation, lumbar myelomeningocele, and coexisting neurenteric cyst. A 17-year-old adolescent girl with a several-month history of myelopathy and urinary incontinence was examined whose spinal MRI scan demonstrated a type II split cord malformation with a large bone spur and an intradural neurenteric cyst in addition to lumbar myelomeningocele. Untethering of the spinal cord was achieved via a lumbar laminectomy.

Intraventricular meningioma: case report and literature review.

In this article we describe the clinical course of a child with an intraventricular meningioma and review the relevant literature. A 7-year-old girl with a several-month history of headaches had a CT scan that demonstrated a large, enhancing, intraventricular tumor. The tumor was completely excised via a superior parietal approach.

Intraventricular vs intrathecal baclofen for secondary dystonia: a comparison of complications.

Background: Intrathecal baclofen (ITB) is an effective treatment for secondary dystonia. However, in many patients with dystonia, placement of an intrathecal catheter is difficult because of anatomic anomalies or spinal fusion. Intraventricular baclofen (IVB) has been shown to be an effective alternate route for drug delivery in a small series of patients.

Use of the NICO Myriad device for tumor and cyst removals in a developing country.

Purpose: To describe the use of the NICO Myriad, a new side-cutting aspiration device for the resection of tumors, in a developing country.

Methods: The 11-, 13-, and 15-ga handpieces were used to resect tumors exposed via craniotomies, and the 19-ga handpiece was used down the side channel of a Storz Oi endoscope to resect tumors exposed endoscopically.

Results: The Myriad was used to resect 23 tumors, including spinal cord tumors, posterior fossa tumors and pineal tumors, and the cysts associated with two craniopharyngiomas.

Technique for insertion of intraventricular baclofen catheters.

Intraventricular baclofen (IVB) infusion has been used recently to treat secondary dystonia. Techniques of catheter implantation have not been thoroughly described. The object of this study was to describe a technique developed in the past 6 years to implant intraventricular catheters for baclofen infusion.

Outcomes of ventriculoperitoneal shunt insertion in Sub-Saharan Africa.

Object: Ventriculoperitoneal (VP) shunts in Sub-Saharan Africa are traditionally associated with high complication rates and poor outcomes. The aim of this study was to review one large institutional experience with VP shunts, to evaluate the feasibility of shunt insertion procedures with acceptable long-term outcomes in Africa, and to identify factors correlated with good and/or poor outcomes.

Methods: A retrospective study was conducted by reviewing the charts of all children who underwent primary (93%) or subsequent VP shunt insertions at the Kijabe Hospital between November 2004 and March 2007.