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Operational Improvement in Pediatric Neurosurgery

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Frailty in Children

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Abstract

In recent years, the concept of frailty in neurosurgery has also been extended to pediatric patients. These patients, in fact, have intrinsic features that make them fragile under stressful events such as neurosurgery.

It must also be considered that the improvement of medical therapy in general has increased survival and, therefore, the number of frail patients.

In order to treat these patients in the best possible way, we have developed the concept of minimally invasive surgery, thanks to various tools such as: neuroendoscopy, stereotactic surgery, microsurgery, and robotics.

The advantages of minimally invasive surgery are increased precision, less tissue disruption, lower morbidity, and shorter hospital days.

Moreover, an increased attention to patients’ needs have developed, so that the improvement in neurosurgery implies a multidisciplinary approach and different medical specialties are involved in order to ameliorate the outcome (neuroradiology, neuro-anesthesia, neuro-oncology, neuropsychology).

In our experience, other complementary figures such as engineers, are essential to improve surgical strategies and techniques.

In fact, since 2016, 3D printing entered the daily clinical practice at Meyer Children’s Hospital. “T3Ddy” laboratory introduced highly customized medical devices and methods to support the treatment of pediatric diseases.

In pediatric neurosurgery, it will therefore be increasingly essential to be aware of technological developments and acquire multi-level skills that allow to improve both the survival and the quality of life of young patients.

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Abbreviations

1H-MRS:

H-magnetic resonance spectroscopy

AA:

Amino acids

AC:

Arachnoid cysts

ADC:

Apparent diffusion coefficient

ASL:

Arterial spin labeling

bFFE:

Balanced fast field-echo

BOLD:

Blood oxygenation level-dependent

CBF:

Cerebral blood flow

Cho:

Choline

CNS:

Central nervous system

Cr:

Creatine

CSF:

Cerebrospinal fluid

CT:

Computed tomography

DIPG:

Diffuse intrinsic pontine glioma

DMN:

Default mode network

DTI:

Diffusion tensor images

DWI:

Diffusion-weighted images

EES:

Endoscopic endonasal surgery

ESC:

Endoscopic strip craniectomy

ETV:

Endoscopic third ventriculocisternostomy

FA:

Fractional anisotropy

FIESTA:

Fast imaging employing steady-state acquisition

FLAIR:

Fluid-Attenuated Inversion Recovery

fMRI:

Functional MRI

GE:

Gradient echo

Gli:

Glutamate glutamine

HARDI:

High-angular resolution diffusion imaging

HCP:

Hydrocephalus

ICA:

Independent component analysis

Lip:

Lipids

LITT:

Laser interstitial thermal therapy

MAP:

Mean arterial pressure

mI:

Myoinositol

MPRAGE:

Magnetization prepared—rapid gradient echo

MRI:

Magnetic resonance imaging

MRS:

Proton MR spectroscopy

MTT:

Mean transit time

NAA:

N-Acetylaspartate

NDI:

Neurite density index

ODI:

Orientation dispersion index

PWI:

Perfusion-weighted imaging

ROSA:

Robotic operating surgical assistant

SE:

Spin echo

SPGR:

Spoiled gradient-recalled

SWI:

Susceptibility-weighted images

T:

Tesla

TrueFISP:

Fast imaging with steady-state free precession

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Authors and Affiliations

  1. Pediatric Neurosurgery Unit, IRCCS, Florence, Italy

    Barbara Spacca, Davide Luglietto, Federico Mussa & Lorenzo Genitori

  2. School of Medicine, Scuola Superiore Sant’Anna, Pisa, Italy

    Octavian Vatavu

  3. Radiology Unit, IRCCS, Florence, Italy

    Ludovico D’Incerti

  4. Pediatric Neuroanesthesia Unit, IRCCS, Florence, Italy

    Germana Tuccinardi, Desy Butti & Leonardo Bussolin

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  1. Barbara Spacca
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  2. Davide Luglietto
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  9. Lorenzo Genitori
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Correspondence to Lorenzo Genitori .

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  1. Pediatric Surgery Unit, Sant’Orsola Hospital IRCCS, University of Bologna, Bologna, Italy

    Mario Lima

  2. Pediatric Intensive Care Unit, Sant’Orsola Hospital IRCCS, University of Bologna, Bologna, Italy

    Maria Cristina Mondardini

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Spacca, B. et al. (2023). Operational Improvement in Pediatric Neurosurgery. In: Lima, M., Mondardini, M.C. (eds) Frailty in Children. Springer, Cham. https://doi.org/10.1007/978-3-031-24307-3_12

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