Michael L. Levy

By Usman A. Khan, Jillian H. Plonsker, Robert C. Rennert and Michael L. Levy

Management of pediatric skull base tumors requires a multi-disciplinary team that integrates advances in neuro-imaging, radiation, medical and surgical treatments, and allied therapies. Tumors of the skull base harbor complex genetic and molecular signatures that have major implications on prognosis and quality of life. Individualized management requires a strong inter-disciplinary alliance amongst practitioners, as well as a strong therapeutic alliance with the patient and family to navigate the complex decision-making process of treatments. In this chapter, we present our experience managing surgical lesions of the pediatric skull base. General considerations to tumor pathology genetics and radiobiology, diagnostic imaging, rehabilitation of cranial neuropathies and cognitive function, surgical anatomy and reconstructive options, and quality of life should be applied to each case. We also present location- and tumor-specific considerations in the anterior, middle, and posterior fossa skull base with a focus on surgical approaches and complication avoidance. Special consideration is given to syndromic tumors, particularly those from neurofibromatosis type 2 (NF-2). Tumors can exist in multiple cranial compartments and as such some redundancy in concepts is unavoidable. Nevertheless, each patient presents with a unique clinical picture and tumor behavior. Knowledge and proficiency in skull base approaches is a necessary tool in every pediatric neurosurgeon’s armamentarium.

Part of the book: Frontiers in Clinical Neurosurgery

By Jillian Plonsker, Michael Brandel, Usman Khan and Michael L. Levy

Penetrating head trauma is rare in the pediatric population, and rarer still in the civilian pediatric population. The high rehabilitation potential of children and the higher likelihood of a low-velocity, survivable injury necessitates careful management to minimize morbidity due to secondary injury from ischemia or infection. Management of penetrating injuries includes patient stabilization, appropriate imaging, and if surgery is needed, entry/exit site debridement with dural closure to prevent cerebrospinal fluid leak. Post-operative care includes infection prevention, intracerebral pressure management, and early identification of vasospasm and pseudoaneurysm formation.

Part of the book: Frontiers In Traumatic Brain Injury