Objective To study the normal reference values of intracranial pressure and cerebral perfusion pressure in children of different ages. Methods A retrospective study was conducted on the children with simple epidural hematoma who received hematoma removal and implantation for intracranial pressure monitoring in our department from January 2015 to June 2022.The intracranial pressure and arterial blood pressure of the children were monitored per hour after surgery, and the changes in intracranial pressure and cerebral perfusion pressure were analyzed based on time and age in different age groups.The intracranial pressure and cerebral perfusion pressure in stable period (72 h after surgery) were used as the relative normal reference values, and the 95% range of intracranial pressure and cerebral perfusion pressure were calculated statistically by percentile method as the reference range. Results A total of 207 children were included in this study, including 25 in the < 2-year-old group, 82 in the 2~6-year-old group and 100 in the >6-year-old group.Intracranial pressure in different age groups was increased rapidly after a short period of low level, while cerebral perfusion pressure experienced a short period of high level, and both reached a peak and a trough from 12 to 24 h after surgery, and gradually reached a stable range at 72 h after surgery.The range of intracranial pressure 72 h after surgery was 3.0~8.0 mmHg for the < 2-year-old group, 5.0~11.0 mmHg for the 2~6-year-old group, and 6.0~14.0 mmHg for the >6-year-old group.Cerebral perfusion pressure range was 50.9~68.7, 55.0~73.3, and 57.3~79.6 mmHg, respectively for the above 3 age groups. Conclusion The normal ranges of intracranial pressure and cerebral perfusion pressure are different in children of different ages, and we suggest increasing with age.

Objective:To investigate the clinical effect of flexible neuroendoscopy-assisted drilling irrigation and external drainage in the treatment of subdural effusion complicated with purulent meningitis in infants.Methods:A retrospective analysis was conducted on the clinical data of 40 infants with purulent meningitis complicated with subdural effusion who were admitted to the Department of Neurosurgery, Children′s Hospital of Chongqing Medical University from January 2016 to December 2020. According to the different treatment methods, 40 children were divided into an endoscopy group (treated by burr hole irrigation and external drainage assisted by flexible neuroendoscopy, 20 cases) and a control group (treated by skull burr hole drainage, 20 cases). The general data, clinical manifestations, treatment-related indicators and complications of the two groups were compared.Results:There was no significant difference between the endoscopy group and the control group in gender, age, course of disease, clinical manifestations, location of effusion, or preoperative cerebrospinal fluid-related indicators (all P>0.05). The improvement time of symptoms and cerebrospinal fluid indicator (the white blood cell count in the cerebrospinal fluid returning to the normal range) in the endoscopy group were earlier than those in the control group (postoperative symptom improvement time: 4.4±2.3 d vs. 8.7±3.0 d; cerebrospinal fluid indicator improvement time: 6.3±3.5 d vs. 13.2±5.2 d). Postoperative anti-infective treatment time [ M ( Q1,Q3)] in the endoscopy group was shorter than that in the control group[11.5 (8.3, 14.0) d vs. 19.0 (14.0, 27.3) d]. All the differences above were statistically significant ( P<0.001). In terms of postoperative complications, there were 5 cases (25%) of secondary subarachnoid hemorrhage and cerebral contusion in the control group, and 0 cases (0%) in the endoscopy group. Conclusion:For purulent meningitis complicated with subdural effusion, infants treated with flexible neuroendoscopy-assisted burr hole irrigation and external drainage can achieve better clinical outcomes compared with skull burr hole drainage.

Objective To evaluate the effectiveness of Ommaya sac combined with external ventricular drainage in improving neurological function after periventricular-intraventricular hemorrhage (PIVH) in neonates. Methods A retrospective cohort study was carried out on the neonates hospitalized due to PIVH in the neonate and neurosurgery departments in our hospital from January 2015 to July 2020. They were divided into Ommaya sac combined with external ventricular drainage surgery group (surgery group) and non-surgery group. All of them were followed up until they were 12 months old. The concentration of inflammatory factors in cerebrospinal fluid in the early stage, the incidence of complications (epilepsy, hydrocephalus, cerebral palsy, and death) during follow-up, and neurodevelopmental outcomes were observed and analyzed in the 2 groups. Results A total of 71 PIVH neonates were enrolled, including 35 cases treated with Ommaya capsule combined with external ventricular drainage, and 36 cases treated without surgery. The levels of neuron enolase (NSE), nerve growth factor (NGF) and neutrophil-to-lymphocyte ratio (NLR) in the cerebrospinal fluid in 3 d after surgery were significantly decreased than the levels before surgery (P < 0.05). In the non-surgery group, no such differences in the above indexes were seen in 3 d after treatment (P>0.05). During the follow-up to 12 months of corrected age, 1 neonate (2.9%) died in the surgery group and 6 neonates (16.7%) died in the non-surgery group. The incidences of complications in the surgery group and non-surgery group were compared as follows: epilepsy (0 vs 2 cases), hydrocephalus (4 vs 9 cases) and cerebral palsy (1 vs 3 cases), and statistical differences were seen in the incidences (P < 0.05). Gesell Developmental Scale score indicated that the developmental of the surviving children in the surgery group were significantly better than those in the non-surgery group in terms of adaptability, fine motor, language and personal social interaction (all P < 0.05). Conclusion Compared with non-surgical treatment, Ommaya sac combined with external ventricular drainage significantly reduces the concentration of inflammatory factors in the cerebrospinal fluid of neonates with moderate and severe PIVH, effectively decreases the incidence of PIVH complications, and improves the prognosis of neurological function.

Objective To analyze the clinical characteristics of changes in intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and determine their intervention thresholds in children with severe traumatic brain injury (STBI). Methods This prospective observational study was conducted among the children with STBI admitted in the Children's Hospital of Chongqing Medical University between June, 2014 and June 2018. ICP and CPP of the children were dynamically monitored at every hour after the operation. The theoretical thresholds of ICP and CPP were adopted from literature, and the pressure-time indexes (PTIs) for these thresholds were calculated and their predictive ability was assessed using the receiver operating characteristic (ROC) curve. For children in different age groups (< 2 years, 2-7 years and >7 years), the area under the ROC curve (AUC) was calculated according to the PTIs for each theoretical threshold and Glasgow Outcome Scale score at 6 months after the trauma. The theoretical thresholds corresponding to the maximum AUC was determined to be the optimal thresholds. Results A total of 115 children with STBI were included in this study. For children aged < 2 years (25 cases), 2-7 years (52 cases) and >7 years (38 cases), the age-specific thresholds of ICP was 14.4, 20.0 and 21.6 mmHg, and those of CPP was 45.0, 55.0 and 55.0 mmHg respectively. Conclusion The intervention thresholds of ICP and CPP differ among the STBI chidren at different ages. In children with STBI aged < 2 years, 2-7 years and >7 years, we recommend postoperative ICP of 14.4, 20.0 and 21.6 mmHg, and CCP of 45.0, 55.0 and 55.0 mmHg respectively, as the thresholds for initiating interventions.

Objective To explore the clinical characteristics and treatments of rupture of intracranial arachnoid cyst (IAC) in children .Methods Retrospective analysis was conducted for clinical data of IAC rupture (n= 29) and re-rupture (n= 4) ,from January 2010 to January 2017 .Treatments and prognoses were analyzed for different types of IAC rupture .There were 23 boys and 6 girls with an average age of (5 .82 ± 3 .82) years .There was a definite history of trauma (n= 17 ,58 .6％ ) .And there were symptoms of intracranial hypertension (n= 27 ,93 .1％ ) .According to the imaging studies ,cranial fossa was common (93 .1％ ) .IAC rupture was divided into subdural hygroma/ hemorrhage (n = 22) ,subdural hematoma (n = 4) ,intracystic bleeding (n= 1) and intracystic & subdural hemorrhage (n= 2) .Treatments included conservative measures (n = 8) ,burr hole (n= 15) ,fistulization (n= 4) and craniotomy hematoma clearance (n= 5) .Results Follow-ups were available for 27 children .The score of Karnofsky performance status (KPS) was 90-100 points .Some cases had mild symptoms and effusion/hematoma became absorbed completely (n= 7) ,significantly less (n= 9) ,less (n= 6) and slightly more (n= 5) .And arachnoid cysts disappeared (n= 6) ,significantly less (n= 5) , shrank (n = 9 ) and remained unchanged (n = 7 ) .Conclusions Treatment of IAC rupture should be comprehensive evaluated by clinical symptoms and imaging data .For intracranial hypertension :with bleeding , burr hole drainage or craniotomy hematoma clearance may be selected .Without bleeding ,fistulization with priority .