Rapid evolution of a growing skull fracture after vacuum extraction in case of fetal hydrocephalus

Severe brain injury with rupture of the superior sagittal sinus after vacuum extraction birth

Vacuum extraction in nonprogressive labor is a relatively safe procedure. Only a few major complications have been reported in the literature. The authors present a case of severe brain damage with rupture of the sinus after vacuum extraction delivery for which surgical repair of the dural tear and brain prolapse was required.

Depressed skull fracture in Ping Pong: elevation with Medeva extractor

INTRODUCTION

The bones of the skull of the newborn and nursing infants, in general, possess great malleability. For this reason, the depressed fractures occurring at this age are called "Ping Pong" or "Green Stick" fractures. The treatment of these fractures is surgical according to different authors, although some of these fractures that happen in childbirth can elevate themselves spontaneously.

TECHNIQUE

A breast milk extractor trade mark "MEDEVA" was used for the procedure in newborns with a depression larger than 2 cm in diameter. Minimal aspiration was performed while observing the elevation through the transparent breast milk extractor MEDEVA until the depression elevated without leaving any trace.

DISCUSSION

The aspiration procedure was satisfactory and curative in the five children treated. The fracture was successfully elevated and the skull returned to its normal position and configuration without complications for the patients.

CONCLUSION

Finally, it has been demonstrated that this procedure is simple, inexpensive, and avoids surgical intervention.

Leptomeningeal cyst due to vacuum extraction delivery in a twin infant

A rare case of a leptomeningeal cyst is reported in a twin male neonate delivered using a vacuum extractor, who presented a huge, non-pulsating, oedematous mass overlying the frontal fontanelle after birth. The mass was initially diagnosed as a cephalo haematoma. Ultrasonography indicated intracranial bleeding and a subsequent CT scan revealed an intraparenchymal bleeding above the left frontal horn, combined with a thin, left-sided, subdural haematoma and subarachnoid haemorrhage in the left Sylvian fissure. Apart from a bulging soft and round formation (2 x 2 x 3 cm) next to the anterior fontanel growing since birth, the neurological development of the infant was normal. MRI examination at the age of 7 months revealed that it consisted of a cystic mass (leptomeningeal cyst) connected to the left frontal horn, stretching right through the brain and also penetrating the dura mater. No signs of the perinatal haematomas were observed at this time. Surgical treatment, with fenestration of the cyst into the frontal horn and a watertight duraplasty with a periosteal flap and thrombin glue covered by small bone chips, was performed at 9 months of age. Due to a residual skull bone defect a second cranioplasty with autologous skull bone was performed three and half years later. During a follow-up period of 12 years the neurological and psychological development of the boy has been indistinguishable to that of his twin brother, indicating the satisfactory outcome of the treatment.

Ventricular reservoir migration into the lateral ventricle through the endoscopic tract after unsuccessful third ventriculostomy

We report a case of reservoir migration into the lateral ventricle through an enlarged endoscopic tract. A full-term female infant with a myelomeningocele, which was repaired surgically after birth, came to us with hydrocephalus, and a reservoir was placed after an unsuccessful endoscopic third ventriculostomy. The tract gradually enlarged and the reservoir eventually slipped into the lateral ventricle 16 days after implantation. This complication may be unique to children, in whom the bone is malleable. As endoscopic surgery is being used more often in infants, the risk of this complication may also be increasing with concurrent reservoir implantation. We believe this complication can be avoided with careful attention to several key points during surgery.

Obstetric vacuum extraction: state of the art in the new millennium

This article summarizes the current state of knowledge of obstetric vacuum extraction. The discussed topics include the history of vacuum extraction, indications and contraindications, technique of the procedure, currently marketed instruments, special uses of the vacuum extractor, comparison of vacuum extraction with forceps delivery, and maternal and fetal outcomes. Areas of controversy are identified and discussed. Vacuum extraction is replacing forceps as the preferred method of instrumental delivery.