Case Stusies
Huo Tingyu
Gender: Male
Age: 12 years
Admission condition:
The child was diagnosed with "developmental delay" at about 7 months old due to poor head control at Zibo Third Hospital. Around the age of 4, the child underwent rehabilitation at Zhoucun District Hospital in Zibo and has been receiving treatment since then. Currently, the child shows limited ability to address as "grandma" or "grandpa," unclear speech, lack of verbal expression, low cognitive and understanding abilities, poor learning and execution skills, hyperactivity, lack of concentration, difficulty in emotional control, and no self-harm behaviors. The child's eyes are inwardly inclined, with the left eye heavier, difficulty in fine motor skills, walking with toes inward and right side heavier, uncoordinated posture, and unstable gait. The child drools, has difficulty swallowing and chewing but can manage basic self-care activities. Currently enrolled in fourth grade at our special education school. The child has undergone treatment at Zibo Central Hospital and Qingdao Children's Rehabilitation Hospital with limited improvement, hence referred to our hospital for further treatment. The child has remained conscious and mentally alert since the onset of the condition, with normal diet and stable weight.
Admission Diagnosis: Cerebral developmental delay
Treatment Process
After admission, relevant examinations were conducted, including routine tests, abdominal and cardiac ultrasound, electrocardiogram, electroencephalogram (EEG), etc., revealing no surgical contraindications, thus deemed fit for surgery. On May 22, 2023, at 13:00, under general anesthesia, the child underwent robot-assisted frameless stereotactic brain surgery. The surgery began with applying Marker points on the head, followed by a head CT scan, data transfer to the Remebot robot, selecting the left internal capsule as the target point, entering through the left frontal area, and setting the surgical path. The child was placed in a supine position, the head was fixed, and standard disinfection and draping were done. The scalp was incised locally, a bone hole drilled, the dura mater punctured with a needle, brain tissue resistance probed with an electrode needle, and then neural modulation with mild electrical stimulation using a radiofrequency needle was performed at the target point, completing the surgery on the left side. The same procedure was followed for the right frontal lobe. The surgery was successful with approximately 3ml of bleeding, followed by needle removal, skin suturing, and pressure dressing. Postoperative head CT showed no significant abnormalities, confirming accurate targeting. The child was clear-minded, in good spirits, with normal pupillary light reflex and no involuntary movements. The surgical site was clean, without drainage tubes. Postoperatively, the child received routine IV fluids, oxygen therapy, and cardiac monitoring, with close monitoring of vital signs.
Discharge Summary:
On the second day after surgery, the child's condition remained stable, with reduced drooling, no headache, nausea, or vomiting, and able to eat. The surgical wound showed no bleeding, swelling, normal bowel and bladder function, and good appetite and sleep. Physical examination findings were consistent with preoperative status. During rounds, attending physician Zhao Xiangyong noted no adverse postoperative reactions, and after 2 days of anti-infection treatment, it was decided to discontinue related medications today. Continued close observation of the surgical wound was advised, maintaining dryness, timely dressing changes, and disinfection, while also preventing accidental falls, choking during meals, and other potential risks. Further monitoring of the child's condition was recommended, and if no abnormalities arise, discharge may be considered after evaluation tomorrow.
Discharge Instructions: