Treatment of low-pressure hydrocephalus using a novel shunt valve technique: applying Bernoulli's equation to fluid statics. Technical note.

Low-pressure hydrocephalus (LPH) is the presence of persistent ventriculomegaly with low to normal intracranial pressure. Patients with LPH respond to subzero drainage, which consists of external ventricular drainage at levels below the external auditory meatus. Multiple treatment modalities have been described in the literature, but due to low intracranial pressures, weaning the external ventricular drain can take weeks to even months.

The occipital interhemispheric transtentorial approach in infants and toddlers: efficacy and complications.

Introduction: Outcomes for pineal region and superior cerebellar tumors in young children often hinge on extent of microsurgical resection, and thus choosing an approach that provides adequate visualization of pathology is essential. The occipital interhemispheric transtentorial (OITT) approach provides excellent exposure while minimizing cerebellar retraction. However, this approach has not been widely accepted as a viable option for very young children due to concerns for potential blood loss when incising the tentorium.

Differences in NAFLD/NASH Management by Provider Specialty: Opportunities for Optimizing Multidisciplinary Care.

Purpose: Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are a part of a complex metabolic disease process requiring a multi-faceted and multidisciplinary management approach. This study was conducted to identify areas where medical education across a multidisciplinary team could be optimized in providing optimal care of patients with NAFLD/NASH.

Methods: A survey instrument including a patient case vignette was developed to understand approaches of US clinicians to diagnosis and management of patients with NAFLD/NASH.

Impact of Telephone Follow-Up on Patient Satisfaction in a Pediatric Neurosurgery Clinic.

Patient satisfaction is a key metric used to measure quality in health care. However, patient satisfaction measures in the pediatric population are less studied and understood than in the adult population. The purpose of this study was to evaluate the impact of telephone follow-up on patient satisfaction in an outpatient pediatric neurosurgery clinic.

Incidence and risk factors for seizures associated with deep brain stimulation surgery.

Objective: The objective of this study was to determine the incidence of seizures following deep brain stimulation (DBS) electrode implantation and to evaluate factors associated with postoperative seizures.

Methods: The authors performed a single-center retrospective case-control study. The outcome of interest was seizure associated with DBS implantation.

Inpatient Hospital Outcomes and its Association with Insurance Type Among Pediatric Neurosurgery Trauma Patients.

Objective: To assess the association of insurance status and inpatient hospital outcomes among a nationally representative population of pediatric trauma neurosurgery patients.

Methods: The 2006, 2009, and 2012 Healthcare Cost and Utilization Project Kids' Inpatient Database was queried for all pediatric neurosurgery patients (birth through 17 years) with primary International Classification of Diseases, Ninth Edition, Clinical Modification, procedure codes for trauma or hematoma.

Results: Self-pay patients were 2.

Using the neutrophil-to-lymphocyte ratio to predict outcomes in pediatric patients with traumatic brain injury.

Objective: The brain's inflammatory reaction to traumatic brain injury (TBI) generally peaks between 24 and 48 h after injury. This inflammatory cascade can be neuroprotective or may mediate secondary brain injury beyond the initial TBI. Therefore, circulating inflammatory markers may be useful for predicting outcomes in pediatric TBI.

Postoperative day 1 versus postoperative day 5 morning cortisol for predicting an intact hypothalamic-pituitary axis: A cohort analysis.

Background: A reliable standard for evaluating postoperative hypothalamic-pituitary-axis (HPA) function following transsphenoidal pituitary surgery (TSS) could reduce hospital stays and unnecessary prolonged steroid therapy. We retrospectively examined the predictive role of morning cortisol levels on long-term HPA function to develop an institutional protocol. Here, we report the results of this analysis, which is the first to report the predictive strength of multiple variables (i.

Anterior two-thirds corpus callosotomy via stereotactic laser ablation.

Anterior two-thirds corpus callosotomy is a common palliative surgical intervention most commonly employed in patients with atonic or drop seizures. Recently, stereotactic laser ablation of the corpus callosum without a craniotomy has shown promise in achieving similar outcomes with fewer side effects and shorter hospitalizations. The authors demonstrate ablation of the anterior two-thirds corpus callosum in a patient with Lennox-Gastaut syndrome and drug-resistant drop seizures.

Trapped ventricle after laser ablation of a subependymal giant cell astrocytoma complicated by intraventricular gadolinium extravasation: case report.

Magnetic resonance imaging-guided stereotactic laser ablation of intracranial targets, including brain tumors, has expanded dramatically over the past decade, but there have been few reports of complications, especially those occurring in a delayed fashion. Laser ablation of subependymal giant cell astrocytomas (SEGAs) is an attractive alternative to maintenance immunotherapy in some children with tuberous sclerosis complex (TSC); however, the effect of treatment on disease progression and the nature and frequency of potential complications remains largely unknown. The authors report the case of a 5-year-old boy with TSC who underwent stereotactic laser ablation of a SEGA at the right foramen of Monro on 2 separate occasions.

Intracranial Anatomical Triangles: A Comprehensive Illustrated Review.

There are multiple anatomical triangles of the skull base. However, to our knowledge, there has been no comprehensive review of these geometric landmarks. To allow for a safe and consistent approach to lesions of the skull base such as those near the internal carotid artery, internal acoustic meatus, and cavernous sinus, a comprehensive review of the variations with illustrations is required.

The Relationship of Electrophysiologic Subthalamic Nucleus Length as a Predictor of Outcomes in Deep Brain Stimulation for Parkinson Disease.

Background: Intraoperative measurement of subthalamic nucleus (STN) width through microelectrode recording (MER) is a common proxy for optimal electrode location during deep brain stimulation (DBS) surgery for Parkinson disease. We assessed whether the MER-determined STN width is a predictor of postoperative Unified Parkinson Disease Rating Scale (UPDRS) improvement.

Methods: Records were reviewed for patients who underwent single-sided STN DBS placement for Parkinson disease between 2005 and 2010 at the UAB Medical Center.

Surveillance survey of family history in children with neural tube defects.

OBJECTIVE Although there are known risk factors for the development of neural tube defects (NTDs), little is known regarding the role of family history. The authors' goal in this study is to describe the family history in their population of patients with NTDs. METHODS Surveys were completed for 254 patients who were accompanied by their biological mother during their annual visit to the multidisciplinary Spina Bifida Clinic at Children's of Alabama.

Design of a Phase I Clinical Trial to Evaluate M032, a Genetically Engineered HSV-1 Expressing IL-12, in Patients with Recurrent/Progressive Glioblastoma Multiforme, Anaplastic Astrocytoma, or Gliosarcoma.

M032 is a second-generation oncolytic herpes simplex virus (oHSV) that selectively replicates in tumor cells. M032 kills tumor cells directly through oncolytic replication and then proceeds to infect tumor cells in proximity, continuing the process of tumor destruction. In addition to this direct oncolytic activity, the virus carries a therapeutic payload-thus acting as a gene therapy vector-and causes the tumor cell to synthesize and secrete the immunity-stimulating protein interleukin-12 (IL-12) before cell death.

Sleep-disordered breathing in patients with myelomeningocele.

OBJECT A paucity of literature examines sleep apnea in patients with myelomeningocele, Chiari malformation Type II (CM-II), and related hydrocephalus. Even less is known about the effect of hydrocephalus treatment or CM-II decompression on sleep hygiene. This study is an exploratory analysis of sleep-disordered breathing in patients with myelomeningocele and the effects of neurosurgical treatments, in particular CM-II decompression and hydrocephalus management, on sleep organization.

Adverse events associated with deep brain stimulation for movement disorders: analysis of 510 consecutive cases.

Background: Although numerous studies have focused on the efficacy of deep brain stimulation (DBS) for movement disorders, less is known about surgical adverse events, especially over longer time intervals.

Objective: Here, we analyze adverse events in 510 consecutive cases from a tertiary movement disorders center at up to 10 years postoperatively.

Methods: We conducted a retrospective review of adverse events from craniotomies between January 2003 and March 2013.

The nonsurgical nature of patients with subarachnoid or intraparenchymal hemorrhage associated with mild traumatic brain injury.

Object: Mild traumatic brain injury (mTBI), as defined by Glasgow Coma Scale (GCS) score of 13 or higher, is a common problem in the United States and worldwide, estimated to affect more than 1 million patients yearly. When associated with intracranial hemorrhage, it is a common reason for neurosurgical consultation and transfer to tertiary care centers. The authors set out to investigate the clinical implications of subarachnoid hemorrhage (SAH) and/or intraparenchymal hemorrhage (IPH) associated with mTBI in hopes of standardization of mTBI clinical care and optimization of resource allocation.

Hemispherectomy for treatment of refractory epilepsy in the pediatric age group: a systematic review.

Object: Evidence in support of hemispherectomy stems from a multitude of retrospective studies illustrating individual institutions' experience. A systematic review of this topic, however, is lacking in the literature.

Methods: A systematic review of hemispherectomy for the treatment of refractory epilepsy available up to October 2013 was performed using the following inclusion criteria: reports of a total of 10 or more patients in the pediatric age group (≤ 20 years) undergoing hemispherectomy, seizure outcome reported after a minimum follow-up of 1 year after the initial procedure, and description of the type of hemispherectomy.

Health care provider management of patients with type 2 diabetes mellitus: analysis of trends in attitudes and practices.

Objective: To identify attitudes and practices of endocrinologists (ENDOs), family practitioners (FPs), internists (IMs), primary care nurse practitioners (NPs), physician assistants (PAs), certified diabetes educators (CDEs), retail pharmacists (R-PHs), and hospital pharmacists (H-PHs) with respect to type 2 diabetes mellitus (T2DM) management; to compare current study data with results from a similar 2011 study.

Methods: A nominal group technique focus group identified barriers to optimal management of patients with T2DM. Five case-vignette surveys were created, 1 for each group of health care professionals (HCPs): ENDOs; FPs and IMs; NPs and PAs; CDEs; and R-PHs and H-PHs.

Fast-sequence MRI studies for surveillance imaging in pediatric hydrocephalus.

Object: Surveillance imaging of the cerebral ventricles can be valuable in following up children with shunt-treated hydrocephalus. There also, however, has been recent increased awareness and concern over the potential risk associated with imaging-related radiation exposure in children. Magnetic resonance imaging represents an imaging alternative that does not use ionizing radiation; however, its practical utility has been limited due to the near-uniform requirement for sedation or general anesthesia in children.

Long-term control of large pontine arteriovenous malformation using gamma knife therapy: a review with illustrative case.

Brain stem arteriovenous malformations (AVMs) are rare and their clinical management is controversial. A location in highly eloquent areas and a greater risk of radionecrosis are both serious issues for radiosurgery of this entity. We report a case of a pontine AVM treated successfully with gamma knife therapy.

Intracranial metastatic neuroblastoma treated with gamma knife stereotactic radiosurgery: report of two novel cases.

Intracranial metastasis of neuroblastoma (IMN) is associated with poor survival. No curative therapy for the treatment of IMN currently exists. Unfractionated radiotherapy may be beneficial in the treatment of IMN given the known radiosensitivity of neuroblastoma as well as its proclivity to metastasize as discrete lesions.