Use of Patient-Specific Interbody Cages Through a Minimally Invasive Lateral Approach for Unstable Lumbar Spondylodiskitis.

Background And Objectives: Patients with diskitis/osteomyelitis who do not respond to medical treatment or develop spinal instability/deformity may warrant surgical intervention. Irregular bony destruction due to the infection can pose a challenge for spinal reconstruction. The authors report a lateral approach using patient-specific interbody cages combined with posterior or lateral instrumentation to achieve spinal reconstruction for spinal instability/deformity from spondylodiskitis.

Designing and Testing a Developmentally Appropriate Intervention for Children in a Psychiatric Residential Treatment Facility.

Preadolescent children in residential care have treatment needs that are different from adolescents. An intervention was created using developmental theory to inform decisions about the timing, objectives, strategies, and context best suited to preadolescents in an intensive residential treatment center. Aggressive behavior, seclusions, and restraints data for preadolescents during a 32-month period was used in the analysis.

Sylvian Arteriovenous Malformation Resection and Associated Middle Cerebral Artery Aneurysm Clipping: Technical Nuances of Concurrent Surgical Treatment.

Approximately 10-30% of brain arteriovenous malformations (AVM) have associated arterial aneurysms (AAA), and the management of these lesions can be challenging. In this video technical note, we demonstrate the microsurgical treatment of an unruptured, Spetzler-Martin grade I AVM in the distal Sylvian fissure with two AAAs arising proximally from the inferior M2 trunk immediately distal to the middle cerebral artery (MCA) bifurcation. First, we resected the superficially located AVM to normalize the blood flow through the Sylvian vein.

Staged Multimodality Treatment of a Large Ruptured Fusiform Supraclinoid Internal Carotid Artery Aneurysm: Microsurgical Clip-assisted Endovascular Coiling.

In the contemporary era of aneurysm management, large fusiform aneurysms presenting with subarachnoid hemorrhage (SAH) remain particularly challenging lesions to successfully manage. We describe a staged, multimodal treatment strategy for a 71-year-old patient who presented with a large ruptured fusiform aneurysm of the supraclinoid internal carotid artery (ICA) and a fetal posterior communicating artery which originated from the inferomedial aspect of the aneurysm. In the first stage, we performed a partial microsurgical clip reconstruction of the fusiform aneurysm and secured its rupture site, which was identified intraoperatively.

Transventricular neuroendoscopic excision of giant racemose subarachnoid cysticercosis.

Purpose: Subarachnoid cysticercosis, an uncommon form of neurocysticercosis, can occasionally grow to giant size causing mass effect and obstructive hydrocephalus. These often require surgical excision to relieve the mass effect and re-establish the cerebrospinal fluid (CSF) pathways.

Clinical Presentation: The authors report a rare case of giant anterior interhemispheric racemose cysticercosis with extension to the region of septum pellucidum causing obstructive hydrocephalus.

Retrospective analysis of unstaged and staged Gamma Knife surgery with and without preceding embolization for the treatment of arteriovenous malformations.

Object: The authors conducted a retrospective study to examine data on rates of obliteration of arteriovenous malformations (AVMs) with use of various combinations of treatment modalities based on Gamma Knife surgery (GKS). The authors believe that this study is the first to report on patients treated with embolization followed by staged GKS.

Methods: The authors identified 150 patients who underwent GKS for treatment of AVMs between 1994 and 2004.

Efficacy of endoscopic third ventriculostomy in fourth ventricular outlet obstruction.

Objective: Fourth ventricular outlet obstruction (FVOO), an uncommon cause of obstructive hydrocephalus, is most commonly associated with prior intraventricular hemorrhage or intraventricular infection in children. There have been few reports of FVOO in an adult population.

Methods: Twenty-two patients with FVOO treated with endoscopic third ventriculostomy (ETV) were analyzed retrospectively.

Intraventricular occurrence of a melanocytoma.

Melanocytomas are rare tumors of the central nervous system that are believed to arise from leptomeningeal melanocytes. A young girl presented with a contrast-enhancing cystic mass in the temporal horn of the left lateral ventricle. Microsurgical resection of a black-colored vascular tumor supplied by the anterior choroidal artery was performed.

Endocrine failure after traumatic brain injury in adults.

Objective: To review histopathological and clinical data linking endocrine failure to traumatic brain injury (TBI) during acute neurosurgical treatment and rehabilitation.

Methods: A focused search of the Medline (PubMed) medical literature database and the authors' files were used to identify selected publications.

Results: Endocrine failure may produce clinically important consequences during acute and convalescent care after TBI, and may be caused by direct injury to the hypothalamic- pituitary axis (HPA), neuroendocrinological effects from catecholamines and cytokines, or from systemic infection/inflammation that produces primary gland failure.

Cerebral mycotic aneurysms treated with a neuroform stent: technical case report.

Objective And Importance: We describe the first documented endovascular treatment of proximal intracranial mycotic aneurysms by a self-expanding, flexible, dedicated, intracranial Neuroform stent. Treatment with this stent rapidly obliterated the aneurysms, eliminated the need for additional coiling, and maintained the patency of the parent arteries.

Clinical Presentation: A 47-year-old male patient with infective endocarditis presented with ischemic stroke and minimal subarachnoid hemorrhage.

Minimal model to document psychometric change after standard anterior temporal lobectomy for intractable seizure disorder.

Neuropsychological assessment of persons with epilepsy is recommended whenever neurosurgery is considered as an alternative therapy for seizure disorders refractory to ordinary medical management. Although psychological assessment is common in centers specialized in the care of epilepsy patients, standardized protocols are not common. This study addresses the question of the optimal minimal test battery necessary to differentiate groups of right-handed patients with refractory, complex partial seizure disorder who receive either right or left anterior temporal lobectomy or no surgery.

Late-developing cerebral arteropathy after pyogenic meningitis.

Background: Although vasculopathy is a recognized complication during acute meningitis, to our knowledge, no previous reports have been published of this phenomenon developing months after successful treatment.

Objective: To report a unique case of a late-developing vasculopathy after pyogenic meningitis in an adult.

Report Of A Case: A 51-year-old woman was seen with severe headache 2 months after treatment of Haemophilus influenzae type C meningitis.

Reversal of attenuation of cerebrovascular reactivity to hypercapnia by a nitric oxide donor after controlled cortical impact in a rat model of traumatic brain injury.

Object: Traumatic brain injury (TBI) attenuates the cerebral vasodilation to hypercapnia. Cortical spreading depression (CSD) also transiently reduces hypercapnic vasodilation. The authors sought to determine whether the CSD elicited by a controlled cortical impact (CCI) injury masks the true effect of TBI on hypercapnic vasodilation, and whether a nitric oxide (NO) donor can reverse the attenuation of hypercapnic vasodilation following CCI.

Fractionated stereotactic intensity-modulated radiotherapy (FS-IMRT) for small acoustic neuromas.

Eight patients with acoustic neuromas were treated using a novel method developed at our institution for delivering fractionated stereotactic intensity-modulated radiotherapy (FS-IMRT). We present treatment parameters, dosimetry analysis, and preliminary clinical outcome. The method incorporates high-precision invasive fixation, obliquely-oriented tomotherapy arcs, and reduced dimension pencil beams.