Ventriculoperitoneal shunting with an on-off valve for patients with leptomeningeal metastases and intracranial hypertension.

Background: We report our experience with using a ventriculoperitoneal shunt (VPS) with an on-off valve and in-line Ommaya reservoir for the treatment of hydrocephalus or intracranial hypertension in patients with leptomeningeal disease (LMD). Our goal was to determine whether control of intracranial pressure elevation combined with intrathecal (IT) chemotherapy would extend patient survival.

Methods: In this IRB-approved retrospective study, we reviewed 58 cases of adult patients with LMD from solid cancers who received a VPS with a reservoir and an on-off valve at M D Anderson Cancer Center from November 1996 through December 2021.

Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited.

Object: Surgical transposition of the ulnar nerve to alleviate entrapment may cause otherwise normal structures to become new sources of nerve compression. Recurrent or persistent neuropathy after anterior transposition is commonly attributable to a new distal compression. The authors sought to clarify the anatomical relationship of the ulnar nerve to the common aponeurosis of the humeral head of the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) muscles following anterior transposition of the nerve.

Neurosurgical tactile discrimination training with haptic-based virtual reality simulation.

Objective: To determine if a computer-based simulation with haptic technology can help surgical trainees improve tactile discrimination using surgical instruments.

Material And Methods: Twenty junior medical students participated in the study and were randomized into two groups. Subjects in Group A participated in virtual simulation training using the ImmersiveTouch simulator (ImmersiveTouch, Inc.

Virtual reality spine surgery simulation: an empirical study of its usefulness.

Objective: This study explores the usefulness of virtual simulation training for learning to place pedicle screws in the lumbar spine.

Methods: Twenty-six senior medical students anonymously participated and were randomized into two groups (A = no simulation; B = simulation). Both groups were given 15 minutes to place two pedicle screws in a sawbones model.

Present and future of neurosurgery training and education.

Multiple challenges are faced by educators and trainees. These challenges are multidimensional and pertain to a scenario in which trainees have to become in a short period of time competent technical neurosurgeons, while at the same time conscious of economic and professional factors that will influence their practice. It is the duty of societies and leading educators to come together in developing continental methods of training aimed towards "organised learning".

A novel virtual reality simulation for hemostasis in a brain surgical cavity: perceived utility for visuomotor skills in current and aspiring neurosurgery residents.

Objective: To understand the perceived utility of a novel simulator to improve operative skill, eye-hand coordination, and depth perception.

Methods: We used the ImmersiveTouch simulation platform (ImmersiveTouch, Inc., Chicago, Illinois, USA) in two U.

Sensory and motor skill testing in neurosurgery applicants: a pilot study using a virtual reality haptic neurosurgical simulator.

Background: Manual skill is important for surgeons, but current methods to evaluate sensory-motor skills in applicants to a surgical residency are limited.

Objective: To develop a method of testing sensory-motor skill using objective and reproducible virtual reality simulation.

Methods: We designed a set of tests on a 3-dimensional surgical simulator with head and arm tracking, colocalization, and haptic feedback: (1) "trajectory planning in a simulated vertebra," ie, 3-dimensional memory and orientation; "hemostasis in the brain," ie, motor planning, sequence, timing, and precision; and "choose the softest object," ie, haptic perception.

C4-C5 post-traumatic spondyloptosis with in situ fusion: systematic literature review and case report.

Study Design: A case report with systematic review of the literature.

Objective: To report a case of post-traumatic C4-C5 spondyloptosis without neurological deficit not associated with posterior element fractures and presenting in a delayed fashion with fusion in situ of C4 and C5 vertebral bodies influencing the management strategy.

Summary Of Background Data: Traumatic spondyloptosis of the subaxial cervical spine is typically associated with neurological injury.

Neurosurgery certification in member societies of the WFNS: global overview.

Objective: To determine the complexity and diversity of the neurosurgery certification and recertification process in member societies of the World Federation of Neurosurgical Societies.

Material And Methods: A 13-item survey was sent to 88 national and regional societies that are members of the World Federation of Neurosurgical Societies. Variables included in the survey covered a wide range of aspects pertaining to the certification process achieved by cognitive and oral examinations.

Neurosurgery certification in member societies of the WFNS: Africa and the Middle East.

Background: This study sought to compare objectively the complexity and diversity of the certification process in neurological surgery in member societies of the World Federation of Neurosurgical Societies (WFNS) in the African and Middle Eastern regions.

Methods: This report centers on two geographic regions: Africa and the Middle East. We provide a subgroup analysis based on the responses provided to the 13-item survey sent in Part I of this study.

Neurosurgery certification in member societies of the World Federation of Neurosurgical Societies: Asia.

Objective: To objectively compare the complexity and diversity of the certification process in neurological surgery in member societies of the World Federation of Neurosurgical Societies.

Methods: This study centers in continental Asia. We provide here an analysis based on the responses provided to a 13-item survey.

Neurosurgery certification in member societies of the WFNS: Europe.

Objective: To objectively compare the complexity and diversity of the certification process in Neurological Surgery in European member societies of the World Federation of Neurosurgical Societies.

Materials And Methods: The attention of this study centers on Europe. We provide here a subgroup analysis based on the responses provided to a 13-item survey.

Neurosurgery certification in member societies of the World Federation of Neurosurgical Societies (WFNS). The Americas.

Introduction: This article aims to objectively compare the complexity and diversity of the certification process in neurologic surgery in member societies of the World Federation of Neurosurgical Societies.

Methods: This study centers on the certification processes in the geographic regions of North, South, and Central America. It presents a subgroup analysis based on the responses provided to a 13-item survey.

Intraoperative magnetic resonance imaging-guided tractography with integrated monopolar subcortical functional mapping for resection of brain tumors. Clinical article.

Object: The object of this study was to describe the utility and safety of using a single probe for combined intraoperative navigation and subcortical mapping in an intraoperative MR (iMR) imaging environment during brain tumor resection.

Methods: The authors retrospectively reviewed those patients who underwent resection in the iMR imaging environment, as well as functional electrophysiological monitoring with continuous motor evoked potential (MEP) and direct subcortical mapping combined with diffusion tensor imaging tractography. RESULTS As a navigational tool the monopolar probe used was safe and accurate.

Dissemination of prostate adenocarcinoma to the skull base mimicking giant trigeminal schwannoma: anatomic relevance of the extradural neural axis component.

We report an unusual case of a large metastatic lesion from prostate adenocarcinoma with its epicenter located in Meckel's cave. The patient presented with acute neurological deterioration due to pontomesencephalic, cranial nerve, and temporal lobe compression. This lesion radiologically mimicked a giant trigeminal schwannoma.

State-of-the-art management and monitoring of brain edema and intracranial hypertension in fulminant hepatic failure. A proposed algorithm.

Aim: Develop an evidence-based clinical algorithm integrating clinical decision making on intracranial pressure (ICP) monitoring and intracranial hypertension (ICH) management in the setting of fulminant hepatic failure (FHF).

Material And Methods: An English-language literature review was conducted using the PubMed database in November 2007. In compiling evidence on current management trends of ICP and FHF, the paired keywords: fulminant hepatic failure and either mannitol, hypertonic saline, hyperventilation, bioartificial liver, hypothermia, indomethacin, thiopental, or propofol were used.

Simultaneous use of functional tractography, neuronavigation-integrated subcortical white matter stimulation and intraoperative magnetic resonance imaging in glioma surgery: technical note.

The importance of preserving function during glioma surgery cannot be overemphasized. There are a number of techniques utilized including functional MRI, direct electrophysiological monitoring and functional neuronavigation to maximize and safely resect gliomas. The intraoperative MRI is an extremely valuable tool and adds to the neurosurgeon's armamentarium.

Neuronavigation-guided endoscopic decompression of superior orbital fissure fracture: case report and literature review.

Objective: We present a rare case of an isolated superior orbital fissure fracture resulting from blunt injury to the face and presenting with selective cranial nerve deficits surgically treated with a neuroendoscopic approach. The anatomy of the superior orbital fissure is detailed, and the peculiarities of the surgical approach described.

Method: A review of the existing literature reveals this is the first reported case of a neuronavigation-assisted endoscopic approach used in the extraction of a superior orbital fracture fragment with good outcome.

Surgical options for ulnar nerve entrapment: an example of individualized decision analysis.

The decision-making process in the diagnosis and treatment of an ulnar nerve entrapment (UNE) at the elbow is presented from the viewpoint of the patient and from that of a physician who in this case, were the same individual. The problems of diagnosis and the selection of the appropriate therapy-conservative or surgical and the choice of a particular surgical approach are discussed in the light of recent evidence-based medicine (EMB) literature.

Apnea and macrocephaly-cutis marmorata telangiectatica congenita.

The authors report a case of an infant girl with macrocephaly-cutis marmorata telangiectatica congenita (Macrocephaly-CMTC). This patient presented with developmental delay, mild subcostal retractions, and occasional apneic spells. An MRI demonstrated mild to moderate lateral ventricle hydrocephalus, left hemi-megalencephaly, and left cerebellar tonsillar herniation with full occlusion of the cisterna magna.

Infratentorial angioleiomyoma: a new location for a rare neoplastic entity.

Angioleiomyomas are benign neoplasms most often located in the subcutaneous tissue of middle-aged individuals and usually confined to the subcuticular and deep dermal layers of the lower extremities. An intracranial site for this tumor is exceedingly rare, with very few reports documenting locations in the neuraxis. To the authors' knowledge the present case represents the first reported instance of an infratentorial angioleiomyoma.

Cerebral pressure autoregulation in traumatic brain injury.

An understanding of normal cerebral autoregulation and its response to pathological derangements is helpful in the diagnosis, monitoring, management, and prognosis of severe traumatic brain injury (TBI). Pressure autoregulation is the most common approach in testing the effects of mean arterial blood pressure on cerebral blood flow. A gold standard for measuring cerebral pressure autoregulation is not available, and the literature shows considerable disparity in methods.

Toxicity and efficacy of protracted low dose temozolomide for the treatment of low grade gliomas.

Protracted low dose temozolomide (75 mg/m(2)/day on days 1-21 of 28 days) offers potential advantages over standard temozolomide schedules (200 mg/m(2)/day on days 1-5 of 28 days) including greater cumulative drug exposure and depletion of O(6)-alkylguanine DNA alkyltransferase levels, theoretically overcoming intrinsic chemoresistance. We retrospectively review our experience in 25 patients with pathologically proven low grade gliomas (LGG) treated with protracted low dose temozolomide to primarily quantify its toxicity and secondarily to assess efficacy. None had previously received radiation.