Does Valve Design Affect the Tensile Strength of Ventriculoperitoneal Shunts?

Background And Objectives: The most common treatment for hydrocephalus is ventriculoperitoneal (VP) shunting, which is problematic as shunts are prone to failure. Shunt disconnections account for a minority (8%-15%) of VP shunt failures but could be reduced through better shunt design. A better understanding of the mechanical properties of VP shunts would help explain why shunt disconnections occur.

Ventriculoperitoneal shunt placement following endoscopic third ventriculostomy failure in the treatment of pediatric hydrocephalus.

Objective: The goal of this study was to evaluate the impact of endoscopic third ventriculostomy (ETV) failure on subsequent risk of ventriculoperitoneal shunt (VPS) placement.

Methods: A retrospective chart review was performed to identify pediatric patients receiving ETV followed by a VPS at Oklahoma Children's Hospital between January 1, 2016, and December 31, 2021. A control group of patients receiving a VPS alone was also gathered.

Through the Looking Glass: Comparing Resident and Attending Views on Competency and Autonomy.

Background: Surgical residencies act as an apprenticeship to train new surgeons, ideally with increasing trainee autonomy and competency. Objective methods of measuring these two qualities are needed.

Methods: The objective of this pilot study is to use the Surgical Autonomy Program to compare resident and attending perception of competency, via Zones of Proximal Development (ZPDs), and autonomy, via Teach, Advise, Guide, Solo (TAGS) scale for a common pediatric neurosurgical procedure.

Pediatric neurosurgery through the lens of time-driven activity-based costing: a pilot study.

Objective: Time-driven activity-based costing (TDABC) is a method used in cost accounting that has gained traction in health economics to identify value optimization initiatives. It measures time, assigns value to time increments spent on a patient, and integrates the cost of material and human resources utilized in each episode of care. In this study, the authors report the first use of TDABC to evaluate costs in a pediatric neurosurgical practice.

A systematic review of the power of standardization in pediatric neurosurgery.

In the current neurosurgical field, there is a constant emphasis on providing the best care with the most value. Such work requires the constant optimization of not only surgical but also perioperative services. Recent work has demonstrated the power of standardized techniques in limiting complication while promoting optimal outcomes.

Bilateral cerebellopontine angle lipomas in an infant with encephalocele: illustrative case.

Background: Bilateral cerebellopontine angle (CPA) lipomas are extremely rare. Herein the authors present a case of bilateral CPA lipomas in an infant along with a literature review of bilateral CPA lipomas.

Observations: A newborn girl was incidentally found to have bilateral CPA lipomas during the workup for an occipital encephalocele.

Influence of the living Pareto chart and data transparency on patient outcomes in neurosurgery.

Objective: Quality improvement (QI) tools are increasingly being used to calibrate healthcare quality. Achieving healthcare quality is essential, as there is a movement toward value-based healthcare delivery. Visual management, such as a living Pareto chart, is a strategy for improvement within the QI framework.

Review of Pediatric Extraosseous Chordomas with a Unique, Illustrative Case.

Introduction: Chordoma is a rare, aggressive tumor that is believed to originate from notochord remnants. It can occur anywhere from the clivus to the sacrum and often recurs even after resection and radiotherapy. We present a unique case that initially suggested a different pathology based on imaging and presentation but was found to be a chordoma on gross and pathological analysis.

Torcular pseudomass in a 14-month-old child: illustrative case.

Background: "Torcular pseudomass," or redundant soft tissue in the torcular region, is not an infrequent incidental finding on advanced imaging of the brain in infants and young children. It was recently codified among pediatric neuroradiologists; however, its report in the pediatric neurosurgical community has not previously been elucidated.

Observations: The authors present a case of a 14-month-old child who presented with fever and a first-time seizure.

Contemporary outcomes of diffuse leptomeningeal glioneuronal tumor in pediatric patients: A case series and literature review.

Background: Diffuse leptomeningeal glioneuronal tumor (DLGNT), also known as oligodendrogliomatosis, is a rare neuro-oncologic condition along the neuraxis that remains poorly understood in children. We sought to describe our institutional experience and quantitively summarize the clinical survival and prognostic features of DLGNT in the pediatric population across the contemporary literature.

Methods: We report four institutional cases of pediatric DLGNT diagnosed between 2000 and 2020 based on retrospective review of our records, and performed a comprehensive literature search for published cases from 2000 onwards to create an integrated cohort for analysis.

Machine learning to predict passenger mortality and hospital length of stay following motor vehicle collision.

Objective: Motor vehicle collisions (MVCs) account for 1.35 million deaths and cost $518 billion US dollars each year worldwide, disproportionately affecting young patients and low-income nations. The ability to successfully anticipate clinical outcomes will help physicians form effective management strategies and counsel families with greater accuracy.

White Cord Syndrome after Thoracic Cord Decompression in a Pediatric Patient.

Introduction: White cord syndrome (WCS) is a rare phenomenon which causes acute neurologic deterioration after a chronically compressed spinal cord is surgically decompressed, resulting in a T2-hyperintense signal to appear in the cord. We present the first case of pediatric WCS in the thoracic spine and the first to show complete resolution of symptoms.

Case Presentation: A 3-year-old girl presented with difficulty ambulating due to pain caused by T4-8 spinal cord compression from a mass of ganglioneuromatous tissue, consistent with her previously treated mediastinal neuroblastoma.

Women in Neurosurgery Around the World: A Systematic Review and Discussion of Barriers, Training, Professional Development, and Solutions.

Background: Women have been a minority in neurosurgery since the foundation of the specialty. Women who choose to pursue neurosurgery or advance in their career must overcome various obstacles. In this article, we discuss the proportion of women in neurosurgery globally and the obstacles they face, as well as the solutions being implemented.

Management of Chiari I malformation in children: personal opinions.

Purpose: This manuscript describes our management philosophy of Chiari I malformation in children based on a single neurosurgeon's personal experience.

Methods: Based on 61 infants and children with Chiari I malformation treated from 2007 to 2017, typical symptoms, surgical indications, types of surgery, and evaluation of surgical decompression are reviewed.

Results: Sixty-one patients had 69 decompressions, with 90% having symptom improvement.

Predictors of Successful Discharge of Patients on Postoperative Day 1 After Craniotomy for Brain Tumor.

Background: Shorter hospital stays have been associated with decreased complication rates, fewer hospital-acquired infections, and lower costs. We evaluated an optimized treatment paradigm for patients undergoing craniotomy allowing for postoperative day 1 (POD1) discharge if the criteria were met. We compared the complication and readmission rates between the POD1 patients and those with longer stays, and examined the patient and surgical variables for predictors of POD1 discharge.

Treatment of posttraumatic lumbar interspinous ligament calcification with partial resection of spinous processes and calcified interspinous ligaments: case report.

The authors report on the first surgical treatment for traumatic interspinous ligament calcification, with significant radiographic and symptomatic improvements at long-term follow-up. Heterotopic ossification occurs following traumatic injury but does not typically affect the interspinous ligaments. While these ligaments can calcify with age, this is rarely seen in patients younger than 50 years of age.

Frontal Sinus Osteoma Presenting with Meningitis and Epilepsy.

Background: Osteomas are benign lesions of bone, most frequently seen in the paranasal sinuses; however, they are typically asymptomatic and without complication. We report a rare case of large frontal sinus osteoma with intracranial extension, associated with meningitis and the development of seizures.

Case Description: The patient is a 38-year-old man with a prolonged history of headache and seizures, who was seen by multiple specialists previously, all of whom deferred treatment.

Central Neurocytoma: Rare Presentation in Fourth Ventricle and Review of Literature.

Central neurocytomas are rare tumors, typically found in the third ventricle. We present the unusual case of a fourth ventricular central neurocytoma in a 70-year-old female presenting with imbalance and headaches, with an enhancing fourth ventricular mass on imaging. We examine the details of her clinical presentation, imaging characteristics, histopathologic analysis, and postoperative course.

Just the Tip: Resection of a Narcotic Catheter-Tip Granuloma: 2-Dimensional Operative Video.

The catheter tip "granuloma" is a rare inflammatory mass that forms in about 3% of patients with an intradural catheter, most commonly from a morphine pump. It has also been seen with other narcotic pumps, narcotic-non-narcotic combinations, and baclofen pumps. Mass formation is associated with increased opioid dose and concentration.

Bridging the gap: creating a self-sustaining neurosurgical residency program in Haiti.

Given Haiti's longstanding socioeconomic burden and recent environmental and epidemiological catastrophes, the capacity for neurosurgery within Haiti has been limited, and outcomes for patients with neurosurgical conditions have remained poor. With few formally trained neurosurgeons (4) in a country of 10.5 million inhabitants, there is a significant need for the development of formal structured neurosurgical training.

Patientem Fortuna Adiuvat: The Delayed Treatment of Surgical Acute Subdural Hematomas-A Case Series.

Background: Current guidelines prescribe emergent decompression of acute subdural hematomas (aSDHs) with width 10 mm or larger or midline shift 5 mm or larger. A subset of patients who meet these criteria, including those with high Glasgow Coma Scale (GCS) scores and coagulopathy because of medication or multiple medical comorbidities, may be treated conservatively until the hematoma can be removed by burr hole drainage. We present a series of conservatively managed surgical patients with aSDH, examining their hospital course and outcomes.

Who Needs Sleep? An Analysis of Patient Tolerance in Awake Craniotomy.

Background: Awake craniotomy (AC) is generally a safe and effective procedure; however, a small but not insignificant portion of cases are aborted due to patient intolerance of the awake portion of surgery. There is not yet a firm understanding of what characteristics indicate patient tolerance or failure of AC.

Methods: We retrospectively reviewed a single-surgeon database of patients treated by AC over a 5-year period.

Flow, Liver, Flow: A Retrospective Analysis of the Interplay of Liver Disease and Coagulopathy in Chronic Subdural Hematoma.

Background: Chronic subdural hematoma (cSDH) is a common neurosurgical ailment, particularly in elderly patients. A recent study uncovered an association between liver disease and recurrence in patients with cSDH. Here, we explored that relationship to identify recurrence predictors in at-risk patients.