Chronic Debilitating Headache in Adults Caused by Craniocerebral Disproportion: Treatment by Cranial Vault Expansion.

Craniocerebral disproportion is rarely considered as a cause for chronic, debilitating headache in adults. Children reported with this disorder typically suffer from headaches and lethargy for many years and have multisutural synostosis. The terms craniocerebral disproportion, craniostenosis, and slit-ventricle syndrome are used inconsistently as diagnostic designations.

Shunt Nephritis: An Increasingly Unfamiliar Diagnosis.

Background: Shunt nephritis is a rare, reversible immune-complex mediated complication of cerebrospinal fluid (CSF) shunt infection that can progress to end-stage renal disease and even death if diagnosis is delayed.

Case Description: The present case report details the manifestation and clinical course of shunt nephritis in a 50-year-old patient who presented with symptoms of nephrotic syndrome 30 years after ventriculojugular shunt placement. Diagnosis was delayed due to initial negative CSF and blood cultures, but a later CSF culture was positive for Propionibacterium acnes.

Differential Pressure Shunt for Simultaneous Diversion of Ventricular Fluid and Extracerebral Fluid.

Background/aims: The management of extracerebral collections of fluid in patients with hydrocephalus can be problematic for either their simultaneous separate management or sequential management, each of which may require multiple surgeries and the management of external drains. The object of this report is to review the experience with a shunt configuration that simultaneously diverts ventricular fluid and extracerebral fluid, whether subdural or subarachnoid in location, through different outflow resistances.

Methods: The medical records, including neuroimaging of patients with hydrocephalus and clinically significant extracerebral collections of low density who were managed by implanting a differential pressure type shunt, were retrospectively reviewed.

Everting Fracture of Entire Frontal Bone: Management and Importance of Preliminary Reconstruction.

A 34-year-old woman with severe craniofacial trauma, which included eversion of the entire frontal bone, survived with high-quality functional and cosmetic results as a consequence of efficient and aggressive action by emergency technicians and physicians. Early preliminary steps of craniofacial reconstruction provided a structural foundation that facilitated this outcome.

Techniques for Achieving Hemostasis from Choanoid Cranial Foramina.

Objective: This report describes 2 techniques for controlling otherwise difficult-to-control hemorrhage from choanoid bony foramina.

Methods: Medical records of 3 patients in whom vigorous and difficult-to-control bleeding from choanoid cranial foramina was successfully halted are reviewed.

Results: In 2 patients, vigorous arterial bleeding from the foramen spinosum was controlled with a wooden peg.

Resistance to venous flow: A mathematical description and implications for compartment syndromes.

Background: The object of this work was to describe resistance to flow within a vein in a closed compartment.

Methods: A vein is mathematically modeled as a collapsible cylinder with fixed perimeter exposed to extraluminal hydrostatic pressure within a closed compartment of the body. The principle of minimization of energy is used to determine the cross-sectional area and resistance to flow through such a cylinder in various states of collapse.

Removal of Vagus Nerve Stimulator Leads and Reuse of Same Site for Reimplantation: Technique and Experience.

Objective: This report describes the authors' experience and technique in removing vagus nerve stimulator leads, including coils, and reuse of the same site on the vagus nerve for implantation of new coils.

Methods: The charts of all patients who underwent complete removal by the authors of vagus nerve stimulator leads between 1 September 2001 and 1 July 2015 were retrospectively reviewed.

Results: Thirty patients underwent 31 surgeries for removal of vagus nerve stimulator leads.

Aplasia Cutis Congenita of the Scalp, Composite Type: The Criticality and Inseparability of Neurosurgical and Plastic Surgical Management.

Background/aims: The object of this report is to review the management of patients having the composite type of aplasia cutis congenita in the context of the relevant literature on this condition.

Methods: Clinical records, neuroimaging and photographic documentation of identified cases of composite type aplasia cutis congenita, with a comprehensive review of the literature, are the material basis of this report.

Results: Two neonates with composite type aplasia cutis congenita are described as examples of this disorder, and their management, including complications, is discussed.

Damage-control neurosurgery: Packing to halt relentless intracranial bleeding.

Background: The objective of this study was to review the efficacy of intracranial packing as a means of tamponade for life-threatening intraoperative hemorrhage that was refractory to more common techniques for achieving hemostasis.

Methods: Neuroimaging and hospital records were reviewed for the seven adult patients who had experienced life-threateningly severe hemorrhage during intracranial surgery and in whom packing was used to control the bleeding. All packing was left in place at the time of closure and was removed when the patient's condition was considered safe for a second operation.

Upward Translation of Cerebellar Tonsils following Surgical Expansion of Supratentorial Cranial Vault: A Unified Biomechanical Explanation of Chiari Type I.

Cerebellar tonsils moved significantly upward in 3 patients with Chiari type I who underwent supratentorial cranial vault expansion to alleviate intracranial pressure related to multisutural craniosynostosis. The Chiari type I deformities in these patients were the biomechanical consequence of posterior fossa-cerebellar disproportion caused by supratentorial craniocerebral disproportion secondary to multisutural craniosynostosis. The authors postulate that all cases of Chiari type I deformity share the sine qua non feature of posterior fossa-cerebellar disproportion.

Experience with a Low Single Cervical Incision for Implantation of a Vagus Nerve Stimulator: Technique and Advantages.

Objective: This report describes the technique for implanting a vagus nerve stimulator via a single low anterior cervical incision and discusses the advantages of this technique over that of the more commonly used 2-incision technique.

Methods: The authors performed a retrospective review of all patients who underwent implantation of a vagus nerve stimulator by the senior author over a 10-year period.

Results: One hundred thirty-one patients underwent implantation of vagus nerve stimulators via the single-incision technique.

Packing to tamponade severe intracranial hemorrhage in pediatric patients.

The medical records of all children in whom packing was used to control severe intracranial hemorrhage were reviewed. Eight children, with ages ranging from newborn to 4 years, met the inclusion criteria and all survived. Five were victims of severe closed head trauma, 2 had received penetrating cranial injuries, and 1 developed severe bleeding while undergoing surgery for a malignant tumor in the posterior fossa.

Breach of Posterior Wall of Frontal Sinus: Management with Preservation of the Sinus.

Objective: To analyze outcomes after the management of mild (<1 mm) and moderately severe (>1 mm and <5 mm) breaches of the posterior wall of the frontal sinus with a goal of maintaining or restoring the functional status of the sinus.

Methods: A retrospective analysis of prospectively accrued data was performed on patients with mild and moderately severe breaches of the posterior wall of their frontal sinus who were managed with the intent to preserve the frontal sinus. Data on presenting features, pathology, details on breaches of the posterior wall, management, outcome, and complications were collected from medical records and neuroimages.

Relationship of vocal cord paralysis to the coil diameter of vagus nerve stimulator leads.

Object: This investigation was done to examine, following implantation of vagus nerve stimulators, the relationship of vocal cord paralysis to the inner diameter of the coils used to attach the stimulator lead to the nerve.

Methods: All data in this investigation were collected, as mandated by the FDA, by the manufacturer of vagus nerve stimulators and were made available without restrictions for analysis by the authors. The data reflect all initial device implantations in the United States for the period from 1997 through 2012.

Recurrent cerebrospinal fluid shunt infection and the efficacy of reusing infected ventricular entry sites.

Object: The objective of this investigation was to review the clinical characteristics of recurrent CSF shunt infections in a large pediatric neurosurgical practice and to assess the safety and efficacy of reusing original ventricular entry sites for external ventricular drainage during treatment of infections and for subsequent reinsertion of shunts.

Methods: Prospectively accrued clinical data on all patients treated at Children's Hospital Colorado for CSF shunt infections within a 10.5-year span were retrospectively investigated.

Syndromic craniosynostosis, fibroblast growth factor receptor 2 (FGFR2) mutations, and sacrococcygeal eversion presenting as human tails.

Introduction: There have been 23 previously published cases of patients with syndromic craniosynostosis and human tails. In many of these, the tail was composed of prominent coccygeal and sacral vertebrae, curved in a retroverted instead of in the normal anterograde fashion. This has been termed sacrococcygeal eversion.

Multidisciplinary approach to cerebrospinal fluid shunt infection with an appeal for attention to details in assessment and standardization in reporting.

Object: The goal of this study was to evaluate the problems encountered in monitoring CSF shunt infection, including the collection, analysis, and reporting of data. The authors propose a system that would produce more accurate, and hence more meaningful, information on shunt infection than do the methodologies and customs now in common use.

Methods: The authors reviewed and analyzed 19 years of quarterly records of a committee that has addressed CSF shunt infection in an ongoing manner.

Cranial vault expansion by distraction osteogenesis.

Object: The object of this report is to present a conceptual and technical approach for expanding the cranial vault, by distraction osteogenesis, in patients with craniocephalic disproportion secondary to pancraniosynostosis and in patients with complex syndromic craniofaciosynostoses undergoing operations for aesthetic improvement.

Methods: The clinical characteristics, techniques used, outcome and complications for all patients who underwent cranial vault expansions with distraction osteogenesis in Children's Hospital of Denver were reviewed.

Results: Twenty-six cranial vault expansions were done in 24 patients.

Reuse of ventricular drain sites for cerebrospinal fluid shunting in patients with no prior infection.

Object: The safety of reusing ventricular drain sites for shunting CSF in patients with no history of infection involving either the ventricular drain or the CSF was the focus of this investigation.

Methods: Prospectively accrued clinical data on all patients who, in an 8-year span ending in June 2008, underwent external ventricular drain placement and subsequently required CSF shunts were retrospectively evaluated for evidence of shunt infection and other complications.

Results: The infection rate for 50 consecutive operations in 50 patients who met the inclusion criteria was 2.

Prognosis for children in cardiac arrest shortly after blunt cranial trauma.

Background: The goal of this investigation is to determine the success rate of aggressive cardiorespiratory resuscitation in children who experience blunt cranial trauma of sufficient magnitude to quickly cause cardiac arrest.

Methods: The records of all the children who, within a 6-year period, suffered cardiac arrest at the scene of injury, during transport or in the emergency department of a level one pediatric trauma center, as a consequence of blunt cranial trauma, form the basis of this study.

Results: One of the 40 children who met the inclusion criteria survived.

Pus and free bone flaps.

Object: The goal of this investigation is to describe the results of a vigorous attempt to preserve contaminated free bone flaps and avoid the problems associated with the traditional and common practice of discarding the flap, administering a course of antibiotics, and after several months, performing a cranioplasty.

Methods: Patients with clearly contaminated, free cranial bone flaps, including so-called high risk cases, were treated by meticulous debridement of the surgical bed, scrubbing, soaking, and then replacing the bone flap in its normal position, and administering a course of intravenous antibiotics.

Results: Fourteen patients with contaminated avascular cranial bone flaps were treated using this technique.

Insulation discontinuity in a vagus nerve stimulator lead: a treatable cause of intolerable stimulation-related symptoms.

Discontinuity in the silicone insulation over an electrode of a left vagus nerve stimulator (VNS) allowed the aberrant leak of current to the phrenic nerve and other structures. This resulted in ipsilateral diaphragmatic dysfunction, inability to vocalize, and severe radiating pain into the jaw and upper incisor for the duration of each stimulation. The device was explanted and a new device was implanted.