Indirect bypass for revascularization in Hutchinson-Gilford progeria syndrome: an illustrative case.

Purpose: Hutchinson-Gilford progeria syndrome (HGPS) is a rare genetic disorder characterized by premature aging. Cerebral hypoperfusion and stroke have been described in HGPS however revascularization techniques have not been reported from a neurosurgical perspective in HGPS patients.

Methods: We present a case of a pediatric patient with HGPS who underwent cerebral bypass along with a review of the literature.

Comparative Efficacy of Ventriculosubgaleal Shunt Versus Ventricular Reservoir in Achieving Shunt Independence for Infants With Posthemorrhagic Hydrocephalus by 6 Months.

Background And Objectives: Low-birth weight, premature infants often have severe intraventricular hemorrhage (IVH), which can result in posthemorrhagic hydrocephalus (PHH), sometimes requiring cerebrospinal fluid diversion. Initial temporizing management of PHH includes placement of a ventriculosubgaleal shunt (VSGS) or ventricular access device (VAD). Studies have found similar permanent shunt conversion rates between VSGS and VAD but were limited by sample scope and size.

Use of a percutaneous bone fiducial screw for elevating simple closed depressed skull fractures: illustrative cases.

Background: Depressed skull fractures in infants often present as "ping-pong ball" fractures with inward buckling of the calvarium, secondary to trauma. Management varies widely, and few concrete guidelines exist in the literature to guide decision-making when choosing a methodology for fracture elevation. The authors present two cases of attempted depressed skull fracture elevation with traction on a percutaneously placed bone fiducial screw, followed by a review of the literature, in order to further investigate the factors considered when selecting an intervention.

Cost-effectiveness of point of care smoking cessation interventions in oncology clinics.

Background: We examined the cost-effectiveness of providing systematic smoking cessation interventions to oncology patients at point-of-care.

Methods: A decision analytic model was completed from the healthcare payer's perspective and included all incident cancer cases involving patients who smoke in New Brunswick, Canada (n = 1040), cancer site stratifications, and risks of mortality, continued smoking, and cancer treatment failure over one year. Usual care (no cessation support) was compared to the standard Ottawa Model for Smoking Cessation (OMSC) intervention, and to OMSC plus unlimited cost-free stop smoking medication (OMSC + SSM), including nicotine replacement therapy, varenicline, or bupropion.

Combined endovascular and skull base surgical management of pediatric craniocervical pathology: a case series.

Objective: Pathological bony abnormalities of the craniocervical region in children sometimes require surgical intervention as part of their management. Rarely, abnormal skeletal or vascular anatomy can render traditional surgical techniques ineffective because of the risk of injury to the vertebral artery. To mitigate these risks, a combined endovascular and skull base approach was devised.

Axenfeld-Rieger syndrome: A systematic review examining genetic, neurological, and neurovascular associations to inform screening.

Axenfeld-Rieger Syndrome (ARS) is comprised of a group of autosomal dominant disorders that are each characterized by anterior segment abnormalities of the eye. Mutations in the transcription factors or are the most well-studied genetic manifestations of this syndrome. Due to the rarity this syndrome, ARS-associated neurological manifestations have not been well characterized.

Post-Surgical Cognitive Outcomes of Moyamoya Disease: A Systematic Review.

Background: Moyamoya disease (MMD) is an occlusive arteriopathy leading to stroke. Progressive if left untreated, revascularization surgery has become the mainstay of treatment. Although clinical and radiographic outcomes of MMD after intervention are well-characterized, cognitive outcomes in pediatric patients remain unclear.

Postischemic Trigeminal Neuropathy Treated With Radiofrequency Ablation.

Trigeminal neuralgia is a pain syndrome that is defined by sharp electrical shock-like pain that radiates in the sensory distribution of the trigeminal nerve. The classical cause of this syndrome is vascular compression, but other causes, such as stroke, have also been described. Instances of post-ischemic trigeminal pain have been described as meeting the classic description, and are termed trigeminal neuropathy.

Safety and efficacy of the Pipeline Flex embolization device with Shield Technology for the acute treatment of ruptured internal carotid artery pseudoaneurysms: a multi-institution case series.

Objective: Ruptured blister, dissecting, and iatrogenic pseudoaneurysms are rare pathologies that pose significant challenges from a treatment standpoint. Endovascular treatment via flow diversion represents an increasingly popular option; however, drawbacks include the requirement for dual antiplatelet therapy and the potential for thromboembolic complications, particularly acute complications in the ruptured setting. The Pipeline Flex embolization device with Shield Technology (PED-Shield) offers reduced material thrombogenicity, which may aid in the treatment of ruptured internal carotid artery pseudoaneurysms.

Middle meningeal artery embolization as a perioperative adjunct to surgical evacuation of nonacute subdural hematomas: An multicenter analysis of safety and efficacy.

Background: By 2030, nonacute subdural hematomas (NASHs) will likely be the most common cranial neurosurgery pathology. Treatment with surgical evacuation may be necessary, but the recurrence rate after surgery is as high as 30%. Minimally invasive middle meningeal artery embolization (MMAE) during the perioperative period has been posited as an adjunctive treatment to decrease the potential for recurrence after surgical evacuation.

Acute Mirror M1 Occlusions Treated With Endovascular First-Pass Contact Aspiration Technique.

Patients with acute bilateral M1 occlusion are usually comatose at presentation and have a grave prognosis. There have been few reports of emergent treatment using endovascular reperfusion therapy (ERT). We describe a patient treated with simultaneous first-pass contact aspiration and review the literature for cases describing the successful use of ERT in patients with bilateral anterior circulation proximal large-vessel occlusion (LVO).

A survey and analysis of pediatric stroke protocols.

Objectives Despite their comparative rarity, about 10,000 ischemic strokes occur in children every year, and no standardized method of treatment exists. Protocols have been effective at increasing diagnosis accuracy and treatment efficacy in adults, but little has been done to evaluate such tools in children. A survey was developed to identify the proportion of pediatric hospitals that have stroke protocols and analyze the components used for diagnosis and treatment to identify consensus.

Radiographic and clinical outcomes with particle or liquid embolic agents for middle meningeal artery embolization of nonacute subdural hematomas.

Background: Middle meningeal artery (MMA) embolization is an apparently efficacious minimally invasive treatment for nonacute subdural hematomas (NASHs), but how different embolisates affect outcomes remains unclear. Our objective was to compare radiographic and clinical outcomes after particle or liquid MMA embolization.

Methods: Patients who had MMA embolization for NASH were retrospectively identified from a multi-institution database.

Stereotactic electroencephalography is associated with reduced opioid and nonsteroidal anti-inflammatory drug use when compared with subdural grids: a pediatric case series.

Patients undergoing surgical intervention for epilepsy mapping are typically administered opioids for pain control. The use of opioids is demonstrably lower after other procedures when a minimally invasive surgery (MIS) technique is used. Our objective was to determine whether using MIS for stereoelectroencephalography (SEEG) resulted in lower opioid requirement by pediatric patients when compared with subdural grid placement after craniotomy (ECoG).

Postoperative magnetic resonance imaging may predict poor outcome in children with severe traumatic brain injuries who undergo cranial surgery.

Objective: Multiple studies have evaluated the use of MRI for prognostication in pediatric patients with severe traumatic brain injury (TBI) and have found a correlation between diffuse axonal injury (DAI)-type lesions and outcome. However, there remains a limited understanding about the use of MRI for prognostication after severe TBI in children who have undergone cranial surgery.

Methods: Children with severe TBI who underwent craniectomy or craniotomy at Primary Children's Hospital in Salt Lake City, Utah, between 2010 and 2019 were identified retrospectively.

Postoperative bowel complications after non-shunt-related neurosurgical procedures: case series and review of the literature.

Postoperative bowel complications after non-shunt-related neurosurgical procedures are relatively rare. In an effort to identify the primary risk factors, we evaluated postoperative bowel complications in cranial, endovascular, and spinal procedures in neurosurgery patients using our own institutional case series along with a literature review.We identified severe postoperative bowel complications that occurred at our institution after non-shunt-related neurosurgical procedures between July 2016 and December 2018.

Work relative value units and perioperative outcomes in patients undergoing brain tumor surgery.

The work relative value unit (wRVU) is a commonly cited surrogate for surgical complexity; however, it is highly susceptible to subjective interpretation and external forces. Our objective was to evaluate whether wRVU is associated with perioperative outcomes, including complications, after brain tumor surgery. The 2006-2014 American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients ≥ 18 years who underwent brain tumor resection.

An Audit and Comparison of pH, Measured Concentration, and Particulate Matter in Mannitol and Hypertonic Saline Solutions.

The preferred hyperosmolar therapy remains controversial. Differences in physical properties such as pH and osmolality may be important considerations in hyperosmolar agent selection. We aimed to characterize important physical properties of commercially available hyperosmolar solutions.

Analyzing the Safety and Efficacy of Flow-Diverting Stents in Pediatric Aneurysms: A Systematic Review.

Ruptured intracranial aneurysms cause 50% of spontaneous subarachnoid hemorrhages in children, resulting in up to 65% mortality when left untreated. Although flow-diverting stents are especially suited to treat the fusiform and giant aneurysms more commonly found in children, the US Food and Drug Administration (FDA) has only approved their use in patients ≥22 years of age. Our objective was to assess the safety of flow-diverting stents in the treatment of pediatric patients with aneurysms through a systematic literature review using the PRISMA criteria.

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series.

Background: Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use.

Objective: To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG).

Methods: Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018.