Journal of neurosurgery. Pediatrics
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J Neurosurg Pediatr · Jul 2008
Meta Analysis Comparative StudyComparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis.
Surgery for Chiari malformation Type I (CM-I) is one of the most common neurosurgical procedures performed in children, although there is clearly no consensus among practitioners about which surgical method is preferred. The objective of this meta-analysis was to compare the outcome of posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) for the treatment of CM-I in children. ⋯ Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation than PFD but a greater risk for cerebrospinal fluid-related complications. There was no significant difference between the 2 operative techniques with respect to clinical improvement or decrease in syringomyelia.
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J Neurosurg Pediatr · Jul 2008
Review Case ReportsThe importance of the cortical subarachnoid space in understanding hydrocephalus.
In this paper the authors define the role of the cortical subarachnoid space (CSAS) in poorly understood forms of hydrocephalus to cerebrospinal fluid (CSF) dynamics to improve understanding of the importance of the CSAS and its role in selecting patients for endoscopic third ventriculostomy (ETV). The secondary purpose of this work was to define testable hypotheses to explain enigmatic disorders of CSF dynamics and to suggest how these concepts could be tested. ⋯ The important role of the CSAS in the pathophysiology of various forms of hydrocephalus has been largely ignored. Attention to the dynamics of the CSF in this compartment will improve understanding of enigmatic conditions of hydrocephalus and improve selection criteria for treatment paradigms such as ETV. These concepts lead to clearly defined problems that may be solved by the creation of a central database to address these issues.
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J Neurosurg Pediatr · Jul 2008
Intraoperative ultrasonography as a guide to patient selection for duraplasty after suboccipital decompression in children with Chiari malformation Type I.
Indications for duraplasty in treatment of Chiari malformation Type I (CM-I) remain unclear. In the present study, the authors evaluate their surgical experience to determine whether intraoperative ultrasonography is effective in the selection of patients with CM-I who can be adequately treated with craniectomy alone without duraplasty. ⋯ In the setting of moderate-to-severe tonsillar CM-I, intraoperative ultrasonography demonstrating decompression of the subarachnoid spaces ventral and dorsal to the tonsils may not effectively select patients in whom bone decompression alone is sufficient. Duraplasty may be warranted in cases of tonsillar herniation that extends below the C-1 lamina regardless of intraoperative ultrasonography findings. More objective cerebrospinal fluid flow or volumetric measures may be needed intraoperatively to guide duraplasty in patients with more pronounced tonsillar herniation.
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J Neurosurg Pediatr · Jun 2008
ReviewA 15-year review of pediatric neurosurgical fellowships: implications for the pediatric neurosurgical workforce.
The Accreditation Council for Pediatric Neurosurgical Fellowships (ACPNF) was established in 1992 to oversee fellowship training in pediatric neurological surgery. The present study is a review of all graduates from 1992 through 2006 to identify predictors of American Board of Pediatric Neurological Surgery (ABPNS) certification. ⋯ Although the present training infrastructure has the theoretical capacity to train > 20 pediatric neurosurgeons each year, this analysis suggests that current levels will provide approximately 6 ABPNS-certified pediatric neurosurgeons annually. This raises the question of the sufficiency of the future pediatric neurosurgical workforce.
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J Neurosurg Pediatr · Jun 2008
Randomized Controlled TrialClinical and economic consequences of antibiotic-impregnated cerebrospinal fluid shunt catheters.
The authors evaluated the safety and efficacy of antibiotic-impregnated shunt catheters (AISCs) and determined the cost-benefit ratio related to the fact that AISCs increase the implant costs of a shunt procedure by approximately $400 per patient. ⋯ From clinical and economic perspectives, AISCs are seemingly a valuable addition in hydrocephalus therapy.