Neurosurgery
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Practice Guideline
Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines, Executive Summary.
The purpose of this work is to identify and synthesize research produced since the second edition of these Guidelines was published and incorporate new results into revised evidence-based recommendations for the treatment of severe traumatic brain injury in pediatric patients. This document provides an overview of our process, lists the new research added, and includes the revised recommendations. Recommendations are only provided when there is supporting evidence. ⋯ The online documents contain summaries and evaluations of all the studies considered, including those from prior editions, and more detailed information on our methodology. New level II and level III evidence-based recommendations and an algorithm provide additional guidance for the development of local protocols to treat pediatric patients with severe traumatic brain injury. Our intention is to identify and institute a sustainable process to update these Guidelines as new evidence becomes available.
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Stereoelectroencephalography (SEEG) is an alternative addition to subdural grids (SDG) in invasive extra-operative monitoring for medically refractory epilepsy. Few studies exist on the clinical efficacy and safety of these techniques in pediatric populations. ⋯ SEEG is a safe alternative to SDG and should be considered on an individual basis for selected pediatric patients.
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Multicenter Study
Venous Thromboembolism in Patients With Spontaneous Intracerebral Hemorrhage: A Multicenter Study.
Patients with spontaneous intracerebral hemorrhage (ICH) are predisposed to venous thromboembolic (VTE) complications, such as deep vein thrombosis and pulmonary embolism. ⋯ Although VTE complications are uncommon after ICH, they are associated with significantly worse outcomes. Further studies will be needed to determine the optimal treatment regimen for the prevention and treatment of VTE complications in ICH patients.
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Observational Study
Metabolic Positron Emission Tomography Response to Gamma Knife of the Ventral Intermediate Nucleus in Essential Tremor.
To understand the substrates of response and nonresponse and to identify potential biomarkers for the selection and follow-up of patients with essential tremor (ET) treated with Gamma Knife (Elekta AB, Stockholm, Sweden) of the ventral intermediate nucleus (GKVIM). ⋯ These findings could lead to better knowledge of the variability in the metabolic PET profiles among patients with ET, particularly the integration of 18F-FDG PET imaging in the pretherapeutic evaluation of patients with refractory ET candidates for GKVIM.
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Idiopathic normal pressure hydrocephalus (iNPH) is treated by insertion of a ventricular peritoneal (VP) shunt. To help identify who would benefit from a VP shunt, patients undergo a tap test (TT). Several measures can identify change from a TT, but the magnitude of change and the combination of measures that indicate the improvement from a TT is unclear. ⋯ These MCIDs provide the first evidence to quantify the significance of post-TT symptom changes and provides objective data to guide recommendations for clinical management. Utilizing a combination of measures, and these MCIDs as cut off values, results in high sensitivity and specificity for identifying improvement from a TT.