Neurosurgery
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Ventriculoperitoneal shunt placement remains the primary treatment modality for children with hydrocephalus. However, morbidity and revision surgery secondary to infection remains high, even while using antibiotic-impregnated shunts. ⋯ These data suggest that for this select group of patients, use of intraventricular antibiotics was associated with decreased rates of re-intervention secondary to infection.
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Shunting procedures have a high failure rate when used to treat pseudotumor cerebri (PTC) patients who have failed medical therapy. This failure is believed to be attributable to the collapsibility of the ventricular system when exposed to increased differential pressure gradients in the cerebral spinal fluid compartments caused by ventriculoperitoneal shunts (VPS). ⋯ CPS is a viable alternative to VPS in PTC patients who have failed traditional shunting methods to give these patients a persistent benefit of a working shunt. The procedure provides this solution with low operative and perioperative morbidity.
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The lack of immune synergy with conventional chemoradiation could explain the failure of checkpoint inhibitors in current clinical trials for high-grade gliomas (HGGs). ⋯ RT, TMZ, and αPD1 modify the immune microenvironment of HGG. The combination of RT with TMZ induces a strong immune suppression which cannot be effectively counteracted by αPD1.