World Neurosurg
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Infection remains the most significant complication of ventriculoperitoneal shunt surgery and the reported rates of cerebrospinal fluid shunt infection vary widely across studies in patients with hydrocephalus. The objective of this study is to review and evaluate the infections complicating ventriculoperitoneal shunt surgery in patients with hydrocephalus. ⋯ Infection remains the most serious complication of ventriculoperitoneal shunt surgery. The findings of this retrospective study show that gender, age, and etiology of hydrocephalus significantly correlated independently with the incidence of infection. Prospective studies are needed to assess the observed associations between the risk factors and incidence of infection in hydrocephalus patients treated with ventriculoperitoneal shunt surgery.
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Brain tumors are rare in infants who are younger than six months of age. These tumors can be challenging to treat surgically. We analyzed a modern series of patients treated by a multidisciplinary team at a tertiary care center and performed a literature review of this unique population. ⋯ Brain tumors are uncommon in children younger than six months of age. Patients present with a variety of tumor pathologies. Children who survive have neurological sequelae. More studies are necessary to understand the impact that different treatment options, tumor pathology, and tumor location have on neurological outcome.
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Case Reports
Beneficial use of a new hand-held CO2 laser fiber in resection of a calcified and vascular intraventricular tumor.
The progression of laser technology in neurosurgery has been limited by the poor maneuverability of traditional line-of-sight carbon dioxide (CO2) lasers and the propensity of other laser energies to cause collateral thermal injury to adjacent neural structures. The advent of a dielectric omnidirectional reflector and the subsequent development of phototonic bandgap fibers (PBF) have transformed the CO2 laser into a low-profile instrument with considerable dexterity and many potential new neurosurgical applications. ⋯ The CO2 laser was exceptionally useful in the resection of this long-standing and extremely calcified, yet vascular mass. A review of the evolution of laser technology applications in neurosurgery is presented, with a specific focus on the innovations that led to the development of the new PBF CO2 laser. This new technology may be advantageous in tumor surgery, particularly in the resection of long-standing calcified and vascular tumors that are not amendable to traditional surgical techniques.
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Transforaminal lumbar interbody fusion (TLIF) augmented with pedicle screw instrumentation has become a favored surgical treatment for management of lumbar degenerative disease and spondylolisthesis. Iliac crest bone graft has traditionally been used for interbody arthrodesis. Many substitutes for autograft have been suggested to reduce iliac crest graft morbidity. The present study was aimed to determine fusion rate and clinical outcome with local bone autograft drill shavings harvested during minimally invasive (MI) TLIF. ⋯ Use of a cage filled with local bone shavings harvested using a specimen trap during MI-TLIF is simple and can result in up to a 70% fusion rate with good clinical outcome in 92% of patients. This is the first study assessing fusion rate with local bone shavings, and the results may help spine surgeons in choosing the best graft option for patients undergoing posterior lumbar fusion surgery.