Journal of Neurosurgery: Pediatrics
Volume 27: Issue 4 (Apr 2021): Pages 375-495

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Authors: Karen Monuszko, Michael Malinzak, Lexie Zidanyue Yang, Donna Niedzwiecki, Herbert Fuchs, Carrie R. Muh, Krista Gingrich, Robert Lark, and Eric M. Thompson

In Brief

The objective of this study was to compare the quality of imaging using EOS low-dose radiography to conventional radiography to evaluate peritoneal shunt tubing. The authors found that overall image quality and hardware delineation of EOS radiography did not significantly differ from conventional radiography for the evaluation of cerebral shunts. EOS appears to be a lower-cost and lower-radiation alternative to radiography for shunt evaluation.

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Authors: Patrick D. Kelly, Aaron M. Yengo-Kahn, and Robert P. Naftel

In Brief

Clinical outcomes of patients undergoing shunt externalization were retrospectively reviewed to test the hypothesis that reimplantation with a ventriculoatrial shunt (VAS) rather than return to a ventriculoperitoneal shunt (VPS) is not associated with increased failure rate and may permit shorter externalization duration. There was no significant difference in shunt survival between patients with VASs and those with VPSs, although the externalization period was not shorter with VASs. Early conversion to a VAS may be a viable treatment option following shunt externalization.

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Authors: Weihong Yuan, Charles B. Stevenson, Mekibib Altaye, Blaise V. Jones, James Leach, Mykhailo Lovha, Noa Rennert, and Francesco T. Mangano

In Brief

The aim of this study was to evaluate a noninvasive biomarker (diffusion tensor imaging [DTI]) and establish its value as a predictor for the need of surgery for hydrocephalus in patients treated with prenatal repair of a myelomeningocele. DTI is an objective biomarker that significantly differentiates between prenatal myelomeningocele patients who need CSF diversion for hydrocephalus and those who do not. Ultimately, these results will help clinicians better evaluate and treat patients with myelomeningocele-associated hydrocephalus, thereby potentially avoiding the long–term neurocognitive ramifications of this lifelong condition.

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Authors: Jessica Berns, Blake Priddy, Ahmed Belal, R. Dianne Seibold, Kristin Zieles, and Andrew Jea

In Brief

The authors analyzed the impact of standardization on surgical costs and outcomes. In the study, two groups of patients were compared, one before and one after implementation of a standardized shunt valve inventory. Findings from the study show that whereas there was no inferiority in outcomes from a limited shunt inventory, there was a significant decrease in costs.

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Authors: Melissa A. LoPresti, Kathryn Wagner, and Sandi Lam
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Authors: Salma M. Bakr, Ajay Patel, Mohamed A. Zaazoue, Kathryn Wagner, Sandi K. Lam, Daniel J. Curry, and Jeffrey S. Raskin

In Brief

The authors developed a set of standard work tools for performing dynamic stereo-electroencephalography. The standard work tools were used to implement this program at another institution with a similar efficiency and safety profile. It is hoped that widespread adoption of these standard work tools will facilitate multisite studies investigating focality.

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Authors: James P. Caruso, M. Burhan Janjua, Alison Dolce, and Angela V. Price

In Brief

The authors assessed the safety and efficacy of corpus callosotomy performed with MR-guided laser interstitial thermal therapy (LITT) in pediatric patients with medically refractory epilepsy. The results of this novel retrospective analysis with long-term follow-up data from patients undergoing LITT or open corpus callosotomy (OCC) indicate that LITT is a safe and effective alternative to OCC. LITT demonstrates great promise as an alternative method for performing corpus callosotomy in carefully selected cases, but additional confirmation of LITT durability is needed.

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Authors: Akikazu Nakamura, Akitsugu Kawashima, Hugo Andrade-Barazarte, Takayuki Funatsu, Juha Hernesniemi, and Takakazu Kawamata

In Brief

The objective of this paper was to evaluate the clinical and hemodynamic benefits of an occipital artery–middle cerebral artery bypass for patients with pediatric moyamoya disease who had recurrent symptoms after initial revascularization. Cerebrovascular reactivity values in both middle cerebral artery and posterior cerebral artery territories are significantly improved, with clinical improvement after occipital artery–middle cerebral artery bypass despite progression of posterior cerebral artery stenosis in most patients. The occipital artery–middle cerebral artery bypass is an effective rescue therapy for cases of pediatric moyamoya disease.

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Authors: Sarah Stricker, Grégoire Boulouis, Sandro Benichi, Marie Bourgeois, Florent Gariel, Lorenzo Garzelli, Jean-François Hak, Quentin Alias, Basile Kerleroux, Kevin Beccaria, Anaïs Chivet, Timothée de Saint Denis, Syril James, Giovanna Paternoster, Michel Zerah, Manoelle Kossorotoff, Nathalie Boddaert, Francis Brunelle, Philippe Meyer, Stéphanie Puget, Olivier Naggara, and Thomas Blauwblomme

In Brief

The authors studied the variable associated with hematoma evacuation in children with ruptured arteriovenous malformations. Determinants of hematoma evacuation were lower Glasgow Coma Scale score, higher intracerebral hemorrhage/brain volume ratio, superficial arteriovenous malformation location, and radiological signs of herniation. This study provides a framework for decision-making in pediatric ruptured arteriovenous malformation.

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Authors: Christine Tschoe, Teddy E. Kim, Kyle M. Fargen, and Stacey Q. Wolfe
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Authors: Nicholas Sader, Walter Hader, Aaron Hockley, Valerie Kirk, Adetayo Adeleye, and Jay Riva-Cambrin

In Brief

The authors evaluated whether operative decompression of Chiari 1.5 malformation in pediatric patients improved sleep-related breathing disorders and whether radiological parameters predicted improvement. This was the first series of pediatric patients with Chiari 1.5 malformations with sleep-related breathing disorders who demonstrated a marked improvement in their polysomnography results postdecompression. Improvements in sleep apnea may have a significant impact on children’s learning and development, further highlighting the importance of diagnosing the Chiari 1.5 malformation and sleep-related breathing disorders in affected children.

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Authors: Alexander T. Yahanda, P. David Adelson, S. Hassan A. Akbari, Gregory W. Albert, Philipp R. Aldana, Tord D. Alden, Richard C. E. Anderson, David F. Bauer, Tammy Bethel-Anderson, Douglas L. Brockmeyer, Joshua J. Chern, Daniel E. Couture, David J. Daniels, Brian J. Dlouhy, Susan R. Durham, Richard G. Ellenbogen, Ramin Eskandari, Timothy M. George, Gerald A. Grant, Patrick C. Graupman, Stephanie Greene, Jeffrey P. Greenfield, Naina L. Gross, Daniel J. Guillaume, Todd C. Hankinson, Gregory G. Heuer, Mark Iantosca, Bermans J. Iskandar, Eric M. Jackson, James M. Johnston, Robert F. Keating, Mark D. Krieger, Jeffrey R. Leonard, Cormac O. Maher, Francesco T. Mangano, J. Gordon McComb, Sean D. McEvoy, Thanda Meehan, Arnold H. Menezes, Brent R. O’Neill, Greg Olavarria, John Ragheb, Nathan R. Selden, Manish N. Shah, Chevis N. Shannon, Joshua S. Shimony, Matthew D. Smyth, Scellig S. D. Stone, Jennifer M. Strahle, James C. Torner, Gerald F. Tuite, Scott D. Wait, John C. Wellons III, William E. Whitehead, Tae Sung Park, and David D. Limbrick Jr.

In Brief

The authors conducted this study to better clarify complication rates and symptom improvements for different kinds of dural graft materials used for posterior fossa decompression with duraplasty in patients with Chiari I malformation and syringomyelia. This study is important because complication rates for these different graft types are not well established and determining what may be the best graft types could be very beneficial to these patients.

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Authors: Inge A. van Erp, Apostolos Gaitanidis, Mohamad El Moheb, Haytham M. A. Kaafarani, Noelle Saillant, Ann-Christine Duhaime, and April E. Mendoza

In Brief

Authors of this study evaluated the outcome of pediatric traumatic brain injury patients receiving low-molecular-weight heparin (LMWH) versus unfractionated heparin (UH). LMWH prophylaxis appeared to be more effective than UH at preventing venous thromboembolism with no increase in the mortality rate or the need for further surgical interventions to control hemorrhage in the LMWH group. These results need to be confirmed in large, prospective studies.

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Authors: Chelsea Shope, Mohammed Alshareef, Thomas Larrew, Christopher Bolling, Justin Reagan, Milad Yazdani, Maria Spampinato, and Ramin Eskandari

In Brief

Researchers used a novel, fast MRI protocol that avoids sedation in pediatric brain injury. The goal of the study was to reduce radiation exposure while maintaining timeliness and improving the accuracy of imaging. MRI was superior to CT in demonstrating all intracranial hemorrhages, with excellent accuracy. This study shows the potential for the use of rapid MRI as a surveillance imaging tool in brain injury in order to reduce unnecessary radiation exposure from CT scans.

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Authors: Sakibul Huq, Nivedha V. Kannapadi, Joshua Casaos, Tarik Lott, Raphael Felder, Riccardo Serra, Noah L. Gorelick, Miguel A. Ruiz-Cardozo, Andy S. Ding, Arba Cecia, Ravi Medikonda, Jeff Ehresman, Henry Brem, Nicolas Skuli, and Betty M. Tyler

In Brief

The authors evaluated the preclinical efficacy of repurposing ribavirin, an FDA-approved antiviral drug, as a targeted therapeutic for the treatment of medulloblastoma. The results demonstrated in vitro that ribavirin reduced medulloblastoma cell growth, migration, and invasion and increased cell death. In vivo, ribavirin extended survival in an aggressive group 3 animal model. Ribavirin may be an appealing candidate for further study in medulloblastoma given its existing regulatory approval, safety profile, multitargeted activity, and radio- and chemosensitizing properties.

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Authors: Katrina Ducis, R. Dianne Seibold, Tylyn Bremer, and Andrew Jea

In Brief

Perioperative hypothermia is associated with increased surgical risk. The authors present an improvement in the perioperative care of pediatric patients undergoing instrumented spine surgery. Using a simplistic protocol, patients experienced improvement in the duration and severity of hypothermia from arrival to the operating room until the start of the operation. This was proven by comparing an observational cohort to an intervention group focused on tracking temperature as well as intentional warming, beginning in the preoperative area.

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Authors: L. Dade Lunsford and Dan Leksell
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Authors: Scott R. Morrison and Chandrasekaran Kaliaperumal
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In Brief

Researchers studied the basic clinical outcomes after pediatric intracerebral hemorrhage (pICH) using a large cohort study and metanalysis. They found that 1 in 6 children died after pICH and that the majority of children had residual neurological deficits at their latest follow-up. In the cohort study, the authors found younger age was associated with higher odds of death. This study sheds light on the functional prognosis of intracerebral hemorrhage in children.

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In Brief

The authors examined whether hospital ownership type and children's hospital designation impacted primary outcomes for pediatric neurosurgery patients. They found that freestanding children's hospitals may be the optimal setting for pediatric patients undergoing neurosurgery for accidental trauma. The federal government invests in children's hospitals to provide specialized clinical care to pediatric patients and valuable training experience to pediatric subspecialists. This study provides evidence that these investments measurably improve outcomes.

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In Brief

A group of experts conducted a modified Delphi study to identify best practices in pediatric cervical spine traction given the lack of evidence-based guidance in the literature. Consensus was reached on 49 best-practice recommendations spanning the utilization and implementation of traction for pediatric cervical trauma and deformity. These recommendations provide a foundation for clinicians to better incorporate cervical traction into their practices.

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In Brief

Hemispherotomy is a major procedure that involves a large craniotomy and significant morbidity. Here, the authors present the preliminary findings of 6 patients who underwent a new technique, robotic thermocoagulative hemispherotomy (ROTCH). This is a minimally invasive “bloodless” procedure. All patients had an International League Against Epilepsy class 1 outcome (except 1 patient with a class 2 outcome). Based on these results, ROTCH seems to be a promising and efficacious technique.

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In Brief

Wearable and portable electronics are rapidly becoming more numerous and mainstream. Many patients with programmable shunt valves either are subjected to strict restrictions or may be unsuspectingly exposing their valves to strong magnets. Ubiquitous smartphone magnetometer technology was shown to be effective at screening devices for safe use in proximity to programmable valves. This concept can be exploited to enhance patient quality of life and safety.

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In Brief

The authors explored the feasibility of using image processing and machine learning algorithms to augment newborn cranial deformity screening, using 2D patient images. Machine learning algorithms, paired with image processing–based craniometrics, can classify orthogonal-view 2D images of the most common cranial deformity types with a high degree of accuracy. This study demonstrates the viability of software-based cranial deformity screening to augment current telehealth practices and reduce usage of expensive and radiation-intensive radiographic screening adjuncts.

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In Brief

A multiinstitution study examined the management of open skull fractures in children. The incidence of infectious complications was low and was not associated with the antibiotic strategy or site of wound care. Most minimally contaminated open skull fractures are probably best managed with a short duration of a single antibiotic and emergency department closure is appropriate unless there is significant contamination or fragment elevation is necessary.

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In Brief

This retrospective cohort study compares postoperative opioid use and clinical measures following selective dorsal rhizotomy between patients who received postoperative epidural analgesia and those who did not. Postoperatively, patients who received epidural analgesia required less systemic opioid use, had at least equivalent reported pain scores, and required less respiratory support. Given heightened concern for harmful effects of systemic opioids, these findings suggest an important strategy for limiting their use while maintaining pain control and potentially increasing safety.

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In Brief

The diagnosis of a nerve root avulsion as an all-or-none phenomenon is troublingly simplistic. In this study, we demonstrated that there exists a large proportion of nerve root avulsions that include either the ventral rootlets or dorsal rootlets in isolation. These findings hope to bring to light the common presence of isolated dorsal or ventral avulsions for consideration during preoperative planning and surgical utilization of nerve roots.

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In Brief

The authors identified preoperative clinical and radiographic risk factors for facial palsy after resection of commonly encountered pediatric posterior fossa tumors. The incidence of postoperative facial palsy can be as high as 20%, and recurrent operations and the presence of other preoperative cranial neuropathies were identified as significant risk factors in multivariate logistic regression analysis. These data can help to guide preoperative counseling when discussing the risks of surgery with patients and their families.

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In Brief

Researchers used a novel algorithm to determine the appropriate timing of intervention in the setting of recurrence/progression of pediatric craniopharyngioma with the aim of optimizing tumor control. An increase (%) in the maximum dimension of the tumor at the time of recurrence/progression can be used as a predictor of the appropriate timing of intervention. This will help neurosurgeons to determine the appropriate timing of intervention and avoid any unnecessary procedures.

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In Brief

The natural course of mild and moderate prenatal ventriculomegaly has been widely reported. The authors retrospectively studied 122 pregnancies with mild or moderate ventriculomegaly between 2010 and 2018. Lateral ventricle dilation was stable or regressed in serial ultrasound studies in most patients with mild or moderate ventriculomegaly. Most cases had near-normal neurodevelopmental status. Due to the lack of sufficient data regarding the natural course, neurodevelopmental status, and prognosis of prenatal ventriculomegaly, the authors were interested in performing a study to find some answers to these questions. More prospective studies with larger sample sizes are needed to obtain more reliable results.

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In Brief

The aim of this study was to evaluate the prevalence of postconcussive symptoms and their relation to health-related quality of life in pediatric and adolescent patients with mild traumatic brain injury (mTBI) with an indication for head CT imaging. Postconcussive symptoms were present in up to one-third of the patients and were significantly associated with decreased health-related quality of life. The authors report a considerable prevalence of postconcussive symptoms in the rarely studied subgroup of young mTBI patients receiving head CT imaging.

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Researchers investigated phase-amplitude coupling of fast activity modulated by slow waves on scalp electroencephalography to evaluate the strength of the modulation index before and after disconnection surgery in children with intractable nonlesional epileptic spasms. A decreased modulation index value due to surgery correlates with good seizure outcomes. The modulation index may indicate epileptogenic neuronal modulation of the interhemispheric corpus callosum and intrahemispheric subcortical network for epileptic spasms.

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In Brief

The researchers evaluated the usefulness and applicability of available neurosurgical morbidity scoring scales in a large cohort of pediatric brain tumors from a single center; their results were favorably comparable to those in the literature. An improved tool to quantify morbidity from pediatric neurooncology is necessary to enable comparative surgical and unit data and reporting.

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In Brief

The authors sought to characterize the long-term rates of shunt infection and malfunction in myelomeningocele (MMC) patients before and after adoption of the Hydrocephalus Clinical Research Network (HCRN) standardized surgical protocols to reduce ventriculoperitoneal (VP) shunt infections. A 21% per person-year revision rate and 2.1% per person-year infection rate were determined in 137 patients with MMC and VP shunts, and both rates improved with adoption of the HCRN protocols. Shunt externalization prior to revision was found to be associated with a higher infection rate.

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In Brief

The authors examined the utility of ventriculogallbladder (VGB) shunts in a series of children with hydrocephalus resulting from intraventricular hemorrhage related to extreme prematurity. VGB shunts can serve as a definitive treatment or as a bridge procedure until the patient is larger and comorbid abdominal or vascular issues have resolved sufficiently to allow conversion back to ventriculoperitoneal or ventriculoatrial devices. VGB shunts should be considered earlier in the treatment of this difficult-to-manage group with hydrocephalus related to extreme prematurity.

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In Brief

Researchers used the Health Outcome Questionnaire (HOQ)–Spanish version to describe the health status of pediatric patients with hydrocephalus treated by endoscopic third ventriculostomy and to identify factors related to worse status. Possible factors related to worse outcomes were the presence of epilepsy, a prior valve, many surgical procedures, and communicating or secondary hydrocephalus. This study helps to identify clinical factors to address to improve the quality of life in pediatric patients, and use of the HOQ scale allows one to evaluate their evolution in an objective way and compare the health status between different populations.

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In Brief

Clinical outcomes of patients undergoing shunt externalization were retrospectively reviewed to test the hypothesis that reimplantation with a ventriculoatrial shunt (VAS) rather than return to a ventriculoperitoneal shunt (VPS) is not associated with increased failure rate and may permit shorter externalization duration. There was no significant difference in shunt survival between patients with VASs and those with VPSs, although the externalization period was not shorter with VASs. Early conversion to a VAS may be a viable treatment option following shunt externalization.

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In Brief

The aim of this study was to evaluate a noninvasive biomarker (diffusion tensor imaging [DTI]) and establish its value as a predictor for the need of surgery for hydrocephalus in patients treated with prenatal repair of a myelomeningocele. DTI is an objective biomarker that significantly differentiates between prenatal myelomeningocele patients who need CSF diversion for hydrocephalus and those who do not. Ultimately, these results will help clinicians better evaluate and treat patients with myelomeningocele-associated hydrocephalus, thereby potentially avoiding the long–term neurocognitive ramifications of this lifelong condition.

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In Brief

The objective of this paper was to evaluate the clinical and hemodynamic benefits of an occipital artery–middle cerebral artery bypass for patients with pediatric moyamoya disease who had recurrent symptoms after initial revascularization. Cerebrovascular reactivity values in both middle cerebral artery and posterior cerebral artery territories are significantly improved, with clinical improvement after occipital artery–middle cerebral artery bypass despite progression of posterior cerebral artery stenosis in most patients. The occipital artery–middle cerebral artery bypass is an effective rescue therapy for cases of pediatric moyamoya disease.

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In Brief

The objective of this study was to compare the quality of imaging using EOS low-dose radiography to conventional radiography to evaluate peritoneal shunt tubing. The authors found that overall image quality and hardware delineation of EOS radiography did not significantly differ from conventional radiography for the evaluation of cerebral shunts. EOS appears to be a lower-cost and lower-radiation alternative to radiography for shunt evaluation.

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In Brief

The authors examined trends in the surgical treatment of pediatric hydrocephalus over an 8-year period and found that important changes in the treatment of this condition have occurred over a very short time frame. This work represents the first study using high-quality registry data to examine changes in the surgical care of pediatric hydrocephalus in North America.

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In Brief

In this study the authors compared the survival between pediatric patients with high-grade gliomas who underwent gross-total resection after one or more reoperations versus those with subtotal resection. The authors found that median overall survival was 17 months, and progression-free survival was 10 months for all patients. The authors also found no differences in survival between patients with gross-total resection after reoperation when compared with those who achieved subtotal resection. These findings highlight the importance of the first attempt to remove the tumor, because the second surgery aiming to achieve gross-total resection may not provide the patient with longer survival.

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In Brief

Using finite element modeling techniques, the authors investigated craniocervical biomechanics in a pediatric patient with Down syndrome (DS). Two age-matched models with identical material properties, one of a patient with DS and one of a child without DS, were created and tested. The authors found increases in craniocervical motion with the DS model, supporting the hypothesis that bony geometry plays a large part in the excessive craniocervical motion that occurs in DS patients and calling into question the role of ligamentous laxity.

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In Brief

The authors present a novel method of extraoperative stereoelectroencephalography (SEEG) monitoring complemented by subsequent intraoperative recordings, designed to tailor multistaged resections in rolandic and perirolandic cortex in a highly selected group of patients with pharmacoresistant rolandic and perirolandic focal epilepsy. The results testified to the feasibility and demonstrated the value of the combined benefits of both extra- and intraoperative SEEG recordings when resecting the rolandic and perirolandic areas. With the proposed novel hybrid method one can precisely limit the volume of resection necessary to abort epileptic activity while preserving the functional cortex as much as possible.

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In Brief

Intrinsic epidermoid tumors of the brainstem are rare, histologically benign lesions associated with a high surgical morbidity and mortality due to their eloquent location. The authors describe a novel technique of endoscope-assisted microsurgery for managing symptomatic lesions and recommend a strategy of conservative surgery with resection of as much of the tumor capsule as is safely possible.

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In Brief

This paper’s objective is to demonstrate a novel innovative approach to tissue-sparing hemispherotomy in patients with intractable hemispheric epilepsy without a lateral ventricle. The surgery successfully disconnected the pathologic hemisphere and the patient has been seizure free with significant improvement in achieving developmental milestones. This technique illustrates a surgical disconnection option with low morbidity for patients who would otherwise undergo a hemispherectomy with a higher risk of significant morbidity and mortality.