Journal of Neurosurgery: Pediatrics
Volume 27: Issue 2 (Feb 2021): Pages 125-242

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Authors: Sulmaz Zahedi, Miles Hudson, Xin Jin, Richard Justin Garling, Jacob Gluski, Caden Nowak, Neena I. Marupudi, Paul Begeman, and Carolyn A. Harris

In Brief

This investigation is aimed at gaining a better understanding of the factors that lead to the mechanical failure of ventriculoperitoneal shunts used for the treatment of hydrocephalus. Our study demonstrates a correlation between shunt mechanical stiffness and shunt disconnection, that catheters that are more flexible are secured for longer periods to their valve counterpart and have a decreased propensity to disconnect. These findings may be utilized to decrease shunt disconnection due to mechanical failure.

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Authors: Jennifer L. Quon, Michelle Han, Lily H. Kim, Mary Ellen Koran, Leo C. Chen, Edward H. Lee, Jason Wright, Vijay Ramaswamy, Robert M. Lober, Michael D. Taylor, Gerald A. Grant, Samuel H. Cheshier, John R. W. Kestle, Michael S. B. Edwards, and Kristen W. Yeom

In Brief

The authors developed an artificial intelligence tool to consistently and objectively measure cerebral ventricular volume, over time, for patients with hydrocephalus. This clinical tool is reliable across different institutional scanners as well as small variations in slice thickness and head angulation. It is faster and more accurate than currently available research tools and will serve as a useful clinical adjunct to standardize and improve patient care.

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Authors: Georgina E. Sellyn, Alan R. Tang, Shilin Zhao, Madeleine Sherburn, Rachel Pellegrino, Stephen R. Gannon, Bradley S. Guidry, Travis R. Ladner, John C. Wellons III, and Chevis N. Shannon

In Brief

The authors investigated the use of a validated instrument, the Chiari Health Index for Pediatrics (CHIP), for measuring health-related quality of life (HRQOL) in pediatric patients with Chiari malformation type I (CM-I). The CHIP instrument was effective in measuring postoperative changes and effectively captured significant improvements in patient HRQOL as well as symptomatology after surgical decompression. Widespread use of this questionnaire can offer physicians more insight into the impact of CM-I on HRQOL, which may guide a more holistic approach to care.

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Authors: Chia-En Wong, Yi-Shan Tsai, Jiann-Shiuh Chen, Yu-Ning Chen, and Jung-Shun Lee
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Authors: Mansour Mathkour, Tyler Scullen, Brendan Huang, Cassidy Werner, Edna E. Gouveia, Hussam Abou-Al-Shaar, Christopher M. Maulucci, Rodney B. Steiner, Hugo St. Hilaire, and Cuong J. Bui
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Authors: Marcos Devanir Silva da Costa, Nicole Cavalari Camargo, Patricia Alessandra Dastoli, Jardel Mendonça Nicácio, Frederico Adolfo Benevides Silva, Maria Luisa Sucharski Figueiredo, Michael Jenwei Chen, Andrea Maria Cappellano, Nasjla Saba da Silva, and Sergio Cavalheiro

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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Authors: Michael M. McDowell, Nathan T. Zwagerman, Eric W. Wang, Carl H. Snyderman, Elizabeth C. Tyler-Kabara, and Paul A. Gardner

In Brief

The objective of this paper was to document the largest available series of pediatric patients with skull base chordomas undergoing endoscopic endonasal resection. Endoscopic endonasal resection was associated with a high rate of tumor control and a low rate of permanent neurological deficits. The authors demonstrate the feasibility, value, and complications associated with adding endoscopic endonasal resection to the treatment armamentarium for pediatric chordomas of the skull base. The findings also suggest that pediatric chordomas are not, as a whole, as aggressive as previously thought.

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Authors: Mitchell W. Couldwell, Samuel Cheshier, Philipp Taussky, Vance Mortimer, and William T. Couldwell
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Authors: Gabriel Crevier-Sorbo, Tristan Brunette-Clément, Edgard Medawar, Francois Mathieu, Benjamin R. Morgan, Laureen D. Hachem, Michael C. Dewan, Aria Fallah, Alexander G. Weil, and George M. Ibrahim

In Brief

Investigators applied a screening tool to estimate the proportion of children evaluated at an epilepsy referral clinic that may be considered for epilepsy surgery in Haiti. Of the subset of children who underwent imaging, a majority met criteria for surgical evaluation. This work suggests that children with epilepsy in Haiti could benefit from being evaluated at a center with the capacity to perform basic brain imaging and neurosurgical treatments.

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Authors: Franz E. Babl, Mark D. Lyttle, Natalie Phillips, Amit Kochar, Sarah Dalton, John A. Cheek, Jeremy Furyk, Jocelyn Neutze, Silvia Bressan, Amanda Williams, Stephen J. C. Hearps, MBiostat, Ed Oakley, Gavin A. Davis, Stuart R. Dalziel, and Meredith L. Borland

In Brief

There is limited evidence as to the risk of abnormalities on CT or clinically important traumatic brain injury (ciTBI) in children with ventricular shunts (VSs) who sustain mild TBI. The authors sought to determine the frequency of these outcomes in children with VSs in a prospective multicenter study. Of 20,137 children with TBI, 35 (0.2%) had a VS. One patient had a CT abnormality, but none required neurosurgery. The rate of ciTBI in children with and without VSs was similar. Congruent with existing evidence, this study provides reasonable grounds to support a more restrictive approach to imaging than current practice.

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Authors: Marta San Luciano, Amy Robichaux-Viehoever, Kristen A. Dodenhoff, Melissa L. Gittings, Aaron C. Viser, Caroline A. Racine, Ian O. Bledsoe, Christa Watson Pereira, Sarah S. Wang, Philip A. Starr, and Jill L. Ostrem

In Brief

The objective of the study was to evaluate a relatively novel brain target of deep brain stimulation surgery for acquired dystonia in a rigorous scientific fashion to set the stage for future larger controlled trials. The key finding was that bilateral thalamic neuromodulation for severe acquired dystonia in children and young adults was well tolerated, and that while improvements in quality of life and disability were noticed, these were not fully captured in usual disease severity rating scales. This study adds value by expanding the knowledge of potential brain targets in pediatric patients with severe acquired medication-refractory dystonia.

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Authors: Neil Kaushal, Keith J. Orland, Andrew M. Schwartz, Jacob M. Wilson, Nicholas D. Fletcher, Anuj Patel, Bryan Menapace, Michelle Ramirez, Martha Wetzel, Dennis Devito, and Joshua Murphy

In Brief

Researchers evaluated differences in blood loss between racial groups undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). There is no relationship between race and blood loss during PSF for AIS. Standardized protocols for minimizing perioperative blood loss can be applied to both Caucasian and African American patients.

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Authors: J. Harley Astin, Christopher G. Wilkerson, Andrew T. Dailey, Benjamin J. Ellis, and Douglas L. Brockmeyer

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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Authors: Zach Pennington, Ethan Cottrill, Daniel Lubelski, Jeff Ehresman, Kurt Lehner, Mari L. Groves, Paul Sponseller, and Daniel M. Sciubba

In Brief

Enhanced recovery after surgery protocols have gained a significant foothold in adult general surgery populations for their ability to improve outcomes and reduce costs. In this study the authors systematically review the application of enhanced recovery after surgery protocols to pediatric scoliosis populations and find that these protocols may shorten hospitalizations, reduce complication rates, and reduce postoperative pain. This is the first quantitative analysis of the pediatric enhanced recovery after surgery literature, and it highlights the need for additional, high-quality studies.

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Authors: Mark R. Harrigan, Jan O. Jansen, and Zane Schnurman
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Authors: Jacob K. Greenberg and David D. Limbrick Jr.
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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

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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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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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 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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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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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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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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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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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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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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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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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 objective of this study was to use resting-state functional MRI to preoperatively map language networks in children with epilepsy. Language networks were identified at the individual level, and more than half of the cases in the study presented with atypical language lateralization, highlighting the need for brain mapping. Preoperatively identifying language networks in pediatric cases is challenging. However, it can help optimize electrode placement.

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In Brief

Researchers conducted a large cross-sectional cohort study pooled in a meta-analysis with existing literature to investigate the etiology of pediatric intracerebral hemorrhage. In all pooled studies, readily identifiable cerebral vascular lesions were the predominant cause, with arteriovenous malformations representing the most frequent subtype. These current data contribute adjusted estimates of the relative prevalence of the various etiologies of intracerebral hemorrhage in children and provide novel data on the increasing prevalence of vascular lesions as age increases during childhood.

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In Brief

The authors explored the functional and structural networks associated with improvement in children undergoing deep brain stimulation (DBS) for dystonia. The area most associated with clinical improvement was located in the posterior globus pallidus pars interna, with structural connectivity with the precentral and postcentral gyri, parietooccipital region, and brainstem. Scant information on the mechanisms of pediatric DBS is available and this study elucidates similarities and differences with the conventional target used for adult dystonia.

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In Brief

The authors conducted a prospective study of isolated pediatric head injury involving analysis of a large cohort (201 children) and demonstrated that initial high blood white cell count has a predictive value for lengthy hospital stay and poor cognitive outcome in these children. This study is important because it represents the first prospective and large cohort study that supports the use of initial white cell count as a predictor of outcome in pediatric head injury.

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In Brief

Researchers tested whether a noninvasive, non–contrast-based cerebral perfusion MRI technique, called arterial spin labeling (ASL), could detect the epileptogenic zone (EZ) in children with focal epilepsy who did not have obvious, well-defined structural brain lesions on MRI. Focal ASL abnormalities were found in over two-thirds of such cases and were concordant with the surgically proven EZ in 91% of children who underwent surgery. Due to the convenient and noninvasive nature of ASL, it may be reasonable to include this sequence in all routine MRIs done for focal epilepsy in children.

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In Brief

The authors evaluated their series of vacuum-assisted elevation of skull fractures in pediatric patients and the variables affecting procedural outcomes. This study will add to the growing literature on the use of nonsurgical management of depressed skull fractures in pediatric patients and help practitioners with decision-making and patient counseling.

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In Brief

The authors reviewed the literature to evaluate folate fortification and supplementation policies and their impact on reducing folate-sensitive neural tube defects (NTDs). Mandatory fortification was more effective than voluntary supplementation. Policies incorporating fortification and supplementation may optimally reduce folate-sensitive NTDs. Reductions in NTDs are cost-effective over time. A multimodal approach incorporating mandatory fortification, appropriate supplementation, and improved infrastructure and access to prenatal care to lead to decreased incidences of NTDs worldwide is optimal. This approach should be context-specific and culturally appropriate, with emphasis on education and consideration for local access to healthcare and social determinants of health.

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In Brief

The goal of this study was to spread word of a new alternative for endovascular treatment of high-flow fistulas in children. This adjuvant maneuver provides safer coil placement. The value of this study is based on a cheap, simple, and relatively low-risk option for flow arrest during embolization of high-flow fistulas.

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In Brief

The authors sought to compare the accuracy of boltless electrode placement with that of standard placement. Placing stereotactic EEG (SEEG) electrodes without anchor bolts is technically feasible. The accuracy of boltless electrodes was similar to that of electrodes placed with standard techniques. This technique allows electrodes to be placed in areas not amenable to standard techniques that utilize an anchor bolt, such as in very thin bone or the back of the head. This is the first description, to the authors’ knowledge, of such a technique being used in SEEG.

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In Brief

The objective of the study was to characterize and understand risk factors of rapid shunt failure in pediatric hydrocephalus. Age at shunt insertion and etiology of hydrocephalus are key risk factors of fast and ultrafast shunt failure. Fast shunt failure is an unfortunately common event in pediatric hydrocephalus. This study has been an important step in defining the phenomenon and trying to understand risk factors for children who experience fast shunt failure.

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In Brief

In this study, the authors defined a new variable, shunt failure cluster, to perform the first analysis of multiple and frequent shunt failures. They found that 6% of children with ventriculoperitoneal shunts have a cluster of shunt failures, and that these patients account for 30% of all shunt revisions. Risk factors for shunt failure cluster include prematurity and history of shunt infection.

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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.